After decades of consultations, putting pressure on the government, advocacy and activism, the Mental Healthcare Bill finally came down to a six hour long discussion, before it was passed by the Lok Sabha on March 27. It’s aim – to provide, promote and fulfil the rights of persons with mental illnesses.
As someone who has worked in the mental health sector, focussing on busting stigma and spreading awareness, it gives me great relief to know that we have finally done away with a legislation, that not only promoted human rights violations, but also looked at an entire section of society as “incapable” of making decisions for themselves.
As much of a good news the passing of this bill is, there are still some aspects of it that call for concern.
While on the one hand, the Advanced Directive gives complete freedom to a person diagnosed with a mental illness to decide the course of action for his/her treatment, it does leave room for this same directive to be questioned, changed and/or be completely ignored.
Jayna Kothari, a human rights lawyer and co-founder of the Centre for Law and Policy Research, shares her view on this.
In a country like India, where doctors are almost always taken at face value and people surrender themselves and their families to their mercy, most Psychiatrists like the rest of the medical fraternity, are used to deciding ‘for the patients’.
This is especially true in low income families, from smaller towns and villages, where the ratio of mental health care services to those who need this care is so skewed, that it becomes a huge burden on the limited number of centres. Hence, the quality of care given is heavily compromised. This in turn leaves a majority of the population undiagnosed and untreated.
Dr PV Bhandary, Medical Director and Psychiatrist at Baliga Memorial Hospital in Udupi, shares the pros and cons of the bill.
In order for the Advanced Directive to play out like it should, shouldn't all of us start educating ourselves about the various treatment options available and outline our choices to be prepared in the future, if we do get diagnosed with a mental illness? This brings me to extreme treatments such as Electroconvulsive Therapy.
Forceful sterilisation of girls and women has plagued India for decades now and this ban by the Bill is a positive step towards ensuring their reproductive rights are not violated. It will be important to ensure that hospitals implement this and are not subjecting the patients to abuse, which is most cases has either gone completely unnoticed or unreported.
The Mental Healthcare Bill’s stand on Electroconvulsive Therapy (shock treatment) has raked in varied opinions. Historically, ECTs have been one of the most controversial treatments in medicine and its portrayal has been polarised, skewing only towards its negative effects. This has made many vary of this form of treatment. Anoopa Anand, a woman living with a mental illness, recently published her take on ECTs specifically.
I take a slightly different stand on this. Studies on the use of ECTs, their advantages, disadvantages and the ways in which they can be administered without causing harm and with informed consent, have been inadequate in India.
Rohan Sabharwal, a filmmaker who has been living with bipolar disorder for nearly two decades, shares his experience with ECTs-
The Department of Psychiatry in Christian Medical College, Vellore conducted a study titled ‘Voices of People Who Have Received ECT’ that outlines both positive and negative responses and perceptions of people who have received ECT. While this study has not been able to ascertain whether or not ECTs should be banned, it does outline a holistic approach, that ensures a basic minimum standard to obtain informed consent and suggestions to improve ECT practices in India.
I couldn’t agree more with Shashi Tharoor when he said in the Lok Sabha that law enforcement agencies and first responders in incidents of suicide must be sensitised. He also urges the Union Minister of Health and Family Welfare to look into the caseload of those locked up involuntarily. Clearly, the passing of the Mental Healthcare Bill is only the first step. As far as the infrastructure of mental healthcare in India is concerned, we still have a long way to go.
The Mental Healthcare Bill has the potential to turn things around and each one of us has a role to play in its implementation.
The Mental Healthcare Bill can be accessed here.
(Rachana Iyer is a writer, social impact specialist and co founder at CraYon Impact, an enterprise that produces content, events and campaigns around issues of Disability, Mental Health and Gender. She is an alumna of The Centre for Disability Studies from the Tata Institute of Social Sciences, Mumbai.)
(Inputs from DNA, WHO)
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Published: 01 Apr 2017,03:27 PM IST