ABSTRACT
Mental Health as defined by the World Health Organisation is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. The research paper aims to establish the need for awareness on this area and understand the social and legal status of the concept of mental health, it also aims to analyse the mental health laws and provides a few suggestions.
INTRODUCTION
Mental Health as defined by the World Health Organisation is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. The positive dimension of mental health is stressed in WHO’s definition of health as contained in its constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Mental health is an essential part of health. It can be explained as a process or a state of equilibrium that is defined by past and present antecedents, by personal resources, individual, social and other factors. Antecedent factors include factors such as genetics, pregnancy and birth, early childhood experiences, family background and set-up, social situations, education, financial position, environment etc. The state of mental health is reflected in our daily life and on our interaction with the outside world, the environment, the society and the culture that we exist in. The existing situation of mental health as secondary to physical health and the resulting neglect of mental health and its awareness are based on flawed assumptions about Mental Health. Authorities of Public Health tend to have a tendency to separate health into physical health and mental health which leads to mental health being neglected.
The reason there needs to be a research on this area is that there has been not much encouragement to research on this topic and there is a need to research about mental health and come up with evidence-based information to promote awareness for the same. The society views mental illness in a very negative light and is considered a taboo, this mentality needs to be changed as mental illness patients are treated as outcastes and disrespected in the society. This can be curbed or stopped only by way of awareness about Mental Health.
History
The written history of mental health and mental illness as a part of medicine, health services and community services is not as long as world medical history, although there are no reasons to assume that mental illnesses have never existed as a part of human reactions and suffering. Still, we do not know much about earlier ways and methods to treat and cure mental symptoms. Compared with the history of medicine the history of the treatment of mental illness is characterised by blatant societal prejudices, fear and antipathy, and the methods of treatment clearly derived from those negative feelings. The so-called Antipsychiatry Movement in the 1960s claimed that psychiatric illness is not medical in nature but social, political and legal; in other words, it was claimed that much of psychiatric illness is socially constructed. The movement itself, as romantic as it was, gave good reasons to study the legislation in many countries and supported the social medicine approaches used in psychiatric practice at that time. The dark side of modern psychiatry reveals that conditions in many of the vast asylums have been quite inhumane. Actually, it was more dangerous to reside in an asylum during the First and Second World Wars than to fight on the front. This was because of the high mortality due to starvation in the mental hospitals during wartime – the black-market food which saved lives outside the institutions did not reach the patients. History also tells about treatment methods which were at the time highly respected but which were later criticized.
History of Mental Health and its services in India
The ancient system of medicine in India, Ayurveda dates back to the 6th Century B.C and it recognized the importance of mental illnesses and its treatment. The religious and superstitious beliefs of the public had a strong impact on the day-to-day lives of the people. The people who deviated from the standard behaviour or acted strangely according to the societal norms were considered to be possessed by devils or demons. The cure for the same was rituals, ceremonies, sacrificial practices etc. Certain shrines, gained fame for the treatment of various mental diseases/illness and till date are famous for the same.
Alongwith the coming of the British in India, mental asylums were established, they were said to be built more for the protection of the community rather than the care and treatment of the mental patients. However, the situation got better with the Indian Lunacy Act,1912 which brought the mental asylums under central supervision and the state of mental asylums improved. Later, after India attained independence in 1947, the focus of the government was on the establishment of psychiatry wards in General Hospitals rather than separate Mental Hospitals and this shift in the focus from specific to general hospital, brought about a difference in the care and treatment of the mentally ill.
SOCIAL STATUS OF MENTAL HEALTH
The concept of witches, sorcery, black magic, etc., was understood and accepted in the 16th and 17th centuries. A belief in the evil power provided a demonological model of mental illness during that period. The acceptance of the demonological model paved the way for the formulation of appropriate therapeutic systems, e.g., the exorcism of the victim possessed by demons and other evil beings. Apart from occasional sensationalised cases reported in the media, belief in the demonological model of mental illness has declined significantly among the clergy and is virtually non-existent in the general population.
Malinowski asserted that all mental illnesses were culture-specific. It meant that each culture construed its own system of rules which people of that culture adhered to. Deviations from such societal rules are considered as forms of mental aberrations and were dealt with in culturally-appropriate ways., e.g., exorcism, social boycott etc. Thus, to comprehend mental illness in another culture it was essential to understand the rules, norms and assumptions which guided the individual and social behaviours of people in that culture.
