Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  Users Online: 317 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

 Table of Contents  
EDUCATIONAL FORUM
Year : 2018  |  Volume : 8  |  Issue : 2  |  Page : 67-70  

Mental healthcare Act 2017: Need to wait and watch


Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

Date of Submission15-Sep-2017
Date of Acceptance25-Jan-2018
Date of Web Publication19-Apr-2018

Correspondence Address:
Dr. Abhiruchi Galhotra
Department of Community and Family Medicine, Room No 2116, Medical College Building, All India Institute of Medicine Sciences, Raipur, Chhattisgarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijabmr.IJABMR_328_17

Rights and Permissions
   Abstract 


Mental health is different from general health as in certain circumstances mentally ill people may not be in a position to make decisions on their own. Those who suffer rarely get access to appropriate medical treatment as their families try to hide their condition out of a sense of shame. Over 300 million people are estimated to suffer from depression, equivalent to 4.4% of the world's total population. According to a study conducted by the National Institute of Mental Health and Neurosciences, 1 in 40 and 1 in 20 people are suffering from the past and current episodes of depression in India. In spite of this big burden of mental health issues, unfortunately, it continues to be misunderstood in developing countries like India. The new Mental Healthcare Act 2017 rescinds/revoked the existing Mental Healthcare Act 1987 which had been widely criticized for not recognizing the rights of a mentally ill person.

Keywords: Advance directive, disability-adjusted life years, electroconvulsive therapy exploitation


How to cite this article:
Mishra A, Galhotra A. Mental healthcare Act 2017: Need to wait and watch. Int J App Basic Med Res 2018;8:67-70

How to cite this URL:
Mishra A, Galhotra A. Mental healthcare Act 2017: Need to wait and watch. Int J App Basic Med Res [serial online] 2018 [cited 2018 Sep 25];8:67-70. Available from: http://www.ijabmr.org/text.asp?2018/8/2/67/230522




   Introduction Top


Health encompasses the composite union of physical, spiritual, mental, and social dimensions according to the World Health Organization (WHO), which recognizes that “mental health and well-being are fundamental to quality of life, enabling people to experience life as meaningful, become creative and active citizens.” Mental health is significantly different from general health as in certain circumstances mentally ill people may not be in a position to make decisions on their own.[1] Mental illness lasts for a protracted period and has a lifelong impact which gradually result in a poor quality of life.[2],[3] Those who suffer rarely get access to appropriate medical counseling and treatment as their families try to hide their condition out of a sense of shame. This attitude not only harms patients but also leaves them vulnerable to exploitation, abuse, neglect, and marginalization.[4],[5],[6]

The global burden of disease report states that mental disorders account for 13% of total disability-adjusted life years lost, with years lived with disability with depression being the leading cause.[7] Over 300 million people are estimated to suffer from depression, equivalent to 4.4% of the world's total population. Various researches have demonstrated the close association of mental disorders as precursors of a wide range of acute and chronic conditions such as noncommunicable diseases, injury and violence, and poor maternal and child health conditions.[8],[9],[10]

According to a study conducted by the National Institute of Mental Health and Neurosciences, India, in 2016, across 12 different states, the prevalence of depression for both current and lifetime is 2.7% and 5.2%, respectively. Approximately 1 in 40 and 1 in 20 people are suffering from past and current episodes of depression all over the country.[11],[12],[13],[14] This survey has shown that the lifetime prevalence of mental disorder is 13.7% as a whole, which would mean at least 150 million Indians are in need of urgent intervention. Mental illness in vulnerable age groups such as adolescent and in geriatric population accounts for more than half of the total burden.[15],[16] Another report regarding the projected burden of mental illness conveys that it will increase more rapidly in India than the other countries over the next 10 years and will account for one-third of the global burden of mental illnesses, a figure greater than all developed countries put together.[17] In spite of this big burden of mental health issues, unfortunately, it continues to be misunderstood in developing countries like India.[18],[19],[20]

