Tata and confined given electro convulsive therapy (ECT) without

Tata Institute of Social Sciences, Mumbai

Master of Hospital Administration

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(2016-18)

SCHOOL OF HEALTH SYSTEM STUDIES

CBCS-MENTAL HEALTH

COURSE TEACHER-SHANKAR DAS

 

 

 

SUBMITTED BY –EVANDALYNE LAMARE

M2016HO013

Master of Hospital Administration

 

Most people in the world will be affected by
mental or neurological disorders at some point in their lives. Globally nearly 450
million people currently are burdened by mental health disorder. Various treatments
are available both therapeutic and rehabilatory, but nearly two-thirds of
people with a known mental disorder decide never to seek help from a health
professional. Stigma, discrimination and neglect prevent proper care and
treatment from reaching people with mental disorders, says the World Health
Organization (WHO). There is a vicious cycle of neglect and misunderstanding
regarding mental health among the general public which overburdens and hampers
proper management.

Claims from psychiatry say that over one
billion people suffer from psychiatric illness. While studies says that
psychiatric treatment is one of the most lucrative, damaging, abusive, brutal,
corrupt business in the world with many prescriptions per year and leading to
many adverse effects like extra pyramidal symptoms, many emergency situations
leading to many birth defects, 25000 suicides, 15000 die annually, many kids
are drugged and many given electroshock. Many people are locked up against
their will, chained and confined given electro convulsive therapy (ECT) without
their own consent locked in institutions. In several instances  they never recover and gets
institutionalized. Living in pathetic condition locked up and denied of basic
sanitation, chained adding to that there are hardly any good diagnostic test
and many of this patients are just classified based on their symptoms and with ineffective
and often dangerous medication.

The Indian constitution under article 21
ensures every human being has a “right to live” which includes right to live
with dignity. Our forefathers tried to ensure that every Indian was truly
independent. But our society till date has been denying this right to people
with mental disabilities. Nearly all our laws regarding mental health apart
from the most recent has been made and enacted with a view of saving the
society from unpleaseant experience of mental disorder. There is even an act
which criminalizes suicide attempt, so when a person suffering mental breakdown
and commits attempted suicide, our laws under IPC 309 makes him a criminal. What
is a better example than this for genral apathy prevailing now in society than
this draconian and outdated law.

Throughout human history we have seen that
people with mental disability are essentially regarded as walking dead. Mental
disorder has always been a taboo, never discussed never understood. There also
seems to be concept of disgust regarding it. Societies in olden days didn’t
have any clue as to what to do regarding them. These people are just branded
insane, and put up to live a separate life. Mental asylum where this people are
usually kept has therefore gained a notoriety as a place to be kept a distance
from for the general public. These mentally ill patients usually were clumped
together in cold unkept places akin to a human zoo. Often times we see
alcoholics and schizophrenia patients kept together. This was the method
preffered in almost everywhere and almost every law was based on this fact that
these people have to be confined to specially designed institution. In western
countries even beggars and lechers were not spared, they too were confined into
this asylums. This practice of instituinalization is nothing but the abuse of
their most basic right, the right to live with dignity.

Having an experience in the medical field and
having had first hand experience regarding the plight of mental health
patients, I feel the bill do provide some relief but overall the condition of
these patients in our vast and varied country is and will for sometime remain
pathetic. In my own state I had the experience of visiting two mental health
hospital one public and the other private. The conditions in either of them was
pitiful but the public hospital was just abject. As a young student I
interacted with a few of the patients. these patients were kept separated into
a male and female enclosure. With no semblance of the need for individual
attention to individual distinct care. Some of them were in the early stages
and had relatively moderate or no symptoms , while some were overtly advanced
cases, but all of them were kept together in just a secluded area. Their
routine consisting of just ambling about the whole day. Many of them didn’t see
their family members in years. while on my community visits I met several
families dealing with mental health, all of them nearly tired and having no
knowledge of any treatment apart from keeping them in asylums. These patients
usually gets abused by their own family members mostly out of frustration. We
have to look at the problem in a broader manner, there has to be more
surveillance more programmes dedicted to making these patients lives better.
The injustice meted out to them has to be stopped. The treatment options should
be varied and effective therapies utilized. The invisible barrier segregating
amd limiting treatment options for the poor has to be brought down.

Mental health care Acts in India

Pre independence

1.1885: Indian
Lunatic asylum act of 1858

2.1912: Indian
Lunacy act of 1912

Post Independence:

1.1947: Indian
Psychiatric association.