In India, Mental Health of an individual is not focused on as much as it should be. Mental illness is viewed in a negative light. The mentally ill people are not properly taken care of and at the same time are mistreated. It is often noticed that mentally ill are abandoned by their family/relatives instead of admitting them to a mental rehabilitation. Mental institutions provide better chances for the mentally diseased to get better and reinstating them into the society as sound individuals. However, the treatment necessary for such people is never provided to them and they are let to suffer with it alone alongwith ill-treatment towards them by the society. Moreover, people who suffer from mental disorders, themselves are hesistant in talking about their problems as they fear society’s judgement and misconceptions, they fear isolation by society and thus, do not make an attempt to recognize their problems. Also, the people are believed to behave abnormally with the mentally-ill as most of them are under fear of being hurt by the mentally-ill and consider them to be a menace to the society. This mentality can be changed by way of awareness among the people of the society and removal of taboo around the concept of mental illness.
LEGAL POSITION OF MENTAL HEALTH
Mental Health Laws are of great importance as they are needed for the protection of rights and dignity of a person suffering from mental illness. Laws for the same are required to treat the mentally ill and to provide efficient healthcare services.
Effective mental health legislation can provide a legal framework to integrate mental health services into the community and to overcome stigma, discrimination and exclusion of mentally-ill persons.Legislation can also create enforceable standards for high quality medical care, improve access to care, and protect civil, political, social and economic rights of mentally-ill individuals, including a right of access to education, housing, employment and social security. Furthermore, mental health law can establish guidelines through which a country develops its mental health policy, or reinforce previously established mental health policies that seek to provide effective and accessible mental health care through the community.
In 1987, the Government passed the Mental Healthcare Act,1987 which had the objectives to establish central and state authorities for licensing and supervising the psychiatric hospitals, establish such psychiatric hospitals and nursing homes, provide a check on working of these hospitals, provide for the custody of mentally ill persons who are unable to look after themselves and are dangerous for themselves and or, others, protect the society from dangerous manifestations of mentally ill, regulate procedure of admission and discharge of mentally ill persons to the psychiatric hospitals or nursing homes either on voluntary basis or on request, safeguard the rights of these detained individuals, protect citizens from being detained unnecessarily, provide for the maintenance charges of mentally ill persons undergoing treatment in such hospitals, provide legal aid to poor mentally ill criminals at state expenses and change offensive terminologies of Indian Lunacy act to new soother ones.
However, this Act was implemented quite poorly and faced heavy criticism for various reasons like lack of accessibility to the mental healthcare services, no provision for community-based, the act does not adhere to the WHO guidelines, legal aspects are given far more considerations than medical aspects and there is no provision which educates the general public against the misconceptions regarding mental illness.
The Mental Healthcare Act,1987 was in much need of amendment and refurnishing due to its shortcomings. Thus, a new Bill was introduced recently, The Mental Healthcare Bill,2016 which became an Act in 2017.
The various provisions under the act are :
- Admission of person with mental disability; defines the process and procedure for admission, treatment, and following discharge of mentally ill persons.
- Rights provided to mentally-ill persons; this act provides mentally ill persons with rights against inhuman treatment, provides them with access to the mental health and legal services, right to good quality treatment and right to complain against deficiencies in provisions.
- Mental Health Set-ups; The government to set up the Central Mental Health Authority at national level and State Mental Health Authority in every state. Training to be provided to the law enforcement officials and medical officials on the provisions of the act.
- Responsibility on Police; the act imposes a duty on the police officers to report the matter to a magistrate in case he/she witnesses ill treatment of a mentally-ill person. Also imposes the duty on Police officials to take into custody any wandering person and send him/her for examination and and upon diagnoses of mental insanity, ultimately to a health institution for treatment.
- Advance Directive; This Act provides for advance directive which allows the patients to determine certain aspects of their treatment.
- Fine; the punishment for violating of provisions under this Act will be imprisonment up to 6 months or Rs. 10,000 one or both. Second time offenders to serve up to 2 years imprisonment or a fine of Rs. 50,000–5 lakhs or both.
- Decriminalises Suicide; The most positive aspect of this Act, is the decriminalizing of attempt to Suicide, as it states that whoever attempts to commit suicide will be assumed to be under depression or mental disturbance, and should not be punished for it as it would add to their mental disturbance. This Act reads down Section 309 of the Indian Penal Code which criminalized attempt to suicide earlier. Moreover, the act prohibits the electro-convulsive therapy without anaesthesia.
