It’s Time for a More Humane Approach to Mental Health Care
Mental illness is a poorly understood issue, marked by ingrained misconceptions and false beliefs that are oftentimes carried across generations. Some of these include perceiving persons living with mental health conditions to be violent, dangerous or unpredictable, or, in common language ‘insane.’ Research indicates that it is such ignorance — held not only by the general public, but also by health professionals and policy makers — that perpetuates human-rights violations in mental health care. Human-rights violations take place in all sorts of settings, including the homes, workplaces and schools of persons living with a mental illness, as well as in hospitals, health care centers, psychiatric institutions and within the legal system.
Human-rights violations in mental health care have reached such epic proportions that practitioners refer to it as an “unresolved global crisis.” People are denied basic citizenship rights such as opening bank accounts or voting in elections. Other rights violations include lack of consent and confidentiality in treatment, involuntary incarceration in mental health institutions, and unhygienic mental health care services. Once a person is deemed to be ‘of unsound mind’, all authority is typically handed over to a family member or guardian, or even service provider. Persons living with mental health issues are thus frequently excluded from decision-making processes on issues that affect them. Many persons living with mental illness are discriminated against in schools, workplaces and public spaces — causing further isolation and compounding mental health issues. Needless to say, these indignities only serve to worsen these individuals’ mental health struggles.
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Compounding this is the fact that mental health care services lean heavily towards an impersonal biomedical model that lacks nuance. This translates into a broad reliance on medication to treat all mental health conditions, including those that are brought on by social factors. For example, conflict, unequal power relationships, and discrimination, all impact a person’s mental health. A single parent, struggling to pay bills as well as single-handedly juggling work and caregiving, might experience certain mental health issues like anxiety, fatigue, worry, and depression, among others. But given the causes, these struggles might be better treated by building people’s pathways for resilience, than by medication alone.
Unfortunately, the current mental health care model doesn’t account for a person’s context, or recognize that psychosocial distress is also a result of discrimination and marginalization. Strongly influenced by Western practices, India’s mental health care services also focus “on chemical imbalances” instead of “power imbalances and inequalities.”
Thus, mental health practitioners have been calling for a shift towards a rights-based approach to mental health that:
- ensures the availability of (and access to) quality mental health care services;
- creates an enabling environment for mental well-being through efforts to reduce stigma, discrimination, violence and inequity; and
- safeguards human rights.
India’s Mental Health Care Act 2017 came into effect on 29 May 2018 and overturns previous rights violations promoted by the Mental Health Act of 1987 — including lack of sufficient opportunity for patients to challenge doctors’ decisions, arbitrary detention and unregulated use of electroconvulsive therapy (ECT).
The current Act incorporates a rights-based approach, and makes certain provisions to counter some of the rights-violations and biomedical focus of the previous act. These rights-based provisions that promote an individual’s autonomy, rights and access to quality of care include:
Universal access to quality mental health care
The new Mental Health Care Act grants a legally binding right to access mental health care and treatment to all Indian citizens. Safeguarding the rights of marginalized groups, the Act “assures free quality treatment for homeless persons or for those living below the poverty line (BPL), even if they do not possess a BPL card.”
Increased focus on human rights
The Act safeguards social rights of persons living with mental health issues including their right to confidentiality, to live within society, live with dignity, have access to safe and hygienic environment and be protected from all forms of physical, verbal, emotional and sexual abuse. Under the new act, a person’s right to access their medical records, to avail free legal aid, to make complaints about deficiencies in services — are also upheld.
Increased patient autonomy
Another progressive feature of the new Act, is Advance Directive, a measure that empowers a mentally ill person to have the right to make an advance directive toward the way they wants to be treated for the requisite illness and who their nominated representative shall be. Under India’s new Mental Health Care Act, persons living with a mental illness and their families play an active role in their own recovery process and not just remain passive recipients of services.
Decriminalization of suicide
The Act also decriminalizes suicide and holds the State responsible for rehabilitating those who have attempted suicide.
But having a progressive law on the books is only half the battle. Extensive collaboration, collective action and rallying the masses is also required to ensure that legal provisions get implemented on the ground. Because the right to health care of any kind has become a legal provision for the first time in India, ensuring that (and budgeting for) 1.5 million people living with mental health conditions have access to quality and affordable care is bound to challenge any public health system. Therefore, without a public nudge and a people’s demand for implementation, the status quo is unlikely to change. #BridgeTheCareGap is such an advocacy campaign to demand for implementation of India’s Mental Health Care Act and Policy.
If effective and humane mental health care services are made available, accessible and affordable, then those living with mental health issues can “avail treatments that help them avoid chronic disability and premature death; and support that gives them a life that is healthier and richer – a life lived with dignity.” If India were to invest in bridging the care gap in mental health, it will ensure that individuals and communities are better able to avoid or cope with the stresses and conflicts of everyday life — and as a result enjoy a better quality of life and better health.