India has one of the highest suicide death rates in the world—both in terms of people who attempt suicide and those who die. Unfortunately, a large number of them are young adults and women, mostly from rural India.
India is also home to one of the largest number of people suffering from various mental health problems ranging from simple anxiety disorders to schizophrenia. Although about 10 percent of our disease-burden is caused by poor mental health, it hasn’t received a fraction of the attention it deserves. Poor mental healthcare facilities, particularly in rural areas; lack of social awareness and efforts to mitigate the impact of chronic conditions; and poor commitment and capacity have made the lives of millions of Indians with some mental health issue utterly miserable.
However, the situation may get better if the government is able to pass a new mental healthcare bill in the next parliament session. Earlier this month, a Group of Ministers (GoM) gave its nod to the new bill. Concurrently, the allocation for mental health has also been raised in the Twelfth Plan.
The new mental health policy, along with increased allocation by the planning commission, can considerably transform the otherwise bleak situation in India despite the infrastructural, socio-cultural and capacity bottlenecks that need to be overcome.
Firstpost spoke to Vikram Patel, member of the policy group that drafted the national mental health policy, about what stirred the government to finally act and how the new bill will ensure better care for the mentally ill.
Patel is joint director of the London-based Centre for Global Mental Health and will head the Centre for Mental Health launched by the Public Health Foundation of India in New Delhi in September.
Excerpts from the interview:
Q: What do you think has led to the government finally waking up to its responsibilities on mental healthcare?
A: I think there are several factors. Firstly, it is evidence-based. The research from India shows how common mental health problems are, what its impacts on people’s lives are and increasingly how these can now be treated even in places where there are very few mental health professionals.
Secondly, in the last 10-15 years India has seen a transition in its epidemiological profile —from primarily infant, maternal health and infectious diseases to non-communicable diseases. As part of the latter, mental illnesses have become proportionately more important.
The third important factor is that there is a demand for better healthcare coming from civil society, people who are affected by mental illness and their families. Fourthly, the scandals of human rights abuses of people with mental illness, which are now prominently being reported in the media.
And finally, suicides. It is often in the news these days, especially in the context of farmers, and increasingly among others as well. Also, there is also a larger global concern about mental disorders in developing countries, which obviously will have an impact on Indian policy making.
Q: Is economics also a concern since mental health problems reduce productivity?
A: Yes, it is. Actually it is a very big concern. There are many different economic arguments. Firstly, having a mental illness profoundly influences the ability of a person to be economically productive. Secondly, certain mental illnesses exclude people from economic opportunities. Thirdly, there is enormous cost associated with caring for people with mental illness in terms of caregivers, who have to stop working, and cost of treatment.
Q: What do you make of the new mental healthcare bill? What significant advances does it make in terms of attitudes towards mental illness and management of mental healthcare?
A: First of all, it is a fantastic bill. It represents in my mind a radical improvement in the existing mental healthcare act. A key element of that difference is the word ‘care’. For the first time, in our country, we have a draft bill that actually entitles people – this is not true for any other health problem – to receiving care.
I think the draft mental healthcare bill if it goes through its legislative process will completely transform the idea of a government-led healthcare system, which is an entitlement for people with mental illness. Hopefully, it will form a model for other health problems as well.
And it is also consistent with the best mental healthcare legislations in developed countries around issues of capacity and consent, for example. It has many safeguards to ensure that the rights of people with mental illness are protected, including in rare situations when their capacity is so impaired that they may require involuntary care.
Q: Do you have any reservations about the bill?
A: Obviously, the biggest reservation is implementation. A key element here is safeguards for people with mental illness when they receive involuntary admission. The procedures are far superior to anything we have had before. The concern is how well will it actually be implemented in the real world. That is something which we need a keep a close watch on.
The clause about involuntary care has raised some concerns. It is in the nature of the area of work that there is no clear-cut rule if someone is able to give consent or not. There is a level of subjectivity here. You have to accept that. Under certain circumstances, people with mental illness will lose the ability or have a reduced ability to give an informed decision about treatment. The question is how do you judge that. And how do you ensure that when someone says they don’t want treatment that they have thought through the pros and cons. This Bill goes a long way in trying to ensure that people’s right to choose care is protected. But we have to acknowledge that in rare circumstances, people lose capacity and to deny them on the grounds of choice is to condemn them.