The Mental Healthcare Act,2017 has umpteen number of positive points but there still are a few shortcomings to the Act, according to me. Firstly, The Provision of Advanced Directive which allows the patient to choose certain aspects of treatment, is a little flawed as in cases of severely ill mental patients whose mental capacity is weak, cannot possible make sound decisions, the medical official in this case should have to use his/her discretion with regard to the treatment of such a patient. Second, the need for awareness on mental health has not been shed light on which, is a very essential move to be made by the legislature. Thirdly, the estimated expenditure required for the enactment of the law is not provided for. There is no disclosing of funds allocated for the same. Moreover, the implementation guidelines for this Act are vague, however, since the Act is recent it is too early to judge how the implementation will be carried out or is carried out.
Mental Health Institutions in India.
Mental health care is largely provided by the government. It is grossly inadequate considering that there are 20 million people needing care and facilities have only 25,000 beds. Such a lack of public facilities has encouraged the growth of a large number of private nursing homes. As the government sector has severe financial constraints on account of other health priorities, the voluntary sector has initiated a few mental health care programs. Psychiatric care is not covered by insurance or social security. However, most government centres provide care free of cost not only for inpatients and outpatients, but also for specialised services. Notable among these are programs for mental retardation, drug addiction, suicide prevention and psychogeriatric care. The three major providers of mental health care are institutions, aftercare services, and general hospital and community services. Institutional Care Forty one mental hospitals with 20,000 beds offer institutional care for the severely mentally ill. Most states have at least India one such institution. Initially planned for long term custodial care, these centres provide special clinics and outpatient care. The ratio of mental hospital beds is .025 per 1000 population in India, which contrasts significantly with the United Kingdom which has between 2.9-3.0 beds per 1000. The availability of most beds gets blocked by long-stay patients and much of the mental health budget is spent on maintaining the infrastructure. Health planners therefore discourage further mushrooming of such centres.
Mental Health Institutions are an intrinsic part of Mental Health and treatment of its illnesses. Efficient mental health institutions would ensure efficient treatment of mentally-ill persons and help them become a part of society again. However, the mental institutions in India are in a deplorable condition. The state of mental institutions is poor with such less facilities for the patients, they are not even provided with the bare minimum. The food provided to them is almost inedible, they do not have proper sanitation facilities, they are made to wear the same clothes for days together, they are chained and given shock treatments more times than the prescribed number, and treated like animals. The institutions are extremely unhygienic and overcrowded. The institutions are in such horrific condition that even people without mental illness would develop one.
According to a Newspaper Report, women and girls are admitted into mental institutions against their will, where they face physical and sexual abuse and are treated worse than animals. There are approximately 45 mental institutions in India out of which hardly 10% percent of it are in habitable condition. There needs to be a complete and drastic change of these mental institutions, it requires reforms desperately.
CONCLUSION AND SUGGESTIONS
I would like to conclude by pointing out that the state of mental health, mental institutions and the judgemental perspective of the society towards mentally-ill will not change unless there is a strict involvement of the Government authorities and science. There needs to be done thorough scientific research in the field of Psychiatry to understand how to treat the mentally-ill. As fas as the Law is concerned, the laws around Mental Health have been made better with the new Mental Healthcare Act of 2017, however, everything in the end boils down to efficient implementation of the laws, and the law being recent, it is too early to conclude whether it is efficient or not. Thus, if the Act of 2017 is implemented efficiently, it can bring out fruitful results in the existing state of Mental health. Coming to the social aspect, more than need for new laws, there is a need for change in mentality and attitude of the society towards the mentally-ill. The society needs to stop viewing the mentally-ill with a negative perspective, all that is required towards the mentally-ill is sympathy and care. This view can be changed through the spread of awareness with regard of mental health. In my opinion, the dilapidated conditions of mental health institutions can be improved by way of proper check and balances by the central and state authorities. The mental institutions should be checked at regular intervals for conditions of the institutions and its patients. Lastly, the people suffering from such illnesses should also come forward to recognize their problems and make an effort to treat it without fearing judgment by society.
BIBLIOGRAPHY
Websites-
• www.heinonline.com
• www.ncbi.nlh.nih.gov
• www.who.in
• www.westlaw.in
• www.prsindia.org
• www.indianjpsychiatry.com
• www.timesofindia.indiatimes.com
• www.oxfordhandbooks.com
• www.ijabmr.org
• www.libertatemagazine.com
• www.guardian.com
Acts-
• Indian Lunacy Act,1912
• Mental Healthcare Act,1987
• Mental Healthcare Act,2017
2018-9-25-1537847999