BackA much-needed mental care Bill
The long-awaited Mental Health Care Bill, after extensive consultations that lasted over two years, has finally entered the legislative process
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The statistics about mental illness in India are grim. Even by the most conservative estimates, at least 5% of our population live with a mental illness, which translates to over 50 million people. Mental illnesses are associated with myriad forms of social disadvantage. People with severe mental illness die earlier, both due to suicides and poor quality medical care. Indeed, suicide is now the leading cause of death in young adults in many regions of the country.
Mental illness is intimately associated with physical health problems, with studies showing a two-fold increased risk of depression in people with heart disease, and when these problems co-occur, the outcome of the heart disease is much worse. Further, the treatment gap for mental health conditions is far greater than that observed for people living with physical health problems.
Unavailability of appropriate, evidence-based mental health care is a major impediment to recovery for a vast majority of patients, especially those living in poverty. Social exclusion, violent victimization and human rights abuse are more prevalent in people with mental illness. The lack of access to evidence-based treatment and care for mental illness has reached a critical point and a concerted national effort is needed to address this public health crisis.
The long-awaited Mental Health Care Bill, after an extensive consultation process that lasted over two years, has finally entered the legislative process. I celebrate this Bill because it enshrines access to healthcare as a right and holds the government accountable for service delivery. Grounded in the Indian reality and yet drawing from best ideological, legislative, clinical and social innovations globally, this Bill strikes a neat balance between the practical needs of users and care givers and international conventions and frameworks.
Some critics have argued that a common law based on the international convention on the rights of persons with disabilities can adequately address the needs and rights of persons with mental illness. However, while mental illnesses can lead to disability, recovery cannot be facilitated without addressing the illness component. Some critics are, rightfully, concerned about violations of rights in the context of involuntary treatment. Sadly though, people with severe mental illness occasionally lack capacity to make decisions and choices.
What do we do then? Paradoxically, if we reject the possibility of care when capacity is impaired, we will relegate the most severely ill to the fringes and reinforce the state of incapacity and disability and potentially increase the probability of their premature death. The Mental Health Care Bill strikes a fine balance between different rights for the same individual notably the right to choice with the right to receive care.
Another landmark move the Bill proposes is to foster a climate of reforms both within mental hospitals and in the community by setting up a Mental Health Review Commission that will regulate admission, discharge and deal with violation of rights. The Bill provides for protection of a host of other rights. For example, people with mental illness have the right to live in the community.
The Bill also mandates that long-term hospitalization should only be used in exceptional circumstances. If people need admission to a hospital, then voluntary treatment is the norm. Only in exceptional circumstances, for example, when a person with mental illness is at grave danger of harming themselves, then this right to choice is temporarily exercised by another person on their behalf. As soon as the person with mental illness recovers the capacity to make choices, the right reverts back to them. As additional protection, a person with mental illness has the right to appeal against such decisions to the review commission.
Drafting a new legislation that involves the expression of rights of people, in particular, people who are vulnerable, is a sensitive process. The development of this Bill was participatory and involved active engagement with representative voices of those whom it intends to serve including, people with mental health problems, activists, mental health professionals and administrators.
No doubt the Bill may need further refinement, and this will happen in due course as part of the legislative process ahead. However, let us for now recognize that we have a visionary draft legislation which forms an outstanding basis for revolutionizing the rights of people of people with mental illness in our country.
Vikram Patel is director of Centre for Global Mental Health at the London School of Hygiene & Tropical Medicine, the UK, and is a member of the mental health policy group constituted by the health ministry.
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