HOW TO MANAGE HAEMOPHILIA PATIENTS DURING PANDEMIC - The Daily Guardian
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HOW TO MANAGE HAEMOPHILIA PATIENTS DURING PANDEMIC

Dr Vishal Sehgal

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The second wave of the Covid-19 pandemic has hit full force. Apart from people infected by the condition, those with diseases, particularly rare ones like haemophilia, have been particularly affected. This is because most hospitals are occupied with Covid-19 patients and visiting them in these times is fraught with risk. The onus, therefore, falls on the patients and their families at home to take precautions and manage the condition. Apart from keeping their vitals under check, they should also consult their healthcare providers in case of any Covid-19-like symptoms. There is a need to raise awareness about haemophilia as well as managing it during the ongoing pandemic.

Haemophilia is a rare genetic bleeding disorder in which the blood does not clot properly. As a result, a person suffers from spontaneous bleeding and may bleed for a longer time following an injury. This occurs due to the absence of clotting factors that are required to stop the bleeding. The intensity of the condition depends on the amount of clotting factor present in the blood.

Haemophilia is of three types: A, B, and C, and the difference between the three lies in the deficiency of a specific factor.

Females are carriers of haemophilia. It is not a life-threatening disorder unless the bleeding extends into a vital organ. However, it can be severely debilitating and there is no known cure for this disorder. About a third of new cases are caused due to a new mutation of the gene in the mother or the child. In cases where the mother is a carrier and the father does not have the disorder, there is a 50% chance of the male child having haemophilia and a 50% chance of the female child being a carrier. One should see a doctor in case the following symptoms show up – a severe headache, repeated vomiting, neck pain, blurred or doubled vision, extreme sleepiness, and continuous bleeding from an injury.

Under the current scenario, patients with haemophilia should also practice preventive measures against Covid-19. This includes rigorous hand hygiene and social distancing to avoid any external contact. For children with haemophilia, parents can undertake home therapy with guidance from their specialist through teleconsultation. This becomes important for both the treatment and prevention of bleeding. This will not only reduce the existing burden on healthcare centres but also allow patients to stay away from the risk of acquiring infections. In case of any emergency situation, it is imperative to keep the bleeding disorder card/disease status handy.

Some other general tips for haemophilia patients are as follows:

• Adequate physical activity can help maintain body weight and improve muscle and bone strength. However, avoid physical activity that can cause injury and resultant bleeding

• Avoid blood-thinning medication such as warfarin and heparin. It is also better to avoid over-the-counter medicines like aspirin and ibuprofen

• Clean your teeth and gums thoroughly. Get tips from your dentist on how to do this without making the gums bleed

• Get tested for blood-borne infections and get your doctor’s advice on hepatitis A and B vaccinations

In case of any complications, one should reach out to the treatment centre so that bleeding episodes can be managed. The centre can also help provide inputs on preventing Covid infection.

The writer is President, Medical Services, Portea Medical.

Under the current scenario, patients with haemophilia should also practice preventive measures against Covid-19. This includes rigorous hand hygiene and social distancing to avoid any external contact. For children with haemophilia, parents can undertake home therapy with guidance from their specialist through teleconsultation. This becomes important for both the treatment and prevention of bleeding. This will not only reduce the existing burden on healthcare centres but also allow patients to stay away from the risk of acquiring infections.

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Health & Wellness

What’s the role of genetic testing in planning a healthy pregnancy?

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The news of pregnancy brings with it different feelings—happiness, anticipation but sometimes worry and anxiety. Some parents worry that their unborn baby might have health problems. While most babies are born healthy, genetic testing can provide you with a closer look and certainty into your and your baby’s health.

 Genetic testing checks for the medical conditions of the babies while in their womb. Even before the pregnancy, genetic testing looks at the parent’s genes to know the chances that the child born might have a genetic disorder.

These genetic tests are mostly optional, but these tests can help you plan a healthy pregnancy. So, you can make the right health decisions and know what to expect when your baby comes.

