A new narrative around mental health
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The Mental Healthcare Bill — approved in the Lok Sabha last week following Rajya Sabha approval in August 2016 — marks a paradigm shift in the care and treatment of persons with mental illness in India. Contents of the Bill such as decriminalisation of suicide have received wide coverage. The facts: 150 million Indians need treatment for mental illness but nearly 80-90% receive NO treatment (so-called treatment gap). We spend less than 1% of the public health budget on mental health although mental health problems constitute nearly 13% of the health burden. Recognising this historic neglect, the Bill makes provision for universal access to a range of mental health-care services in the community, at the district level, through the public health system. The Bill also makes it compulsory for insurance companies to include mental illness cover in medical insurance policies. These steps will ensure more people get treatment and reduce the treatment gap.

Some concerns have been expressed about the provision of Advance Directive (AD) and Nominated Representative (NR) in the Bill. AD allows all citizens, not just persons with mental illness, to state (when they are well) their treatment choices in the event a future mental illness takes away their ability to make treatment-related decisions. This is not a compulsory requirement but it is a hugely empowering option. No one will be left untreated because they did not write an AD but many will recognise its importance, especially those who are wary of unscrupulous medical practice or who have indeed suffered from such practice in the past. Similarly, the Bill has provisions for individuals to appoint a nominated representative to make decisions on their behalf when they are unwell and cannot make decisions for themselves. This too is an option and if no such appointment is made, family members are the default NR. Both provisions give a measure of control back to individuals with mental illness, particularly women, allowing them to actively participate in decision-making about their care and treatment.

Given the historical context of denial of rights and poor quality treatment to persons with mental illness, this Bill takes an aspirational stance. The challenge lies in its implementation, not easy, but eminently possible.

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