The Mental Health Bill, 2013, lays emphasis on the rights of the mentally-ill, a much-neglected sector in the country. Up for discussion in the Winter Session, the Bill seeks to replace the archaic Mental Health Act, 1987, which had, for so long, given legal backing to electroconvulsive, or shock, therapy for children. The Bill aims to give patients the required access to healthcare funded by the government. It also offers protection from inhuman treatment, besides free legal services. Psychiatrist and physician Shyam Bhat, founder of technology-driven counselling and psychotherapy centre Seraniti, speaks to Nikita Puri about the Bill and state of mental healthcare in India. Excerpts:
What are the most common types of mental disorders you see?
The most common issues faced include depression in its various forms, from minor to major, along with anxiety disorders, relationship issues, and substance abuse.
Many people live unconsciously with the subtle toxicity of shame and "conditional self acceptance", the idea that you are a valuable and worthy human being only if you achieve or get something from others - high marks on exams, a good college, finding perfect love and acceptance from another- is an antidote to the lack of self-acceptance. What is needed then is prevention. Every school in India today needs to teach its students emotional intelligence and emotional self-management.
A study recently conducted by the National Institute of Mental Health and Neurosciences shows that nearly 150 million people in the 12 states surveyed require active intervention. Would you agree that since most disorders go undiagnosed, the number may be much higher than we estimate it to be?
It's hard to know the exact prevalence of mental issues in our country. But the issue is that there is no biological test for depression or anxiety, and diagnosis, and therefore prevalence, depends on the criteria and threshold for diagnosis. The prevalence rates have ranged from as low as 9 per cent to as high as 36 per cent. Having said that, conservatively, at least 200 million people in India would be suffering from anxiety, depression or another common mental disorder.
The Bill requires for mental health services in every district with all facilities. As good as that provision may be on paper, are we really equipped with the large number of professionals required to be present in these facilities?
There is a major deficiency of mental health professionals in the country. Although social workers and other frontline workers can take care of some of the first-line needs when supervised by psychiatrist and psychologist, India definitely needs more psychologists and psychiatrists. At this point, our country has a total of 6,500 psychiatrists for 1.2 billion people, which is woefully inadequate. (On the upside, the Bill calls for a ban on electroconvulsive therapy for minors; it will be allowed for adults only with the use of muscle relaxants and anaesthesia. It also calls for providing medical insurance for the mentally-ill and decriminalising suicide attempts for those considered to be unwell at the time. More than 135,000 people commit suicide in India every year, and as many as 20,000 of them end their life because of heartbreak, says Bhat, the author of How to Heal Your Broken Heart: A Psychiatrist's Guide to Dealing With Heartbreak.)
The Bill, with a feature called 'advanced directives,' allows for the opportunity to nominate representatives to take major decisions on behalf of the patient -such representatives need not be family. Is this progressive?
The provision for advanced directives is a welcome one since it is required in a few circumstances - sometimes, a severe mental illnesses can compromise a person's judgement and the ability to make informed decisions.
Are there chances of this provision being misused? Also, since according to this Bill, those decisions can also be challenged by a quasi-judicial board of members, would it undermine the purpose of advanced directives?
Yes, as with any law, there is the potential for misuse in this case also and in order to prevent this, an independent review board is required. Having such a board is vital and extremely important to ensure that there is no misuse of advanced directives and to ensure that rights of the patient are protected.