Another critical aspect is the existing infrastructure and workforce in our country to address this health challenge. There are just about 40 mental institutions (out of which only nine are equipped to provide treatment for children) and fewer than 26,000 beds available for a nation comprising 150 billion people.[21] The WHO report on the Mental Health  Atlas More Details reveals that there are just three psychiatrists, and even lesser number of psychologists for every million people in India, which is 18 times fewer than the commonwealth norm of 5.6 psychiatrists/100,000 people.[22]

Keeping in view the massive health burden of mental illness in our country, existing inadequate infrastructure/workforce, the social stigma attached, and glaring shortcomings of Mental Healthcare Act 1987, it becomes imperative for the government and various stakeholders to address these issues. There is also a need to work on the country's international obligation toward the mentally ill people as per the Convention on Rights of Persons with Disability (2007) and its optimal protocol.[23] Hence, a patient-centric bill that safeguards available, affordable, and accessible mental healthcare services was a long due in India.[24]


   Mental Healthcare Act 2017 Top


On March 27, 2017, Lok Sabha in a unanimous decision passed the Mental Healthcare Act 2017 which was passed in Rajya Sabha on August 2016 and got its approval from Honorable President of India on April 2017. The new act defines “mental illness” as a substantial disorder of thinking, mood, perception, orientation, or memory that grossly impairs judgment or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs.”[25] This act rescinds/revoked the existing Mental Healthcare Act 1987 which had been widely criticized for not recognizing the rights of a mentally ill person and paving the way for isolating such dangerous patients.[26],[27],[28],[29],[30] This act has overturned 309 Indian Penal Code which criminalizes attempted suicide by mentally ill person. Another highlight of this Act is to protect the rights of a person with mental illness, and thereby facilitating his/her access to treatment and by an advance directive; how he/she wants to be treated for his/her illness.[31]

The various provisions under the Mental Healthcare Bill are as follows.[32]

Rights of persons with mental illness

Every person will have the right to access mental healthcare services. Such services should be of good quality, convenient, affordable, and accessible. This act further seeks to protect such persons from inhuman treatment, to gain access to free legal services and their medical records, and have the right to complain in the event of deficiencies in provisions

Advance Directive: This empowers a mentally ill person to have the right to make an advance directive toward the way she/he wants to be treated for the requisite illness and who her/his nominated representative shall be. This directive has to be vetted by a medical practitioner.

Mental Health Establishments: The government has to set up the Central Mental Health Authority at national level and State Mental Health Authority in every state. All mental health practitioners (clinical psychologists, mental health nurses, and psychiatric social workers) and every mental health institute will have to be registered with this authority. These bodies will (a) register, supervise, and maintain a register of all mental health establishments; (b) develop quality and service provision norms for such establishments; (c) maintain a register of mental health professionals; (d) train law enforcement officials and mental health professionals on the provisions of the act; (e) receive complaints about deficiencies in provision of services; and (f) advise the government on matters relating to mental health.

Admission of persons with mental illness

The act also outlines the procedure and process for admission, treatment, and subsequent discharge of mentally ill persons.

Decriminalizing suicide and prohibiting electroconvulsive therapy

It decriminalizes suicide attempt by a mentally ill person. It also imposes on the government a duty to rehabilitate such person to ensure that there is no recurrence of attempt to suicide. A person with mental illness shall not be subjected to electroconvulsive therapy (ECT) therapy without the use of muscle relaxants and anesthesia. Furthermore, ECT therapy will not be performed for minors.

Responsibility of certain other agencies

A police officer in charge of a police station shall report to the Magistrate if he has reason to believe that a mentally ill person is being ill-treated or neglected. The bill also imposes a duty on the police officer in the charge of a police station to take under protection any wandering person; such person will be subject to examination by a medical officer and based on such examination will be either admitted to a mental health establishment or be taken to her residence or to an establishment for homeless persons.

Financial punishment

The punishment for violating of provisions under this Act will be imprisonment up to 6 months or Rs. 10,000 one or both. Repeat offenders can face up to 2 years in jail or a fine of Rs. 50,000–5 lakhs or both.


