Tata Institute of Social Sciences, MumbaiMaster of Hospital Administration(2016-18) SCHOOL OF HEALTH SYSTEM STUDIESCBCS-MENTAL HEALTHCOURSE TEACHER-SHANKAR DAS SUBMITTED BY –EVANDALYNE LAMAREM2016HO013Master of Hospital Administration Most people in the world will be affected bymental or neurological disorders at some point in their lives.
Globally nearly 450million people currently are burdened by mental health disorder. Varioustreatments are available both therapeutic and rehabilatory, but nearlytwo-thirds of people with a known mental disorder decide never to seek helpfrom a health professional. Stigma, discrimination and neglect prevent proper careand treatment from reaching people with mental disorders, says the World HealthOrganization (WHO).
There is a vicious cycle of neglect and misunderstandingregarding mental health among the general public which overburdens and hampersproper management.Claims from psychiatry say that over onebillion people suffer from psychiatric illness. While studies says thatpsychiatric treatment is one of the most lucrative, damaging, abusive, brutal,corrupt business in the world with many prescriptions per year and leading tomany adverse effects like extra pyramidal symptoms, many emergency situationsleading to many birth defects, 25000 suicides, 15000 die annually, many kidsare drugged and many given electroshock. Many people are locked up againsttheir will, chained and confined given electro convulsive therapy (ECT) withouttheir own consent locked in institutions. In several instances they neverrecover and get institutionalized. Living in pathetic condition locked up anddenied of basic sanitation, chained adding to that there are hardly any good diagnostictest and many of this patients are just classified based on their symptoms andwith ineffective and often dangerous medication.
The Indian constitution under article 21ensures every human being has a “right to live” which includes right to livewith dignity. Our forefathers tried to ensure that every Indian was trulyindependent. But our society till date has been denying this right to peoplewith mental disabilities. Nearly all our laws regarding mental health apartfrom the most recent has been made and enacted with a view of saving thesociety from unpleasant experience of mental disorder. There is even an actwhich criminalizes suicide attempt, so when a person suffering mental breakdownand commits attempted suicide, our laws under IPC 309 makes him a criminal.What is a better example than this for general apathy prevailing now in societythan this draconian and outdated law?Throughout human history we have seen thatpeople with mental disability are essentially regarded as walking dead. Mentaldisorder has always been a taboo, never discussed never understood. There alsoseems to be concept of disgust regarding it.
Societies in olden days didn’thave any clue as to what to do regarding them. These people are just brandedinsane, and put up to live a separate life. Mental asylum where this people areusually kept has therefore gained notoriety as a place to be kept a distancefrom for the general public.
These mentally ill patients usually were clumpedtogether in cold unkempt places akin to a human zoo. Often times we see alcoholicsand schizophrenia patients kept together. This was the method preferred inalmost everywhere and almost every law was based on this fact that these peoplehave to be confined to specially designed institution. In western countrieseven beggars and lechers were not spared, they too were confined into theseasylums. This practice of institutionalization is nothing but the abuse oftheir most basic right, the right to live with dignity.Having an experience in the medical field andhaving had firsthand experience regarding the plight of mental health patients,I feel the bill do provide some relief but overall the condition of thesepatients in our vast and varied country is and will for sometime remainpathetic. In my own state I had the experience of visiting two mental healthhospital one public and the other private.
The conditions in either of themwere pitiful but the public hospital was just abject. As a young student Iinteracted with a few of the patients. These patients were kept separated intoa male and female enclosure.
With no semblance of the need for individualattention to individual distinct care. Some of them were in the early stagesand had relatively moderate or no symptoms, while some were overtly advancedcases, but all of them were kept together in just a secluded area. Theirroutine consisting of just ambling about the whole day. Many of them didn’t seetheir family members in years. While on my community visits I met severalfamilies dealing with mental health, all of them nearly tired and having noknowledge of any treatment apart from keeping them in asylums.
These patientsusually get abused by their own family members mostly out of frustration. Wehave to look at the problem in a broader manner, there has to be moresurveillance more programs dedicated to making these patients lives better. Theinjustice meted out to them has to be stopped. The treatment options should bevaried and effective therapies utilized. The invisible barrier segregating andlimiting treatment options for the poor have to be brought down.Mental health care Acts in IndiaPre independence1.1885: IndianLunatic asylum act of 18582.1912: IndianLunacy act of 1912Post Independence:1.