Genetic testing before and during the pregnancy

Genetic testing is important to plan a pregnancy because it shows the likelihood that an unborn child will have certain inherited health conditions. If a parent (mother or father) has a gene for the disorder but doesn’t have the condition themselves, they are called a carrier. Genetic screening before pregnancy tells you if you or your partner possess those genes, and if so, what are the chances that you might pass these genes to your children.

Genetic testing during the pregnancy determines with as much certainty as possible if the unborn child has certain genetic disorders or birth defects. With the help of genetic tests during the pregnancy, parents can make an informed decision after consulting with the health care provider. Genetic tests also help your healthcare provider personalise their care for the parents or newborn baby, which enhances the chances for a healthy pregnancy.

Many new-age diagnostic companies are providing genetic testing to parents for a healthy pregnancy. For example, Genes2Me, India’s leading diagnostic company, offers a mother and child care segment dedicated to covering each facet of the pregnancy journey. The genetic testing lab offers prenatal and postnatal screenings, newborn screenings, and pediatric developmental disorders with complete pregnancy screening solutions all in a single place.

Genetic tests before pregnancy 

Many genetic abnormalities can be found before the baby’s birth. Your health care provider may recommend you take the genetic screening test if you or your partner has a family history of genetic disorders. In addition, if you have had a fetus or baby with a genetic abnormality before, genetic testing can help you know your unborn baby’s health.

Some of the genetic disorders that can be diagnosed before birth include Cystic fibrosis, Duchenne muscular dystrophy, Hemophilia A, Polycystic kidney disease, Sickle cell disease, Tay-Sachs disease, and Thalassemia. Genetic testing before birth can help you know if you are likely to have a baby with the above genetic disorder.

Genetic test at each stage of pregnancy 

There are different pregnancy genetic tests during each stage of the pregnancy.

First-trimester screening tests – During the first trimester, parents are recommended by the health care provider to go for a blood test and an ultrasound test. This test is required to measure the size of the clear space in the tissue at the back of a baby’s neck (nuchal translucency). In the case of nuchal translucency measurement is abnormally large, it may imply that the child is suffering from Down syndrome or other medical conditions. Also, the couple carrier screening of beta-thalassemia and sickle cell anaemia is highly recommended during the first trimester. 

Second-trimester screening tests – During the second trimester, Quad screen tests are recommended. This is a blood test where levels of four substances are measured in the blood. The test determines the risk of carrying a baby with certain chromosomal conditions, such as down syndrome, trisomy 18, etc. The genetic test also helps detect neural tube defects—any abnormalities of the spinal cord or brain.

Prenatal cell-free DNA screening – Fetal DNA in the maternal bloodstream is examined to screen for the increased chance for specific chromosome problems, such as Down syndrome. You can also gather information about the baby’s rhesus (Rh) blood type.

Newborn screening test – After the baby is born, newborn screening tests are recommended to detect any abnormalities in your baby’s genes that might cause him or her to develop certain health conditions, such as inborn errors of metabolism. Genetic tests are important because they can diagnose the medical condition early, and therefore treatment can be started before any complications develop.

The way forward

It is the parents’ choice to choose any carrier screening, prenatal screening, or prenatal diagnostic tests. Genetic testing for pregnancy checks the unborn babies for medical conditions while they are still in the womb. Even before the pregnancy, genetic tests are helpful to understand what kind of genes the parents are passing to their child(children). Genetic testing plays a crucial role in planning a healthy pregnancy, and therefore many parents are opting for these genetic tests because they do not want to leave their chances to fate.

The writer is founder and CEO of Genes2Me.

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Health & Wellness

Phenomenon of healthy ageing and physiology of ageing

Neha Sinha

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Ageing is not a disease but a biological universal phenomenon and is attributed to various factors including disease, environment, genetics, lifestyle, and the natural process itself. Today most people can expect longevity in their 60s and beyond. People worldwide are living longer. WHO states that by 2050, the world’s population of people aged 60 years and older will double (2.1billion) and the number of persons aged 80 years or older is expected to triple between 2020 and 2050 (to reach 426 million). The impact of ageing is becoming more and more prominent with increased life expectancy, better healthcare, and changing social structures.

