Mental health issues are often-neglected healthcare in India. There is no true awareness on the importance of mental health issues in India. Mental health includes our emotional, psychological, and social well-being. It incorporates a wide range of issues, from clinically diagnosed mental disorders to substance abuse and addiction.
There are various reasons which can lead to mental health issues in people. In India, alcohol abuse, economic hardships, unemployment, domestic violence, and debt are few of the reasons for mental health issues. This can lead to a massive mental health crisis. Though, this will affect most of the population it will inexplicably affect the poor, the marginalised and the most vulnerable groups.
Children, mainly teenagers, are victims of mental health issues. The prime reason being Destigmatization. The society has created a stigma mainly through lack of awareness about mental health and its affects on the human body. In many cities, children with mental health issues are not acknowledged by the family and the society. Mental health issues in general is not acknowledged in India, because of it is often connected to being insane or of an unsound mind.
Globally, around 8,00,000 persons die by suicide each year (1 death every 40 seconds), while over 264 million people of all ages suffer from depression. According to the WHO, at least 57 million people in India are depressed – the highest in the world.
Mental health issues have also been observed to be more prevalent in urban areas with specific disorders such as schizophrenia and other psychosis, mood disorders, and neurotic or stress-related disorders almost three times more prevalent in urban metros. Almost 50 percent of people with major depressive disorders reported difficulties in carrying out their daily activities. It has already been estimated that the mental health crisis will cost India a trillion dollars in loss of productivity by 2030.
Despite these astounding numbers, there are clear gaps in the preventive and curative care of these mental disorders. For example, the mental health workforce in the country is less than 4,000 psychiatrists. The lack of funding is another deterrent. While the total health budget increased by 7% in 2020, there was no corresponding increase in the budget for the National Mental Health Program; the allocated amount is only 0.05% of the total health budget. The actual expenditure for implementing the provisions of the Mental Healthcare Act, 2017, is a very small fraction of the conservative estimate of '94,073 crores.
The Mental Health Care Act, 2017, was seen as a historic intervention in the field of medical care. It was referred to as a 'pro-right' document for the PMI.
The Act gives persons with mental illness the right to make an advance directive on how they should and should not be treated in the event of their mental illness. In addition, it also has the right, in the Advance Directive, to appoint a nominee who has the duty to act on his behalf in taking treatment decisions and for all other purposes as set out in the Act, which must be in the best interests of the PMI.
The services provided should be affordable and of good quality, so that financial status is not an obstacle to people suffering from mental illness. In addition, it is the right of the PMI not to compromise the quality of the services.
The services must be in sufficient quantity and the geographical inaccessibility of the PMI should no longer be a hindrance. As a result, the Act ensures that the PMI does not have to travel far to access treatment.
To this end, the Act also imposes a duty on the government to ensure that health care facilities are available in each district administered or financed by the government. In addition, if the government fails to provide such facilities in the district, of a PMI, then it is the duty of the government to ensure that the facility at any other health centre is accessible to him, the cost of which is to be borne by the appropriate government.
Prejudice on any grounds such as gender, sex, sexual orientation, class, religion, caste, etc. shall be prohibited in the provision of mental health services.
Persons living below the poverty line or persons who are homeless or destitute have the right to use mental health services and facilities free of charge and without any financial cost whatsoever in government-run or government-funded facilities. In addition, other health centres may also be designated by the appropriate government where this provision is made available. In addition, all persons with mental illnesses have the right to make use of all medicinal products listed in the Essential Drug List, as notified by the appropriate government, at free of cost. Such availability has to be made by the government at all the state-run and state-funded health establishments.
Under the Act, the government is obliged to provide such healthcare facilities so that a person suffering from mental illness can live in a community with his or her family. Such persons cannot be isolated from society, and if it is impossible for them to live with the family or for the family to be abandoned, it is the duty of the government to help. Moreover, the mother of a child who is under three years of age has the right not to be separated from her child because she is mentally ill. This right may be reasonably restricted if there is a risk of harm to the child and the child may be temporarily separated from the mother.
The roots of the right to a dignified life are laid down in Article 21 of the Constitution. This has been incorporated in the Mental Health Care Act, which provides that every person suffering from mental illness has the right to live with dignity. In addition, such persons also have the right to be protected against cruel, inhuman, and degrading treatment in any health establishment. They also have various other rights, such as the right to a safe and hygienic environment and other conditions, such as the right to privacy. The Act totally prohibits electroconvulsive therapy for children. The therapy has also been performed for adults by taking certain precautions, such as using muscle relaxants and anaesthesia.
