Mental health legislation: A journey back to "madhouses era?".

Abstract

Byline: James. Antony The authors of the Mental Health Bill-2013[sup][1] seem to think that the new Law would be a “Magna Carta” to liberate all the mentally ill, all over the country! Their logic appears to be that with the word “care” inserted in the title, the new Law would ensure that every mentally ill person in India would enjoy the Governments' benevolence! However, ground realities are far from this. In an earlier write-up, this scribe had discussed briefly about some serious hassles which might arise, because the Bill has such a wide and textbooklike definition of mental illness.[sup][2] The over-inclusive definition would lead to a situation where even those with “minor” disorders would get “stamped” as “mental.” And, as a result, their whole family would be forced to face many stigma-related problems all their lives. In this situation, people would be ready to forsake any Government favor rather than admit to having a family member with mental illness! Many authors have brought out their different viewpoints regarding the Mental Health Bill-2013.[sup][3],[4] Many criticisms remind us of the importance of definitions of various terms used in a legislation being very clear-cut and unequivocal. However with regards to the present Bill, the definition being over-inclusive is not its only problem. The very idea of going for a definition of “mental illness” rather than defining “persons with mental illness (PMI)” is itself not a desirable approach. “Illness,” being a nontangible concept, could be useful only in a clinical situation. In a Law, various enforcement agencies as well as others have to locate the “right” candidates and deal with them as per the provisions that are laid down. To make their task easy, it would have been better to pinpoint “PMI” by having a good definition for it. In mental health legislations, right from the beginning, this principle of going for tangible concepts used to be followed. Even the “Indian Lunacy Act,”[sup][5] which got enacted more than a century ago, has precise definitions of various terms. This ensured that the number of persons who got included as “mentally ill persons” was kept to the minimum. The big advantage is that it excludes from the preview of the Law not just those with “minor” disorders, but even many victims of “major” mental diseases. And, by that one measure, the 1912 law ensured that all of them could live with dignity, exactly the way all medically ill persons do, avoiding all stigma related hurts and humiliations. Though the Mental Health Act-1987 arrived as an improvement on the old law and has many positive aspects, unfortunately, it has some shortcomings as well. The inclusion, in the preview of the law, of private hospitals and nursing homes where psychotic patients are admitted with a bystander, is one such shortcoming. This has been pointed out along with critical comments on certain other inadequacies in that particular Law, way back in 2000.[sup][7] However, the authors of the present draft Bill have not cared to consider those criticisms, while drafting the new Bill. This issue of creating unnecessary problems by including private facilities where psychiatric patients are admitted, in the preview of the new Law, is also criticized in a recent writing.[sup][8] Even while defining mentally ill persons in a restrictive manner, thereby excluding as many persons as possible, it is essential to ensure a “legal umbrella”, for two clear-cut sub-groups of major psychotics. It is for their welfare as well as for the safety of the society. First, the legal cover is needed for “acute psychotics” who refuse treatment, even while being a threat to themselves or others. …