New Delhi, Aug. 21: An estimated 120 million mentally ill patients across India will have the right to seek quality mental health care and treatment from the government under a bill introduced by the Union health ministry this week.
The Mental Health Care Bill seeks to reform the management of mental illness in the country, tainted in the past by the cruel practices of mentally ill patients being chained, forcibly sterilised, and given electric shocks without anaesthesia.
The bill also seeks to decriminalise attempts to commit suicide and makes it obligatory on the government to provide care, treatment and rehabilitation to people who attempt suicide, presuming they are suffering from mental illness.
“This is a landmark bill. I think this is the first ever bill that seeks to enshrine the right to quality health care for a set of illnesses,” said Vikram Patel, a senior consultant psychiatrist in Goa who was not associated with the drafting of the document.
The bill seeks to provide mentally ill patients treatment and rehabilitation “in the least restrictive environment possible, and in a manner that does not intrude on their rights or dignity”, Union health minister Ghulam Nabi Azad said, outlining its objectives.
But sections of psychiatrists caution that the bill will demand a vast network of human resources and infrastructure that India does not currently possess. India has an estimated 4,500 psychiatrists, most of them concentrated in towns and cities.
“The government would want at least one public psychiatrist in each district, but we estimate that less than 300 of India’s 600-plus districts have a public psychiatrist,” said Sunil Mittal, a psychiatrist in New Delhi who is the chair of the parliamentary committee of the Indian Psychiatric Society.
“Finding the human resources and creating mechanisms for providing the services will be a huge challenge — the private sector will need to be heavily involved.”
The bill introduces the concept of a so-called advance directive that allows people to make a declaration in advance on how they would wish to be treated if they were to become mentally ill.
The proposed legislation also prohibits mentally ill patients from being chained, disallows the use of electro-convulsive therapy (electric shocks) without the use of muscle relaxants and anaesthesia, and prohibits the procedure altogether for minors. The bill also seeks a ban on the sterilisation of men or women when it is intended as a treatment for mental illness.
Some psychiatrists, however, say the advance directive and the ban on electro-convulsive therapy without anaesthesia will be contentious issues.
“In some cases, mentally ill patients might during periods of remission declare that they do not want to be institutionalised or even treated,” said Mittal.
“And the risk of electro-convulsive therapy is lower than the potential risk of anaesthesia — it can be life-saving in certain situations.”