Persons with mental illnesses have the right to be treated equally with physically ill patients at the time of treatment, i.e., with regard to emergency services, ambulance services, etc. Furthermore, there is no discrimination on any basis that includes sex, sex, sexual orientation, religion, culture, caste, social or political beliefs, class, or disability.
The Act assumes that every person, including persons with mental illness, has the capacity to make decisions. The Act provides, therefore, that any decision taken should be informed. Consequently, such a person has the right to know the provisions of the Act under which he has been admitted, together with the criteria for the same. The person has also the right to know all the facets of the treatment for which he has been admitted, which includes the information of the side-effects of such treatment. Such information has to be made in an understandable language to the person who has been admitted and his nominated representative.
It is the right of every person with a mental illness to have confidentiality in the details of his or her mental illness and treatment. Such confidentiality is also extended to information stored in a digital or electronic format. It was therefore the duty of health professionals not to disclose any such information subject to certain exceptions, such as the prevention of harm, in the interests of public safety and security, etc. In addition, such information may also be made available to the nominated representative and other health professionals for treatment purposes.
Article 39A of the Constitution provides for a Directive on free legal aid This has been incorporated under the Act for persons with mental illness who may seek legal assistance in the exercise of the rights provided for in the Act. It also has the right to be informed of this right by the competent authority. In addition, the person also has the right to complain about a deficiency in mental health services or facilities provided to him or her.
In addition to these rights, there are other rights, such as the right to access medical records and the right to personal contact and communication. The latter includes the right to refuse and communicate to any visitor.
The Act also sets out the duties of the appropriate government, together with the establishment of the Central Mental Health Authority, for the effective implementation of these rights. In addition, the Act also provides for the State Mental Health Authority, among other authorities, to achieve the implementation of the ground level.
During the last few decades, innovations have helped to address gap that exists in the delivery of mental health services in India. The innovative approach not only makes mental health services more accessible and affordable, but also facilitates community members' early detection and prevention of mental illness and appropriate treatment referrals.
The Constitution of India guarantees a person's right to life and personal liberty, which include their right to freedom of movement and freedom of expression. That being said, contrary to what is stated in the Constitution, there are many threats to people with mental disorders that violate their basic rights. This is not always due to abuse or wrongdoing. Many times, the treatment of PMI involves the restriction of their liberty and also the attachment of responsibility for their long-term care to someone else, the removal of their freedom of movement or expression.
Laws must also determine the competence or danger of people suffering from mental health issues and mental disorders, in particular when it comes to the determination of personal responsibility for actions.
But people with mental health issues face many unrelated threats to their treatment. These threats arise from a variety quarters, which include family members, caregivers, friends, institutions and other communities and people in society, who may in some way abuse or take advantage of these individuals. There is therefore a need for protective mechanisms to ensure that the individuals concerned receive proper attention and care, and defined policies and provisions are put in place to protect the rights of this vulnerable group. Like most countries in the world, India has laws that regulate the treatment of psychiatric patients or mentally ill patients. A few particular instance sub-sections of different types of Acts deal with mental illness, but like the matter of divorce in the Hindu Marriage Act, they are more for the benefit others than those with people with mental health issues.
The most significant challenge in the years ahead is the need for a concerted drive to improve human resources in the field of mental health. It must be emphasised that the ultimate aim of any act or law or other legal provision should be the welfare of the PMI and the society at large.
Some changes or methods the government for the well-being and peaceful living of people with mental issues include, a national mental health literacy plan should be envisaged. Mental health should also be integrated with the National Urban Health Mission and other programmes to address the high prevalence of mental health problems in urban areas. An incentive-based approach should be used to promote interest in psychiatry and psychology and to address the lack of healthcare professionals in the field. While Ayushman Bharat makes it possible for mentally ill health insurance, financial protection in the form of allowances should be initiated. Corporate Social Responsibility (CSR) in the field of mental health should be encouraged. Solitary confinement of a mentally ill patients. The Act provides for the establishment of central and state mental health authorities for the training of medical professionals. Insurance companies are also mandated to provide mental health insurance. Ayushman Bharat, a medical insurance scheme for economically disadvantaged people, was also launched by the Government in 2018.
-KIRAN SONA PUTHAN (3rd YEAR, BBA. LLB),
LOVELY PROFESSIONAL UNIVERSITY, PUNJAB.