Everyone does not age at the same time and at the same rate. Senescence (biological ageing) is typically counted from 60 and beyond, and the number in millions is now exceeding billions. Chronological age (the number of years you have lived) and biological age (your body’s age) can be different. A 90-year-old can seem 20 years younger and a 30-year-old can look much older! Ageing is multidimensional and apart from physical changes, it also has an impact on our emotional, social, and professional identities. There are many theories on when we start to age including some who believe the process starts as soon as we are born. Around the age of 30, our metabolism begins to slow down, and bone mass stops increasing. After a certain age, our brain also loses the plasticity to grasp new things as easily. The physiology of ageing is a vast subject that covers the impact of ageing on a body from head to toe in a dynamic way. From nervous to musculoskeletal, arthritis, obesity, and cognitive decline, ageing affects everything.

Neurons in the brain get destroyed with time and this, in turn, affects cognition and other functions. The changes in the brain structure are considered a normal part of ageing. Studies also show that neurons are highly sensitive to oxygen supply that reaches the brain through various direct and indirect exposures, and disease like arteriosclerosis cuts off the oxygen supply.

Inevitably, ageing is associated with diseases. Genetic and environmental factors like smoking, and living in polluted, chemical-pack cities are also seen as red flags for the neurological changes to be expedited. Changes like lost connections between neurons or certain cells of the brain can cause loss of memory or identification. Much advanced form of this, may lead to dementia when the elderly start forgetting things and loses cognitive skills accompanied by several behavioural changes.

Our special senses like vision, hearing, taste, smell, and touch start fading away with neurological decline. With time we need a hearing aid, glasses, lose appetite, find it difficult to have a strong grip, and so on. There are several minor changes also, at times, elders are seen as more drawn to sweets than salt, sour or other flavours. This is due to their tongue reception disdaining salt and exaggerating bitterness. Excessive consumption of sweets and decreased mobility put elders at risk for obesity which, in turn, has an impact on cardiovascular health.

The list of the physiology of ageing doesn’t end here. It is elaborate and goes from organ to organ covering multiple systems like respiratory, musculoskeletal, digestive, and others. What’s crucial is to focus on active ageing given all the prospects of a natural process comprising final retirement. Awareness needs to be raised regarding active ageing and preparing for it need to start much earlier in life. The younger generation has a role to play in valuing, encouraging, and contributing to an elder-friendly society. Active ageing aims to preserve the active role of senior adults with continued opportunities for healthcare, social participation, and security. Countering many physiological and psychological changes in the elderly by promoting, preparing, and planning for future ageing can be seen as the derivative of improved quality of life, overall well-being, and independence enabling them to maintain autonomy.

Active ageing needs to be a global goal, and a sense of urgency needs to be created to implement this across nations so that the combined impact can be lessened and elders can be perceived more and more as assets than liabilities. Disease prevention, encouraging healthy lifestyles, reducing stress, improving social and vocational avenues, and reforming care systems would all contribute to this universal goal

The writer is a dementia specialist as well as CEO & co-founder of Epoch Elder Care.

Ageing is not a disease but a biological universal phenomenon and is attributed to various factors including disease, environment, genetics, lifestyle, and the natural process itself. Today most people can expect longevity in their 60s and beyond. People worldwide are living longer. WHO states that by 2050, the world’s population of people aged 60 years and older will double (2.1billion) and the number of persons aged 80 years or older is expected to triple between 2020 and 2050 (to reach 426 million). The impact of ageing is becoming more and more prominent with increased life expectancy, better healthcare, and changing social structures.

