The Mental Health Care Bill, 2013, which is awaiting nod from the Lok Sabha, is an important piece of legislation to deal with a serious but grossly neglected public health issue.
The new Bill, which was unanimously passed by the Rajya Sabha early this month, when enacted, will replace the archaic Mental Health Act of 1987. In 2007, India ratified the UN Convention on the Rights of Persons with Disabilities, which requires signatory countries to change their laws to give effect to the rights of persons with mental illness.
The reformist 2013 Act has bought a change in the description of mental illness as any other mental disorder apart from being mentally retarded.
The Bill guarantees every person the right to access mental healthcare and treatment from the government. This right includes affordable, good quality, easy access to services such as minimum mental health services in every district. Persons with mental illness also have the right to equality of treatment and protection from inhuman and degrading treatment.
Decriminalisation of the attempt to suicide is one of the most outstanding facets of the new Bill, which considers it as a sign of mental illness that requires treatment, unless otherwise proved. In 2008, the Law Commission, in its 210th report, called for decriminalising and humanisation of attempt to suicide. At present, it is punishable with a jail term or fine under Section 309 of the Indian Penal Code. This law has received widespread criticism since a long time.
The introduction of advance directives, the most crucial aspect of the Bill, empowers people with mental health disorders to choose the mode of treatment, to say no to institutionalisation, and to nominate representatives to ensure their options are carried out.
It makes inhuman and degrading treatment of the mentally ill as a crime, bans the use of shock therapy for treating children, and allows it for adults only after it’s approved by the district medical board and done under anaesthesia.
Considered as a watershed legislation, the Bill mandates provision of mental health services in every district with all facilities. It provides for the establishment of a State Mental Health Authority and a Central Mental Health Authority, along with a Mental Health Review Commission, to regulate the sector and register institutions. The Bill requires that every insurance company shall provide medical insurance for the mentally ill on the same basis as is available for physical illnesses.
According to the WHO, one in four adults across the world suffers from some form of mental illness and it will become one of the leading causes of ill-health globally. The UN report on Mental Health Matters 2014 lists 20% of youth across the world as suffering from at least one mental condition, with those from low- and middle-income countries at particular risk.
Though there are no official estimates as of now, in 2005 it was estimated that 6-7% of the Indian population suffered from mental disorders, and 1-2% suffered from severe mental disorders such as schizophrenia, bipolar disorder, and alcohol and drug abuse. Nearly 5% suffered from common mental disorders such as depression and anxiety. Only one in 10 get treated, reported The Lancet in May this year. However, the real numbers could be higher, as mental illness often goes under-reported due to the associated stigma.
In India, suicide is among the top 10 causes of death, with the National Crime Records Bureau reporting 1,31,666 suicides 2014, up 15.8% since in 2004. The decadal population growth in the period was 14.6%.
Healthcare experts term the Bill as a step forward. “It has finally decriminalised attempts to commit suicide, and mandates that governments provide affordable, quality, geographically accessible mental healthcare,” said Vandana Gopikumar, co-founder of Banyan, a mental health NGO for women.
Some experts feel the proposed legislation has major drawbacks. It is too western a concept to think of people with high illiteracy to give advance directives with regard to what type of management should be given; also, the Bill ignores parents and families. Since many mentally-ill patients lack insight during acute phase of illness, they can be easily cheated by the so-called nominated representatives.
The existing medical infrastructure is poor. The other is the lack of specialists to treat mental disorders. India has just 0.3 psychiatrists for 1 lakh people, compared to 1.7 psychiatrists per 1 lakh in China. Over 50% of the mentally ill in India have no access to healthcare.
“A lot should change with the new legislation, especially in terms of allocation of funds. Besides trained staff, more funds are needed for resources like community health centres,” according to Supreme Court lawyer Rahul Gupta.
To bolster the mental health system and improve access, we need a multi-pronged approach—awareness through advertising campaign and talks, pulling in expert counsellors and psychologists, community and family support, good hospital infrastructure—to treat mental illness. India allocates just over 1% of the Centre’s health budget to mental health, with states making comparable allocations. This situation should change for meaningful results.
Making mental healthcare affordable is the most important measure. It’s important that insurance companies address this to ensure universal access to mental health facilities.