Tata Institute of Social Sciences, MumbaiMaster of Hospital Administration(2016-18) SCHOOL OF HEALTH SYSTEM STUDIESCBCS-MENTAL HEALTHCOURSE TEACHER-SHANKAR DAS SUBMITTED BY –EVANDALYNE LAMAREM2016HO013Master of Hospital Administration Most people in the world will be affected bymental or neurological disorders at some point in their lives. Around 450million people currently suffer from such conditions. Treatments are available,but nearly two-thirds of people with a known mental disorder never seek helpfrom a health professional. Stigma, discrimination and neglect prevent care andtreatment from reaching people with mental disorders, says the World HealthOrganization (WHO).
Where there is neglect, there is little or nounderstanding. Where there is no understanding, there is neglect.Claims from psychiatry say that over onebillion people suffer from psychiatric illness. While studies says thatpsychiatric treatment is one of the most lucrative, damaging, abusive, brutal,corrupt business in the world with many prescriptions per year and leading tomany adverse effects like extra pyramidal symptoms many emergency situationsleading to many birth defects 25000 suicides, 15000 die annually many kids aredrugged and many given electroshock. Many people are locked up against theirwill, chained and confined given ECT without their own consent locked ininstitutions sometimes they never recovered and come back but get used toinstitutionalization living in pathetic condition locked up and denied of basicsanitation, chained adding to that there are zero diagnostic test and many arebeing classified into symptoms and with zero effective treatments.
While posingas “authorities” on the mind and mental health, psychiatry has no scientificbasis for any of its treatments or methods. Mental health care Act is a short title usedfor all kinds of legislation relating to mental health laws developed toprotect the basic fundamental right of people “Right to live” that comes underarticle 21 of Indian constitution IPC 309 which criminalizes attempt tosuicide. The mental health Care bill sets out when and how people can betreated if they have a mental disorder, when people treated or taken intohospital against their will? What people rights are, and the safeguards whichensure that these rights are protected.Mental health care Acts in IndiaPre independence1.1885: IndianLunatic asylum act of 18582.
1912: IndianLunacy act of 1912Post Independence:1.1947: IndianPsychiatric association.2.1987 Mental healthact of 1987(Indian Psychiatric society).3. Mental healthcare Bill Proposed in 2013.4.
Nationalmental health Policy 2014.5. Mental HealthCare Act 2017.Mental Health act 1987 needed amendmentbecause concerning with legal proceeding and guardianship MHA 1987 has not beenable to adequately protect the rights of person with mental illness and topromote access to mental health Care in the country. Human right issues andmental health care delivery are not properly address in this act. Many human rightsactivist have questioned the constitutional validity of MHA, 1987 because itinvolves curtailment of personal liberty without the provision of proper reviewby any judicial body .
Where as in the new bill it is provided that research canbe carried out by the consent of guardian. This provision violated human right.Once a person is admitted to mental hospital he is termed insane or mad by thesociety. There should be provision in the act to educate the society againstthe misconception in which the acts lacks. Right of the mentally ill patientwas not focused in mental Health Act 1987. On 28 March 2017, the Parliamentpassed the Mental Healthcare Bill, 2016 which will be repealing the existingMental Health Act, 1987.
The bill was already passed by the Rajya Sabha inAugust, 2016. After receiving the assent of the President on the 7th April,2017, the Mental Healthcare Act, 2017 has come into existence.The objective of the Act is to protect,promote and fulfil the rights of people with mental illness and to secure forthem appropriate mental healthcare and services and to ensure that these peoplelive with dignity and their rights are not being compromised. The basicframework of the Act is Convention on rights of person with disability and itsoptional protocol which has been adapted by United Nations on 13th December,2006 in New York and which came into force on 3rd may, 2008. India signed andlegalised this Convention in 2007 making it necessary to align and modify itsprevailing laws with regard to the Convention. The Act redefined “mentalillness” as a considerable disorder of thinking, mood, perception, orientationor memory that grossly impairs judgment, behavior, capability to acknowledgereality or ability to fulfill the standard demands of life, mental conditionsrelated to the abuse of alcohol and medicines.
