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In letter and spirit
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In the zonal consultative meeting for developing a national dementia strategy happening in Coimbatore on July 25, one of the issues to be discussed is the legal hassles that plague patients and their families.
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Photo: V. Sreenivasa Murthy
A pressing need for a National Policy Members of Alzheimer’s and Related Disorders Society of India, Bangalore Chapter at an awareness drive
The Mental Health Act (1987), which came into effect in April 1993, replaced the anachronistic Indian Lunacy Act (1912). It did away with offensive terminology like “lunatic”, established licensing authorities and recognized the human rights of those afflicted. But is this enough?
According to Prof. K. Selvaraj of Vazhikatti Mental Health Centre and Research Institute, Avanashi road, despite the Act, State funding for establishing mental health institutions and day care centres is minimal and the wishes of guardians of the patient are respected over the patient’s own preferences.
"In the west, the advanced directives or Living Will concept is recognized, which helps individuals make their own healthcare decisions," he says.
"We’ve come a long way since ’87," says advocate N. V. Sreejaya. Any improvement to the ’87 Act must make it "imperative on doctors to notify the authorities when their patients begin to show signs of mental illness," she says. Due to lack of awareness there is a stigma against mental illness. Parents are unwilling to treat their children for mental illness because such evidence may deny the child a chance of getting married. Even after marriage, parents show resistance to treatment as evidence of mental instability is a ground for divorce. They wreck, not only the lives of their children and grandchildren, but also those of the spouses and those around the patient. The silver lining is that more and more people are beginning to seek mental health care. Acceptance is rising as people see peers benefiting from such treatment, says Selvaraj. Mental illnesses can be arrested in their early stages. In countries like the UK, psychiatric camps are held at school level and parents are alerted.
India, that boasts of one of the best home-care systems, can do much better if guardians are trained to give the correct treatment. Very often, parents with dementia are perceived as difficult. Awareness of the condition will help both the patients and those around them.
The Alzheimer’s and Related Disorders Society of India (ARDSI) is distributing posters about the symptoms of the illness.
Sreejaya says that a major lacuna in the system is the lack of legally acceptable standardized tests for determining the mental health of a person. Such tests are only used for healthcare decisions in India. In custody cases involving children, courts and young children aren’t able to identify the parent as mentally ill. This can seriously affect the upbringing of the children and in some cases jeopardizes their lives.
Most people in India are unaware of the legal remedies available to Alzheimers’ patients if they forget their signature, says Sreejaya. Shyam Viswanathan, whose father is afflicted by the illness, agrees.
He says that from producing a life certificate to receive pension, or operating a bank account, or even disposing of property; the legal procedures are just too cumbersome. "My father is unable to even have a coherent conversation with the officer concerned," he says. Also, how does a person leave money for their dependents with dementia, in event of anything happening to the former?
Sreejaya says that a recognised photo identity card like an elector’s photo identity card (EPIC) can be used to prove one’s identity, if the signature has been forgotten. As a precautionary measure, a guardian can make a testamentary will that identifies another person to take over as guardian in event of death of the former.
Psychiatrists and lawyers advise people to make their wills as soon as they realize their memory is failing with age. It is advisable to have a psychiatrist as witness and video record the proceedings. A little bit of caution can avoid senseless violence over wealth.
New wine cannot be held in old wineskin. The law needs to formalize procedures such as accepting thumb impressions of senior citizens who forget their signature. Nuclear families find it very hard to care for their elderly and there is a crying need for good and affordable day care centres for the mentally ill. Also, licensing authorities should appoint psychiatrists as inspecting officers for mental health facilities.
The zonal consultative meeting is at Jenney’s Residency, Avanashi road.
For details or volunteering call Dr. Selvaraj- 9842259062 or Mrs. Vijayalakshmi- 9786133333.
PHEROZE L. VINCENT
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