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Mental Health Care Bill Passed, Big boost but still a long way to go

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The Rajya Sabha passed the Mental Health Care Bill (MHC), 2016 last week marking the culmination of a six-year process to review and replace the existing Mental Health Act, 1987. Many commentators have welcomed the fact that the new law finally decriminalises attempted suicide, a clause which received considerable media attention.

This was a long-standing demand from civil society, mental health professionals and the Law Commission of India. However, the law goes well beyond this specific clause and enshrines fundamental rights to care and dignity for persons with mental illness. There have been two previous mental health laws – the Indian Lunacy Act, 1912 and the Mental Health Act, 1987.

The Indian Lunacy Act was primarily focussed on protecting society from persons with mental illness and its emphasis was on custodial care in institutions. The Lunacy Act presumed that persons with mental illness will spend the rest of their lives in such custodial institutions and the law focussed on the rules for how people would be admitted to institutions and the management of their property subsequent to their admission to hospital. The Mental Health Act, 1987 saw progress with provisions for treatment of persons with mental illness in general hospitals and provisions for discharge from institutions. However, MHA, 1987 continued with certain regressive aspects of the Indian Lunacy Act, such as guardianship and management of property of persons with mental illness. The MHA, 1987 was also criticised for being largely concerned with the regulation and administration of mental health care in institutional settings rather than addressing mental health problems of the community or protecting the rights of persons with mental illness.

At the heart of the new law are the twin rights of the person with mental illness to receive care and to live a life with dignity. The most significant public health measure in the new law is to expand access to mental health care across the country, directly addressing the large treatment gap for mental illness in India. Even the limited range of mental health services in the country either tend to be located in private facilities or in large mental hospitals which are still home to nearly 80 per cent of all mental health beds in the country. Neglect, segregation and social exclusion of persons with mental illness continue to pervade the experience of mental health care.

However, no matter how progressive the new bill is, it is still just a baby-step in the direction of reform. The bill only recognises the role of psychiatrists in the treatment of a mental illness. It still does not acknowledge the roles of counsellors and psychologists who also work with patients suffering from mental and emotional distress. Also, the bill largely addresses requirements of those people in mental healthcare facilities, but not every person diagnosed with a mental illness needs institutionalisation. While the bill mandates insurance companies to provide medical insurance or the mentally ill on the same grounds that they would issue insurance for physical illnesses, counselling services would probably not be covered even in the new insurance schemes.

Implementation of the Act will also pose to be a problem. There is a shortage of mental health professionals in our country. “For every four lakh Indians, there is only one psychiatrist,” Dr Rajesh Sagar was quoted as saying in DNA. With budget cuts in the health sector, how will state governments successfully implement the dictates of this new law?

The new bill largely adopts a biomedical model to treat mental illness. It does not talk about newer modalities like arts-based therapy, for instance, which helps people cope with stress, and speeds the recovery process.The bill provides facilities to the mentally ill, but how far does it address the stigma and discrimination a person with a diagnostic label is forced to endure? To what extent does it shape the nation into adopting a healthier attitude towards the issue of mental health? Only time will tell.

Adapted from Hindu oped: Boost for mental care

& Firstpost article:Mental Health Care Bill: A much-needed reform that still has a long way to go

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