Everyone does not age at the same time and at the same rate. Senescence (biological ageing) is typically counted from 60 and beyond, and the number in millions is now exceeding billions. Chronological age (the number of years you have lived) and biological age (your body’s age) can be different. A 90-year-old can seem 20 years younger and a 30-year-old can look much older! Ageing is multidimensional and apart from physical changes, it also has an impact on our emotional, social, and professional identities. There are many theories on when we start to age including some who believe the process starts as soon as we are born. Around the age of 30, our metabolism begins to slow down, and bone mass stops increasing. After a certain age, our brain also loses the plasticity to grasp new things as easily. The physiology of ageing is a vast subject that covers the impact of ageing on a body from head to toe in a dynamic way. From nervous to musculoskeletal, arthritis, obesity, and cognitive decline, ageing affects everything.

Neurons in the brain get destroyed with time and this, in turn, affects cognition and other functions. The changes in the brain structure are considered a normal part of ageing. Studies also show that neurons are highly sensitive to oxygen supply that reaches the brain through various direct and indirect exposures, and disease like arteriosclerosis cuts off the oxygen supply.

Inevitably, ageing is associated with diseases. Genetic and environmental factors like smoking, and living in polluted, chemical-pack cities are also seen as red flags for the neurological changes to be expedited. Changes like lost connections between neurons or certain cells of the brain can cause loss of memory or identification. Much advanced form of this, may lead to dementia when the elderly start forgetting things and loses cognitive skills accompanied by several behavioural changes.

Our special senses like vision, hearing, taste, smell, and touch start fading away with neurological decline. With time we need a hearing aid, glasses, lose appetite, find it difficult to have a strong grip, and so on. There are several minor changes also, at times, elders are seen as more drawn to sweets than salt, sour or other flavours. This is due to their tongue reception disdaining salt and exaggerating bitterness. Excessive consumption of sweets and decreased mobility put elders at risk for obesity which, in turn, has an impact on cardiovascular health.

The list of the physiology of ageing doesn’t end here. It is elaborate and goes from organ to organ covering multiple systems like respiratory, musculoskeletal, digestive, and others. What’s crucial is to focus on active ageing given all the prospects of a natural process comprising final retirement. Awareness needs to be raised regarding active ageing and preparing for it need to start much earlier in life. The younger generation has a role to play in valuing, encouraging, and contributing to an elder-friendly society. Active ageing aims to preserve the active role of senior adults with continued opportunities for healthcare, social participation, and security. Countering many physiological and psychological changes in the elderly by promoting, preparing, and planning for future ageing can be seen as the derivative of improved quality of life, overall well-being, and independence enabling them to maintain autonomy.

Active ageing needs to be a global goal, and a sense of urgency needs to be created to implement this across nations so that the combined impact can be lessened and elders can be perceived more and more as assets than liabilities. Disease prevention, encouraging healthy lifestyles, reducing stress, improving social and vocational avenues, and reforming care systems would all contribute to this universal goal

The writer is a dementia specialist as well as CEO & co-founder of Epoch Elder Care.

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Health & Wellness

DECODING THE LINK BETWEEN HYPERTENSION, HEART DISEASE AND STROKE

Hypertension, heart disease, and stroke are three different conditions. But if you have hypertension, the risk of developing heart disease or stroke also increases. If the blockage occurs near the brain or heart, it can lead to either a stroke or heart attack, respectively.

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Hypertension or high blood pressure is described as the number one killer disease in the world. It occurs when the pressure of blood pushing against a person’s arteries is higher than normal. Hypertension can lead to several health concerns. It can cause multiple life-threatening problems slowly without the knowledge of a person and either kills or impairs the quality of life in later stages.

Hypertension, heart disease, and stroke are three different conditions. But if you have hypertension, the risk of developing heart disease or stroke also increases. If the blockage occurs near the brain or heart, it can lead to either a stroke or heart attack, respectively.

How to identify if you have high blood pressure?

Often termed as a silent disease, hypertension may or may not show any signs or symptoms. People usually don’t know that they have it. Hence, it is important for all adults above18 years or older to regularly monitor their blood pressure, especially if it has ever been high or above the “normal” range, or if you have a family history of hypertension.

