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Mental Health Bill ignores the role of counsellors and psychologists

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The Rajya Sabha on August 8, 2016, passed the Mental Health Care Bill 2013. Before going through any details, the government deserves some applause for its efforts at being vocal on an issue which is still considered ‘taboo’ in our society.  As it passed the upper house of the parliament, there was and is a sense of celebration among activists as well as citizens. The new bill in many aspects differs from the outdated Mental Health Act 1987 and the new bill will replace the old act once it clears the Lok Sabha.

The definition of mental illness itself  changes in the new bill. The new bill defines mental illness as “a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by sub normality of intelligence.” It is more inclusive and based on medical science. The old one, however, was limited to “any mental disorder other than mental retardation”.

The Health Minister Jagat Prakash Nadda refers to this bill as a historical step on his twitter account. During the debate in parliament the Health Minister said the Mental Health Care Bill, 2013, is patient-centric and focuses on how more facilities and support could be provided to patients. Various stakeholders, including the academia, experts and various political establishments, were consulted while formulating the bill. He also added that around 6-7% of the country’s population suffered from some kind of mental illness, while 1-2% suffered from acute mental diseases. According to the Mental Health Care Bill, every person shall have the right to access mental healthcare and treatment from services run or funded by the government.

In today’s date, government merely spends 1. 2 percent of its GDP on public healthcare and the allocation for mental health is only 1 percent of the allocated amount. The situation today is a far cry from what is promised.

The bill includes several unique features which are completely opposite from the previous one. The new bill has provision to decriminalise ‘attempt to suicide’. Now a person who attempts suicide does not have to go to jail for a year or pay a fine but will be facilitated for special care provided by government. Earlier it used to be considered as offence. Now a humanistic approach has been taken in this matter. It is very reformative. It is a significant progress from regulated healthcare to rights-based mental health approach, a senior health ministry official said.

M V Rajeev Gowda of the Congress said that there are many many good things in this bill and one of the most important ones is the fact that it decriminalizes suicides.”When a person attempts to take his or her own life that person is crying for help, that person is not someone who should be treated as a criminal and thrown behind bars. We need to reach out and find a way to overcome the problems that have caused that kind of action,” he said.

The bill also guides insurance companies to provide medical insurance facilities to mental ill persons as in the case of physical illness. Another feature of the bill is to ensure right to the patients about choosing the methods to get treated while the patient can choose a nominative representative who would take care of him or her.

It also provides for establishment of Central and State Mental Health Authority. The bill defines mental illness as well as its treatment. Under the bill, psycho-surgery will only be allowed if the district medical board approves it.

These are the certain provision which makes this bill a ‘reformist’ act. However, even with all these, there are also some healthy criticisms and questions over its implementation. And the very first is the budget allocation. In today’s date, government merely spends 1. 2 percent of its GDP on public healthcare and the allocation for mental health is only 1 percent of the allocated amount. The situation today is a far cry from what is promised. While the bill says mental health services should be available at the district level, even States with well-functioning district hospitals do not offer regular psychiatric outpatient services, leave alone in-patient facilities. In government hospitals, medication to treat even the more common psychiatric disorders is not always available. These and other deficiencies need not have waited for a law. This severe criticism appeared on The Hindu daily digital portal.

However, no matter how progressive the new bill is, it is still just a baby-step in the direction of reform. The bill only recognises the role of psychiatrists in the treatment of a mental illness. It still does not acknowledge the roles of counsellors and psychologists who also work with patients suffering from mental and emotional distress. Also, the bill largely addresses requirements of those people in mental healthcare facilities, but not every person diagnosed with a mental illness needs institutionalisation. While the bill mandates insurance companies to provide medical insurance to the mentally ill on the same grounds that they would issue insurance for physical illnesses, counselling services would probably not be covered even in the new insurance schemes, (writes) Divya Srivasta.

Madhusudan Mistry (INC), in a passionate speech also raised several relevant issues pointing out that the Bill fails to lay down any provisions for creating awareness and addressing the stigma associated with mental illness. He also pointed out that the Bill is ‘individualistic in nature’ and does not make sufficient provisions for family members and caregivers who also face a lot of challenges.

The bill however commands central as well as state government to ensure access to mental health services in every district and the establishment of community-based rehabilitations but it failed to give information about the expenditure requirement and makes no mention even of financial sharing between state and central government. The obvious question arose over the implementation because nothing has been mentioned about funds, financial costs and how to meet them. The bill also failed to specify the punishment and penalty provisions adequately if one violates the law. The passed bill with its reformist provisions also carries some heavy flaws. For its successful implementation the lawmakers have to address those leakages sincerely.

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is a freelance journalist and currently works with the Goa-based Organisation, Video Volunteers. He is a former editorial Member of the Companion and writes on the issues of politics and justice of religious and economically marginalized. He tweets at @Ianwarulhoda

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