December 11, 2021
Saving the mind
To: either/view subscribers
KNOW YOUR RIGHTS – EDITION 18
Rights of Mentally Ill Persons
Good morning. Over the past few years, the topic of mental health has gained more ground, gotten more of the spotlight, and has become relatively less taboo. There is no doubt that there is still work to do on these fronts. When it comes to addressing and treating mental health, it is a mixed bag for India. Just consider the country’s population – a billion-plus. Tackling mental health in such a scenario is a big task. With the pandemic, mental health hasn’t been more urgent to address.
An India State-Level Disease Burden Initiative study showed the disease burden due to mental disorders increased from 2.5% in 1990 to 4.7% in 2017. It is in terms of disability-adjusted life years. Mental illness was the leading contributor to years lived with disability at 14.5%. One of the barriers to diagnosis and treatment of mental health in India is stigma. A National Mental Health Survey (NMHS), 2015-16, stated 80% of those who had a mental illness did not receive treatment for over a year.
A 2016 study by the National Institute of Mental Health and Neurosciences showed 13% of Indians suffer from mental illness. It stated that nearly 150 million Indians needed medical intervention. Another study by the ‘Live Love Laugh Foundation’ in 2018 showed 87% of respondents showed awareness of mental health. Out of this, 71% used ‘stigma’ or associated terms regarding mental health.
Past efforts concerning legislation on mental illness go back to British India with the Lunatic Removal Act, 1851, among others. Most of the laws under the British dealt with the establishment of mental asylums and procedures to deal with mentally ill people.
The first law to govern mental health in India was the Indian Lunacy Act 1912. Post World War II and the adoption of the Universal Declaration of Human Rights (UDHR) by the UN General Assembly, the Indian Lunacy Act, 1912 was replaced with the Mental Health Act, 1987. India has made efforts to align its mental health laws with the UN Convention on the Rights of Persons with Disabilities (CRPD) adopted in 2006 and ratified by India in 2007.
As mental health has taken on more importance in the public consciousness in India, there has been some awareness, thanks to health experts. For example, the Indian Psychiatry Society asked politicians not to use ‘mental’ to describe their opponents when campaigning during the 2019 Lok Sabha elections. It wrote to the Election Commission on the same.
In 2013, the Mental Health Care Bill was introduced in the Rajya Sabha. It sought to align its goals with the CRPD. Following more than a hundred amendments, it passed in August 2016. In 2017, President Ram Nath Kovind stated India faces a possible mental health epidemic.
Here are the rights contained in the law:
1. Access to affordable and accessible healthcare
The law states that every person has the right to access mental healthcare and treatment. Doctors and staff at any facility that treats those with mental illness cannot discriminate against anyone based on gender, sexual orientation, caste, religion, disability, etc. The bill put the onus on Public Health Centres (PHCs) to identify and treat people with common mental illnesses. Here is what it contains –
- The services should be in sufficient quantity and geographically accessible.
- Each district should have healthcare facilities and services run or funded by the government.
A person living below the poverty line or homeless has the right to avail of mental healthcare and treatment free of cost in government-run or government-funded facilities. Any person with a mental illness can get the medicines included in the Essential Drug list for free.
2. Access to information
Being correctly diagnosed and receiving the appropriate treatment is a basic right for anyone. The Act states that any decision made by a person should be an informed one. The person has the right to know all the components of the treatment prescribed such as cost, procedures, side effects, etc. It should be presented to the person in an understandable manner and without obfuscation.
3. Consent and power to take decisions
A person living with mental illness can make their own decisions concerning their health and treatment as long as they understand the information related to the treatment. No one can forcefully admit the person to a hospital provided they are lucid.
4. Protection from cruel and inhumane treatment
Article 21 of the Constitution deals with the right to a dignified life. It is incorporated into the Mental Healthcare Act. It states that any person living with a mental illness has the right to live with dignity. They also have to be protected from degrading, inhumane, and cruel treatment in any healthcare establishment.
5. To live in a community
Those who live with mental illness have the right to live in a community not secluded from society. Otherwise, it would only further stigmatise mental illness. If this is not possible, in a situation where the person is abandoned or cannot live with the family, the government should provide legal, financial, and other forms of support.
As with medical illnesses and treatments in general, the principle of confidentiality applies to mental health as well. Every person has a right to know that the details of their mental illness and treatment are protected. This confidentiality also extends to information in digital and electronic forms. Health professionals should not reveal this information subject to exceptions, such as public safety interests and security. The information can be given to a nominated person and other health professionals.
7. Legal aid
A person with mental illness can seek legal aid to exercise their rights under the Act. Article 39A of the Constitution lays out this directive. A person can also file a complaint if they have been deprived of healthcare services or received deficient treatment.
Room for improvement
Mental health has gained ground as people with large platforms from various walks of life ranging from entertainment to sports have spoken up about their mental health struggles. The WHO estimated the economic loss to India due to mental health disorders to be at $1.03 trillion. Despite progress on legislation nationally, as of 2021, only a handful of states have a standalone line item in their budgets for mental healthcare and infrastructure.
With the onset of the coronavirus pandemic, mental health has come to the forefront in many cases. A survey by the Indian Psychiatry Society showed a sharp rise in Indians suffering from mental illness; a 20% increase. Among those affected the most are children, migrant workers, and women. On average, developed countries allocate 5-18% of their annual healthcare budget for mental health. For India, it is barely 0.05%. That needs to change.