“It’s not enough to be up to date, you have to be up to tomorrow.” ―David Ben-Gurion
The Mental Health Care Act, 2017, which will come into effect from July 7, 2018, shows that the mental health scene in India is about to change drastically. One of the major reasons for this is that the Act ensures that People Living with Mental Health Issues (PLMHI) will have a right to live with dignity. As per the Act there shall be no discrimination on the basis of non-conformity with moral, social, cultural, work or political values; religious beliefs prevailing in a person’s community; one’s political, economic or social status; one’s membership of a cultural, racial or religious group; or for any other reason not directly relevant to mental health status of the person.
Chapter 2 of the Mental Health Care Act is a massive improvement from the previous act which was extremely outdated. Mental Health Care Act(1987) stated that the Inspecting Officer (a person authorised by the State Government or by the licensing authority to inspect any psychiatric hospital or psychiatric nursing home) is the one who can report if a patient is not being provided proper treatment, and the patients themselves did not have any right to complain about their own treatment. It was the will of the medical officer in charge to do what they deemed fit for the patient. A relative of the patient could only report the improper treatment of the patient to the Magistrate. The Magistrate of the district where the mental health institution is, was in charge of the well being of the patient with absolutely no knowledge of mental health care. The new act ensures discrimination- and bias-free services as well as right to proper care to PLMHI. Now the responsibility falls on the Mental Health Professionals to update themselves.
Many of the mental health professionals lack the skills to provide discrimination- and bias-free care to their patients (in a hospital setting)/clients (in a private setting). Constant discrimination on the basis of their sexual orientation, caste, class, gender, disability, and religion is quite prevalent amongst mental health professionals as a lot of them have not updated their knowledge base or are unaware of the intersections between these social spheres and how it would affect the client/patient’s mental health. Thus sensitisation of mental health professionals becomes a concern that the government has to keep in mind as well now.
Universities, except for a few, do not have it as a part of the curriculum to sensitize the students towards issues of gender, sexuality, caste, class and so on. Karma Center for Counselling & Wellbeing is one such organisation which provides a sensitivity workshop regarding Sexuality and Gender to practitioners. The rest of the intersections still stay untouched. The government is not investing in sensitizing the mental health professionals who are currently practising either. The Act in itself is very theoretical and has no means for practical application.
Providing the client with fair and unbiased mental health care would be something that this act has tried to ensure for PLMHI but lack of a supervising organisation for mental health practitioners is still a concern that we can’t dismiss because this act has been passed by the government. The clients/patients still do not have awareness about how mental health care is supposed to be and whether it is fair to them or not. There is no set standard that people can rely on. They have the right but have no idea how to exercise it in real life. A proper supervisory organisation would help keep a check on the malpractices and ensure a standard of mental health care, thus empowering PLMHI.
Then comes another debate, over the definition of ‘mental health professionals’. This definition forgets a massive chunk of mental health professionals such as psychotherapists, psychoanalysts, social workers (not psychiatric social workers) and counselors. By definition, only a clinical psychologist has been mentioned to be a mental health professional which is quite problematic. Usually people tend to go to psychiatrists or clinical psychologists for care rather than a counsellor or psychotherapist. This is due to the fact that no one knows how the latter two work. Would you go to a cancer specialist if your lungs start to hurt? Hopefully not. You would go to a general physician first. It is vague definitions in such acts that make it difficult for people to get proper mental health care.
This act is in many ways far superior and inclusive than the last one, and to a certain extent will change the present situation of mental health care in India, which, by the way, is quiet horrendous. People in mental health institutions are ill-treated and discriminated against on several occasions. This is ground reality of mental health care in India.
Can one really pin all their hopes on the latest Mental Health Bill for being one of the latest improvement in the field of mental health? Only time will tell.