   Critical Insight Into the Act Top


The Mental Healthcare Act 2017 aims to provide mental healthcare services for persons with mental illness. It ensures that these persons have a right to live life with dignity by not being discriminated against or harassed. There are many positive/constructive aspects to this bill, but it is not without its shortcomings, it is not foolproof in the Indian context. Few of these are elaborated here: This act states the right to live life with dignity and no discrimination on basis of sex, religion, culture, and caste. Every person shall have a right to confidentiality in respect of his/her illness and treatment. As per new provisions, ECT has not to be performed without anesthesia, and there is no ECT for the minor. Sterilization shall not be performed in such patients neither they will be put into solitary confinement nor isolation.

This act empowers accessibility to mental health services for all. This right is meant to ensure that services be accessible, affordable, and of good quality. It also mandates the provision of mental health services be established and available in every district of the country. However, with already inadequate medical infrastructure at district and subdistrict levels, the financial burden to be borne by the state governments will be massive unless the central government allocates a larger portion of the budget to incur the expenditure.

The concept of advance directive, which gives patients more power to decide certain aspects of their own treatment, has been picked up from the West. However, unlike developed countries, local factors such as existing mental health resources and lack of awareness about mental illness in India have not been taken into account. Mentally ill persons who suffer from serious psychological disorder often lack the ability to make sound decisions and do not always have a relative to speak on their behalf. In such a situation, treating physician is the best to take decisions because patients or their nominated representatives have limited knowledge on mental health and mental illness. Hence, from a physician perspective, this new directive will definitely lengthen the time of admission of mentally ill persons.[33]

The act also recognizes the right to community living; right to live with dignity; protection from cruel, inhuman, or degrading treatment; treatment equal to persons with physical illness; right to relevant information concerning treatment, other rights and recourses; right to confidentiality; right to access their basic medical records; right to personal contacts and communication; right to legal aid; and recourse against deficiencies in provision of care, treatment, and services. However, the estimate of expenditure required to meet the obligations under the law is not available. It is also not clear how the funds will be allocated between the central and the state governments.

The act also assures free quality treatment for homeless persons or for those belong to below poverty line (BPL), even if they do not possess a BPL card. In our country, where mental illness is considered equal to depression, the obvious financial burden on government will be too high. For the financial year 2017–2018, the proposed health expenditure of 1.2% of gross domestic product in India. It is among the lowest in the world and the public health expenditure has consistently declined since 2013–2014.[34] India spends 0.06% of its health budget on mental health care, which is significantly less than what Bangladesh spends (0.44%). Most developed nations spend above 4% of their budgets on mental health research, infrastructure, frameworks, and workforce, according to 2011 WHO report.[35] While the new act makes several provisions, it provides no guidelines or rules of implementation.

The newly introduced decriminalization of suicide is definitely a welcome move. There could be very much a possibility of misuse of this bill. However, in cases of dowry-related burning/attempted homicide, this can be twisted as attempted suicide and will not warrant the needed attention.

In developing countries like India, persons with mental illness and their situations are being aggravated by socioeconomic and cultural factors, such as lack of access to healthcare, superstition, lack of awareness, stigma, and discrimination. The bill does not direct any provisions to address these factors. The mental healthcare bill does not offer much on prevention and early intervention.


   Conclusion Top


The new Mental Healthcare Act 2017 is supposed to change the fundamental approach on mental health issues including a sensible patient-centric health care, instead of a criminal-centric one, in India, the second most populous country and one of the fastest economies in the world. The guidelines need to be reviewed on aspects such as primary prevention, reintegration, and rehabilitation because without such strengthening, its implementation would be incomplete and the issue of former mental health patients will continue to exist. Hence, being optimistic about the bill, there is a need to wait and watch for its implementation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Patel V, Kleinman A. Poverty and common mental disorders in developing countries. Bull World Health Organ 2003;81:609-15.  Back to cited text no. 1
[PUBMED]    
2.
Sharma S, Varma LP. History of mental hospitals in Indian sub-continent. Indian J Psychiatry 1984;26:295-300.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Mander H. Living Rough Surviving City Streets. A Study of Homeless Populations in Delhi, Chennai, Patna and Madurai – For the Planning Commission of India. Available from: http://www.planningcommission.nic.in/reports/sereport/ser/ ser_rough.pdf. [ Last accessed on 2017 May 03].  Back to cited text no. 3
    
