AURANGABAD: Modelled after the western concept of institutional psychiatric care, the new legislation on mental healthcare — Mental Health Care Bill (MHCB), 2013, ignores the role of the family in taking care of the mentally sick, say experts.
India is estimated to have only about 3,500 psychiatrists and over 50% of the mentally ill have no access to healthcare.
Experts feel that the proposed legislation has major drawbacks and if the government decides to go ahead with it, it will be retrogressive and will do more harm to the cause of mental health in the country and will push the mentally ill back to being stigmatised.
Rashmin Achaliya, head of psychiatry department at the Government Medical College and Hospital (GMCH), said, “The bill is not feasible in our country. Unfortunately, the Parliamentary Standing Committee has cleared it without remedying the defects. In its present form, the bill would have a negative impact on the future of mental healthcare in the country. Unless mental health professionals take some effective action, the bill’s repercussions on the future practice of psychiatry would be terrible.”
City-based psychiatrist Aziz Ahmed Quadri said, “The bill marginalises the families, who, in India bear the major burden of care of the mentally ill. The MHCB totally ignores the parents and families and for the first time proposes that the patient can nominate any person as his nominated representative who will take all major decisions regarding his care and property.”
“Since many mentally ill patients lack insight during acute phase of illness, they can be easily cheated by the so-called nominated representatives. The bill seeks to segregate the treatment of the mentally ill from the mainstream medical establishments and it is likely to increase the stigma,” he said.
“The MHCB also proposes that all major decisions relating to treatment of mental illnesses will be taken by the Mental Health Review Commission. The parents of minor children will not be able to seek indoor treatment without the permission of the Commission. This process will not only increase the treatment cost but would lead to more paper-work, harassment of doctors and patients’ relatives,” added Quadri.
Achaliya said that the MHCB also proposes that patients suffering from major mental illness cannot be treated without their consent.
Senior psychiatrist A K Janadhan said, “The landmark development in India was starting of the psychiatry unit in general hospitals and medical colleges. These facilities are now proposed to be brought under the MHCB, which will make the treatment very cumbersome. This will also affect the postgraduate psychiatry training as the students will be denied the opportunity to see variety of cases as all the beds will soon get filled with chronic cases and there will be no bed for psychiatry emergencies.”
Quadri said, “The biggest challenge in the treatment of mental illness is the rehabilitation, but MHCB is totally silent about the care and rehabilitation of patients after discharge from long-stay facilities. These patients require constant care and support while staying in the community and the MHCB must address this issue.”
“In the present form, the MHCB will be worse than the existing Mental Health Act, 1987,” he added.