Sample Material of Current Public Administration Magazine
Mental Health Bill
The Rajya Sabha recently passed the Mental Healthcare Bill. It is a major
advance over the Mental Health Act, 1987. However, the need for legislation
which recognises the rights of individuals and the responsibilities of a
civilised society demands a nuanced understanding of mental health issues.
The term “mental health” encompasses a wide variety of conditions, issues and
contexts. While illness represents individual suffering, disease implies
structural and functional abnormalities. The inter-changeable use of these
concepts is supported by academia and health, insurance and pharmaceutical
industries. Clinical presentations of individual suffering are usually viewed
through the biomedical lens and that leads to such suffering being seen as
disease. Pharmacological therapies are then recommended for such diseases.
However, social determinants of mental health (poverty, gender, literacy,
employment and social exclusion) are ignored. The heterogeneity of experiences
and the disparity of contexts make the task of employing a single framework
difficult. The stigma associated with mental illness further complicates the
Activism by people with psychosocial disability has challenged biomedical and
psychiatric discourses. They have argued against the use of compulsory treatment
for psychosocial conditions including mental illness, suggesting that such
approaches are influenced by prejudice, and are a breach of the human right to
equality. Such movements resulted in the United Nations Convention on the Rights
of People with Disability (UNCRPD). It argued that people with disability,
including mental illness, have rights to seek legal opinion, liberty, and to
informed consent. While UNCRPD’s broad structure does not explicitly ban the use
of force in the treatment of the mentally ill, its logic clearly suggests
prohibition of compulsion.
Activists who support non-discrimination between physically ill and mentally
ill people contend that legislation, which specifically targets people with
mental illness, adds to the disadvantage of an already marginalised group. They
suggest that such laws are an easy way out for mental health professionals and
they reduce channels of communication, negotiation and persuasion. Medicine
focuses on the “right to health and treatment”. Legal perspectives, in contrast,
favour the individual’s autonomy, choice and right to refuse treatment. Medicine
in India prefers a paternalistic culture while legal frameworks support
contractual relationships between patients and physicians. These contrasting
perspectives have resulted in uneasy compromises the world over. While
psychiatry acknowledges that individual autonomy is fundamental, it also
supports the takeover of decision-making in certain situations. Most countries
have mental health laws, which permit coercion, compulsory hospitalisation and
psychiatric interventions without patient consent.
The Mental Healthcare Bill attempts to protect human rights of the mentally
ill. It mandates registration, licensing, inspection and audit of mental
healthcare institutions. It permits involuntary hospitalisation only in
exceptional circumstances — for example, when there is a risk of harm to the
patient and others. It mandates a range of services including community
rehabilitation. It decriminalises attempts to suicide and bans the use of
electro-convulsive therapy without anesthesia and prohibits its use in minors.
It puts the onus of responsibility on the state for training mental health
professionals and providing access to public healthcare. It requires insurance
companies to provide health cover for people with mental illness. It tries to
provide checks and balances to ensure the dignity of the mentally ill.
However, it has not pleased all the stakeholders. Psychiatrists resent
interference in clinical decision-making while activists argue that the bill
does not comply with the UNCRPD. The bill should be seen as a work in progress.
The way it is implemented will determine its success in reducing the burden of
mental illness and in supporting the human rights of people with mental illness.
Periodic reviews can help plug gaps between practice and theory, and law and
(Source- The Indian Express)
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