1947: IndianPsychiatric association.2.1987 Mentalhealth act of 1987(Indian Psychiatric society).3. Mental healthcare Bill Proposed in 2013.4. Nationalmental health Policy 2014.
5. Mental HealthCare Act 2017.Mental Health act 1987 needed amendmentbecause of concerns with legal proceeding and guardianship. MHA, 1987 has notbeen able to adequately protect the rights of person with mental illness and topromote access to mental health Care in the country. Human right issues andmental health care delivery are not properly address in this act. Many humanrights activist have questioned the constitutional validity of MHA, 1987because it involves curtailment of personal liberty without the provision ofproper review by any judicial body .Where as in the new bill it is providedthat research can be carried out by the consent of guardian.
This provisionviolated human right. Once a person is admitted to mental hospital he is termedinsane or mad by the society. There should be provision in the act to educatethe society against the misconception which this acts lacks.
Right of thementally ill patient was not focused in mental Health Act 1987. On 28 March2017, the Parliament passed the Mental Healthcare Bill, 2016 which will berepealing the existing Mental Health Act, 1987. The bill was already passed bythe Rajya Sabha in August, 2016. After receiving the assent of the President onthe 7th April, 2017, the Mental Healthcare Act, 2017 has come into existence.
The objective of the Act is to protect,promote and fulfill the rights of people with mental illness and to secure forthem appropriate mental healthcare and services and to ensure that these peoplelive with dignity and their rights are not being compromised. The basicframework of the Act is Convention on rights of person with disability and itsoptional protocol which has been adapted by United Nations on 13th December,2006 in New York and which came into force on 3rd may, 2008. India signed and legalizedthis Convention in 2007 making it necessary to align and modify its prevailinglaws with regard to the Convention. The Act redefined “mental illness” as aconsiderable disorder of thinking, mood, perception, orientation or memory thatgrossly impairs judgment, behavior, capability to acknowledge reality orability to fulfill the standard demands of life, mental conditions related tothe abuse of alcohol and medicines. However, it doesn’t embody slowness of mindthat may be a condition of inactive or incomplete development of mind of anindividual, specially characterized by sub-normality of intelligence.
Rights of person with mental illness-The Act guarantees every person right toaccess mental healthcare and treatment from mental health services run orfunded by the Government. It helps in providing accessible, costefficient mental health services for all without any discrimination. Patients who arebelow poverty line or who are destitute or homeless would be provided propertreatment and services free of any charges at all establishments funded by thegovernment. Right to Confidentiality: Person withmental illness will have the right to confidentiality in respect of his mentalhealth, treatment and physical healthcare. It restricts release of informationin respect of mental illness. Without proper consent of any information can bereleased to media by the mental health establishment.
However, all such personswith mental illness will have the right to access their basic medical records.However till now the practice is still not yet practiced.Right to legal aid: This right provides free legal service tomentally ill people.
This act also recognizes their right to live with dignity,to live with community, to have personal contacts, against discrimination andinhuman treatment. This act provides cover in medical insurance for mentalillness on par with any other illness of the body.AdvancedDirectivesThis act empowers a mentally-ill person tohave the right to make decisions regarding his/her own treatment plan and whoher/his nominated representative shall be. ECT is made unlawful for minors andits use in adults has been restricted to be done under anesthesia. Solitaryconfinement has been banished and chaining of patients is banned, physicalrestrains may be applied as and when necessary.Promotion ofMental Health and Preventive ProgrammeThe act directs government to plan andimplement programs for mental health and to create awareness to reduce thestigma associated with mental illness. It also requires the government toincrease and improve the human resource available to tackle mental illnessissues by recruiting and educating more professionals.Establishment of Central & State MentalHealth Authority-The Act directsthe Government to set up a Central Mental Health Authority within a period ofnine months from the date on which this Act receives the assent of thePresident.
