Time to face new realities; mental health care bill-2013

Abstract

Byline: Anirudh. Kala A young man has been brought by the family and got admitted with history of marked insomnia, excitement, violence, being boisterous, and spending away to an impending ruin. He demands to be released since is fine and does not need any treatment. Familiar so far? If the Mental Health Care Bill, 2013, tabled in the Rajya Sabha on the 19 [sup]th August, 2013, is passed by the parliament,which is likely, following will be a routine continuum of the above scenario. The patient is offered a chair and explained about the concept of 'supported admission', which is the new and politically correct name for 'involuntary admission'. He is given a phone number to call if he has any objection to being admitted. The phone rings in the office of the district mental health review panel and somebody listens carefully, jots down details, and reassures the patient that a team will visit shortly and look into this matter. The team, which is actually a judicial body headed by a former district judge does visit the hospital, conducts a court hearing, and decides whether the patient needs to continue staying in the hospital or not. If the decision is in patient's favor, he will be allowed to go home. Welcome to the world of post admission judicial review. All involuntary admissions, in all Mental Health Establishments, which is the new name for any and all such places, wherever a person with mental illness is admitted even for a day, whenever challenged by the patient; will undergo a review by panels of Mental Health Review Commission, which will be located at district levels. Theoretically, family as well as the psychiatrist can appeal against the decision, but appeal against the panel lies with the high court, which would mean several visits to the state capital and whatever else is involved in going in an appeal to a high court including costly lawyers. Psychiatrists who have worked in the West will find some similarities in it to the system of Mental Health Tribunals. The provision in principle is undoubtedly progressive. After all we are talking about civil detention and curtailing patients' most basic right, that is, liberty; and so, a review if asked for by the patient, should be possible. It will also take care of an occasional complaint that patients file with the police, who having no sensitization about situations associated with severe mental illness, are sometimes a source of considerable trouble to mental health professionals. The mainstream judicial system is equally incapable of handling such complaints because of lack of sensitivity and also being clogged with a huge pendendency of mainstream cases. But are we, as a society ready for this large scale, countrywide post admission review in almost all cases of involuntary admissions? Because let us face it, all patients who are admitted involuntarily believe that they do not need admission; that is why, it is involuntary admission in the first place? A cynic would say that it would officialize, bureaucratize, and stigmatize mental illness even more. Terms like 'feasibility', 'ground reality', and 'administrative bottle-necks blocking access'; reflexely come to mind. More importantly, in a country where families bear the total burden of mental illness, and constitute by far the largest manpower resource in treating mental illness in an otherwise resource strapped country, such a step would put families and patients on the opposite side of the legal fence, as adversaries and push a wedge between the two. It is argued that it will sabotage goodwill and bonding, and make families less willing to be as proactive in the treatment of their wards as at present, which will be an unmitigated disaster. In an ideal world, the state should be in a position to support treatment and rehabilitation of the mentally ill, so that dependence on families is minimized, but that does not seem to be happening very soon. …