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The mental health care bill 2013: A disaster in the offing?

Byline: James. Antony The Mental Health Care Bill-2013 has an over-inclusive definition for mental illness. This will hurt a huge number of victims of even minor mental illnesses and their families, because of the wide prevalence of stigma. There is no mention about the huge resource-mobilization that is required to realize various promises that the Bill is holding out. Without penal provisions that would force them to act, Government functionaries are unlikely to extend various promised services to concerned beneficiaries. Nor could patients and their families seek relief through courts of Law. A better approach to realize various objectives of the Bill is to have a precise and restrictive definition for mental illness. That way, vast majority of victims of mental illness in the country would not be required to face stigma-related problems. Enforcement of the Law will be easy and such an elaborate machinery, with Mental Health Review Commission and District Mental Health Boards, would not be required. Also, issues like "Competence" and "Advance Directive" will not be relevant any more. It is undesirable to have too many controls on the professional functioning of psychiatrists. By strengthening the State Mental Health Authorities properly, all good objectives envisaged in the Bill can be achieved. The "Mental Health Care Bill-2013" has already been cleared by the Parliamentary Standing Committee. Unfortunately, they have cleared it without remedying many defects and retaining many counter-productive provisions. In its present form, the Bill would have a negative impact on the future delivery of mental health care in the whole country. Unless mental health professionals in India take some effective action collectively and cure many serious deficiencies in this Bill, at least at this late stage, its repercussions on the future practice of psychiatry in this entire country would be terrible. The purported objective of the new Law is to provide remedy all inadequacies in the field of mental health and protect mentally ill persons. For this, the primary strategy adopted by the authors of the Bill is to have an over-inclusive definition for "mental illness." The one given in chapter I, section 1[r], of the Bill is a very broad one and is more like definitions given in textbooks or classification manuals. [sup][1] Based on this sweeping definition, the figure is just mind-boggling: On a modest estimate, at least 15% of the population or over 19,50,00,000-[195 million] persons in the country have a "mental illness"! Even persons with minor mental ailments are to be deemed as having "mental illness," as per the proposed Law! Further, in chapter II section 3[2] the Bill advocates to follow "internationally accepted medical standards" for "case-finding." [sup][1] These two positions taken in the Bill, namely an over-inclusive definition along with its liberal method of "case-finding," makes one think that the authors of the Bill believe that just by bringing in more persons into the "mental illness-group," their plight would improve! But unfortunately, this stand is diametrically opposite to that of the well-established position of professionals as well as policy-makers all over the world, on this issue. The widely accepted stand in this field is that a tag of "mentally ill" should be given only to the least number of persons! Such a restrictive view about mental illness is taken by thoughtful people all over the world based on their awareness about various "stigma-related" issues in the field of mental-health. Even in these modern times, once a person gets the label of "mental patient" he is treated as an outcast not just by the public, but even by governments! For the victim, that label would destroy his very sense of identity deep inside. And the family would go to any length, just to avoid others knowing it! They would keep away from institutions and even doctors who are known to treat mental illnesses! …