Mental Healthcare Act: A step in the right direction, but ‘loopholes’ remain
Dr Savita Malhotra raised questions over various clauses in the Act, including the decision to have district judges to chair the mental health review board.
The enforcement of the Mental Healthcare Act (MHCA), 2017, has brought in many positives such as affordable and quality care to mentally ill people, but according to an expert, there are a few ‘loopholes’ that need to be rectified.
Dr Savita Malhotra, former dean and head of psychiatry department, Postgraduate Institute of Medical Education and Research, and former president of the Indian Association for Social Psychiatry said, “There is a clause of Advance Directive (AD), which means a patient can decide how he/she wants to be treated/or not treated. It pre supposes that patients will have a sufficient knowledge about the various treatment options or the pros and cons of non-treatment, which is highly improbable in an Indian setting.”
Talking about Nominated Representative (NR) given priority over family, Dr Savita said, “Now a psychiatrist will have to first ascertain if the patient has appointed NR or not. If not, then second option is of family. This concept has been taken from the West, where family system is not strong. But in a country, where 99% of mentally ill patients are taken care by families, giving importance to NR is illogical,” she said.
According to the doctor it will only increase paperwork and lot of legality will go into the process. As before the admission, psychiatrist will have to ensure if the person has any NR or AD. “NRs might also misuse their position, in case the patient is wealthy,” she said.
‘Misleading, stigmatising clause’
The another important point is that as per the Act, the only condition for supported admission (Section 89) to psychiatry hospital is that a patient can cause harm to self or others or is unable to take care of self with potential for harm. “It is misleading and stigmatising, as it equates severe mental illness with dangerousness.”
“It also means we should wait until condition worsens and a patient starts damaging themselves or others and then admit them? Majority of patients are of no harm but need admissions for treatment and prevention of deterioration,” she said.
Further, mental health review boards will be chaired by a district judge “What competence can they have on matters of admission, discharge, adequacy of treatment?” she asks.