The mental health care bill 2013: A disaster in the offing?

Dealing with statutory bodies under the Mental Healthcare Act 2017

India has an enormous burden of mental illness. In spite of the recognition of this population of people living with mental illness, the treatment gap continues to be about 83%. In order to meet this vast unmet need and in the view of aligning the mental health legislation with the international standards and the UN-Convention on the Rights of Persons with Disabilities, the Mental Healthcare Act 2017 was passed and enforced recently. The provisions in the act have been controversial from its conception. Now after the enforcement of the act, all mental health professionals (MHPs) have a legal binding to follow the provisions in the law. The MHPs are accountable to the statutory bodies - the Central Mental Health Authority, State Mental Health Authority (SMHA), Mental Health Review Board, and finally, the High Court or the Supreme Court. The Mental Healthcare Act (MHCA) and relevant articles/documents obtained pertaining to MHCA and their evaluation were reviewed, the major focus being on the role of statutory/regulatory bodies. Furthermore, an attempt was made to summarize the previous experiences in inspection of mental health establishments by SMHA of Karnataka. We concluded that the MHCA will have both positive and negative aspects. Many of the provisions in the law may appear unclear and unrealistic by many practitioners. However, it becomes precautionary for the MHPs to be well equipped with the MHCA and be acquainted with the requirements of the statutory bodies for ensuring a safe practice. The outcome of the implementation of the act will become evident only with time.

Mental health law in India: origins and proposed reforms

Although mental health legislation has existed in India since the mid-19th century, it has gone through various changes over the years and the Mental Health Care Bill 2013 has generated a lot of debate and criticism. Despite its shortcomings, the general expectation is that this bill will usher in a new era of proper care and allow people with mental disorders to lead a dignified life.

Suicide in India

SOURCES OF DATA

The current report reviews the data from the series Accidental Death and Suicide in India published by India's National Crime Records Bureau (NCRB) reporting official suicide rates based on police reports over the period of 10 years from 2004 to 2013. A reference to wider literature is made to present a comprehensive picture.

AREAS OF AGREEMENT

Suicide in India is more prevalent in young, is likely to involve hanging and ingestion of pesticides and is related to social and economic causes. Reducing alcohol consumption, unemployment, poverty, social inequities, domestic violence and improving social justice are essential to reduce suicide in India.

AREAS OF CONTROVERSY

NCRB data might underreport suicide. Discrepancy in farmers' suicide rate between reports suggests that this might be overrepresented in NCRB data.

GROWING POINTS

An integrated suicide prevention programme with a multidimensional approach is needed. Mental health care bill and the recent launch of first national mental health policy are welcome measures. Decriminalization of suicide is likely to positively influence mental health practice and policy in India.

AREA TIMELY FOR DEVELOPING RESEARCH

Nationally representative studies investigating fatal and non-fatal suicidal behaviours, evaluation of models of service delivery for the vulnerable population, investigating suicide following different treatment services and effects of decriminalization of suicide on suicide rates should be the focus of future research.

The mental health care bill 2013: a critical appraisal

The Mental Health Care Bill - 2013 has been introduced in Rajya Sabha and is now waiting for enactment. The Bill entails unprecedented measures to be undertaken by the Government ensuring everyone right to access mental health care and treatment from services run or funded by the Government. The Government is to meet the man-power requirement of mental health professionals according to international standard within a period of ten years. Various rights of persons with mental illness have been ensured. All the places where psychiatric patients are admitted and treated including the general hospital psychiatry units (GHPU) are to be registered as mental health establishments. Unmodified ECT has been banned and ECT to minors can be given only after approval from the Mental Health Review Board. This article advocates for exemption of GHPU from the purview of the Bill, taking into consideration impediment created in the treatment of vast majority of psychiatric patients who retain their insight into the illness and seldom require involuntary admissions. It is also advocated to reconsider ban on unmodified ECT and restriction placed on ECT to minor which are very effective treatment methods based on scientific evidence. In our country, family is an important asset in management of mental illness. But requirement of seeking approval from the Board in many of the mental health care decision may discourage the families to be proactive in taking care of their wards. The Board and Mental Health Authorities at the central and the state levels are authorized to take many crucial decisions, but these panels have very few experts in the field of mental health.