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Lack of will, resources dog Mental Health Bill - Deccan Herald
Lack of will, resources dog Mental Health Bill
Yogesh Vajpayi, April 13, 2017, Deccan Herald News Service
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In his monumental work Madness and Civilization, French Philosopher Michel Foucault refers to the "stammered dialogue between madness and reason" and proposes that in the 19th century this was interrupted by a "great confinement" - the impulse to segregate lunatics from society. In the Indian context, the Mental Healthcare Bill cleared by Parliament recently is the first revolutionary step to liberate.

Despite minor tinkering, the thrust of the earlier Indian laws was on preventing the society from the dangerousness of mentally ill people. The Lunacy Act of 1921 was primarily focused on regulation of lunatic asylums under the supervision of a central authority. The Medical Health Bill of 1987 that replaced it renamed these asylums as hospitals but failed to address the issues human rights and mental healthcare delivery adequately.

Apart from decriminalising suicide, the new law adopts a rights-based approach towards care of the mentally sick, signifying a paradigm shift in our approach to a health issue that is growing in its severity and socio-economic cost.

Its immediate effect would be to spare those who attempt to commit suicide but fail. Earlier, they were arrested under section 309 of the Indian Penal Code and forced to face a traumatic criminal trial, only adding to their agony. The decision is based on the 210th report of the Law Commission of India and affirmative responses by 18 states and four union territories. The Commission had said that attempting suicide is the "manifestation of a diseased condition of mind" that needs treatment and care rather than punishment.

The Bill, however, goes much beyond decriminalising suicide. It imposes on the government a duty to rehabilitate such a person to ensure that there is no recurrence of attempt to suicide. Most significantly, it promises to ensure healthcare, treatment and rehabilitation of persons with mental illness "in a manner that does not intrude on their rights and dignity." It guarantees easy access to affordable and quality mental healthcare and treatment from the government as a matter of right. It also focuses on community-based treatment and provides for special treatment for women.

The intent is unquestionably laudable. However, as is the case with any other social legislation, the problem with this Healthcare Bill is not the intent of the government but its capacity and the will to implement it. An estimated 6-7% of the country's population suffers from some kind of mental illness and 1-2% has an acute condition.

Yet, India has a woeful lack of qualified mental health professionals to address the high incidence of such illnesses. There are just 3,500 psychiatrists in the country. This works out to three per one million people, compared to 100 in Australia or 150 in developed countries. In public services, 80% of districts don't have even one psychiatrist.

If the objectives of the new Bill are to be fulfilled, it will require massive investments in expanding mental healthcare infrastructure and training mental health professionals to deal with mentally sick persons in a scientific and humane manner.

Not a priority
It is problematic if neither the Centre nor states - which will have to bear the bulk of the burden - has sufficient resources to undertake this gigantic task. As it is, the national spending on health is around 1.4% of the GDP and despite the target of doubling it in the new health policy, we have not been able to meet the target fixed by the 2002 policy for 2010.

The expenditure on mental healthcare is hardly 1% of our total spending on health, a clear indication that mental health has been accorded a very low health priority. This raises questions of asserting the rights given in the new law, especially when mentally ill people don't form an organised group and are voiceless in articulating their needs.

Given the fact that mental illness attracts stigma and is prone to discrimination, changing the mindset of the mental health caretakers as well as the society will be a greater challenge. In many mental health institutions, patients are manhandled and abused simply because their behaviour is considered deviant.

According to a study by the National Commission of Human Rights, most mental hospitals in India are merely 'dumping grounds' for families to abandon their mentally ill member, for either economic reasons or a lack of understanding and awareness of mental illness. Their role is predominantly custodial.

Medical treatment is used to keep patients manageable and very little effort is made to preserve or enhance their daily living skills. "These hospitals are violating the rights of the mentally ill persons to appropriate treatment and rehabilitation and a right to community and family life," the study says.

Unfortunately, the targeted beneficiaries of the new legislation are themselves a hapless class of people whose fate is decided by others who treat them as pariahs. In a country where mental illness is still being treated by indigenous treatments, including witchcraft and other rituals, the mentally sick do not only represent a purely health challenge. They are also vulnerable to exploitation by their relatives and care givers as well as the society because of caste, creed and gender considerations.

This does not mean that the new law is useless. It only means that social change in a society means a long road. A progressive law is only the beginning of this journey.

(The writer is a senior journalist based in New Delhi)