Mental Healthcare: Time to change

By Dr. Mudasir Firdosi

Published on August 9, 2017

With the President’s assent, The Mental Health Care Bill 2016 became law as the Mental Health Care Act 2017. Under the new law, every person shall have the right to access mental healthcare and treatment from services run or funded by the government.

As such, a patient with mental illness will be able to access services and facilities such as the provision of essential psychotropic medications, free of cost; insurance coverage for mental illness; funding for private consultation if a district mental health service is not available.

The law further ensures that treatment and rehabilitation will be available in the least restrictive environment and will respect the rights and dignity of patients, including those from disadvantaged socioeconomic backgrounds. The outcome of these recommendations is that the financial burden, as well as the psychosocial burden, placed upon carers, will be reduced to a large extent.

The bill requires the establishment of central and state mental health authorities. Also, every mental health establishment will have to be registered with the relevant central or state mental health authority. The act provides right to confidentiality to patients suffering from mental disorder. Patients have a right for an advance directive and say in their treatment when they lose the capacity to decide for themselves.

Significantly the new law decriminalised attempted suicide as a criminal act and assumes the act as a result of severe stress and mental disorder. However, this is more as a stop-gap arrangement, by creating a presumption of mental illness in every case of attempted suicide unless proved otherwise. Suicide should be completely decriminalised, without any conditions attached, which would help reduce stigma, create openness and make it easier to seek help.

Overall, the Mental Health Care Act 2017 is a significant improvement over the Mental health Act 1987, bringing about protection and empowerment of persons with mental illness. Effective implementation will require a substantial change in the system currently in place and will need an extensive input of staff and finance.

The average number of psychiatrists in India is only 0.2 per 100 000 population, compared with a global average of 1.2 per 100 000 population. Similarly, the figures for psychologists, social workers and nurses working in mental healthcare are 0.03, 0.03 and 0.05 per 100 000 population in India, compared with global averages of 0.60, 0.40 and 2.00 per 100 000, respectively (World Health Organization, 2005).

With a meagre overall health budget, India spends only 0.06 percent of its health budget on mental healthcare, which is almost nothing compared to even poor nations in the world.

This law will only become a success when its financial implications are taken seriously and provided for, or else it may become another tool for corruption and nepotism for many involved in its implementation.  As per a WHO report, most developed nations spend more than four percent of their budgets on mental health research, infrastructure, frameworks and talent pool.

There are certain ambiguities in the new law which question its applicability and meaningfulness for the Indian population. As admission procedures, treatment options and decision-making would become legalised and bureaucratised, certain experts are apprehensive that the bill will likely increase the stigma and hesitation to seek treatment from mental health professionals mostly due to cultural, educational and social factors, particularly in rural India.

But at the same time, the revised legislation could mark a start of a new era for anti-stigma campaigns. It could lead to greater allocation of resources to mental health and the training and retention of mental health professionals, including psychiatrists, psychiatric nurses and other allied professions.

Hence, if appropriately implemented and financed, in addition to improved access to mental health services, the human rights of people who are mentally unwell could be safeguarded to a greater extent by the new act when it comes into power.

Dr Mudasir Firdosi is a Consultant Psychiatrist currently working at South West London & St George’s Mental Health NHS Trust, London.