Worldwide about 450 million people live with mental disorders that are among the causes of ill-health and disability as per the WHO report, 2001. Being a part of the existing mental health response system, I as well as other mental health professionals should have the courage to accept that the fragile health system has not been able to address or cope with the large treatment gaps and need for mental health care. The treatment gaps and need for care of the mental problems have further deteriorated due to the pandemic of COVID-19 and its socio-economic consequences.
National Institute of Mental Health and Neurosciences, Bangalore, reported in India in 2016 that at least 150 million persons with mental illness are in need of urgent intervention. Another report regarding the projected burden of mental illness conveys that it will increase more rapidly in India than other countries in the next decade and will account for one-third of the global burden of mental illnesses. In spite of this big burden of mental health issues, unfortunately, it continues to be misunderstood in developing countries like India. Despite a growth in mental health awareness, mental health investment has been stagnant across the globe and the result is an increase in treatment gap.
In last two decades, the suicide rate has increased from 7.9 to 10.3 per 100000. About 37.8 per cent of suicides in India are by those below the age of 30 years and 71 per cent by those below the age of 44 years.
According to WHO’s 2014 survey, the government of different countries spend on average 3 per cent of their health budgets on mental health, ranging from less than 1 per cent in low income countries to 5 per cent in high income countries. The value of investment needs to be increased for scaling up treatment of mental patients.
Keeping in view above facts the theme of the World Mental Health Day 2020 for this year has been kept as -- “Mental Health for All, Greater Investment-Greater access”.
It means there is a need for an increase in mental health investment to increase easy access of mental health service to the mental patients. It will decrease the treatment gaps and disability.
Today on the occasion of World Mental Health Day, 2020, it is pertinent to discuss the steps that the State Government has taken and has plans to make comprehensive mental health services accessible to the patients and decrease the treatment gap? As we are aware of the enormity of the problem in comparison to existing resources, it is always appreciable if the strategy is to start working on the most basic and important needs of the mental patients.
A. What are the patients’ needs?
The persons with mental illness have varied needs and they are considered non-productive or partially productive. They need to take consultations and treatment for a long period. In India, they have needs primarily for free treatment especially drug treatment. They also have shelter needs, security needs and employment needs. The health department is running various establishments and has been working with other sectors to satisfy all the needs.
B. Implementation of important provisions of mental health act, 2017 in Jharkhand:-
In case of Jharkhand, as being the member secretary of State Mental Health Authority, Jharkhand still has to go a long way. We have a wonderful document, the Mental Healthcare Act, 2017. It has been formulated focusing on the needs of the patients’ suffering from mental illnesses. It provides enormous scope to the state government, concerned institutes, medical colleges, every individual mental health professional/legal volunteer/ health worker/ general physician/care giver/NGO worker/member of Human Right Commission or Women’s Commission to work for the welfare of marginalized groups of people with mental illness. It also includes the other sectors of the government like Dept of Social Welfare, Department of Home etc. to work in tandem with mental health professionals.
What are the important provisions/rights of Mental Healthcare Act, 2017 and steps so far taken by Jharkhand Govt?
1. Right to access mental health services.
The Jharkhand Govt is running and funding following mental health establishments to make the mental health services accessible to all:
a. Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS),Ranch,
b. District Mental Health Programmes (DMHPs)
c. Psychiatric Units in Medical Colleges.
d. Community Based Mental Health Establishments:
a. Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS), Ranchi: - RINPAS is a specialised Mental Health Care Teaching Hospital established to cater all types of mental health needs. RINPAS runs Out Patient Dept. (OPD), In-patient Dept. (IPD), satellite clinics and Rehabilitative services. It has 550 beds for persons with mental illness including 50 beds for persons with substance use disorders. It used to manage around 500-600 patients/day (prior to onset of Covid-19 pandemic). Due to the pandemic, the number of patients has decreased to 100 per day. It has two rehabilitation units where the patients are trained in different trades like tailoring, carpentry, embroidery, etc. and two half way homes have recently been started. It provides pharmacotherapy (drug therapy), psychotherapy, and rehabilitative therapy free of cost. The hospitalized patients get all the basic facilities for free of cost based on the guidelines laid down by NHRC. In addition to psychiatrists, psychologists and psychiatric social workers, it has general medical officers, dentist, pathologist, gynecologist, physiotherapist and yoga-therapist for looking after the indoor as well as outdoor patients. The possible comprehensive services are provided to all patients, who are in need.
