Mental Health Care Bill, 2016: A boon or bane?

Byline: Choudhary. Narayan, Deep. Shikha, Mridula. Narayan After India signed and ratified the United Nations' Convention on Rights of Persons with Disability, 2006 (UNCRPD), Ministry of Health and Family Welfare (MOHFW) initiated the exercise of revising the Mental Health Act - 1987 (MHA-1987) to bring it in harmony with the UNCRPD in 2010. After about 31/2 years long drafting and consultation process, the proposed legislation named Mental Health Care Bill, 2013 (MHCB) was introduced in the Rajya Sabha in August 2013. The Parliamentary Standing Committee on Health Related Matters submitted its report with suggestions of some minor changes in November 2013. [sup][1] Though invited to the consultation process at different stages, Indian Psychiatry Society (IPS) was not assigned any role in drafting of the current Bill. IPS and other professional bodies of psychiatrists have expressed apprehensions about a number of provisions in the Bill, which are not considered to be in the interest of persons with mental illness (PMI). IPS has submitted its representations at various stages expressing these concerns. Antony (2014) said that the Bill has an over-inclusive definition for mental illness, which will hurt a huge number of victims of even minor mental illnesses and their families, because of the wide prevalence of stigma. [sup][2] Though there are provisions of emergency admission on any bed anywhere in the country for a maximum period of 72 h (96 h in NE states), all the hospitals or nursing homes who admit PMI have been brought under the purview of the Bill and are required to be registered as mental health establishments (MHEs). All involuntary admissions in MHE even for a day may be subject to review by Mental Health Review Board to be established throughout the country by the Mental Health Review Commission. Kala (2013) said that the provision is undoubtedly progressive, but expressed his doubt that whether we as a society, are ready for this large scale countrywide post-admission review in almost all cases of involuntary admissions. [sup][3] Unmodified electroconvulsive therapy (ECT) has been totally banned, and ECT to minors can be given only after approval from the board. Many other provisions like those of nominated representative, advance directive etc., are supposed to create an obstacle in the treatment of PMI. The Bill has many positive features as well which, if properly and genuinely implemented, are set to revolutionize mental health care services in our country. The Bill ensures the right of every person to access affordable and good quality mental health services funded by the government. All PMI have the right to equality of treatment, protection from inhuman and degrading treatment, free legal services, right to access their medical records, and right to complain regarding deficiencies in provisions of mental health care. [sup][4] Special emphasis has been given to human rights of PMI, and there is a separate chapter in the Bill for this purpose. The government is mandated to establish good quality mental health services at all levels so as to ensure everyone to have access to mental health care services. Decriminalizing suicide is another welcome feature of the Bill. The single provision, which is supposed to inflict greatest damage to the system of mental health care delivery, is that of bringing all the general hospital psychiatry unit (GHPU) within the ambit of definition of MHE. It will result in moving the clock backwards, so far as the development of psychiatry and mental health care in our country is concerned. In Indian Lunacy Act, 1912, there was no mention of the GHPU. In MHA-1987, "any general hospital or general nursing home established or maintained by the government and which provides also for psychiatric services" were excluded from the ambit of definition "psychiatric hospital/ psychiatric nursing home". Thus, the GHPU established or maintained by the government were exempted from obtaining a "license" for running psychiatric inpatient services. …

Opportunities in mental health services research.

Byline: Choudhary. Narayan Sir, The Guest Editorial titled, “Mental Health Care Bill, 2016: A boon or bane?” published in the July-Septemper (volume 58) issue of your esteemed journal provides an excellent critical appraisal by describing the positive features of the Bill as well as highlighting the probable difficulties expected to be created by the Bill in the delivery of mental healthcare. It is rightly said that the major task would be to effectively formulate the rules which takes into account the opinions of all stakeholders and is in the best interest of the person with mental illness (PMI).[sup][1] I would like to point out that the nomenclature has now been changed to Mental Healthcare Bill (MHCB), 2016 (i.e. the word “health care” is combined and now “healthcare”) by the amendments introduced by Rajya Sabha.[sup][2],[3] It is important to mention that the provisions regarding judicial inquisition as described in the Chapter VI in the Mental Health Act – 1987 (MHA-87) have been dropped in the MHCB. It is because of the fact that after adoption of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), all persons with disability including the PMI are to have rights, equally with others, to own or inherit property, movable or immovable and to control their financial affairs.[sup][4] The provisions regarding guardianship for the PMI have now been included in the Right of Persons with Disabilities Bill, 2014 (RPWD Bill), which has now been passed by both the houses. The Section 13 of the RPWD Bill authorizes any District Court to record a finding that a mentally ill person is incapable of taking care of himself/herself and of taking any legally binding decisions on his/her own. It should be noted that the RPWD Bill uses the term “mentally ill person” and not “persons with mental illness” as in the MHCB. After recording the finding, the court shall make an order for appointment of a limited guardian to take care of such mentally ill person and take all legal binding decisions on his/her behalf in consultation with such person. The district court may grant plenary guardianship to the mentally ill person under extraordinary situations where limited guardianship may not be awarded. The plenary guardian may take all legally binding decision on his/her behalf without any obligation to consult such person.[sup][5] Now, as the RPWD Bill, 2016 has been passed by both the houses of the Parliament, it would come into force after notification by the Central Government from a certain appointed date. As the section 13 of this Bill starts with the phrase “Notwithstanding anything contained in any other law for the time being in force”, the provision of the section 13 would prevail over the provisions of judicial inquisition of the MHA-1987. But it is not clear what would happen to proceedings already started and the orders already passed under the MHA-1987. Section 111 of the RPWD Bill, which gives power to the Central Government to remove difficulties, may come out to be helpful in this respect. Concerns have been raised that blanket requirement of registration of all places of where the PMI are admitted, reside at or kept in for care, treatment, convalescence, or rehabilitation would invite a sort of “license raj” of harassing mental health-care providers. It is prudent to keep general hospital psychiatry units (with open units only) to be kept out of the requirement of registration. …

The central place of psychiatry in health care worldwide.

