Mental Health Problems

• Mental health problems are more common than cancer and heart diseases combined. Despite high prevalence of mental disorders (58.2 to 73 per thousand population), more than 80 per cent of persons suffering from mental disorders are not getting proper treatment in the existing healthcare system.
• The major reasons for huge treatment gap ; the difference between the number of persons requiring treatment and number of persons who actually receive treatment, are, shortage of mental health professionals, stigma associated with seeking treatment from psychiatrists, limited mental- health facilities and the high cost of treatment.  These untreated cases are a huge burden on the family and society. 
• Untreated mental disorders are known to lead to mental and physical disability, violence and high suicide rate.
• According to WHO, 1 in 4 persons suffers from mental disorders in both developed and developing countries. Out of the six leading causes of disability the major ones are mental disorders which include depression, alcoholism, schizophrenia, and bipolar disorder.
• In 2010 depression alone ranked second for global disease burden and it is predicted by the WHO that by 2020, depression will be the top most leading cause of years lived with disability worldwide. 
• About 1 million people die by committing suicide every year worldwide and India has the highest number of suicides in the world. 
• Majority of suicide victims are adolescents and young adults. It is the second leading cause of death in youth, aged 10 to 24 and it is estimated that in about 90 per cent of suicides, mental illness is the major attributing cause.

HUMAN RIGHTS VIOLATION:

• A large number of persons suffering from mental disorders lack proper treatment which results in facing discrimination and human rights violations. The consequences of untreated mental disorders include homelessness, incarceration and exploitation.
• Approximately one-third of total homeless people suffer from untreated psychiatric illnesses. These persons face physical and sexual abuse on the streets.
• About 16 percent of untreated major mental disorder sufferers are lodged in jails and prisons, and are incarcerated with minor charges as they fail to defend themselves. Even the family members avoid them and do not apply for bail or fight the case in the court. People with untreated psychiatric illnesses spend twice as much time in jail as people with sound mental health and are more likely to commit suicide.

ROLE OF LEGISLATION:

• Mental health legislation is essential for protecting the rights and dignity of persons with mental disorders, and for developing accessible and effective mental health services.
• Indian Lunacy Act, 1912 was governing mental health in India till the Independence. It was repealed with the Mental Health Act (MHA) in 1987 so as to keep pace with advances in psychopathology and psychopharmacology. 
• Various positive changes in the MHA, 1987 included a more humane approach to problems of the mentally ill by changing the terminology e.g. lunatics and criminal lunatics  were replaced by the term mentally ill person and mentally ill prisoner, new provisions on management of their property and protection of human rights were  included, Central and State Mental Health Authorities were created for safeguarding  the interests of the mentally ill person under one authority, procedure for admission and discharge of voluntary patients was simplified and liberalized. 
• In order to comply with United Nations Conventions on Rights of Persons with Disability (UNCRPD) and to satisfy the long- pending demands of mental health professional and the caregivers, the Government of India, in 2013 introduced Mental Health Care Bill (MHCB), 2013.
• MHCB proposes that all the major decisions relating to treatment of mental illnesses will be taken by judiciary i.e. Mental Health Review Commission.

PROBLEMS IN MHCB:

• The major problems in the MHCB are, the Bill marginalizes the families, who, in India bear the major burden of care of the mentally ill. 
• The MHCB totally ignores the parents and families and, for the first time proposes that the patient can nominate any person as his nominated representative who will take all the major decisions regarding his care and property. Since many mentally ill patients lack insight during acute phase of illness, they can be easily cheated by the so-called nominated representatives, leaving the parents and other close relatives helpless.
• Further, shifting the burden of care on “other persons” who are not emotionally involved with the patients is unlikely to show compassion needed for such patients in the Indian setting.
• The Bill seeks to segregate the treatment of the mentally ill from the mainstream medical establishments and it is likely to increase stigma.  
• The biggest challenge in the treatment of mental illness is the rehabilitation, but MHCB is totally silent about the care and rehabilitation of patients after discharge from long- stay facilities. These patients will require constant care and support while staying in the community and MHCB must address this issue like rest of the world has done. 

By: Dr. Vivek Rana