2.1987 Mental health
act of 1987(Indian Psychiatric society).

3. Mental health
care Bill Proposed in 2013.

4. National
mental health Policy 2014.

5. Mental Health
Care Act 2017.

Mental Health act 1987 needed amendment
because concerning with legal proceeding and guardianship MHA 1987 has not been
able to adequately protect the rights of person with mental illness and to
promote access to mental health Care in the country. Human right issues and
mental health care delivery are not properly address in this act. Many human rights
activist have questioned the constitutional validity of MHA, 1987 because it
involves curtailment of personal liberty without the provision of proper review
by any judicial body .Where as in the new bill it is provided that research can
be carried out by the consent of guardian. This provision violated human right.
Once a person is admitted to mental hospital he is termed insane or mad by the
society. There should be provision in the act to educate the society against
the misconception in which the acts lacks. Right of the mentally ill patient
was not focused in mental Health Act 1987. On 28 March 2017, the Parliament
passed the Mental Healthcare Bill, 2016 which will be repealing the existing
Mental Health Act, 1987. The bill was already passed by the Rajya Sabha in
August, 2016. After receiving the assent of the President on the 7th April,
2017, the Mental Healthcare Act, 2017 has come into existence.

The objective of the Act is to protect,
promote and fulfill the rights of people with mental illness and to secure for
them appropriate mental healthcare and services and to ensure that these people
live with dignity and their rights are not being compromised. The basic
framework of the Act is Convention on rights of person with disability and its
optional protocol which has been adapted by United Nations on 13th December,
2006 in New York and which came into force on 3rd may, 2008. India signed and legalized
this Convention in 2007 making it necessary to align and modify its prevailing
laws with regard to the Convention. The Act redefined “mental illness” as a
considerable disorder of thinking, mood, perception, orientation or memory that
grossly impairs judgment, behavior, capability to acknowledge reality or
ability to fulfill the standard demands of life, mental conditions related to
the abuse of alcohol and medicines. However, it doesn’t embody slowness of mind
that may be a condition of inactive or incomplete development of mind of an
individual, specially characterized by sub-normality of intelligence.

Rights of person with mental illness-

The Act guarantees every person right to
access mental healthcare and treatment from mental health services run or
funded by the Government also help in providing mental health services of good
quality at affordable cost and also ensure that the mental health services are
geographically accessible and are provided without discrimination. Persons with
mental illness living below the poverty line or who are destitute or homeless
will be entitled to mental health treatment and services free of any charge and
at no financial cost at all mental health establishments run or funded by the
Government.

Right to Confidentiality: Person with mental illness will have the
right to confidentiality in respect of his mental health, mental healthcare,
treatment and physical healthcare. It also restricts release of information in
respect of mental illness. Without the consent of the person with mental
illness no information can be released to media by the mental health
establishment. However, all such persons with mental illness will have the
right to access their basic medical records. However till now the practice is
still not yet practiced.  Right to legal aid: It also guarantees
a person with mental illness will be entitled to receive free legal services to
exercise any of his rights given under this Act. The Act also recognizes the
right to live with dignity, right to community living, right to personal
contacts and communication; protection from cruel, inhuman or degrading
treatment, treatment equal to persons with physical illness as many cases are
still prevailing that many times people were denied communication to their
family members cutting all relationship with the outside world patients were
called with numbers and the machinery like structure in the system where the
patients just have to obey the words of doctors and if they rebuke to be given
punishment and locked up and have to show good behavior only Many people are
chained and live in pathetic situations still rampant in our country. Every
insurer is bound to make provision for medical insurance for treatment of
mental illness on the same basis as is available for treatment of physical
illness.

Advanced Directives

The Act states that every person will have the right to specify how he would
like to be treated for mental illness in the event of a mental health
situation. An individual will also here the right to specify who will be the
person responsible for taking decisions with regard to the treatment, his
admission into a hospital, etc. It also says that a medical practitioner or a
mental health professional shall not be held liable for any unforeseen
consequences on following a valid advance directive. As per the Act, a person
with mental illness will not be subjected to electro-convulsive therapy without
the use of muscle relaxants and anesthesia. Also, electro-convulsive therapy
will not be performed for minors. It also restricts use of sterilization on
such persons. They shall not be chained in any manner or form whatsoever under
any circumstances.

According to the Act, a person with mental
illness will not be subjected to solitary confinement. Physical restraint may
only be used, if necessary. Promotion of Mental Health and Preventive Programme
The Act directs the Government to plan, design and implement programs for the
promotion of mental health and prevention of mental illness in the country.
Measures should be taken to create awareness about mental health and illness
and reducing stigma associated with mental illness. The Government will take
measures to address the human resource requirements of mental health services
in the country by planning, developing and implementing educational and
training programs. This will be done in collaboration with institutions of higher
education and training. The aim will be to increase the human resources
available to deliver mental health interventions and to improve the skills of
the available human resources to better address the needs of persons with
mental illness.
As per the Act, the Government will train all medical officers in public
healthcare establishments and all medical officers in the prisons or jails to
provide basic and emergency mental healthcare.

Establishment of Central & State Mental
Health Authority-

The Act directs
the Government to set up a Central Mental Health Authority within a period of
nine months from the date on which this Act receives the assent of the
President.
Functions of the Central Mental Health Authority

Establishment of
Central & State Mental Health Authority
The Act directs the Government to set up a Central Mental Health Authority
within a period of nine months from the date on which this Act receives the
assent of the President.
Functions of the Central Mental Health Authority:

The Authority will register all mental health
establishments under the control of the Central Government. It will maintain a
register of all mental health establishments in the country based on
information provided by all State Mental Health Authorities of registered establishments
and compile update and publish a register of such establishments.

