#India – Mental Health Care Bill cleared by Cabinet

The Union Cabinet  cleared the Mental Health Care Bill, 2013 that makes access to mental health care a right of all persons

Submitted on Fri, 06/14/2013 – 16:55

The Union Cabinet on Thursday cleared the Mental Health Care Bill, 2013 that makes access to mental health care a right of all persons. Such services should be affordable, of good quality and available without discrimination, it said. The proposed law decriminalises suicide.

The Bill, in consonance with international laws, has the provision of Advance Directives — described as a progressive and far-sighted step. No person who has recorded an Advance Directive to State that he or she should not be admitted to a facility without consent can be so admitted.

A rights-based Bill also has a provision wherein a person with mental illness can appoint a nominated representative to take decisions for him or her. Under the provisions of the Bill, government has an obligation to provide half way homes, community caring centres and other shelters for mentally ill people. This has been planned under the District Mental Health Programme in the 12th Plan.

In 2005, the National Commission on Macroeconomics and Health reported that 10-12 million or one to two per cent of the population suffered from severe mental disorders such as schizophrenia and bipolar disorder, and nearly 50 million or five per cent from common mental disorders such as depression and anxiety, yielding an overall estimate of 6.5 per cent of the population. The prevalence of mental disorders was higher among women, those who were homeless, poor and living in urban areas, Union Health and Family Welfare Minister Ghulam Nabi Azad told The Hindu.

The new Bill, once approved by Parliament, will repeal the Mental Health Act, 1987, which had vested extraordinary power in the hands of the treating psychiatrists. There was enough evidence of misuse and unscrupulous families collaborating with psychiatrists in addition to badly functional or non-functional Central and Mental Health Authorities primarily because of lack of funds.

Under the proposed new law, there is provision for voluntary admission with supported admission limited to specific circumstances; appeals can be made to the Mental Health Review Commission, which will also review all admission beyond 30 days and free care for all homeless, destitute and poor people suffering from mental disorder. The Bill provides right to confidentiality and protection from cruel, inhuman and degrading treatment, in addition to right to live in a community and legal aid. It bans the electric-convulsive therapy without anesthesia and restricts psychosurgery, Mr. Azad said.

He said the Bill tries to address the needs of the families and caregivers, and the needs of the homeless mentally ill. It provides for setting up Central and State Mental Health Authorities, which would act as administrative bodies, while the Mental Health Review Commission would be a quasi-judicial body to oversee the functioning of mental health facilities and protect the rights of persons with mental illness in mental health facilities.

Credit and Source: The Hindu

 

Achieving parity between mental and physical health

Whole-person care: from rhetoric to reality

 

 

Royal College of Psychiatrists –UK – March 2013

 

Available online PDF [95p.] at: http://bit.ly/YFvjwS 

 

 

 

“…..In our society mental health does not receive the same attention as physical health. People with mental health problems frequently experience stigma and discrimination, not only in the wider community but also from services. This is exemplified in part by lower treatment rates for mental health conditions and an underfunding of mental healthcare relative to the scale and impact of mental health problems….”
Professor Sue Bailey, FRCPsych, OBE President, The Royal College of Psychiatrists

 

 

 

“…..This report should be seen as the first stage of an ongoing process over the next 5–10 years that will deliver parity for mental health and make whole-person care a reality. It builds on the Implementation Framework for the Mental Health Strategy5  in providing further analysis of why parity does not currently exist, and the actions required to bring it about.

 

A ‘parity approach’ should enable NHS and local authority health and social care services to provide a holistic, ‘whole person’ response to each individual, whatever their needs, and should ensure that all publicly funded services, including those provided by private organisations, give people’s mental health equal status to their physical health needs.

 

Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that this influence works in both directions. Poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems. Mental health affects physical health and viceversa…  “..[AU]

 

 

 

Content:

 

Key recommendations
Introduction

 

Terms of reference and methodology

 

Definition and vision for parity of esteem

 

The funding gap: disparity in funding for mental health

 

The treatment gap: disparity in access to treatment for mental health problems

 

NHS Outcomes Framework Domain 1: Preventing people from dying prematurely

 

NHS Outcomes Framework Domain 2: Enhancing quality of life for people with long-term conditions

 

NHS Outcomes Framework Domain 3: Helping people to recover from episodes of ill health or following injury

 

NHS Outcomes Framework Domain 4: Ensuring that people have a positive experience of care

 

NHS Outcomes Framework Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

 

A life-course approach: early intervention, children and young people and older people

 

Measurement and monitoring of parity: data, research, audit and inspection

 

A cross-government approach to parity

 

Annexe A1. Lester UK Adaptation: Positive Cardiometabolic Health Resource

 

Annexe A2. Programme for implementing the Lester UK Adaptation

 

Annexe B. Summary of recommendations for parity

 

Annexe C. Parity commitments from working group member organisations, Royal Colleges and others

 

References

 

Related articles

 

• It’s time to end the NHS bias against mental health (telegraph.co.uk)
• Give mental health same priority as physical, says Royal College of Psychiatrists (telegraph.co.uk)
• Paul Burstow: NHS is ‘biased’ against treating mental health (telegraph.co.uk)

 

Forgetfulness is minor neurocognitive disorder says DSM-V #mentalhealth #WTFnews

Eat or surf a lot? You risk being labelled mentally ill

Malathy Iyer, TNN | Mar 24, 2013, 

The latest psychiatry manual will, for the first time, spell out Adult Attention Deficit Disorder, minor neurocognitive disorder (like forgetfulness), binge eating, internet addiction, etc. Each new condition could trigger a mega sale of pills.

