Very often, we all come across news about persons with psychosocial disability, mental illness and their vulnerable condition in family. Many of them confined to small rooms and chained for years by family members without treatment because there is lack of adequate public mental healthcare facility.
Studies have found that about 80 per cent of the patients of mentally challenged belonging to poor families who cannot afford quality treatment. The worst part is there are persons roaming in public mostly found in railway stations, bus stands and market areas or in the city outskirt slums in a very wretched condition. There is absence of reliable figure about the number of persons with mental illness but privately it is estimated that about one per cent of population suffer from mental disorders such as schizophrenia and bipolar disorder. It is being told that increasing stress and depression due to number of socio-eco, socio-psychological reasons, poverty, illiteracy and social discrimination will further enhance the number of people with mental illness in coming days if quality treatment and other related facilities will not improve.
There have been inadequate mental hospitals and healthcare related infrastructure to cater to the need of the growing of mentally ill persons in our country. With increase in liberalisation of health sector, India’s expenditure on health has been below 5 per cent of its GDP for last five years. The WHO estimates that the advanced countries such as USA, Canada, Netherland, Sweden, Denmark, Germany, Japan and France have been spending more than 10 per cent of their GDP on health. However, in poorer countries like India the expenses are too less.
The Government of India has declared the mental health policy in 2014 but the policy has not been translated into action to change the poor condition. The backward States such as Odisha has no institutions like National Institute of Mental Health and Neuroscience and after the introduction of National Mental Healthcare Programme in 1982, the district mental health care programme has been setup in each district. The Government has done very little in promoting training and capacity building of health professionals to provide adequate quality service to the persons with mental illness. There is a list of scheduled drugs which should be made available in all public health establishments and also psychiatrics but this has not been done adequately in the State. The Odisha Government has to integrate mental health service into general health delivery system from CHC to district level for larger access of all. The inadequate financial support and technical clearance has been a hurdle in bringing improvement in the health sector of the State. Many families in the State are suffering in the absence of non-availability of mental healthcare facility at district level. There have been reports of cruel and inhuman treatment even by family members because of poor financial status and the social taboos related to mental illness. Doctors opine that more than 90 per cent mental illness cases are curable and recovery is possible but old mind set, cultural practices and belief system and unwanted social systems still exist in rural villages which need to be changed with dignified human values and modern human rights laws that respect human dignity and support a decent dignified living of all individuals.
In the context of mental healthcare service in the country, the Mental Healthcare Bill 2016 passed by the Rajya Sabha on August 8, 2016 has created hope for a systematic intervention by the Central and State Governments in improving the public mental healthcare facility in our country with a rights-based approach to the issues of mental health that recognises the healthcare rights of people with mental illness. It is a long awaited progressive legislation which aims to provide mental healthcare and service for persons with mental illness and to protect, promote and fulfil the rights of such persons.
The Bill has many required provisions in comprehensively addressing the issues and fulfilling the international obligation of India towards people with disabilities and its optional protocol adopted by UN in 2006. India has signed and rectified the convention on October 1, 2007. The Bill also replaces the inadequate Mental Health Act 1987 by adding many new provisions in a right perspective and also to harmonize the existing laws in alignment with the international standard. The provisions of the Bill says every person shall have a right to access mental healthcare and treatment from mental health service run or funded by the appropriate Government. The mental health service must be in affordable cost with good quality and availability in sufficient quantity while accessible geographically. The Bill says about discrimination free treatment irrespective of social, caste, gender, sex, political, economic, religious, cultural and sexual identity of a mentally ill person. The person with mental illness including children and older person should not travel long distance to access mental healthcare services and the Government has to arrange such facilities at each district. Persons living below poverty line even without a valid card, destitute and homeless deserve a complete free service and treatment facility without any payment in any Government run hospitals and other establishments for the purpose. Financial condition and social status should not be a barrier for accessing treatment facility. The Government has to notify essential drug list and all essential drug should be made available in all hospitals free of cost.
Every person has right to live a community living with dignity and not to be segregated from society and his/her right to a family. The person with mental illness must be protected from cruel, inhuman and degrading treatment anywhere by any one. The personal hygienic environment, sanitary condition, privacy, dignity and proper clothing to maintain dignity must be ensured along with provision for adequate food by the Government. The Government has to create awareness about mental health and illness and in reducing stigma related to mental health and illness and appropriate measures should be taken to develop human resources development and training.
As per the Bill, there will be a Central mental health authority at national level and State mental health authority at State level. The punishment for contravention of the provisions includes imprisonment for a period of six months to two years or with a fine of Rs 10,000 or both. There are a few things left out in the Bill which may get a place in the rules as clarified by many. It is expected that the historic legislation of international standard will bring major change in the health sector and specially in ameliorating the condition of the most deserving vulnerable persons in human society but the implementation of laws needs a change of mindset and human commitment without which it will not bring desired change.
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