Mental healthcare

The much awaited parliamentary approval has come for a law that takes a rights-based approach to people suffering from mental illnesses. Approved by Rajya Sabha in August last year and passed by Lok Sabha recently, the Mental Healthcare Bill, 2016 is being considered a major step forward in how mental illnesses are viewed. “A substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment or ability to meet the ordiry demands of life, mental conditions associated with the abuse of alcohol and drugs,” is how ‘mental illness’ has been defined in the bill. It grants every person the right to avail of mental healthcare services operated or funded by the government. For poor and homeless persons, such treatment can be provided free of cost, even if they do not possess BPL card. Another significant change is the de-crimilisation of suicide (earlier governed by section 309 of IPC); the new law states that a person who attempts suicide should be presumed to have ‘severe stress’, and shall not therefore be punished. Rather, it will be government’s duty to provide care, treatment and rehabilitation to a person who attempted suicide due to severe stress, and to reduce the risk of recurrence of any such attempt. The bill also mandates setting up the Central Mental Health Authority at the tiol level and state level authorities on similar lines to maintain registries, train law enforcement and mental health professions on the provisions of the Act, and advise the government on all matters relating to mental healthcare and services. This apart, a Mental Health Review Board has been envisaged to protect the rights of persons with mental illnesses, who will also have the right to make an ‘advance directive’ stating how he or she wants to be treated for the illness, and nomite a representative. The new bill recognises that patients with mental illness are often kept in the dark about their treatment procedures and the extent of their mental health problems; now, it is mandatory that they be provided complete information about medical procedure, treatment plans and records. The patient will also have the right to confidentiality of such information.
In many ways therefore, the new bill marks an ambitious improvement of the existing Mental Health Act of 1987, considered archaic and grossly idequate to changing realities in this country. A recent WHO report titled ‘Depression and Other Common Mental Disorders - Global Health Estimates’, estimated that roughly 7.5 percent of India’s population suffers from some form of major or minor mental illness. By 2020, this figure is likely to rise to 20 percent (or one-fifth) of the population, the report warns. Quoting figures of cases recorded in 2015, the report put the number of patients with depressive disorders at 5.7 crore (4.5 percent of the population) and those with anxiety disorders at 3.8 crore (3 percent). According to an India Spend report, the number of Indians suffering from mental illnesses exceeds that of the population of South Africa! Clearly, the country is sitting atop a problem that is likely to assume serious dimensions within a few years, yet the shame associated with mental illness continues to drive away sufferers from seeking counselling and treatment. Even for afflicted individuals brave enough to go for treatment openly, the health infrastructure in the country provides little scope. Another WHO report reveals that for every 10 lakh people in India, there are just three psychiatrists and even fewer clinical psychologists (as per government data itself, there are 3,800 psychiatrists and 898 clinical psychologists in the entire country). What is more, these experts are mostly concentrated in urban areas, even though mental illnesses are beginning to plague poor people in rural areas in ever greater numbers. It is good that the new law seeks to provide fincial relief to such patients by mandating all insurance companies to provide medical aid for mental illnesses similar to insurance cover for physical ailments. However, it will also make health insurance products costlier with higher premiums. It now remains to be seen whether the government will build up the health infrastructure needed to match its well-meaning ambition, considering how understaffed and overworked the country’s healthcare sector happens to be. To begin with, the Central government ought to increase the budget allocation for mental healthcare, which stands at a pitiful 0.06 percent at present.