4.
World Health Organization. WHO's Role, Mandate and Activities to Counter the World Drug Problem- A Public Health Perspective. Geneva: World Health Organization; 2015.  Back to cited text no. 4
    
5.
Kriti S. “Treated worse than animals”: Abuses against women and girls with psychosocial or intellectual disabilities in institutions in India. Human Rights Watch. Library of Congress; 2014. Available from: https://www.lccn.loc.gov/201530402. [Last accessed on 2017 Apr 12].  Back to cited text no. 5
    
6.
Nagaraja DN, Murthy P. Mental Health Care and Human Rights. 1st ed. New Delhi: National Human Rights Commission; 2008.  Back to cited text no. 6
    
7.
Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the global burden of disease study 2013. Lancet 2015;386:743-800.  Back to cited text no. 7
[PUBMED]    
8.
Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al. No health without mental health. Lancet 2007;370:859-77.  Back to cited text no. 8
[PUBMED]    
9.
Keyes CL. The nexus of cardiovascular disease and depression revisited: The complete mental health perspective and the moderating role of age and gender. Aging Ment Health 2004;8:266-74.  Back to cited text no. 9
[PUBMED]    
10.
Murthy P, Bharath S, Narayanan G, Soundarya S. Integrating mental health care and non-communicable disorders. Background Document to the Gulbenkian NIMHANS Symposium on Integrating Mental Health Care and Non-Communicable Disorders. Bangalore: NIMHANS; November, 2015.  Back to cited text no. 10
    
11.
Murthy RS. National mental health survey of India 2015-2016. Indian J Psychiatry 2017;59:21-6.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Math SB, Srinivasaraju R. Indian psychiatric epidemiological studies: Learning from the past. Indian J Psychiatry 2010;52:S95-103.  Back to cited text no. 12
[PUBMED]    
13.
Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med 2011;9:90.  Back to cited text no. 13
[PUBMED]    
14.
The National Mental Health Survey of India 2015-16, Insight; December, 2016. Available from: http://www.insightsonindia.com/2016/12/31/3-national-mental-health-survey-india-2015-16-12-state-survey-conducted-national-institute-mental-health-neurosciences-found-1-surveyed-hi/. [Last accessed on 2017 Apr 14].  Back to cited text no. 14
    
15.
Tiwari SC, Srivastava G, Tripathi RK, Pandey NM, Agarwal GG, Pandey S, et al. Prevalence of psychiatric morbidity amongst the community dwelling rural older adults in Northern India. Indian J Med Res 2013;138:504-14.  Back to cited text no. 15
[PUBMED]  [Full text]  
16.
Nadkarni A, Murthy P, Crome IB, Rao R. Alcohol use and alcohol-use disorders among older adults in India: A literature review. Aging Ment Health 2013;17:979-91.  Back to cited text no. 16
[PUBMED]    
17.
Mental Illness India's Ticking Bomb, Only 1 in 10 Treated: Lancet Study. 19th May, 2016. Available from: http://www.indianexpress.com/article/india/india-news-india/mental-illness-indias-ticking-bomb-only-1-in-10-treated-lancet-study-2807987. [Last accessed on 2017 Jan 20].  Back to cited text no. 17
    
18.
Why mental health services in low- and middle-income countries are under-resourced, underperforming: An Indian perspective. Natl Med J India 2011;24:94-7.  Back to cited text no. 18
    
19.
Assessment of Pattern, Profile and Correlates of Substance use Among Children in India. National Commission for Protection of Child Rights (NCPCR); 2013. Available from: http://www.ncpcr.gov.in/. [Last accessed on 2017 Mar 15].  Back to cited text no. 19
    
20.
Chandrashekar CR, Isaac MK, Kapur RL, Sarathy RP. Management of priority mental disorders in the community. Indian J Psychiatry 1981;23:174-8.  Back to cited text no. 20
[PUBMED]  [Full text]  
21.
Gururaj G, Girish N, Isaac MK. Mental, neurological and substance use disorders: Strategies towards a systems approach. NCMH Background Papers-Burden of disease in India. New Delhi: Ministry of Health and Family Welfare; 2004.  Back to cited text no. 21
    
