Creating a better world for the mentally ill
Mentally ill are treated with bias, subjected to harassment, ridiculed, expelled from schools, jobs and, most importantly, lose the support of loved ones Photograph: (Others)
The term ‘disclosure’ is an unusual word, especially for a person who is suffering from mental illness, as the act of making a ‘disclosure’ requires telling someone about personal suffering. Mentally-ill, quite rightfully, fear that disclosure will invite discrimination. Evidence suggests patients are reluctant to make a disclosure, fearing dangerous consequences; they are treated with bias, subjected to harassment, ridiculed, expelled from schools, jobs, lose the support of loved ones. The list is endless with the nadir reached with exclusion and isolation. Social stigma and inadequate public support for treatment leave them with few options.
However, the time has come for a steady erosion of such beliefs. In this context, Indian lawmakers deserve a compliment for having taken a major step to pass the Mental Healthcare Bill, 2016. Indeed, it is a landmark achievement considering that this step has come almost after two decades. The Bill seeks to adopt a modern, sensitive and humane approach to deal with mental problems and simultaneously promises to protect the rights of persons with mental illness. Very importantly, the Bill contains provisions of bolstering treatment and healthcare facilities, ensuring accountability and availability of the services to the needy.
The importance of this piece of legislation can be gauged from the quantum of mental health-related problems in the country. According to the World Health Organisation’s most recent report, 7.5 per cent of Indians suffer from some kind of major or minor mental disorders. On similar lines, a report released by the National Institute of Mental Health and Neurosciences in October 2016, said that the incidence of depression is roughly one in every 20 Indians — or five per cent of the population. What is even more depressing is, while the burden of mental illness is rapidly growing in the country, a large section of the impacted population do not receive treatment at all.
The reason behind this is the limited to psychiatric outreach. According to a Lancet study, there are 0·3 psychiatrists per a hundred thousands population.
Barriers to effective mental health care are many, and they include lack of resources and a shortage of trained healthcare professionals, clinical psychologists and social workers. Crucially, by passing this piece of legislation, our policymakers have bid adieu to the archaic laws of the Mental Health Act of 1987. While this ancient Act was a landmark in itself, in the sense that it replaced the century-old Indian Lunacy Act 1912, yet, there were numerous drawbacks. Not only did it lack any sense of human rights but also missed a clear direction in providing mental health services. The role of the family, which is so essential in management, was completely ignored. Hence, a revision of the laws was essential.
The new Mental Healthcare Bill, 2016, outlays several positive notes:
First, and most importantly, the Bill seeks to decriminalise Section 309 of the Indian Penal Code, under which suicide attempt by the mentally-ill people was considered to be a criminal offence. It is clearly understood that any act of crime undertaken by a mentally-ill person, which often gets violent, is not a deliberate attempt but merely a result of an unusual or strange behaviour. Hence, the new Bill has adopted a pragmatic approach by treating such instances as an outcome of severe stress. Besides, the new law also calls for the rehabilitation of such individuals.
The second important aspect of the Bill is, it accords the right to access mental healthcare services and treatment run or funded by the Government. Additionally, it calls for a free supply of all notified essential medicines to the mentally ill patients. Situations that have existed until now really present a grim scenario, with many well-functioning hospitals not providing regular psychiatric outpatient services, leave alone in-patient facilities. In fact, in most of the hospitals, a psychiatrist or even a bed for such people is not available. This had become a long-entrenched barrier to their treatment. It is here that the new laws mandate parity for mental and physical healthcare. It calls to raise the number of psychologists and psychiatrists, who are in short supply across the country.
Third, the new legislation places a strong emphasis on advance directive, which means a mentally-ill person will have the right to direct his doctor/psychiatrist on the kind of treatment he/she wants to opt for along with empowering them with the right to nominate their representative.
Fourth, the Bill calls for improved healthcare services and facilities. On its priority list are: Effective primary and district-level coverage of mental health services; increase in the base of psychiatrists, which remains abysmally low when compared to the actual demand; training medical practitioners (according to studies, many doctors are not even confident in diagnosing the disease, leave alone treating); give more preference to professional counselling, which is perhaps the best way to cure this disease; increase health insurance in view of the growth of private players which has seen a sharp rise in out-of-pocket expenditures.
On the one hand, when India has taken tremendous strides in the field of medicine, such scientific and normative advances were in dire need of support in the form of progressive laws, which the new Bill has successfully addressed. However, a patient-friendly legislation that makes promises is not enough. What has been promised on paper must be executed. Second, an attempt must be made to change deep-seated attitudes that a mentally ill patient is different from other sick people and is inferior. As a matter of fact, mental illness is very much curable when detected early. More than anything else, we need to get out of the colonial mode of treatment as that of being confined to a mental asylum (pagal khana) as this makes the patient doubly vulnerable.
It is, therefore, important that people affected by this disease come out openly and talk about it. Noted Bollywood actors are examples as they have come out of the darkness by candidly speaking about their stressed emotional conditions, how it affected them, and how they managed it.
It is expected that the new Bill, along with sustained efforts on the part of doctors, psychiatrists, community healthcare professionals, friends and family members, will go a long way to improve India's outlook towards critical mental health issues and will also push the country to the club of the most liberal democracies of the world where the mentally-ill are given an opportunity to be part of the mainstream.