The Act defines access to mental health as a right, makes it mandatory for all healthcare facilities to improve psychiatric services, which was not possible otherwise. It will allow any hospital or nursing home to set up psychiatry wards, which also was not possible earlier and healthcare providers avoided psychiatry like the plague even though mental health is the most expensive of all illnesses. Importantly, the Act mandates insurance companies to cover mental health. So what can be possibly wrong about this new Right? It seems it’s a highly fraught decision and there’s a furore in the medical circle.
A Vital Contribution
Dr Jain, who was part of the team that contributed to the Mental Health Policy, which is closely linked to the new Act, is a psychiatrist at the Bengaluru-based National Institute of Mental Health and Neurosciences (NIMHANS). He has also been chronicling the history of psychiatry in South Asia, most recently funded by the European charity Wellcome Trust. And he believes the needs of mental health in India will increase as compared to that of physical health. In the wake of the new Act, we ask him how will things change on the ground.
The Ken: Why do we need a separate law for mental health when most countries have done away with it?
Jain: The range of problems is so large that to expect a law to address those is not fair. Still, let me cite two examples. Right now, we are trying to get treatment for a person who is a senior corporate executive. He is under the delusion that the camera on his computer is spying on him, the satellites are taking pictures and that his children are under threat. He wants to pull them out of school so that he can protect them. There’s no way the family can get him for treatment because he starts talking about his rights and that nobody has any business to call him mad, tells the doctor that he is earning a salary twice that of [the doctor] and wards off his wife saying. ‘it is my life’.
On the other hand, there’s someone on the street, sitting on a dustbin who couldn’t have demanded care or whom nobody bothered to rush to a hospital because no hospital would take her.
The fact that psychiatric care requires a restriction on the freedom of movement for a period of time becomes an issue. People don’t give consent. Which is why mental illness is always viewed differently. Some countries have done away with all laws; if people are ill, you treat them. Here [in India], unless there’s an emergency, we don’t bother. For this reason, alone, India made a separate Mental Health policy [which is linked to the new legislation].
The Ken: Now that we have a legislation, what is going to change on the ground?
Jain: For physical health, you get all the facilities. You can demand it anywhere. But for psychiatry, you cannot demand it. You can’t go to a hospital, private or public, and say I need psychiatric care and want admission. They don’t have wards. Because the law so far has been such—it said, if you want to treat mentally ill, you need to follow many rules, need to be connected with an asylum. A lot of paperwork is required. Nobody wants to do that.
This Act does away with that distinction. It says nursing homes can create wards and beds in psychiatry like any other speciality.
Is Everything Fine?
The disregard for psychiatry services will be a thing of the past. There certainly will be some improvement in the ground reality.
The Ken: The Act makes mental health care a matter of right. Is the supply side good enough to ensure this right?
Jain: New psychiatry wards and beds will be set up in every hospital. Those who have will now have to list the beds. About half of the 400+ medical colleges in the country do not have departments of psychiatry. They will have to be set up. Every medical college hospital will require inpatient beds and services. That will add 10,000 beds. Then the private sector will add many beds. So, the fixed number of beds [~20,000] that we’ve had in psychiatry for so long will now rapidly scale.
It’s big business too. By most conservative estimates, at least 1% of the population is seriously ill. A third of them, that is four million, will need long-term stay. Multiply that with Rs 2000/day.