No abstract

The Mental Health Care Bill – 2013 has been introduced in Rajya Sabha and is now waiting for enactment. The Bill entails unprecedented measures to be undertaken by the Government ensuring everyone right to access mental health care and treatment from services run or funded by the Government. The Government is to meet the man-power requirement of mental health professionals according to international standard within a period of ten years. Various rights of persons with mental illness have been ensured. All the places where psychiatric patients are admitted and treated including the general hospital psychiatry units (GHPU) are to be registered as mental health establishments. Unmodified ECT has been banned and ECT to minors can be given only after approval from the Mental Health Review Board. This article advocates for exemption of GHPU from the purview of the Bill, taking into consideration impediment created in the treatment of vast majority of psychiatric patients who retain their insight into the illness and seldom require involuntary admissions. It is also advocated to reconsider ban on unmodified ECT and restriction placed on ECT to minor which are very effective treatment methods based on scientific evidence. In our country, family is an important asset in management of mental illness. But requirement of seeking approval from the Board in many of the mental health care decision may discourage the families to be proactive in taking care of their wards. The Board and Mental Health Authorities at the central and the state levels are authorized to take many crucial decisions, but these panels have very few experts in the field of mental health.

Purpose India’s Mental Healthcare Act 2017 provides a right to mental healthcare, revises admission and review procedures, effectively decriminalises suicide and has strong non-discrimination measures, among other provisions. The purpose of this paper is to examine Indian mental health professionals’ views of these changes as they relate to stigma and inclusion of the mentally ill. Design/methodology/approach The authors held nine focus groups in three Indian states, involving 61 mental health professionals including 56 psychiatrists. Findings Several themes relating to stigma and inclusion emerged: stigma is ubiquitous and results in social exclusion; stigma might be increased rather than remedied by certain regulations in the 2017 Act; stigma is not adequately dealt with in the legislation; stigma might discourage people from making “advance directives”; and there is a crucial relationship between stigma and education. Practical implications Implementation of India’s 2017 Act needs to be accompanied by adequate service resourcing and extensive education, including public education. This has commenced but needs substantial resources in order to fulfil the Act’s potential. Social implications India’s mental health legislation governs the mental healthcare of 1.3bn people, one sixth of the planet’s population; seeking to use law to diminish stigma and enhance inclusion in such a large country sets a strong example for other nations. Originality/value This is the first study of stigma and inclusion since India’s 2017 Act was commenced and it highlights both the potential and the challenges of such ambitious rights-based legislation.

Context:The mental healthcare act 2017 represents a complete overhaul of Indian mental health legislation.Aims:The aim of this study was to establish the opinions of Indian psychiatrists regarding the new act.Settings:Mental health professionals in Bihar and Jharkhand were interviewed.Design:A focus group design was utilized.Materials and Methods:Key questions explored the positive and negative aspects of the act and the management of the transitional phase. All focus groups were recorded and transcribed.Analysis:Data were coded and analyzed using an inductive approach.Results:Many positive aspects of the new legislation were identified especially relating to rights, autonomy, and the decriminalization of suicide. However, psychiatrists have significant concerns that the new legislation may negatively impact patients and increase stigma. Psychiatrists held varying views on the proposed licensing and inspection of general hospital psychiatric units.Conclusions:Careful evaluation of the new legislation is needed as the concerns raised warrant ongoing monitoring.

Although there was a rich tradition of legal system in Ancient India, the present judicial system of the country derives largely from the British system and is based on English Common Law, a system of law based on recorded judicial precedents. Earlier legislations in respect of mental health were primarily concerned with custodial aspects of persons with mental illness and protection of the society. Indian laws are also concerned with determination of competency, diminished responsibility and/or welfare of the society. United Nations Convention for Rights of Persons with Disabilities (UNCRPD) was adopted in 2006, which marks a paradigm shift in respect of disabilities (including disability due to mental illness) from a social welfare concern to a human right issue. The new paradigm is based on presumption of legal capacity, equality and dignity. Following ratification of the convention by India in 2008, it became obligatory to revise all the disability laws to bring them in harmony with the UNCRPD. Therefore, the Mental Health Act – 1987 and Persons with Disability Act – 1995 are under process of revision and draft bills have been prepared. Human right activists groups are pressing for provisions for legal capacity for persons with mental illness in absolute terms, whereas the psychiatrists are in favor of retaining provisions for involuntary hospitalization in special circumstances.