However, it doesn’t embodyslowness of mind that may be a condition of inactive or incomplete developmentof mind of an individual, specially characterised by sub-normality ofintelligence.Rights of person with mental illness-The Act guarantees every person right toaccess mental healthcare and treatment from mental health services run orfunded by the Government also help in providing mental health services of goodquality at affordable cost and also ensure that the mental health services aregeographically accessible and are provided without discrimination. Persons withmental illness living below the poverty line or who are destitute or homelesswill be entitled to mental health treatment and services free of any charge andat no financial cost at all mental health establishments run or funded by theGovernment.
Right to Confidentiality: Person with mental illness will have theright to confidentiality in respect of his mental health, mental healthcare,treatment and physical healthcare. It also restricts release of information inrespect of mental illness. Without the consent of the person with mentalillness no information can be released to media by the mental healthestablishment. However, all such persons with mental illness will have theright to access their basic medical records. However till now the practice isstill not yet practiced. Right to legal aid: It also guaranteesa person with mental illness will be entitled to receive free legal services toexercise any of his rights given under this Act. The Act also recognizes theright to live with dignity, right to community living, right to personalcontacts and communication; protection from cruel, inhuman or degradingtreatment, treatment equal to persons with physical illness as many cases arestill prevailing that many times people were denied communication to theirfamily members cutting all relationship with the outside world patients werecalled with numbers and the machinery like structure in the system where thepatients just have to obey the words of doctors and if they rebuke to be givenpunishment and locked up and have to show good behavior only Many people arechained and live in pathetic situations still rampant in our country. Everyinsurer is bound to make provision for medical insurance for treatment ofmental illness on the same basis as is available for treatment of physicalillness.
AdvancedDirectivesThe Act states that every person will have the right to specify how he wouldlike to be treated for mental illness in the event of a mental healthsituation. An individual will also here the right to specify who will be theperson responsible for taking decisions with regard to the treatment, hisadmission into a hospital, etc.It also says that a medical practitioner or amental health professional shall not be held liable for any unforeseenconsequences on following a valid advance directive.As per the Act, a personwith mental illness will not be subjected to electro-convulsive therapy withoutthe use of muscle relaxants and anesthesia. Also, electro-convulsive therapywill not be performed for minors. It also restricts use of sterilization onsuch persons.
They shall not be chained in any manner or form whatsoever underany circumstances.According to the Act, a person with mentalillness will not be subjected to solitary confinement. Physical restraint mayonly be used, if necessary. Promotion of Mental Health and Preventive ProgrammeThe Act directs the Government to plan, design and implement programmes for thepromotion of mental health and prevention of mental illness in the country.Measures should be taken to create awareness about mental health and illnessand reducing stigma associated with mental illness. The Government will takemeasures to address the human resource requirements of mental health servicesin the country by planning, developing and implementing educational andtraining programmes. This will be done in collaboration with institutions of highereducation and training. The aim will be to increase the human resourcesavailable to deliver mental health interventions and to improve the skills ofthe available human resources to better address the needs of persons withmental illness.
As per the Act, the Government will train all medical officers in publichealthcare establishments and all medical officers in the prisons or jails toprovide basic and emergency mental healthcare.Establishment of Central & State MentalHealth Authority-The Act directsthe Government to set up a Central Mental Health Authority within a period ofnine months from the date on which this Act receives the assent of thePresident.Functions of the Central Mental Health AuthorityEstablishment ofCentral & State Mental Health AuthorityThe Act directs the Government to set up a Central Mental Health Authoritywithin a period of nine months from the date on which this Act receives theassent of the President.Functions of the Central Mental Health Authority:The Authority will register all mental healthestablishments under the control of the Central Government. It will maintain aregister of all mental health establishments in the country based oninformation provided by all State Mental Health Authorities of registered establishmentsand compile update and publish a register of such establishments.The Authority will develop quality and serviceprovision norms for different types of mental health establishments under theCentral Government.
It will supervise all mental health establishments underthe Central Government and receive complaints about deficiencies in provisionof services. It will maintain a national register of clinical psychologists,mental health nurses and psychiatric social workers based on information providedby all State Authorities of persons registered to work as mental healthprofessionals for the purpose of this Act and publish the list of suchregistered mental health professionals.The Authority has also been tasked to train law enforcement officials, mentalhealth professionals and other health professionals about the provisions andimplementation of this Act. It will also advise the Central Government on allmatters relating to mental healthcare and services.