The government has recently notified the Recruitment Rules for Teaching cadres of RINPAS and is in the process of creation of posts required to support all the mental health establishments and Out Patient Door clinics run by the state government. RINPAS has sent a proposal of 44 posts to be created. If these posts are approved and appointment to these posts is done, all the mental health establishments will get support and the patients will get access to the minimum required treatment within 70 km radius and in next 5-10 years, it can be expected to have all kinds of mental health establishments equipped with manpower in every district.
b. District Mental Health Programmes.
The state government is running OPD service units (District Mental Health Programme) under National Mental Health Program (NMHP) in Dumka, Gumla, Daltangunj, Eat-Singhbhum, Bokaro, Giridih and Hazaribagh districts where free medicines are being given to all the patients. The state government has plans to include all the districts under the NMHP.
The Jharkhand nodal office of National Mental Health Programme has received sanction to start DMHP centers in another 7 districts in the state. The centers will be made functional.
c. The Psychiatric Units in Medical colleges.
The State has 6 medical colleges. All have psychiatric units (OPDs). Some have started dispensing medicines free of cost and rest of the colleges have plans to start giving medicines as per rule.
Keeping in view the increasing number of admissible mental patients, the proposal has been formulated for approval of the inpatient wards in medical colleges. It will be discussed in the meeting of the State Mental Health Authority.
d. Community Based Mental Health Establishments:
After recovery or partial recovery of the patients in any Mental hospital, the patients can be transferred to any community based establishment nearer to his/her home.
The community based health establishments like Half Way Home or group homes have to be established by the Social Welfare Department , Govt of Jharkhand.
Five HalfWay Homes under the process of establishment. Out of five, RINPAS has been entrusted to start TWO which has recently been started.
2. Right to quality treatment to patients:
The State has constituted a State Mental Health authority to monitor the minimum standard of the government or private mental health establishments (hospitals or nursing homes).
The authority will make regulations for the establishments and monitor the functioning of establishments as per the specifications prescribed under the regulations. The State Government will ensure that mental health establishments are providing the safe and hygienic environment along with free drugs or other treatment to persons with mental illness. In addition to this, the authority will constitute and notify Mental Health Review Boards in districts which will hear the grievances related to treatment of the persons with mental illness. The state government will ensure that mental health establishments are providing a safe and hygienic environment along with free drugs or other treatment to persons with mental illness.
3. The care and protection of the wandering or homeless persons with mental illness:
The in- charge of a police station should bear the responsibility to identify and protect any person with mental illness found wandering or homeless or ill-treated or neglected and produce him/her to concerned Magistrate and request for reception order to get the person treated in any mental health establishment.
After recovery of the patients, the authorities of the mental hospital have to inquire about the address of the person and inform the guardians of the person. If guardians refuse to take the person, the authority of the mental health establishment can write to NHRC or NWC. The commission can take appropriate action.
4. Right to community living.
The state has to provide the Half Way Homes and group homes which are less restrictive community based establishments than long stay mental hospitals.
5. Right to legal aid
Any person with mental illness shall be entitled to receive free legal services to exercise any of his rights given in the Act.
The writer is Director, RINPAS, Kanke, Ranchi-cum- member secretary, State Mental Health Authority, Jharkhand. He is an MD (Psychiatry) from AIIMS, New Delhi and is motivated to work for neglected and poor patients. He believes that every professional has to be kind and just to achieve the goal set by the Govt.