The Authority will develop quality and service
provision norms for different types of mental health establishments under the
Central Government. It will supervise all mental health establishments under
the Central Government and receive complaints about deficiencies in provision
of services. It will maintain a national register of clinical psychologists,
mental health nurses and psychiatric social workers based on information provided
by all State Authorities of persons registered to work as mental health
professionals for the purpose of this Act and publish the list of such
registered mental health professionals.
The Authority has also been tasked to train law enforcement officials, mental
health professionals and other health professionals about the provisions and
implementation of this Act. It will also advise the Central Government on all
matters relating to mental healthcare and services.
A fund named the Central Mental Health Authority Fund will be constituted where
grants and loans made to the Authority by the Central Government and all fees
and charges received by the Authority under this Act will be credited.

D. No person shall be admitted to or held in a psychiatric
institution, hospital or facility because of their political, religious or
cultural beliefs and practices.

E. Any patient has:

1. The right to be treated with dignity as a human being.

2. The right to hospital amenities without distinction as to
race, color, sex, language, religion, political opinion, social origin or
status by right of birth or property.

3. The right to have a thorough, physical and clinical
examination by a competent registered general practitioner of one’s choice, to
ensure that one’s mental condition is not caused by any undetected and
untreated physical illness, injury or defect and the right to seek a second
medical opinion of one’s choice.

4. The right to fully equipped medical facilities and
appropriately trained medical staff in hospitals, so that competent physical,
clinical examinations can be performed.

5. The right to choose the kind or type of therapy to be
employed, and the right to discuss this with a general practitioner, healer or
minister of one’s choice.

6. The right to have all the side effects of any offered
treatment made clear and understandable to the patient, in written form and in
the patient’s native language.

7. The right to accept or refuse treatment but in particular,
the right to refuse sterilization, electroshock treatment, insulin shock,
lobotomy (or any other psychosurgical brain operation), aversion therapy,
narcotherapy, deep sleep therapy and any drugs producing unwanted side effects.

8. The right to make official complaints, without reprisal,
to an independent board which is composed of nonpsychiatric personnel, lawyers
and lay people. Complaints may encompass any torturous, cruel, inhuman or
degrading treatment or punishment received while under psychiatric care

9. The right to have private counsel with a legal advisor and
to take legal action.

10. The right to discharge oneself at any time and to be
discharged without restriction, having committed no offense.

11. The right to manage one’s own property and affairs with a
legal advisor, if necessary, or if deemed incompetent by a court of law, to
have a State appointed executor to manage such until one is adjudicated
competent. Such executor is accountable to the patient’s next of kin, or legal
advisor or guardian.

12. The right to see and possess one’s hospital records and
to take legal action with regard to any false information contained therein
which may be damaging to one’s reputation.

13. The right to take criminal action, with the full
assistance of law enforcement agents, against any psychiatrist, psychologist or
hospital staff for any abuse, false imprisonment, assault from treatment,
sexual abuse or rape, or any violation of mental health or other law. And the
right to a mental health law that does not indemnify or modify the penalties
for criminal, abusive or negligent treatment of patients committed by any
psychiatrist, psychologist or hospital staff.

14. The right to sue psychiatrists, their associations and
colleges, the institution, or staff for unlawful detention, false reports or
damaging treatment.

15. The right to work or to refuse to work, and the right to
receive just compensation on a pay scale comparable to union or state/national
wages for similar work, for any work performed while hospitalized.

16. The right to education or training so as to enable one to
earn a living when discharged, and the right of choice over what kind of
education or training is received.

17. The right to receive visitors and a minister of one’s own
faith.

18. The right to make and receive telephone calls and the
right to privacy with regard to all personal correspondence to and from anyone.

19. The right to freely associate or not with any group or
person in a psychiatric institution, hospital or facility.

20. The right to a safe environment without having in the
environment, persons placed there for criminal reasons.

21. The right to be with others of one’s own age group.

22. The right to wear personal clothing, to have personal
effects and to have a secure place in which to keep them.

23. The right to daily physical exercise in the open.

24. The right to a proper diet and nutrition and to three
meals a day.

25. The right to hygienic conditions and non overcrowded
facilities, and to sufficient, undisturbed leisure and rest.

 

 

Reference

1. Choudhary, L.
N. (2015) The Mental Health Care Bill 2013: A Critical Appraisal, Indian Journal of
Psychological Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418257/

2. Citizens
Commission on Human Rights (2018) Mental health declaration of Human rights
Retrieved from http://www.cchr.org/about-us/mental-health-declaration-of-human-rights.html

3. Das, M
(28/03/2017) India has new mental healthcare law and heres all you need know
about it Retrieved from https://www.thenewsminute.com/article/india-has-new-mental-healthcare-law-and-heres-all-you-need-know-about-it-59404