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

Meeting the UN Sustainable Development Goals for mental health: why greater prioritization and adequately tracking progress are critical.

Rethinking India's psychiatric care

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Byline: Afzal. Javed, M. Amering The concept of human rights increasingly defines the discourse on ethical, moral, and legal frameworks of nations as well as international organizations. Their international and universal character was set out in the 1948 Universal Declaration of Human Rights and reinforced consistently ever since. At the same time, discussions on differences regarding their interpretation and application involve all of us on a daily basis on a political, professional, and personal level. Although human rights are promoted in a wider perspective and all population groups fall under their protection, there are on-going discourses around the world over the human rights needs of individuals diagnosed with psychiatric disorders and those experiencing mental health problems. Reports have confirmed the severity of human rights violations among this group almost in all cultures and countries though there are variations in frequency, intensity or severity. The practices and policies to follow human rights also change from one country to another with a number of concerns for disparities. Recent Historic Firsts In recent years, several historic firsts occurred, which have a strong bearing on the current developments in mental health and human rights: *For the first time in history, the human rights for persons with disabilities were specifically formulated in the 2006 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). This was deemed necessary because persons with disabilities have been denied their human rights on many levels and in all cultures and societies despite the fact that all prior human rights legislation, of course, applies to persons with disabilities in the same way as to every human being. This process of assessing the human rights situation of a particular group of people responding to the documented need for extra attention can be understood in analogy with the formulation of the UN-Convention on the Elimination of All Forms of Discrimination against Women in 1979 or the UN-Convention on the Rights of the Child in 1989 *For the first time in history persons with a lived experience of disability were part of the negotiating process at the United Nations. This brought about a plethora of novel experiences and “New Diplomacy” strategies with remarkable successes and only partly overcome stumble blocks [sup][1] *For the first time in history persons with a lived experience of disabilities from mental health problems (psychosocial disabilities) joined the movement of disability activists and were equal partners in the process of drafting the UN-CRPD. As a result, the convention obliges states to involve persons with disabilities in policy development. Therefore, from now on, people with a lived experience background will as rights-holders be part of the activities of international and national monitoring bodies with regard to UN-CRPD as well as all negotiating processes of international, national or local policies that concern their care and their lives in their communities. Furthermore, the UN-CRPD has a place in history with an exceptionally fast ratification process. By June 2016, 165 States Parties have ratified the UN-CRPD, thereby making it applicable in their countries. The consequent changes in policy and practice of mental health care concern high-as well as low- and middle-income countries.[sup][2] As a majority of people will be experiencing some form of disability either personally or as a family carer or friend at some point in time in their lives and disabilities from mental health problems affect millions of people all around the globe the significance of the claims and consequences of a successful meeting of the obligations of this particular UN-Convention can hardly be overestimated. The Un-Convention on the Rights of Persons With Disabilities The UN-CRPD includes freedom rights, such as the right to be free from exploitation, violence and abuse and requests nondiscrimination in terms of capacity and equal recognition before the law. …

Health Care Reform and Care at the Behavioral Health--Primary Care Interface

A new resolution for global mental health

Interface of Law and Psychiatric Problems in the Elderly.

India ratified the United Nations Convention on the Rights of Person with Disabilities (UNCRPD) in 2007. This is a welcome step towards realizing the rights of the persons with disability. The UNCRPD proclaims that disability results from interaction of impairments with attitudinal and environmental barriers which hinders full and active participation in society on an equal basis with others. Further, the convention also mandates the signatory governments to change their local laws, to identify and eliminate obstacles and barriers and to comply with the terms of the UNCRPD in order to protect the rights of the person with disabilities, hence the amendments of the national laws. Hence, the Government of India drafted two important bill the Right of Persons with Disabilities Bill, 2014 (RPWD Bill, 2014) and Mental Health Care Bill, 2013 (MHC Bill, 2013). There is no doubt that persons with mental illness are stigmatized and discriminated across the civil societies, which hinders full and active participation in society. This situation becomes worse with regard to providing mental health care, rehabilitation and social welfare measures to persons with mental illness. There is an urgent need to address this issue of attitudinal barrier so that the rights of persons with mental illness is upheld. Hence, this article discusses shortcomings in the Right of Persons with Disabilities Bill, 2014 (RPWD Bill, 2014) from the perspective of persons with mental illness. Further, the article highlights the need to synchronize both the RPWD Bill, 2014 and Mental Health Care Bill, 2013 to provide justice for persons with mental illness.

Untreated Chronic Illness Blamed for High Mortality

A conceptual framework for the revision of the ICD‐10 classification of mental and behavioural disorders