A blood pressure reading of 120/80 mmHg or below is considered normal and a reading of more than or equal to 130/80 mmHg is considered hypertension.

Hypertension and heart diseases

Over time, hypertension can cause damage to the blood vessels and LDL (bad) cholesterol to accumulate in the wall of the arteries. It can cause the arteries to narrow which can limit the flow of blood and oxygen to the heart muscle. This can lead to ischemic heart disease and ultimately heart attack. This is a serious medical condition. If left untreated, people can die from ischemic heart disease.

Hypertension can put pressure on your heart and force the heart to work hard to pump blood. This can lead to the thickening of the heart muscle and make the heart less elastic. All these changes to the arteries and heart can reduce the blood flow and lead to problems such as coronary artery disease, heart attack and heart failure.

Hypertension and stroke

According to the Centers for Disease Control and Prevention (CDC), 7 in 10 people who experience a first heart attack and 8 in 10 people who experience a first stroke also have high blood pressure. Stroke is a medical emergency and it is the leading cause of disability and one of the leading causes of mortality worldwide. When the arteries leading to the brain burst or become blocked, it can cause a stroke. In this state, the brain no longer receives oxygen-rich blood, it can cause brain cells and the arteries to die. A stroke occurs due to the damaging effects of hypertension on the arteries. It can cause Ischemic and Hemorrhagic stroke.

Lowering hypertension for the prevention of heart diseases and stroke

Preventing hypertension can lower the risk of heart disease and stroke. One can keep the blood pressure in a healthy range by following a healthy lifestyle. One can follow the tips below to prevent hypertension.

♦ Eat healthily. Include plenty of fresh fruits and vegetables in your diet. Follow the DASH diet, a flexible and balanced eating plan that helps create a heart-healthy eating style for life.

♦ Maintain a healthy weight. Being overweight or obese can increase the risk of hypertension

♦ Be physically active. One can do moderate-intensity exercise, such as brisk walking or bicycling

♦ Avoid smoking and drinking alcohol. Smoking can increase the risk of hypertension and can cause heart attack and stroke. Also, consuming an excessive amount of alcohol can lead to hypertension.

♦ Take good rest and adequate amount of sleep. Not getting enough sleep on a regular basis is associated with an increased risk of hypertension, heart disease and stroke.

The writer is senior consultant – Interventional Cardiology, Aster CMI Hospital.

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RESEARCHERS USE AI TO ANALYSE LARGE AMOUNTS OF BIOLOGICAL DATA

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University of Missouri researchers have applied a form of artificial intelligence (AI), previously used to analyze how National Basketball Association (NBA) players move their bodies, to now help scientists develop new drug therapies for medical treatments targeting cancers and other diseases.

The findings of the study were published in the journal Nature Communications. The type of AI, called a graph neural network, can help scientists with speeding up the time it takes to sift through large amounts of data generated by studying protein dynamics. This approach can provide new ways to identify target sites on proteins for drugs to work effectively, said Dong Xu, a Curators’ Distinguished Professor in the Department of Electrical Engineering and Computer Science at the MU College of Engineering and one of the study’s authors.

“Previously, drug designers may have known about a couple places on a protein’s structure to target with their therapies,” said Xu, who is also the Paul K. and Dianne Shumaker Professor in bioinformatics. “A novel outcome of this method is that we identified a pathway between different areas of the protein structure, which could potentially allow scientists who are designing drugs to see additional possible target sites for delivering their targeted therapies. This can increase the chances that the therapy may be successful.”

Xu said they can also simulate how proteins can change in relation to different conditions, such as the development of cancer, and then use that information to infer their relationships with other bodily functions.

“With machine learning we can really study what are the important interactions within different areas of the protein structure,” Xu said. “Our method provides a systematic review of the data involved when studying proteins, as well as a protein’s energy state, which could help when identifying any possible mutation’s effect. This is important because protein mutations can enhance the possibility of cancers and other diseases developing in the body.”

