Volume 7 Issue 6 June, 2017
Mental health law in the Indian has been evolving over the past few decades, in keeping with improved delivery of care, societal changes, and the demand for enhanced accountability from a population that is increasingly aware of its rights. There have been rapid socio- economic, cultural, and psychosocial changes in the traditional, rurally oriented, and family centered society. Despite the fact that family and friends are often intimately involved in patient care many people with mental illness are abandoned by their families and their outcome is both unknown and a matter of grave concern.
Why a Mental Health Legislation?
People with mental disorders are amongst the most vulnerable in society. Often persons with mental disorder would be treated against their will or will lack insight. Legislation is for social cohesion which allows group to work together for identifiable common aims. It is required to maintain order in society and it exist to protect individuals, affording them the opportunity for personal growth and development. The rule of law is used to balance competing interests between individuals or between individuals and society.
Historical Development
- Lunatic Removal Act 1851, which ceased in 1891. This law was mainly enacted to regulate the transfer of British patients back to England.
- The Lunacy Act 1858
- The Indian Lunatic Asylum Act 1858 (with amendments passed in 1886 and 1889)
- The Military Lunatic Act 1877
- Indian Lunacy Act (ILA), 1912
- Mental Health Act (MHA), 1987
Background of MHCA 2017 & United Nations Convention on Rights of Persons with Disability (UNCRPD)
UNCRPD is an effective Convention which specifically focuses on protecting and promoting the rights of persons with disabilities. It was adopted in December 2006 and it was ratified by the Government of India in September 2007 and was approved by the Indian Parliament in May 2008. The new MHCA, 2017 is primarily based on UNCRPD.
Some of the Criticisms/Concerns/Challenges by Psychiatrists about MHCA 2017
- Mental Illness Vs. Mental Retardation: the services/provisions to be provided is still overlapping and lacks clarity
- Treatment Vs. Health : it is good that a positive note focusing on health is expressed in the Care act, but, has it compromised on comprehensive treatment
- Capacity : Valuing the capacity of the patient substituted care is replaced by supportive care, when, how, and to what extent is a clinical issue rather than a judiciary judgment (Are we barking the wrong tree)
- Advanced Directives – Nominated Representative : How effective in a family based culture like India
- Healthcare establishment and duties: will be under constant scrutiny which the psychiatrist feel a hindrance to a fear free clinical services.
- Too much of Judiciary – Family? Marginalises Psychiatrist?
- After voluntary discharge what next? Level of symptom relief, recovery and acceptance by society, chances of relapse, rehabilitation? Reoffending? Prison?
Highlights of MHCA 2017
- Primarily it is patients right based ensuring autonomy
- Right to access to mental healthcare, and a range of services for persons with mental illness including shelter homes, supported accommodation, community based rehabilitation
- Right to community living, the right to live with dignity, protection against cruel, degrading and inhuman treatment
- Right to equality and non-discrimination
- Right to information, confidentiality and access to medical records
- Right to personal communication, legal aid and the right to make complaints about deficiencies in provision of services in addition to other similar legal remedies
- Right to make an advance directive, empowering him/her to decide how he/she should and should not be cared and treated for a mental illness in the future
- Nominated Representative
- Informed consent
- Decriminalizing suicide
- Duties of Government : The burden of planning, designing, implementing programs for promotion of mental health and prevention of mental illness, creating awareness about mental illnesses, reducing stigma, sensitizing govt. officials including police officers, implementing public health programs to reduce suicides and other such programs
Conclusion
The current MHCA 2017 has first time that any law has guaranteed rights to equality, non-discrimination and the positive rights for provision of basic services to persons with mental illness. It is Right based complying with UNCRPD. The act is to bring about protection and empowerment of persons with mental illness. Legislations for Person with Mental Disorder are meant for them and not for the Mental Health Professionals or the human right activist groups. It is based on slogan by the service user “Nothing about Us without Us”. The success when compared to that of MHA 1987 will be known only with times to come…
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