Mental Health Care Bill - Right to CONFIDENTIALITY OF DATA WITHHELD ?

.....And an audience to SEE your ‘care’ for FREE?


Once Individuals with serious mental illness enter the portals of the care centres defined as 'mental health establishments' in the Mental health Care Bill - which won’t be easy after all the legal documentation -> one would be offered a platter of treatments.
The Bill is silent on the kinds of treatments which would be offered. Also silent on a prescribed fundamental standard of care to meet the varying degrees of cognitive impairments and complex medical needs of individuals with serious mental illness.

Strange when the constitution of India one of the few constitutions in the world spells out ‘scientific temper.’
Most of the print and electronic media in India short of slobbering and falling at the Government of India’s feet has been hailing the Bill as a ‘revolution’ after constantly publishing photographs of bewildered individuals with mental illness foraging garbage, peeping through windows complacently from one of the forty Government Mental Hospitals in India or chained by their families and claiming that all the families in India who have a family member with Mental illness are ‘dumped’ in Tiger Reserves or out to get their property and this much before the Land Acquisition Bill was passed by our Parliament. Most of the print media have gone on to say that our government is benevolent and compassionate for being so generous to bestow our family members with serious mental illness ‘rights’. 

Somewhere it was missed out that yet another crucial right has been withheld. ->the Right to Confidentiality Data. So the case history, a source of great vulnerability for individuals with serious mental illness would be *poached*.

The Mental Health Care Bill –No Priority Right to Care for individuals with serious mental illness but priority...

cartels -mental health establishments with NO prescribed fundamental standard of Care...?

The Wayand district of Kerala where the Kabini river originates, is rich in biodiversity. The tribal population living in this district is surrounded by medicinal plants and they possess the traditional knowledge of their properties.

It stands to reason that the intense, overwhelming feelings of despair and hopelessness, precursors to dying by suicide would be averted if these plants had those properties to chase away those thoughts. If plucking leaves from medicinal plants and eating them was a remedy, most of the tribals would be alive today which is not what is happening; deaths by suicides are only increasing.

As reported in the print media which appeared in 
- The New Indian Express dated 08 September 2012 which is given below -
Tribal suicide rates escalate in Wayanad
Tribal suicides are increasing in Wayanad, thanks to the burgeoning economic distress among tribals. A majority of the tribals here are agricultural workers. In the 2011 survey, it was found that there was a dramatic decline in the total number of working days available in the agrarian sector. Out of the 43,428 men who got work, only 31.02 percent got work for more than 180 days. The number for women is a mere 10.55 percent. The drastic decline in paddy cultivation, the total area for which shrank from 30,000 hectare in 1980 to 7,000 by 2001, seems to have taken a heavy toll on the livelihood of these women. It is said that even the MNREGS could not attract many tribals. “The delay in the payment of wages made the tribals indifferent to the Centre’s flagship employment guarantee scheme,” an official said. “For many years, small scale farmers haven’t been able to do cultivation in a sustainable way. The tribal workers who depended on these farmers started migrating to neighbouring states in search of work. Migration may alter the tribal social fabric in myriad ways,” said E G Joseph, former joint director of the department of ST Development.

The Mental Health Care Bill which is in the website of the Rajya Sabha in CHAPTER I PRELIMINARY Defiinitions states that -

(o) “mental health establishment” means any health establishment, including Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy establishment, by whatever name called, either wholly or partly, meant for the care of persons with mental illness, established, owned, controlled or maintained by the appropriate Government, local authority, trust, whether private or public, corporation, co-operative society, organisation or any other entity or person, where persons with mental illness are admitted and reside at, or kept in, for care, treatment, convalescence and rehabilitation, either temporarily or otherwise; and includes any general hospital or general nursing home established or maintained by the appropriate Government, local authority, trust, whether private or public, corporation, co-operative society, organisation or any other entity or person; but does not include a family residential place where a person with mental illness resides with his relatives or friends;
It is relevant to note that- 
1. That no fundamental standard of care with the essential skills for giving care are prescribed for these establishments which is vital for the ongoing care of the vast majority of individuals with serious mental illness in India who are living with varying degrees of cognitive impairments and complex medical needs.

2. With powers being vested on all kinds of establishments through legislation, cartels of mental health establishments using the taxpayers’ money would be administering ‘herbal’ remedies through pills, teas, potions etc. before offering any empirical evidence and  peer review of their bioavailability, efficacy and safety.

3. This despite the fact that these remedies are not saving the lives of the tribal population of Wayanad in Kerala who are living amidst the rich flora and fauna of medicinal plants with traditional knowledge yet dying by suicide.
Links to –
1. Article in the New Indian Express
http://newindianexpress.com/states/kerala/Tribal-suicide-rates-escalate-in-Wayanad/2013/09/08/article1773911.ece
2.The Mental Health Care Bill as introduced in Rajya Sabha http://164.100.24.219/BillsTexts/RSBillTexts/asintroduced/Mentlcare-E%20I.pdf

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