The Hindu : National : Needed: new Mental Health Act

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Sunday, Jan 30, 2005

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Needed: new Mental Health Act

By Seshadri Harihar and Hiramalini Seshadri

We need a new Mental Health Act — this was brought into sharp focus by the tsunami. Three tsunami victims with acute worsening of their psychotic illness were rushed to a private nursing home near Cuddalore. It was with great reluctance that the nursing home agreed to admit them and a psychiatrist came forward to treat them. The reason? The nursing home did not have the licence to treat the mentally ill; both the hospital and doctor risked losing their right to practise for though they occupied the moral high ground they were acting illegally and could be prosecuted under the Mental Health Act (MHA). Post-Erwadi, in many parts of India, the draconian implementation of the MHA has been a hindrance to public health; for example, in Chhattisgarh the health authorities demanded that the outpatient clinic of a psychiatrist be shut, as he did not have the licence under the MHA!

Fundamental flaws

Although a great improvement on its predecessor, the 1902 Lunacy Act, the MHA of 1987 suffers from some fundamental flaws. First, it appears to have been drafted on the basic premise that the mentally ill are violent, that they are a danger to themselves and others, that mental illness is incurable and that the subject loses his/her reasoning and power of judgment and therefore loses his/her fundamental rights under the Constitution. Today, about two decades later, we know that mental illness is just like any other illness.

It is due to chemical disturbances in the brain which can be picked up by sophisticated scans and corrected with pharmacological treatment and an understanding, loving supportive milieu which itself helps the brain correct its chemistry.

In a majority of cases all the symptoms can be brought under control just as in the case of diabetes, hypertension, etc., In many cases, a total cure too can be achieved and we have today any number of doctors, lawyers, bankers, accountants, businessmen, teachers, farmers, housewives and students all functioning normally and doing their jobs while taking medicines for mental illness, just like diabetics, hypertensives and asthmatics.

Patients with mental illness therefore should have the same rights as other patients; for example, the right to get admitted to any hospital of their choice and be treated by a psychiatrist of their choice.

The MHA condemns them to be admitted only in psychiatric hospitals.

Most mental illnesses can be cured or controlled in less than 90 days and the patients continue to keep well with medication.

But under MHA these patients risk losing their fundamental rights guaranteed by the Constitution. This has to change.

The MHA provisions are needed only for the five per cent who remain chronically mentally ill despite treatment and need to be protected from exploitation by unscrupulous elements.

Private sector has a vital role

A second basic flaw with the MHA 1987, is that it is totally divorced from reality; and perhaps this is so because it was drafted by law-givers and government psychiatrists who were probably not in touch with the ground realities in private psychiatry. Importantly, it is the private sector hospitals which cater to the bulk of the mentally ill needing hospitalisation.

As in all branches of medicine, in the field of psychiatry also the private sector has more hospital beds than government; the government psychiatric beds nationwide number 20,000 while in the private sector there are around two lakh psychiatric beds.

The MHA is very lax on government general hospitals and mental hospitals; but it bars private nursing homes from treating the mentally ill and to get a licence empowering one to run a private hospital for the mentally ill one has to satisfy impossible criteria. For example, one clinical psychologist has to be there for every 10 beds. India has only 700 psychologists! In other words, most of the mentally ill being treated today in private nursing homes are being treated ``illegally''! This has grave connotations from the health manpower point of view.

With just about 3,000 psychiatrists for our billion population, we need to retain every one of our psychiatrists. But thanks to the MHA 1987, fresh psychiatry MDs have no choice but to emigrate, says Dr. Thirunavukkarasu, Professor of Psychiatry, Chennai; for the government does not have jobs for all of them and while an MD in medicine or orthopaedics or obstetrics can start his/her own nursing home, these young doctors cannot; for not only is the licence so wrapped up in red tape that it takes years to get, its provisions are just impossible to fulfil.

The options then? Stay on in India and practise psychiatry ``illegally'' in the private sector or emigrate to the West where one can practise one's profession honestly with peace of mind. The WHO and all mental health professionals have been calling for inclusion to be the basis of treatment of mental illness; that all stigma be removed and awareness programmes be started so that society at large views mental illness as no different from other illnesses.

The National Conference of the Indian Association of Private Psychiatry, (IAPP) just concluded in Chennai, underscored the issue, called for a revamping of the MHA and recommended that the IAPP be part of the body formulating a new practical MHA. The tsunami has now highlighted the need for a humane practical and progressive Mental Health Act. When will our government and legislators take note?

(Dr. Seshadri Harihar is Senior Consultant Psychiatrist and Dr. Hirmalaini Seshadri is Senior Consultant Physician, Apollo Hospitals, Chennai.)

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