India is one of the few countries that has a National Health Policy (NHP, 2002) that categorically mentions mental health, as well as a National Mental Health Program (NMHP) and a dedicated Mental Health Act 1987 (MHA). The most recent one is THE MENTAL HEALTHCARE BILL (ACT) passed in 2016.
The objective of the Act is “to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto.”
Simply put, this means that any individual with a diagnosed mental illness has the right to access healthcare and any other related services. These services will be delivered with dignity and respect to the individual.
The act clearly defines all parties and subjects mentioned in the bill. It addresses what mental healthcare is (analysis, diagnosis, treatment and rehabilitation of an individual with a diagnosed or suspected mental illness). It outlines the parties involved including family members and caregivers, psychiatric social workers and mental health professionals. It very importantly defines and underlines all the aspects of informed consent, a very significant matter in a country where a quarter of the population are illiterate and lakhs are medically uneducated. It also clearly and comprehensively defines mental illness as different from mental retardation.
The bill is very important to the average Indian citizen because it finally opens up the mental health space to anyone who wants help, regardless of the diagnosis. In the coming years, it could go a long way to destigmatise mental health treatment. Here are some of the most important points of the act that we all need to be aware of as its beneficiaries:
Decriminalisation of attempted suicide
In a much needed move, survivors of attempted suicide will not be sent to jail but instead to a rehabilitation program where they can receive treatment for their issues. The individual shall be presumed to be suffering from ‘severe stress’, a term which has replaced the earlier bill’s assumption of ‘mental illness’. They are therefore exempt from trial and punishment.
Empowerment of the mentally ill
While earlier acts sought to ‘protect’ the general population from those suffering from mental illness, the new bill recognises the agency and abilities of such people and grants them facilities for rehabilitation and support. This means recognising the inherent dignity of such persons and according them the right to make decisions regarding their treatment, if they can understand relevant information. It also gives every person the right to make an Advance Directive regarding the treatment they wish to receive in the case of any future mental illness, and this Directive must be followed unless overturned by the respective Board.
Restricted use of Electro-Convulsive Therapy (ECT)
Electro-Convulsive Therapy will only be used in the rarest of cases and with informed consent. It is completely prohibited as emergency treatment, without muscle relaxants and anaesthesia and minors, although the last one is subject to permission from the guardian and the relevant Board. The Bill also prohibits the sterilisation of the mentally ill unless it is part of their rehabilitation.
Empowerment of the police
Police officers will be required to take under their protection any mentally-ill person on the streets within the limits of their police station. They are also to take notice of any case of ill-treatment of a mentally-ill person and report it to the Magistrate, who can then have the individual examined by a mental health professional and rehabilitated if necessary.
The importance of informed consent
In the definition of informed consent, there’s a very crucial factor marked out: using language that the individual can understand. Too often professionals trained in urban areas consider it too cumbersome to actually break down complex terms and biological processes to patients who, regardless of economic or educational background, may have difficulty grasping these concepts. It’s very important as mental health professionals to remember that their purpose is to help, not to dictate. It is the ethical responsibility of treating professionals to work with people rather than simply assume that educational qualifications alone give the power to dictate an individual’s treatment. The bill also grants the patient complete access to their medical records unless such a disclosure would result in harm to themselves or others.
Placing responsibility on the government
The very first line of the act allocates responsibility to the government to either run or fund mental health care centres that will make a range of quality treatment accessible to all citizens, regardless of economic or social background. The act goes on to make special provisions for those living below the poverty line, destitute or homeless, entitling them to free care.
Placing the quality of healthcare for mental illness on par with that for physical illness
This is another strong step towards the destigmatisation of mental health. By assuring care equal in quality, the bill aims to bring mental health care into the mainstream, and no longer treat it as rare and specialty treatment only available for the wealthy and urban citizens.
The right to complain
By outlining the steps a citizen can take if discriminated against, and detailing the persons to be approached, the area of mental health care is finally transparent. If a patient suffers a breach of confidence or poor quality care, they can approach the medical officer or mental health professional in charge of the establishment, the concerned Board and finally the State Authority to seek justice.
To take control of your health, it is important to know your rights. Being informed is the first step towards being a better citizen.