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Towards a new mental health act for India
Asian Journal of Psychiatry 6 (2013) 82
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Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Letter to Editor Towards a new mental health act for India The mentally unwell often need to be admitted to a psychiatric hospital against their will for their own safety and/or that of others. This often necessitates the use of provisions under a mental health act (MHA). The current Indian Mental Health Act (1987) is an upgrade on the earlier Indian Lunatic Act of 1912 (Narayan et al., 2011). While a lot of changes were made in this new act, it still draws considerable flak from both practitioners of psychiatry and public at large (Kala and Kala, 2007). The Government of India has now initiated the process of drafting a new MHA to align with the United Nations Convention on the Rights of people with Disabilities, to which India is a signatory. One mode of involuntary admission in the current MHA is through magisterial ‘Reception Order’ (RO). RO is issued by a magistrate on application by close family member or the police, if a mentally ill person is subjected to cruelty or not under proper care and control (The Gazette of India). In a recently concluded project we have assessed the profile and clinical outcomes of patients who get admitted through this process and the efficiency of the process itself. We found that ROs appear to reliably serve the purpose of getting overtly mentally ill persons who are not under proper care into the mental health care system. However, the absence of any provision for periodic review after such admission means that patients can languish in mental hospitals for years even after remission, leading to grave human rights violation. We also found that mentally sound, poor and homeless people could inadvertently get admitted into mental hospitals through this process, in the absence of appropriate social security for such people. The criteria’s for involuntary admissions have a lot to do with the time when the particular Act was drafted. Before effective treatment for mental illness became available the emphasis was on containment rather than treatment using the ‘‘unsoundness of mind’’ approach (Thornicroft, 2006). The new MHA will have to be based on the principles of capacity assessment, as recommended by the WHO, as it respects the patients’ right to choose but at the same time permits ‘‘soft’’ paternalism when decision-making is impaired (Fistein et al., 2009). We believe that legislation which is
1876-2018/$ – see front matter ß 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajp.2012.06.004
overtly paternalistic in approach has to be discouraged as it undermines individual autonomy. The new MHA will have to consider more safeguards to prevent misuse of involuntary admissions. While there is scope to reduce the role of the judiciary to the minimum, a system to monitor involuntary admissions should be considered, in order to safe guard the rights of the mentally ill. Finally we conclude that the RO is a useful provision in the current MHA, allowing for treatment of patients with mental illnesses who would otherwise have been neglected but it does little to address the issue of continuity of care and revolving door patients. We hope that the new MHA will address these issues. References Fistein, E.C., Holland, A.J., Clare, I.C.H., Gunn, M.J., 2009. A comparison of mental health legislation from diverse Commonwealth jurisdictions. International Journal of Law and Psychiatry 32, 147–155. Kala, K., Kala, A.K., 2007. Mental health legislation in contemporary India: a critical review. International Psychiatry 3, 69–71. Narayan, C.L., Narayan, M., Shikha, D., 2011. The ongoing process of amendments in MHA-87 and PWD Act-95 and their implications on mental health care. Indian Journal of Psychiatry 53, 343–350. The Gazette of India. The Mental Health Act, 1987. Government of India. Thornicroft, G., 2006. Shunned. Discrimination Against People with Mental Illness. Oxford University Press, Oxford.
Anil Rane* Institute of Psychiatry & Human Behaviour, Goa, India Abhijit Nadkarni London School of Hygiene & Tropical Medicine, London, UK *Corresponding author E-mail address: [email protected] (A. Rane)
3 June 2012
Contents lists available at SciVerse ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Letter to Editor Towards a new mental health act for India The mentally unwell often need to be admitted to a psychiatric hospital against their will for their own safety and/or that of others. This often necessitates the use of provisions under a mental health act (MHA). The current Indian Mental Health Act (1987) is an upgrade on the earlier Indian Lunatic Act of 1912 (Narayan et al., 2011). While a lot of changes were made in this new act, it still draws considerable flak from both practitioners of psychiatry and public at large (Kala and Kala, 2007). The Government of India has now initiated the process of drafting a new MHA to align with the United Nations Convention on the Rights of people with Disabilities, to which India is a signatory. One mode of involuntary admission in the current MHA is through magisterial ‘Reception Order’ (RO). RO is issued by a magistrate on application by close family member or the police, if a mentally ill person is subjected to cruelty or not under proper care and control (The Gazette of India). In a recently concluded project we have assessed the profile and clinical outcomes of patients who get admitted through this process and the efficiency of the process itself. We found that ROs appear to reliably serve the purpose of getting overtly mentally ill persons who are not under proper care into the mental health care system. However, the absence of any provision for periodic review after such admission means that patients can languish in mental hospitals for years even after remission, leading to grave human rights violation. We also found that mentally sound, poor and homeless people could inadvertently get admitted into mental hospitals through this process, in the absence of appropriate social security for such people. The criteria’s for involuntary admissions have a lot to do with the time when the particular Act was drafted. Before effective treatment for mental illness became available the emphasis was on containment rather than treatment using the ‘‘unsoundness of mind’’ approach (Thornicroft, 2006). The new MHA will have to be based on the principles of capacity assessment, as recommended by the WHO, as it respects the patients’ right to choose but at the same time permits ‘‘soft’’ paternalism when decision-making is impaired (Fistein et al., 2009). We believe that legislation which is
1876-2018/$ – see front matter ß 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajp.2012.06.004
overtly paternalistic in approach has to be discouraged as it undermines individual autonomy. The new MHA will have to consider more safeguards to prevent misuse of involuntary admissions. While there is scope to reduce the role of the judiciary to the minimum, a system to monitor involuntary admissions should be considered, in order to safe guard the rights of the mentally ill. Finally we conclude that the RO is a useful provision in the current MHA, allowing for treatment of patients with mental illnesses who would otherwise have been neglected but it does little to address the issue of continuity of care and revolving door patients. We hope that the new MHA will address these issues. References Fistein, E.C., Holland, A.J., Clare, I.C.H., Gunn, M.J., 2009. A comparison of mental health legislation from diverse Commonwealth jurisdictions. International Journal of Law and Psychiatry 32, 147–155. Kala, K., Kala, A.K., 2007. Mental health legislation in contemporary India: a critical review. International Psychiatry 3, 69–71. Narayan, C.L., Narayan, M., Shikha, D., 2011. The ongoing process of amendments in MHA-87 and PWD Act-95 and their implications on mental health care. Indian Journal of Psychiatry 53, 343–350. The Gazette of India. The Mental Health Act, 1987. Government of India. Thornicroft, G., 2006. Shunned. Discrimination Against People with Mental Illness. Oxford University Press, Oxford.
Anil Rane* Institute of Psychiatry & Human Behaviour, Goa, India Abhijit Nadkarni London School of Hygiene & Tropical Medicine, London, UK *Corresponding author E-mail address: [email protected] (A. Rane)
3 June 2012