The Mental Health Care Bill 2013: When Legislation for Individuals with serious Mental Illness becomes too conforming, rigidly locked

.....in the 'economic' language of 'Rights'.

In Chapter I PRELIMINARY in 2(d) in the Mental Health Care Bill 2013, the definition of a ‘caregiver’ is-

“care-giver” means a person who resides with a person with mental illness and is responsible for providing care to that person and includes a relative or any other person who performs this function, either free or with remuneration;

This definition holds mostly for –

“commercial", ‘paid’ caregivers working in Government /Private Hospitals, private ‘establishments’, for resource rich families, for people equipped with finances, researchers as volunteers for research studies, students as volunteers for a resume for college admissions abroad or for altruism have been all covered and bunched together with a… ‘relative’.

A commercial approach to the definition of a caregiver - as these commercial caregivers do not ‘live’ together in the same household and share the same kitchen as ‘family caregivers’ do.

To codify that all individuals with serious mental illness need spaces away from their families would be discrediting the diversity of 'care' they need which will not alleviate the tremendous suffering that these illnesses bring.


'Family Caregivers' of loved ones with a serious mental illness considered as 'externalities' by economists despite providing the bulk of the long-term ongoing care in India and not computed in its GNP?

Mental Health Care Bill 2013: When Legislations for Individuals with Serious Mental Illness in India are based on mistrust and the presumption..

...that all their families have the sole intent of stripping them of their movable and immovable assets. 
 
The Mental Health Care Bill 2013 is going to add to the miseries of the majority of the families in India who are giving a rich quality of care with little resources - with the added expenses for travelling for legal documentation for seeking treatments for their loved ones and for the flood of impending litigations because of the inherent trust in authority by the people of India.

The individual impacted the most in the family will be the one with a serious mental illness. Individuals with Cancer after chemotherapy which has terrible side-effects need to keep away from public places to avoid infections. Individuals with serious Mental Illness need an environment of peace without any conflict to heal after the treatments begin. Just as care is crucial after treatments for Cancer so it is for serious Mental Illness.

During the Consultative Process of making the Mental Health Care Bill 2013 the Government representatives and their legal advisers met numerous family care givers who spoke out their concerns and their willingness not to stand in the way of any of the rights of their loved ones with severe mental illness.

It is unfortunate that somewhere along the way there crept in the creators of the Bill - an intolerance to accept the social structure of the family in India.
 
"There are 65 million Indians with serious mental illnesses like Schizophrenia, Bipolar disorder, Major depression…’ 
– states the report by National Commission on Macroeconomics and Health, Ministry of Health & Family Welfare, Government of India, New Delhi in August 2005

The Press Information Bureau release in August 2013 titled State-of-the-Art  Mental Hospital states –“there are ‘40 State run Mental Hospitals’. 

It is relevant to point out the following-

(a) That the numbers of patients in these hospitals who have not been reunited with their families are less than 2000.

(b) All the remaining millions of individuals with serious mental illness are not homeless.

(c) Where are they? Where else but living with their families.

Serious Mental Illnesses become chronic due to delay in treatments. With ongoing treatments, ongoing care is vital for individuals with serious mental illnesses to resume their daily activities and return to their education and/or employment to lead a life with purpose.

This crucial ‘informal’ care is being provided by members of families. The immense contribution of the 'family caregiver' in providing ‘informal’ care since India’s independence without laying stakes to their own Rights which the State is obligated to provide -> has not been acknowledged, recognized or defined in the Mental Health Care Bill 2013. Strange when there is an acute shortage of health care workers In India. 

The Vice President of India, Shri M. Hamid Ansari in his Address at the 16th Convocation of National Institute of Mental Health and Neuro Sciences at Bangalore stated the following-  
"Currently India has five psychiatric nurses per ten million population to the global figure of 200; 
three psychologists per ten million population to the global figure of 60; and
three social workers per ten million population to the global average of 40;" 


Extremely strange too that the following exhortations of 
The UN Convention of the Rights of Persons with Disabilities (UNCRPD) have been disregarded especially when the objective of the Mental Health Care Bill is to be in consonance with the UNCRPD.

(i) ‘recognizes the need to promote and protect the human rights of all persons with disabilities including those who require more intensive support.’

(ii) ‘That the family is the natural and fundamental group unit of society and is entitled to protection by society and the State and that persons with disabilities and their family members should receive the necessary protection and assistance to enable families to contribute towards the full and equal enjoyment of the rights of persons with disabilities.’

Links:
1.State-of-the-Art Mental Hospitals
http://pib.nic.in/newsite/PrintRelease.aspx?relid=98101 

2.Shortage of health care workers:Vice President http://pib.nic.in/newsite/erelease.aspx?relid=79749

BBC & Down to Earth reporting Mental Health Care Bill - engaging in Antilocution of Mothers/family in India.

"Since patients are looked after at home there is no burden on the State" states the first report on the Statistics of Mental Health in independent India issued by the Government in 1970.

Recent reporting in the media about the Mental Health Care Bill has been subjective through anecdotes and Government hand-outs. Examples of these in the international and Indian media reporting are given in these links - http://www.bbc.co.uk/programmes/p018vhb  http://www.downtoearth.org.in/content/troubled-beautiful-minds They reinforce negative stereotypes of mothers family caregivers and families in India who have children and family members with serious mental Illness. The Indian report appears in a publication headed by a scientist has gone to the extent of referring to Schizophrenia, a serious disabling brain illness as an ‘eccentricity’.
 