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Health & Wellness

RESEARCHERS FIND NEW APPROACH FOR TREATMENT OF DEVASTATING BRAIN TUMOURS

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The findings from a seven-year research project suggests that there could be a new approach to treating one of the most common and devastating forms of brain cancer in adults, Glioblastoma Multiforme (GBM).

In a peer-reviewed study published by BMC Cancer, scientists from the University of Surrey show that a short chain of amino acids (the HTL-001 peptide) is effective at targeting and inhibiting the function of a family of genes responsible for the growth of GBM – Hox genes. The study was conducted in cell and animal models. The HTL-001 peptide used in the study has undergone safety testing and is suitable for patient trials. These trials are now being considered in GBM and other cancers.

Hardev Pandha, project lead and Professor of Medical Oncology at the University of Surrey, said:

“People who suffer from Glioblastoma Multiforme have a five per cent survival rate over a five-year period – a figure that has not improved in decades. While we are still early in the process, our seven-year project offers a glimmer of hope for finding a solution to Hox gene dysregulation, which is associated with the growth of GBM and other cancers, and which has proven to be elusive as a target for so many years.”

Ironically, Hox genes are responsible for the healthy growth of brain tissue but are ordinarily silenced at birth after vigorous activity in the growing embryo. However, if they are inappropriately ‘switched on’ again, their activity can lead to the progression of cancer. Hox gene dysregulation has long been recognised in GBM.

The project was carried out in collaboration with the universities of Surrey, Leeds and Texas, and HOX Therapeutics, a University of Surrey start-up company based on the University’s Surrey Research Park.

Professor Susan Short, co-author of the study from the University of Leeds, said, “We desperately need new treatment avenues for these aggressive brain tumours. Targeting developmental genes like the HOX genes that are abnormally switched on in the tumour cells could be a novel and effective way to stop glioblastomas growing and becoming life-threatening.”

James Culverwell, CEO of HOX Therapeutics, said, “HOX Therapeutics is excited to be associated with this project and we hope that with our continuing support, this research will eventually lead to novel and effective treatments for both brain and other cancers where HOX gene over-expression is a clear therapeutic target.”

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Health & Wellness

IT’S TIME TO SECURE THE RIGHTS OF MENTAL HEALTH PATIENTS

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A recent news report revealed the dire conditions of a Government Mental Health Centre in Peroorkada, a suburb of Thiruvananthapuram, the capital of Kerala. The living conditions of institutionalized patients were worse than in a prison cell. The authorities kept patients confined in tiny, overcrowded cells with poor ventilation and extreme heat, aggravating their existing conditions with dehydration, decreased sleep, and poor drug compliance, among other issues. The description of the mental health centre, with cells covered with grills and iron bars securing windows and doors, is reminiscent of the conditions of the faith-based mental asylum in Ramanathapuram, Tamil Nadu, where a fire in 2001 led to the death of 28 inmates. Overcrowding and confinement are not only disasters waiting to happen but also act as significant impediments to the recovery of persons with mental illnesses. A study on public attitudes to mental health hospitals in 2016-17 in Odisha concluded that the credibility of such institutes has a vital bearing on the negative attitudes that they invoke amongst the populations they serve.

India’s journey towards attaining accessible and safe mental healthcare has been slow and rife with challenges. Following the global trend to shift away from institutional care to community-based treatment, India has enacted laws to ensure better treatment for persons with mental illnesses. However, the battle is ongoing and appears to be a long fight ahead.

According to a recent survey by NIMHANS in 2015-2016, 14% of India’s population lives with some form of mental illness, out of which 1.9% suffer from severe mental illness. The survey also noted a stark treatment gap of 72–92%. Mental health reports released by the National Human Rights Commission in 1999 and 2012 mentioned other infrastructural gaps. The survey also cited severe staff shortages, violations of patients’ rights, involuntary admissions and limited treatments. ActionAid Association’s study on mental illness in Kashmir in 2016 also uncovered severe treatment gaps in a valley widespread with mental illness and extremely high suicidality. Out of the 4000 persons interviewed, only 12.6% could access treatment.

