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Read Editorial – The modern way: mental health law can be used to strengthen primary care

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The passage of the Mental Healthcare Bill in the Lok Sabha, putting it on course to become law and repealing (officially cancel) the Mental Health Act of 1987, will potentially help India catch up with the advances made in the field by other countries. India urgently needs to make a transition from old-fashioned approaches to providing care for those suffering from mental illnesses, something that China, for example, has achieved through state-led policy reform (make changes in order to improve it). Even the sketchy studies on the nature of care available to Indians indicate that in terms of population coverage the new law faces a big challenge.

The country’s grossly inadequate (lacking the quality or quantity required; insufficient for a purpose) base of professional resources is evident from its ratio of 0.3 psychiatrists for 100,000 people (with marginally higher numbers taking independent private practitioners into account), compared to China’s 1.7. Then there are massive deficiencies in the availability of trained clinical psychologists and psychiatric social workers. Evidently, the National Mental Health Programme has not been sufficiently funded within the health budget; neither has capability been built in most States to absorb the meagre (lacking in quality or quantity) allocation.

Delayed though it is, the new legislation can bring about change with its positive features. The important provisions (the action of providing or supplying something for use) relate to the recognition of the right to medical treatment, decriminalisation of attempted suicide, explicit acceptance of agency of people with mental illness and their freedom to choose treatments, prohibition of discrimination and regulation of establishments working in the field.

Raising effective primary and district-level coverage of mental health services for the general population, without requiring people to travel long distances to see a specialist and get medicines, should be a priority. Since the base of psychiatrists is low in relation to the need, the use of trained general practitioners as the first line of contact assumes importance. Some studies show many of them are not confident enough with their training to detect diagnose and manage mental illnesses. With a concerted effort, primary care physicians can be trained to help people with mild and severe problems, ranging from anxiety (a feeling of worry, nervousness) disorders to depression, psychoses and conditions arising from alcohol and substance abuse. Being able to get professional counselling will reduce the complications arising from extreme stress, often the trigger for suicide.

Extending health insurance cover is also a step forward, since out-of-pocket expenditure has risen along with the expansion of the private sector in this sphere, just as for other ailments. The provision in the new legislation prohibiting seclusion (the state of being private and away from other people) of patients, something that is frequently resorted to in asylums (an institution for the care of people who are mentally ill), and the general use of electro-convulsive (uncontrollable) therapy must be welcomed. Modern treatment approaches rely (be dependent on) more on family and community support. The new Central and State regulatory authorities should speedily weed out (remove; separate) shady non-governmental rehabilitation (the action of restoring something that has been damaged to its former condition) organisations in this field.


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