Theauthority will register all central and state mental health establishments andcompile, update and publish a register of all such establishments. It willmaintain a national register of clinical psychologists, mental health nursesand psychiatric social worker and publish the list of such registered mentalhealth professionals.The Authority has also been tasked to train law enforcementofficials, mental health professionals and other health professionalsabout the provisions and implementation of this Act. It will also advise theCentral Government on all matters relating to mental healthcare and services.A fund named the Central Mental Health Authority Fund will be constituted wheregrants and loans made to the Authority by the Central Government and all feesand charges received by the Authority under this Act will be credited.No person shall be admitted to or held in a psychiatricinstitution, hospital or facility because of their political, religious or culturalbeliefs and practices.E. All mental health patients have:1.
The right to be treated with dignity as a human being.2. The right to hospital amenities without distinction as torace, color, sex, language, religion, political opinion, social origin orstatus by right of birth or property.3. The right to have a thorough, physical and clinicalexamination by a competent registered general practitioner of one’s choice, toensure that one’s mental condition is not caused by any undetected anduntreated physical illness, injury or defect and the right to seek a secondmedical opinion of one’s choice.4.
The right to fully equipped medical facilities andappropriately trained medical staff in hospitals, so that competent physical,clinical examinations can be performed.5. The right to choose the kind or type of therapy to beemployed, and the right to discuss this with a general practitioner, healer orminister of one’s choice.6. The right to have all the side effects of any offeredtreatment made clear and understandable to the patient, in written form and inthe patient’s native language.7. The right to accept or refuse treatment but in particular,the right to refuse sterilization, electroshock treatment, insulin shock,lobotomy (or any other psychosurgical brain operation), aversion therapy,narcotherapy, deep sleep therapy and any drugs producing unwanted side effects.
8. The right to make official complaints, without reprisal,to an independent board which is composed of nonpsychiatric personnel, lawyersand lay people. Complaints may encompass any torturous, cruel, inhuman ordegrading treatment or punishment received while under psychiatric care9.
The right to have private counsel with a legal advisor andto take legal action.10. The right to discharge oneself at any time and to bedischarged without restriction, having committed no offense.11. The right to manage one’s own property and affairs with alegal advisor, if necessary, or if deemed incompetent by a court of law, tohave a State appointed executor to manage such until one is adjudicatedcompetent.
Such executor is accountable to the patient’s next of kin, or legaladvisor or guardian.12. The right to see and possess one’s hospital records andto take legal action with regard to any false information contained thereinwhich may be damaging to one’s reputation.13. The right to take criminal action, with the fullassistance of law enforcement agents, against any psychiatrist, psychologist orhospital staff for any abuse, false imprisonment, assault from treatment,sexual abuse or rape, or any violation of mental health or other law. And theright to a mental health law that does not indemnify or modify the penaltiesfor criminal, abusive or negligent treatment of patients committed by any psychiatrist,psychologist or hospital staff.
14. The right to sue psychiatrists, their associations andcolleges, the institution, or staff for unlawful detention, false reports ordamaging treatment.15.
The right to work or to refuse to work, and the right toreceive just compensation on a pay scale comparable to union or state/nationalwages for similar work, for any work performed while hospitalized.16. The right to education or training so as to enable one toearn a living when discharged, and the right of choice over what kind ofeducation or training is received.17. The right to receive visitors and a minister of one’s ownfaith.
18. The right to make and receive telephone calls and theright to privacy with regard to all personal correspondence to and from anyone.19. The right to freely associate or not with any group orperson in a psychiatric institution, hospital or facility.20. The right to a safe environment without having in theenvironment, persons placed there for criminal reasons.21. The right to be with others of one’s own age group.
22. The right to wear personal clothing, to have personaleffects and to have a secure place in which to keep them.23. The right to daily physical exercise in the open.24. The right to a proper diet and nutrition and to threemeals a day.
25. The right to hygienic conditions and non overcrowdedfacilities, and to sufficient, undisturbed leisure and rest. Reference1. Choudhary, L.N. (2015) The Mental Health Care Bill 2013: A Critical Appraisal, Indian Journal ofPsychological Medicine https://www.
gov/pmc/articles/PMC4418257/2. CitizensCommission on Human Rights (2018) Mental health declaration of Human rightsRetrieved from http://www.cchr.org/about-us/mental-health-declaration-of-human-rights.
html3. Das, M(28/03/2017) India has new mental healthcare law and heres all you need knowabout it Retrieved from https://www.thenewsminute.com/article/india-has-new-mental-healthcare-law-and-heres-all-you-need-know-about-it-59404