The spread of coronavirus has shaken not just India but almost every country in the world. Even though every individual is affected by the economic fall, the psychological effect is much larger. While for some it is just rising numbers in losses others are finding it difficult to fight this mental battle for survival. We amidst this strongly feel that while the government is targeting the physical aspect of people’s health, mental health shouldn’t be ignored.
The containment plans and coercive physical measures taken by the governments around the globe have had a huge effect on the mental health of the people. We in our article have tried targeting the stigma associated with mental health and lack of awareness about the variants of mental health itself. Even though India has a foot in the progression of mental health in the country, yet we are far behind the road of implementation.
Keywords: Covid-19, Mental Disorders, Mental Healthcare Act, and Implementation.
The pandemic at hand is an unusual one. As we agonize over the physical and financial complications, the mental ones have begun to surface compelling us to give it, it’s due emphasis. In the current scenario, the implications of our right to Mental Health and the adversity of its implementation is the primary question we’re dealing with here.
Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease. Although, the Indian Constitution under Article 21 administers upon its citizens, a right to protection of health, yet mental wellbeing does not even surface on the priority list of people in India.
Covid-19 has subsequently been a prominent factor causing fear, anxiety and depression in the minds of people, especially the ones already suffering from a Mental Disorder. This heightened fear among people of contracting Covid-19 has led them to experience an increased sense of anxiety which is recognized as Mental Disorder- hypochondria. The Supreme Court in a recent case, Accused ‘X’ v. State of Maharashtra defined Mental Disorder as:
“a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or development processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities.”
Mental Disorder diagnostic criteria comprise symptoms, risk & prognostic factors, associated with the development of gender and culture related diagnostic issues. We say this because depression, anxiety, fear, panic attacks are all a nemesis of mental health which either are ignored as perseverance of stress or are considered to be elements unknown by the Indian society which require due treatment.
FACTS AND FINDINGS
A 2019-20 survey conducted by the National Mental Health Survey of India, shows that merely 30 million people are seeking treatment out of the 150 million affected by mental health in India. This survey itself shows that Mental Health is not treated at par with physical health.
Further, a catastrophe such as Covid-19 has become a prominent cause of deteriorating mental health among people. We say this because the elongated nationwide lockdown has triggered societal concerns like loss of life and livelihood, domestic violence, child abuse, lack of access to essential resources, separation from kith and kin etc. According to the World Health statistics 2019 published by the World Health Organization, the suicide rate in India is 17.8 suicides per 1,00,000 people much higher than 10.5, the suicide rate globally. This period has thus seen an unprecedented rise in the number of suicide cases in India triggered by distress caused due to the same. There has also been a further sharp rise in the percentage of people suffering from neurotic episodes in contrast to the already alarming estimate of 1 in 20 people, according to the survey conducted by the National Institute of Mental Health and Neurosciences in 2016.
Even though the state has a constitutional obligation towards its citizens to provide efficient health facilities, the ascending proportion of mental illness cases in India is not accompanied by a parallel increase in mental healthcare resources and infrastructure. This year being the third consecutive year since the Mental Health Care Act, 2017 (“Act”) came into force, only a marginal percentage of 0.05% has been allocated to mental healthcare despite there being a 7% increase in the overall healthcare budget. Thence, mental healthcare continues to be neglected in India, in contrast to a minimum expectancy of a 5% budget allocation in developed countries.
The Supreme Court in Re: Death of 25 Chained in Asylum Fire in T.N. v Union of India & Ors, issued directions to investigate the plight of mentally ill patients in asylums in lieu of the unfortunate incident of fire in which 25 inmates of a mental asylum died as they were chained to their beds. Further, there are just about 40 mental healthcare institutions (out of which only nine are equipped to provide treatment for children) and fewer than 26,000 beds available for a nation comprising 150 billion people. Thus the insensitive treatment of mentally ill patients is a concern of minimal resources and infrastructure of mental healthcare in our country.
CHALLENGES POSED BY THE ACT
- The Act is exclusive of any specific guidelines pertaining to disaster management such as the present one. The Act fails to mention effective and prompt responses by the mental healthcare institutions or the government authorities for the adherence of the mentally ill, drastically prone to such critical situations. Failure on the part of the state to provide timely medical treatment to a person in need of such treatment results in violation of his right to life guaranteed under Article 21.