More recently, during the Covid-19 pandemic, mental health needs and gaps were exacerbated. For example, a study of severely mentally ill patients during lockdown found that 80% of patients missed their appointments and failed to contact their mental health professionals, 30% showed features of relapse of symptoms during the lockdown, and 22% stopped their psychiatric medication.

These alarming numbers point to the need for advocacy and evidence-based policy recommendations. ActionAid Association was a member of the National Human Rights Commission Core Group on Health and Mental Health until 2017 and has conducted several research projects and initiatives in mental hospitals in Kashmir, Gwalior, Bhopal, Agra and Ranchi. Learning from these initiatives, ActionAid Association has recommended policy and structural changes to promote mental health.

The Mental Healthcare Act (MHCA) 2017 differs from preceding acts. It treats persons with mental illness equally, protects them from cruel and degrading treatment and makes provisions for community-based treatment. In addition, the law guarantees confidentiality, access to medical records, and legal aid. It also creates barriers against arbitrary institutional care, a practice used by family members against women to resolve disputes.

The Act mandates the creation of regulatory bodies such as State Mental Health Authorities and District Mental Health Review Boards tasked with registering, reviewing, altering, modifying or cancelling advance directives made by individuals.

However, MHCA 2017 does not institute any third-party assessment or monitoring of the human rights situations in mental healthcare facilities. The appointment of an independent human rights monitor would be a transparent mechanism for safeguarding human rights. The Act also misses significant measures for reintegration and rehabilitation of patients with their families. According to a study, one in every four women in mental health centres is abandoned by their families. There is a strong need for a feminist approach to destigmatize mental illness and rehabilitate and reintegrate patients back into mainstream society.

Implementation of the Act has been sluggish. As of 2021, Maharashtra only has eight District Mental Health Review Boards to cater to 36 districts, and Uttar Pradesh has one in Kanpur. In Delhi, the State Mental Health Authority acts as an interim Mental Health Review Board, which leads to the erosion of accountability and the dissolution of responsibilities.

As the MHCA 2017 is on the concurrent list, States are meant to frame rules for the implementation of the Act and set standards concerning mental healthcare facilities. These standards ensure no overcrowding, cruelty or poor sanitation of patients and facilities. However, until October 2021, only eight states and UTs had sent draft rules to the Ministry of Health and Family Welfare for approval.

There also exist lacunae in the budgetary allocations. The preceding four Union Budgets had allocated less than one per cent of the total budget to mental health. In the Union Budget for 2022-2023, an increased allocation amounting to 2.18% of the total budget has been made. However, the lion’s share (94%) of the allocation is towards two centrally run mental health institutes; NIMHANS Bengaluru and Lokpriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur. There is a measly 6% of the allocation (Rupees 40 Crores) left for the National Mental Health Program, which ensures the availability and accessibility of minimum mental healthcare to all.

For a more comprehensive approach to promoting mental health, we require measures to make family systems more conducive to rehabilitation. Localized mental health centres can facilitate psychoeducation and case management for at-risk families. We need to activate community leaders to destigmatize mental illness and provide financial incentives to community-based structures to enable the rehabilitation of persons with mental illnesses. The use of halfway homes must be increased to reintegrate persons who have recently recovered from mental illnesses.

The swift and effective implementation of the law, independent monitoring of human rights violations, more robust community-based interventions and increased financial allocations are imperative in ensuring that Peroorkada is not the image that comes to mind when one thinks of mental health hospitals. Such an approach will go a long way in preventing another Erwadi-like tragedy and in ensuring the rights and dignity of persons with mental illnesses.

Iyce Malhotra works with the Policy and Research Unit of ActionAid Association. The views expressed here are personal and do not necessarily reflect those of her organisation.

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