The first report on the Statistics of Mental Health in India issued in 1970 by the Central Bureau of Health Intelligence (CBHI) which comes under the Ministry of Health and Family titled - ‘Mental Health in India’ by S K Sen Gupta and D R Chawla stated – “There were 38 Mental Hospitals in 1969 with 17,906 beds. There were 10 Child Guidance Clinics in these hospitals. Mental Illness is common among the poorest – 89 percent of the inpatients belonged to the income group of Re 1 to Rs. 100 per month. The incidence of Mental Illness is said to 2 per 1000 of population.’

So the economically poor were seeking medical help in Mental Hospitals after India’s independence from 1947-1969. The report has also stated that a small number of patients are incurable and have to stay in Mental Hospitals. Why the Central Bureau of Health Intelligence (CBHI) an organization which still exists, has stopped investigating and reporting about Mental health in India has not been mentioned, investigated or even analyzed in the BBC and Down to Earth reports is a mystery.

Today there are 38 Mental Hospitals in India, same as in 1969. ‘Since patients are looked after at home there is no burden on the State ‘– states Mental Health in India in 1970. BBC and Down to Earth reports fail to mention what are the costs of giving care to each patient living in these 38 Mental Hospitals run by the Government with its retinue of workers. Mothers /family caregivers struggle to nurture and assist amidst the increasing inflation with no medical insurance so that their loved ones with serious mental illness can resume their daily activities and go back to studying or working which is so essential to lead a life with some meaning and purpose.
 
Instead of including Mothers and Family Caregivers of individuals with serious mental illness in the Mental Health Care Bill they have been excluded by the Government and there is the Antilocution of Mothers and families in such  media reports using the bogey of human rights. Missing is the fact that there is already a violation of human rights of mothers and family care givers of individuals with severe mental illness due to neglect by successive Governments to assist them in the care process of their ‘disabled children/family member' which is the State’s obligation as per the Human Rights Instruments in the UN conventions which India has ratified.

Both BBC and Down to Earth are silent on Ayurveda, Yoga, Unani, Siddha, Homeopathy, Naturopathy practitioners being vested with the power to run Mental Health Establishments for individuals with severe mental illness as per the definition of medical-officer-in-charge and medical practitioner given in the Mental health Care Bill. They have not questioned authorities as to why the bill is silent on the standard of care which is crucial with treatments for severe disabling mental illnesses like schizophrenia, bipolar disorder, major depression in these establishments. The promotions of  such establishments which would be guzzling enormous amounts of taxpayers money as the bill veers sharply from the  road to Mental Health Care to filling the coffers of such establishments has not even been addressed.

Mental Health Care Bill - No Science-based treatments for Severe Mental Illness?

Ayurveda, Yoga, Unani, Siddha, Homeopathy, Naturopathy practitioners vested to run Mental Health Establishments for individuals with severe mental illness.

Given below are Sections of the Mental Health Care Bill, available on the website of the Ministry of Health and Family Welfare, Government of India-



(m) “Medical-officer-in-charge” in relation to any mental health establishment means the psychiatrist or medical practitioner who for the time being, is in charge of that mental health establishment. (Clause ( j) of Mental Health Act )

(n) Medical practitioner means a person who possesses a recognized medical qualification-

102 of 1956 (i) As defined in Clause (h) of Section 2 of the Indian Medical Council Act 1956 and whose name has been entered in the State Medical Register, as defined in Clause (k) of that section; or

48 of 1970(ii) as defined in clause (h) of sub section (1) of section 2 of the Indian Medicine Central council Act, 1970 and whose name has been entered in a State Register of Indian Medicine, as defined in clause (j) of sub-section (1) of that section; or

59 of 1973 (iii) as defined in Clause (g) of sub-section (1) of Sec. 2 of the Homoeopathy Central Council Act, 1973 (59 of 1973), and whose name has been entered in a State Register of Homoeopathy, as defined in Cl. (I) of sub-section 1) of that section; or

48 of 1970 (iv) in ayurveda, yoga, unani, siddha,homeopathy or naturopathy, registered under the Indian Medicine Central Council Act, and working in the field of “Manas Rog” having a postgraduate degree in “Manas Rog”. 



What are the Science-based treatments which these practitioners would use on individuals with severe mental illnesses: Bill silent

What is the standard of care which is crucial along with treatments: Bill silent



Link to Bill:  http://mohfw.nic.in/WriteReadData/l892s/MHC%20BILL%20SCAN%20%28Chapter%20I%20-%20II%29-90558705.pdf#page=9&zoom=125,0,480

Clause k -Incorporated in the new Mental Health Care Bill - vesting powers in all kinds of practitioners?

Clause k of Mental Health Act 1987

k. "medical practitioner" means a person who possesses a recognised medical qualification as defined -

i. in Cl (h) of Sec 2 of the Indian Medical Council Act, 1956 (102 of 1956), and whose name has been entered in the State Medical Register, as defined in Cl. (k) of that section;

ii. in Cl (h) of sub-section (1) of Sec. 2 of the Indian Medicine Central Council Act, 1970 (48 of 1970), and whose name has been entered in a State Register of Indian Medicine, as defined in cl (j) of sub-section (1) of that section; and

iii. in Cl. (g) of sub-section (1) of Sec. 2 of the Homoeopathy Central Council Act, 1973 (59 of 1973), and whose name has been entered in a State Register of Homoeopathy, as defined in Cl. (I) of sub-section 1) of that section;