- The focus of the Act lies in giving mentally ill patients, the right to seek mental help, to further file a complaint if such right is denied, and thus protect mentally ill persons from inhuman treatment. However, such right exists only when the mentally ill are accommodated in the hospitals but the same are ostracised when it comes to community inhabitation.
- The government as the Act suggests is supposed to set up Mental Health Authorities and Review Boards at national and state levels which will then impose a mandate upon all mental health practitioners (like clinical psychologists, mental health nurses etc.) to register under such authority. These review boards although set-up for developing quality and service norms for training mental health professionals yet fail at the grass root level of implementation. We say this because these review boards set up at the district level are quasi-judicial bodies which overlook the implementation of the mental healthcare system. This system fails to deliver efficient services due to non- availability of sufficient mental healthcare professionals, infrastructure and judicial workforce.
- No cognizant rules affirm the sharing of funds between the centre and the state to meet the rising obligations.
- Delhi High Court in M/S United India Insurance Company Ltd v. Jai Prakash Tayal, emphasized the relevance of equivalent treatment of every individual irrespective of their mental condition. It directed the Insurance Regulatory Development Authority of India (IRDA) to re-look the exclusionary clauses in insurance contracts and ensure that insurance companies do not reject claims based on exclusions relating to genetic disorders, thereby substantiating that a person, suffering from a genetic disorder, needs medical insurance as much as others. The Act further directs insurance companies to make provisions for the inclusion of treatment of mental illnesses in insurance policies, but the same hasn’t. A writ petition although pending before the Supreme Court seeks an order in the direction, yet the same hasn’t been advanced or implemented even after 2 years of the Act in its enforcement. Thus, the Act although a step in the right direction is far behind the road of implementation.
- Lastly, the Act fails to draw a realistic picture for allocation of budget and resources in Mental Healthcare and rehabilitation services.
- An officer should be appointed especially for Mental Healthcare from the Ministry of Health and Family welfare during disaster management situations like the ongoing one. This would lead to not only effective implementation of the Act but also prompt addressal of the situation.
- In order to sensitize the community towards the mentally ill, there is a need to focus more on community friendly ads and campaigns as a primary step.
- As a long term measure, the seats for psychiatry should be increased in medical courses for more number of trained mental healthcare professionals.
- The level of investment in the training and medical infrastructure of psychiatric institutions should be increased along with an increase in the number of primary healthcare centres required for counselling and awareness drives both at rural and urban levels. Especially in times like the present one, there is an adequate need for mental healthcare professionals.
- Along with an adequate amount of budget allocation, effective rehabilitation programmes should also be organised both at district and state levels. The same can be done primarily through community interactive sessions and workshops.
- Further, as a prompt response to which frontline workers can be made aware of the basic concepts of psychology which would help them gain an instructive approach towards the patients both in terms of mind and body.
- NIMHANS although as a persuasive measure of mental healthcare has made telephonic counselling readily accessible through a helpline number, lack of knowledge about the same has left the issue unaddressed. The Covid-19 information imparted through a telephonic message can include mental healthcare helpline number for an effective response.
- AarogyaSetu app although inclusive of the preventive measures to safeguard our physical health lacks any consideration about the impact; Covid-19 has had on our mental health. Thus, in order to bring mental health at par with physical health, inclusion of mental health concerns in the app can be a significant step in the direction.
The Mental Healthcare Act was a proposed measure to harbour a positive attitude in society towards mental illnesses along with access to basic, political, cultural and civil rights to the mentally ill. The massive healthcare burden has thus been intensified by the pandemic leaving the government with limited resources to deal with both mental and physical wellbeing of the people. We conclude with the hope for a better legislature policy in areas of reintegration and rehabilitation of the mentally ill.
Author: Alisha Luthra, Campus Law Centre, University of Delhi and Hridyansha Chugh, Fairfield Institute of Management and Technology, Guru Gobind Singh Indraprastha UniversitySource:https://images.app.goo.gl/XfpWRgNDhdeXakuV8