SETTING THE PREMISE: THE INDIAN MENTAL HEALTHCARE ACT, 2017
The World Health Organization has defined health as a state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity.” We have travelled a long way to arrive at a definition to include mental health as one of the core aspects of a healthy life.
The Indian Mental Healthcare Act, 2017 is a legislation that deals with aspects pertaining to care, administration and regulation of people who suffer from mental illness or disorders.
It is a progressive step from its 1987 counterpart which lacked a holistic approach towards mental health as well as its treatment. India amended it’s Mental Healthcare Act, owing to its obligations under the the United Nations Convention on the Rights of Persons with Disabilities of 2006; a convention that intends to bring a humane approach towards people with disabilities.
The new Act introduces definitions like advanced directive;caregivers; clinical psychologists; mental health nurse; mental health institutions; mental health professional; psychiatric social worker amongst others. These definitions not only broaden the scope of application of the act but also present a progressive view towards changing the conventional way of mental health treatment. Professions like clinical psychologist, psychiatric social worker, mental health nurse have been recognized under the Act, which comes as a welcoming move by the legislature, as it serves a two fold purpose: firstly, dignifying these degrees as professionals and secondly, it will help in increasing awareness about these new fields within Psychology and Psychiatry.
IMPLEMENTATION AND IMPLICATION
The Act came into force in 2018. It fulfills the Constitutional mandate of being inclusive and giving the people suffering from mental disorders an equal right to a dignified life as envisioned under Article 21 of our Constitution.
The Act prohibits any form of discrimination against people suffering from mental illness or disorders as enshrined under Article 14 of our Constitution.
These provisions will allow for a healthier recovery phase and most importantly will aid in de stigmatizing taboos around people undergoing treatment for mental health.
The inclusive definition of mental illness also reflects on the various aspects of mental health care that are less talked about. Inclusion of Alcohol and drug abuse, known as Substance Use Disorders within this definition has been met with some criticism by researchers. The lack of definition of terms like “abuse” is concerning and also the usage of the word abuse is against the global standards laid down by the Diagnostic and Statistical Manual(DSM)-5 as well as International Classification of Diseases (ICD) of the World Health Organization (WHO). The lack of definition thus makes it difficult to comprehend the scope of substance use disorders that can fall within the purview of the Act.
The inclusion of an advanced directive which allows patients to nominate representatives to take important decisions regarding their treatment, also becomes difficult to implement in cases of substance use disorders because in most cases, the substance user doesn’t feel they have a disorder or require treatment.
ACCESS AND THE LACK OF IT
Access to mental healthcare is another important aspect covered under the new legislation. The Act mandates that the Government should include mental healthcare within the primary healthcare sector, aiming for an integration and hopefully a better response from people after the ease of access. The state of Kerala has successfully achieved this integration not only at the healthcare institutions but even in schools. Kerala also has contributed 1.16% of its budget to mental healthcare.
Whereas only Rs40 Crores have been allocated for the National Mental Health Programme as per the 2021 budget. Institutes like NIMHANS have been given Rs500 crore in order to promote research in the field.
However, critics opine that there needs to be decentralization of these funds for better mental healthcare management at the ground level.
Moreover, a survey conducted by National Mental Health Survey (NMHS) in 2020, revealed that India has 0.75 psychiatrists, 0.12 nurses, 0.07 psychologists and 0.07 social workers per 10,000 populations with the desirable number being 3. These numbers are far from the ideal and depict the state of mental health management within the country, which seems rather chaotic and overburdened.
THE PANDEMIC AND SUBSEQUENT AWAKENING
The Covid-19 pandemic and lockdowns that came along with it, haven’t been easy on our mental health, not only individually but as a society. The concept of “collective trauma” has been a prominent factor that has bonded us together. Apart from the harm the virus can cause to our physical health, our mental health took an equal or a greater toll. Especially, the frontline workers who are seeing and experiencing tragedy as a first hand witness on the pandemic battlefield. Conversations about mental health have been gaining prominence ever since. However, with therapy going online, quacks have been on the rise. With an estimate that one in ten people having a mental health concern in India, quacks only induce a more uncertain picture adding to the lack of professionals.
The lack of awareness about mental health in general is a cause for concern, most people aren’t aware about their conditions which leads to mental morbidity. Mental health should be given priority with equal footing like physical health. There have been positive steps taken by various organizations, institutions to talk about mental health issues and provide professional help if necessary. Some organizations started suicide prevention helplines, some provided a platform to express, while some connected people to a professional. Organizations centric towards frontline workers and their mental health also gained prominence.
As per the guidelines issued by Insurance Regulatory and Development Authority of India, mental illnesses should also be covered in health insurances, which is an inclusive and welcoming move.
But, we need to use this momentum and spread awareness about mental health disorders, the right treatment approaches and schemes by the Government for the benefit of the masses
CONCLUSION AND RECOMMENDATION
India’s Mental Health Act, 2017 has been considered to be one of the most pioneering legislations for mental health. The Act presents a promising future if implemented with the intent it was created for. The effort is applaudable as the Act not only aims at a better mental health care infrastructure it also aims at better rehabilitation for patients back into the society, equal opportunities and rights for them. Though the act is positive, we are short staffed with professionals who play a vital role in implementation and execution.
The author recommends the following:
● School curriculums should include a chapter on introduction to mental health and how it can be managed effectively, with inputs from practicing psychologists and psychiatrists. This will not only spread awareness but will also introduce students to a new profession and reduce the stigma around it.
● A body under the Rehabilitation Council of India should be set up to check on the fake websites and professionals within the field.
● The government should increase its spending on the mental health infrastructure in the country. The money allocated should be decentralized so that it reaches the ground levels.
There is a need for awareness campaigns through modes like television, radio, social media so that it reaches maximum people.