22.
World Health Organization. Mental Health Atlas 2011 – Department of Mental Health and Substance Abuse. Geneva: World Health Organization; 2011.  Back to cited text no. 22
    
23.
World Health Organization. Disability and Health, Fact Sheet. Geneva: World Health Organization; 2016. Available from: http://www.who.int/mediacentre/factsheets/fs352/en/. [Last accessed on 2017 Jan 10].  Back to cited text no. 23
    
24.
Evaluation of District Mental Health Programme – Final Report Ministry of Health and Family Welfare Government of India. New Delhi: Indian Council of Marketing Research; 2009.  Back to cited text no. 24
    
25.
What is Mental Healthcare Bill? The Indian Express; 28th March, 2017. Available from: http://www.indianexpress.com/article/what-is/mental-healthcare-bill-passed-parliament-lok-sabha. [Last accessed on 2017 May 12].  Back to cited text no. 25
    
26.
van Ginneken N, Jain S, Patel V, Berridge V. The development of mental health services within primary care in India: Learning from oral history. Int J Ment Health Syst 2014;8:30.  Back to cited text no. 26
[PUBMED]    
27.
Murthy RS. Mental health initiatives in India (1947-2010). Natl Med J India 2011;24:98-107.  Back to cited text no. 27
[PUBMED]    
28.
Isaac M, Kulhara P. Themes and issues in contemporary Indian psychiatry. National Mental Health Programme: Time for Reappraisal. New Delhi: Indian Psychiatric Society; 2011.  Back to cited text no. 28
    
29.
vvan Ginneken, N; Tharyan, P; Lewin, S; Rao, GN; Meera, SM; Pian, J; Chandrashekar, S; Patel, V (2013) Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database Syst Rev, 11 (11). CD009149.  Back to cited text no. 29
    
30.
A Mentally Ill Patient has the Same Right of Freedom as Any Indian, Governance now; 4th May, 2017. Available from: http://www.governancenow.com/views/interview/a-mentally-ill-patient-has-the-same-right-freedom-as-any-indian#sthash.mWrQzjP3.dpuf. [Last accessed on 2017 Jun 08].  Back to cited text no. 30
    
31.
Mental Healthcare Bill Decriminalizes Suicide Attempt Passed by Parliament. Hindustan Times; 27th March, 2017. Available from: http://www.hindustantimes.com/india-news/mental-healthcare-bill-that-decriminalises-suicide-attempt-passed-by-parliament/story-iL3DXiatxP7BFhS2t4zGCM.html. [Last accessed on 2017 Apr 23].  Back to cited text no. 31
    
32.
New Mental Health Bill Provisions-and Some Challenges in their Implementation. The Indian Express; 10th August, 2016. Available from: http://www.indianexpress.com/article/explained/new-mental-health-bill-provisions-rajya-sabha-2964545/. [Last accessed on 2016 Dec 12].  Back to cited text no. 32
    
33.
Mental Healthcare Bill: Despite the Positive Reforms, a Lot More Needs to be Done for the Mentally Ill. First Post; 08th April, 2017. Available from: http://www. firstpost.com/india/mental-healthcare-bill-despite-the-positive-reform-a-lot-more-needs-to-be-done-for-the-mentally-ill-3373156.html. [Last accessed on 2017 May 08].  Back to cited text no. 33
    
34.
Center State Government Spends 1.3% of GDP on Health Care in 2015-2016. Times of India; 2nd August, 2016. Available from: http://www.timesofindia.indiatimes.com/india/Centre-state-governments-spent-1-3-of-GDP-on-healthcare-in-2015-16/articleshow/53509406.cms. [Last accessed on 2017 Feb 12].  Back to cited text no. 34
    
35.
World Health Organization. Spending on Health: A Global Over View. Geneva: World Health Organization; 2012. Available from: http://www.who.int/mediacentre/factsheets/fs319/en/. [Last accessed on 2017 Jan 14].  Back to cited text no. 35
    




 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Mental Healthcar...
    Critical Insight...
   Conclusion
    References

 Article Access Statistics
    Viewed1037    
    Printed47    
    Emailed0    
    PDF Downloaded201    
    Comments [Add]    

Recommend this journal