New law, but slow progress on mental health

Aditya Vikram Rametra

Persons with disabilities generally have a hard time in our society; persons with mental illness particularly face a lot of discrimination and apathy. A large part of this discrimination stems from ignorance; we don’t understand mental illness and therefore are unable to empathise. It is only greater understanding and sensitisation that would spur change in public attitudes and government policies.

What is mental illness?

As per the definition in ‘The Mental Healthcare Act, 2017’: “Mental illness means 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.”

So, first and foremost, we must differentiate between ‘mental illness’ and ‘mental retardation’. The term mental retardation, though used in the Act, is outdated; the new term currently being used for such conditions is ‘intellectual disability’.

Mental illnesses could include fairly common conditions like depression and anxiety disorder, as also chronic disorders like schizophrenia, bipolar disorder, and major depressive disorder, among others. Most people with mental illness may have average or even above average IQ; they have usually been fully functional individuals in early childhood and adolescence; are sometimes well qualified and employed before the onset of illness; and can lead fairly independent lives after adequate treatment, but may need lifelong support for some activities.

The support required would vary depending on the individual’s aptitude and the severity of mental illness.

National Mental Health Survey

According to the ‘National Mental Health Survey, 2016’, the most exhaustive study on mental health undertaken across India till date, over 10% of the Indian adult population has a diagnosable mental disorder and nearly 2% is suffering from severe mental disorders.

Since Punjab was a partner state, an exhaustive study was undertaken, titled ‘National Mental Health Survey – Punjab State Report, 2016-17’, conducted by Department of Psychiatry, GMCH, Chandigarh, and coordinated by National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, with Central support.

The primary objectives were to assess the number of people suffering from various mental disorders, treatment and rehabilitation options available and the gaps in mental health services and facilities. The survey results estimated different rates of severe mental disorders and substance use disorders varying from 0.7% to 7.58% of the total population of the state.

As per these statistics, the number of persons with severe mental illness in Punjab who need support services runs into a few lakhs! The parents and guardians spend sleepless nights worrying as to what would happen to their wards once they are not around them anymore! Therefore, the provision of adequate number of support facilities and services by the appropriate government becomes very important.

New laws: A ray of hope

While in India we are still stuck with the ‘medical model’ and ‘welfare attitude’ in treatment and rehabilitation, many developed nations have moved on to more humane ‘social care’ and empowering ‘human rights’ oriented approaches for treatment and long-term rehabilitation. The silver lining though is that now we have progressive new laws for persons with disabilities in India that unambiguously take a ‘rights-based’ approach, rather than the earlier patronising attitude of doling out welfare schemes.

In 2007, India ratified the UN Convention on Rights of Persons with Disabilities (UNCRPD), which brought a paradigm shift in perspective – rather than seeing people with disabilities (PwD) as objects needing medical care and welfare schemes, it viewed them as subjects having fundamental human rights and freedoms.

India had to bring its laws in consonance with the principles and values enshrined in UNCRPD. So we had a new ‘Rights of Persons with Disabilities (RPwD) Act, 2016’, and ‘The Mental Healthcare Act, 2017’.

Mental Healthcare Act, 2017

Some of the most important ‘rights’ enshrined in the new Mental Healthcare Act, 2017, are:

• Right to access mental healthcare
• Right to community living
• Right to protection from cruel, inhuman and degrading treatment
• Right to equality and non-discrimination
• Right to information and confidentiality
• Right to legal aid, among several others…

At the same time, the Act lays down the ‘duties of the appropriate government’, thereby putting the onus clearly on the government to provide the necessary services and facilities.

Some of the challenges that still remain to be addressed are:

• A change in society’s understanding of and attitudes towards persons with mental illness
• A strong political will and government policies to improve the mental health infrastructure and services
• A massive increase in budgetary provisions for mental health. [India spends a mere 1.3% of its GDP on health expenditure; the expense on mental health is just 2-3% of the total amount spent on health! In contrast, most European countries spend 7-8% of their GDP on health, and a significant share goes to mental health]

Compared to the developed countries, we are lagging far behind in terms of mental health infrastructure and services. The number of trained professionals – psychiatrists, clinical psychologists and psychiatric-social workers – is abysmally low. Many insurance companies still discriminate when it comes to providing coverage for mental illness [such discrimination is illegal as per the new Act!]. As a society, we still fail to realise that mental illness is a systemic public health issue.

We need a supportive mental health ecosystem comprising appropriate infrastructure, professionals, and services so persons with mental illness and their families don’t feel isolated and helpless.

(The writer is a social worker and mental health advocate. He can be reached at arametra@gmail.com)