Mental Wellness- Can the Mental Health Bill 2016 Get us there?
As R looked at her family with confused eyes, her emotions oscillating from anger to fear and back to confusion; the reality of her advanced stages of dementia dawned upon the family. Dementia: A chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning- this is the first hit that the family got when google was asked questions pertaining to R’s health. What does this definition mean and how accurately does it sum up the lives of those surrounding a dementia patient? As the family ran from pillar to post getting treatment for R and managing her “changed” state, the knowledge they received about how to care for a dementia patient was sparse and erratic. There were several instances where R ate incorrect medication, before her family realised that medicines should not be freely accessible to her or she gave away money without realising that she had paid twice already or she forgot to eat. R’s family learnt to take care of her through experience, by navigating through mistakes and because they were committed to making her life comfortable. This family in India had the resources and the inclination to take care of a person who was suffering from a mental disorder. R got the best possible care and treatment.
Unfortunately the same cannot be said for the majority of the population suffering from mental disorders. In India it is estimated that approximately 5% of the population i.e. around 50 million people suffer from mental disorders and to add to the gravity of the situation nearly half of the cases go untreated and uncared for. These statistics do not take into account the widespread need for counselling. It is estimated that every 1 in 5 people need counselling, either psychological or psychiatric.
The changing landscape of mental health laws across the globe is aimed at integrating and protecting people suffering with psychological disorders and abolishing segregation and discrimination. The continued and overpowering influence of Human Rights had finally led to viewing people with psychological disorders as individuals with equal rights that can be enforced by the States and International Bodies. International communities furthered this change in mind-set through the United Nations Convention on the Rights of Persons with Disabilities 2006(commonly known as the Disability Convention’) and Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (or simply the MI Principles).
Though India has ratified the Disabilities Convention, it has been unable to meet the standards set by the convention. The Mental Health Act 1987 which provided inadequate protection to rights of mentally ill people needs to be upgraded immediately. The Mental Health Act of 1987 laid stringent licensing requirements for providing healthcare for mental disorders. A non-heritable and non-transferable license was needed for establishing a mental health institution. Unfortunately, the law discriminated between private and government intuitions, with relaxed licence requirements for the latter. This became a deterrent for the private sector to invest in healthcare for psychological disorders. The Mental Health Bill 2016 repeals the existing act and aims to fulfil India’s international obligation to the Convention on Rights of Persons with Disabilities. The current bill is intended to empower persons with mental disabilities by adopting a humanistic rights based approach- a first in India’s mental health laws. The Mental Health Bill 2016 further provides for the creation of Central and State Mental Health Authorities to ensure enforcement of regulations and develop quality mental health establishments. The Bill also promotes registration of psychologists, mental health workers and nurses and training of law enforcement officials about amended laws and implementation of the Bill. The Mental Health Bill 2016 has also mandated the development of Mental Health Review Boards to ensure that rights and protection are guaranteed to patients admitted into mental health establishments. Further the Bill has decriminalised suicide and allows individuals with a predisposition to a mental illness to nominate a representative and make an advance directive about how they want their treatment to progress.
The recent article about the Asha Kiran Home for Mentally Challenged, where 600 women have died since 2001 is a shocking revelation about the abysmal care provided at a large number of mental institutions. Though some deaths can be attributed to the advance mental and physical illness of patients, a large number also occur due to overcrowding at the facilities and lack of understanding of patient needs.
Stark contrasts to this are the dementia villages which are coming up across the world. The dementia village, Hogewey in Weesp, Netherlands is a model village in many ways. Dementia and Alzheimer patients live in a gated complex where all workers starting from the salon to the grocery store are trained care givers. Patients are given as normal a life as possible within the walls of the village. Further, the trained professionals ensure that the patients live a secure and comfortable life. Special features such as no money transactions and themed residential areas provide a life that is reminiscent to the patient of his/her formative years.
If R lived in Netherlands such a facility would be a boon for her as well as her family. Rather than struggling with her condition, she would have received appropriate care, while the family spent quality time with her regularly. In a country like India, where a large proportion of the population needs psychological care such models should become the yardstick for mental health wellness initiatives. While slowly people are embracing the concept of counselling, severe mental disorders are treated with disdain and the patient is more often than not abandoned. The passing of the Mental Health Bill 2016 is a positive step forward. A change in mind-set, rapid changes in existing laws and a larger role of the private sector in developing mental health facilities will become important factors in combating discrimination towards persons suffering from mental disorders. The time to take small steps is past. Inclusive development is possible only through giant leaps in this sector and integration of people suffering with psychological disorders.
Disclaimer: The blog represents the views and opinions of the author. IPE CKD does not take responsibility for the views expressed in the blog