Mental illness as defined by Mental Healthcare Act 2017 as “substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behavior, capacity to recognize reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterized by subnormality of intelligence.”
Mental illness affects about 7.5% Indian population as per WHO report. Mental illness constitutes 1/6th of all health related disorders. But, unfortunately the Indian society has a stereotypical view on this grave issue and there exists a socio-cultural barrier. A common stigma exists between against mentally ill people that results in them being subjected discrimination and mental illness is considered as shameful. The common use of the word “mad” for mentally ill people shows the callous and harsh attitude of society towards them. There also exists a common myth that mentally ill people cannot be a part of mainstream society as they are unsociable, aggressive and can inflict harm to others. These views are the major reasons due to which people with mental illness become isolated and do not prefer to come out with their issues. Subsequently, this results in delayed treatment and in majority cases this goes untreated. The lack of support and help from society and even family pushes mentally ill people towards the path of suicide.
There have been alarming reports regarding mental illness, its treatment and suicides related to mental illness. According to National Mental Health Survey 2016, “over 85% of people with common mental disorder and 73.6% of people with severe mental health problem do not receive mental health care or treatment.” The 2015 National Crime Records Bureau report shows the massive number of suicide cases reported due to mental illness. As per NCRB in 2015, “ a total of 8409 suicides due to mental illness were reported out of which 522 were below 18 years, 2470 were in 18-30 years age group, 2659 were in 30-45 years age group, 1805 were in 45-60 years age group and 953 were in 60 years and above age group.” Mental illness was the 2nd highest cause of suicides in the category of suicides due to illness. These reports indicate that mental illness does not only affect teenagers but is affecting people from all age groups. These statistics portray that serious drawbacks exist in India’s mental healthcare sector.
India has an abysmal number of psychiatrists and counselors. Out of 9 lakh doctors in the country only around 9000 psychiatrists are present. As per WHO estimates India has only 0.3 psychiatrists, 0.07 psychologists and 0.12 nurses available per 1 lakh people. Apart from this, India also lacks intrained general practitioners who play a vital role in early diagnosis and detection of mental illness. Rural areas lack even basic primary care due to this lack of practitioners. The condition is not so good in even urban areas as in proper district hospitals also there are no regular and efficient services available for mentally ill people. Even the infrastructural support is missing in India. Further, adding to the woes is the infinitesimal budget allocation of about 1% for mental healthcare. In this allocation government does not account for some of the direct medical expenses but the indirect costs like regular hospital visits, consultation, travel, loss of income from work, cost for care of patient at home tc go unnoticed. As mental illness requires prolonged medical attention with proper care and support it increases the cost of treatment which proves to be a hindrance. Apart from these most important issue faced by India’s mental healthcare is lack of awareness among people due to existing societal taboo.
The government in 2017 passed the Mental Healthcare Act that came into force in 2018 superseding the previous Mental Health Act 1987. Some significant steps have been taken in the act with respect to mental healthcare which are discussed below:
- The act recognizes access to proper mental healthcare as a right of every citizen.
- The act provides for free treatment for homeless people or people below poverty line.
- The act prohibits discrimination against mentally ill people on any grounds like caste, sex, age etc.
- The act ensures right to confidentiality about mental health condition of a patient.
- The act gives a right to advanced directive to all people. According to this a person can make directive in advance stating the way in which he/she wants to be treated and can nominate a representative who shall take decision on his/her behalf if such situation arises.
- Government will setup a Mental Health Authority at central and state level to look after mental healthcare. Mental health institutes and practitioners including psychiatrists and psychiatric social workers will have to be registered with this authority.
- Attempt to suicide is decriminalized with the consideration that person attempting suicide is mentally ill.
- The act bans any form of chained treatment of mentally ill people and they should not be subjected to solitary confinement. It has also banned use of electroconvulsive therapy other than in emergencies.
- The act mandates mental health treatment coverage under insurance policy.
Thought he act aims to bring about a new era in mental health care field yet there exists some loopholes in the act which are discussed below:
- The act empowers mentally ill people but not to seek treatment and thereby makes treatment of such patients difficult.
- The act decriminalizes attempt to suicide but it neglects the fact that all suicides are not result of mental illness. Decriminalizing suicide gives a blanket cover to suicides due to work stress, suicides due to familial issues etc.
- The government has adopted a decentralized mode of mental healthcare system but it ignores the lack of modern infrastructure needed in order to improve mental healthcare.
- The act does not provide for necessary steps required to eliminate the major issue of societal taboo that exists against mental illness.
- The act does not recognize psychotherapists, counselors and psychoanalysts as mental health professionals even though they play a crucial role in preliminary diagnosis of mental illness.
- The act does not specify the time period of insurance cover and also is silent about the point that whether the policy is applicable to people currently undergoing treatment or not. The act does not mention if insurance policy is applicable to other diseases as a result of which a person becomes mentally ill.
The mental healthcare act is a welcome step by the government in order to ensure proper healthcare for mentally ill people primarily as it is the 1st law that mandates a right to mental healthcare for all people. But there are some blind spots which needs to be modified for the act to be a true gamechanger. Furthermore, the most crucial aspect of this act will be its proper implementation which will ultimately decide the benefits that people will enjoy from this act.