A fund named the Central Mental Health Authority Fund will be constituted wheregrants and loans made to the Authority by the Central Government and all feesand charges received by the Authority under this Act will be credited.D. No person shall be admitted to or held in a psychiatricinstitution, hospital or facility because of their political, religious orcultural beliefs and practices.E. Any patient has:1. The right to be treated with dignity as a human being.
2. The right to hospital amenities without distinction as torace, color, sex, language, religion, political opinion, social origin orstatus by right of birth or property.3. The right to have a thorough, physical and clinicalexamination by a competent registered general practitioner of one’s choice, toensure that one’s mental condition is not caused by any undetected anduntreated physical illness, injury or defect and the right to seek a secondmedical opinion of one’s choice.4.
The right to fully equipped medical facilities andappropriately trained medical staff in hospitals, so that competent physical,clinical examinations can be performed.5. The right to choose the kind or type of therapy to beemployed, and the right to discuss this with a general practitioner, healer orminister of one’s choice.6. The right to have all the side effects of any offeredtreatment made clear and understandable to the patient, in written form and inthe patient’s native language.
7. The right to accept or refuse treatment but in particular,the right to refuse sterilization, electroshock treatment, insulin shock,lobotomy (or any other psychosurgical brain operation), aversion therapy,narcotherapy, deep sleep therapy and any drugs producing unwanted side effects.8. The right to make official complaints, without reprisal,to an independent board which is composed of nonpsychiatric personnel, lawyersand lay people.
Complaints may encompass any torturous, cruel, inhuman ordegrading treatment or punishment received while under psychiatric care9. The right to have private counsel with a legal advisor andto take legal action.10. The right to discharge oneself at any time and to bedischarged without restriction, having committed no offense.11. The right to manage one’s own property and affairs with alegal advisor, if necessary, or if deemed incompetent by a court of law, tohave a State appointed executor to manage such until one is adjudicatedcompetent.
Such executor is accountable to the patient’s next of kin, or legaladvisor or guardian.12. The right to see and possess one’s hospital records andto take legal action with regard to any false information contained thereinwhich may be damaging to one’s reputation.13. The right to take criminal action, with the fullassistance of law enforcement agents, against any psychiatrist, psychologist orhospital staff for any abuse, false imprisonment, assault from treatment,sexual abuse or rape, or any violation of mental health or other law.
And theright to a mental health law that does not indemnify or modify the penaltiesfor criminal, abusive or negligent treatment of patients committed by anypsychiatrist, psychologist or hospital staff.14. The right to sue psychiatrists, their associations andcolleges, the institution, or staff for unlawful detention, false reports ordamaging treatment.
15. The right to work or to refuse to work, and the right toreceive just compensation on a pay scale comparable to union or state/nationalwages for similar work, for any work performed while hospitalized.16. The right to education or training so as to enable one toearn a living when discharged, and the right of choice over what kind ofeducation or training is received.
17. The right to receive visitors and a minister of one’s ownfaith.18. The right to make and receive telephone calls and theright to privacy with regard to all personal correspondence to and from anyone.19.
The right to freely associate or not with any group orperson in a psychiatric institution, hospital or facility.20. The right to a safe environment without having in theenvironment, persons placed there for criminal reasons.
21. The right to be with others of one’s own age group.22. The right to wear personal clothing, to have personaleffects and to have a secure place in which to keep them.
23. The right to daily physical exercise in the open.24.
The right to a proper diet and nutrition and to threemeals a day.25. The right to hygienic conditions and non overcrowdedfacilities, and to sufficient, undisturbed leisure and rest. Reference1.
Choudhary, L.N. (2015) The Mental Health Care Bill 2013: A Critical Appraisal, Indian Journal ofPsychological Medicine https://www.ncbi.nlm.nih.
gov/pmc/articles/PMC4418257/2. CitizensCommission on Human Rights (2018) Mental health declaration of Human rightsRetrieved from http://www.cchr.org/about-us/mental-health-declaration-of-human-rights.
html3. Das, M(28/03/2017) india has new mental healthcare law and heres all you need knowabout it Retrieved from https://www.thenewsminute.com/article/india-has-new-mental-healthcare-law-and-heres-all-you-need-know-about-it-59404