#dnaEdit: Mindful of the crisis

The Mental Health Care Bill, awaiting approval from Parliament, is expected to introduce a revolutionary change in the way people with mental illnesses are treated by doctors, hospitals, society and the criminal laws of the land. A progressive piece of legislation, it decriminalises suicide and restores dignity to patients with psychological conditions. The bill also brings such ailments under the purview of medical insurance, making it mandatory for insurance companies to include them in their policies. It’s a move that will bring financial relief to millions — battling acute depression, schizophrenia or bi-polar disorders — seeking admission to hospitals.

The importance of this bill, in spite of its share of controversies, cannot be overstated. The sweeping nature of the epidemic of mental illnesses is evident in the numbers. Back in 2011, the Bangalore-based National Institute of Mental Health and Neuro Sciences (Nimhans) had stated that two crore Indians in the grip of serious psychological diseases need urgent medical attention while an additional five crore are living on the edge of a not-so-serious medical condition. Though a fortunate few can buy the services of psychiatrists in private institutions, the vast majority is forced to seek aid in government hospitals. The deplorable conditions in government facilities — where patients are subjected to cruelty, often tied to chains and gagged and made to starve — continue to persist. Most mental asylums in India are steeped in regressive medieval ethos, showing no inclination to imbibe the modern techniques and practices in psychiatric treatment. What has aggravated matters is the acute dearth of psychiatrists. At present there is just one psychiatrist for about 3 lakh people of the general population.

In the midst of a depressing scenario, the bill’s revolutionary scope reflects a compassionate approach — taking cognisance of the mental condition of a person committing suicide by pushing for an amendment of the criminal law. It is only under desperate circumstances that a person is forced to end his/her life. And, a situation where unemployment is on the rise and living conditions have drastically deteriorated, suicides are bound to increase. If passed, it will also put an end to the evil practice of chaining patients. Restraining them with dignity is allowed only in cases when patients can harm themselves or others.

However, it is also important to examine the thorny issues that have raised the hackles of both activists and medical practitioners. Even as some Indian doctors vouch for the efficacy of shock treatment or Electro-Convulsive Therapy — long banned in the West — activists are opposed to the bill allowing such treatment, and retaining the controversial neurosurgical procedures. Doctors have opposed the bill on the ground that it empowers the patient to choose the line of treatment — citing the mental condition of the person as the biggest impediment to an informed decision. 

These will have to be thoroughly debated when the bill comes up for consideration in Parliament in the coming weeks — though how MPs, with little or no knowledge in medical science, are qualified to dwell on these important issues is another matter altogether. The only way to thrash out a consensus is to bring all stakeholders to the table, and address the concerns of the dissenting voices. It is not an impossible task, given that the bill is going to decide the fate of millions who continue to suffer cruelty and social ostracism.