MUMBAI: Come May, psychiatrists will acquire a new manual to diagnose mental illnesses. But instead of anticipation, there seems to be an air of trepidation hanging around the fifth installment of the Diagnostic and Statistical Manual of Mental Disorders — DSM-V, in short — that is published by the American Psychiatric Association and followed across the world.

Several practitioners are voicing reservations about DSM-V’s new labels. Hinting at a pharmaceuticals-driven manual, a senior psychiatrist said: “It’s about molecules … DSM-Vhas identified so many new conditions that people will be handed out prescriptions more rapidly then before.”

The psychiatry manual will, for the first time, spell out Adult Attention Deficit Disorder, minor neurocognitive disorder (like forgetfulness), binge eating, internet addiction, etc. Each new condition could trigger a mega sale of pills, but the DSM-V team has shrilly denied any connection with the big-buck pharma sector.

Manual key to research

Earlier this week, American psychiatrist Allen Frances, who helped devise the fourth edition of the manual (DSM-IV), lashed out against the new installment in the British Medical Journal. “It risks mislabelling a sizeable number of population as mentally ill,” Frances wrote.

He is disturbed about a new introduction called ‘somatic symptom disorder’ that will need only one bodily symptom distressing or disrupting daily life for about six months. “This new category will extend the scope of mental disorder classification by eliminating the requirement that somatic symptoms must be medically unexplained,” he wrote. In a field trial study to check for somatic symptom disorder, the results included 15% of patients with cancer or heart disease and 26% with irritable bowel syndrome or fibromyalgia. “The rate of psychiatric disorder among medically ill patients is unknown, but these rates seem high,” added Frances.

Doctors in India are not too supportive of the somatic symptom disorder. “One symptom cannot be used to diagnose a mental condition,” said Dr Shubhangi Parkar, who heads KEM Hospital’s psychiatry department. “In India, we need to take into account the patient’s body language, our social milieu and families before making a diagnosis,” she said.

Dr Rochelle Suri, a counsellor, said she is not a big fan of DSM-V because it is too generalized. “Just because someone has a few of the symptoms doesn’t mean they have the illness,” she said. Dr Harish Shetty from L H Hiranandani Hospital said: “Treatment modalities should focus on the narratives of life and not on presentation of symptoms alone. A clear diagnosis should be viewed as a trailer and not the movie that needs treatment.”

How important is DSM-V in the Indian context? Parkar said: “DSM-V is important because care has been taken to ensure that cultural context is considered in diagnosis.” In fact, the Indian Psychiatric Society set up a task force to discuss DSM-V and send its recommendations.

Dr B N Gangadhar, professor at Nimhans who was on the IPS task force on DSM-V, said: “DSM is important mainly for doctors who are doing research. With growing amount of research conducted in the country, DSM-V will be an important tool.” But he added diagnosis in India is mainly done on the basis of World Health Organisation’s parallel scale called ICD ( International Classification of Diseases).

Suri said DSM is becoming popular in India’s “westernized” metros because it aids fast diagnosis. “People want a treatment plan as quickly as possible. Hence, DSM would be a good tool in the cities, but in rural settings, where western influence is low, it may not be possible to use it,” she added.

Parkar said each DSM has brought about debate and changes while Shetty viewed it as flexing of muscles. “DSM-V is an aggressive campaign for space and more power for psychiatry in a world where physical illnesses are the emperors,” Shetty said.

New illnesses in psychiatry handbook 

Temper tantrums are now Disruptive Mood Dysregulation Disorder

Grief is Major Depressive Disorder

Forgetfulness is minor neurocognitive disorder

Adults can have Attention Deficit Disorder too

Binge Eating Disorder

Internet Addiction

DSM

DSM stands for Diagnostic and Statistical Manual of Mental Disorders. It’s published by the American Psychiatric Association (APA) and contains descriptions, symptoms, and other criteria for diagnosing mental disorders. This ensures that a diagnosis of schizophrenia is consistent from one clinician to another, across the world. DSM is also important to establish criteria for diagnosis that can be used in research on psychiatric disorders.

DSM has been periodically reviewed and revised since the publication of DSM-I in 1952. Given the burst of information in neurology, genetics and behavioral sciences, experts feel the need to upgrade the scale of diagnosis.

DSM V has been courting controversy for the last four-five years because as critics say, it’s trying to be the game-changer in psychiatry.

In an internet forum, American psychiatrist Dr Allen Frances, who was in the team to draw up DSM-IV, listed the 10 worst changes in DSM-V:

(1) Disruptive Mood Dysregulation Disorder: DSM-5 will turn temper tantrums into a mental disorder. Children and youngsters may be given medication.

(2) Normal grief will become Major Depressive Disorder, thus medicalising emotional reactions to the loss of a loved one. More pills

(3) The old-age characteristic of forgetting could be diagnosed as minor neurocognitive disorder, creating a huge false positive population of people who are not at special risk for dementia

(4) DSM-5 could lead to overdiagnosis of Adult Attention Deficit Disorder and widespread misuse of drugs

(5) Excessive eating 12 times in three months will not be considered gluttony, but a psychiatric illness called Binge Eating Disorder.

(6) DSM-V may exclude Asperger Syndrome, a form of high-functioning autism. Autism diagnosis is likely to fall

(7) First-time substance abusers will be clubbed with long-time addicts

(8) DSM-5 has introduced Behavioral Addictions. Could lead to over-diagnosis of internet and sex addiction

(9) DSM-5 highlights Generalized Anxiety Disorder and the worries of everyday life.

(10) DSM-5 could lead to misdiagnosis of post-traumatic stress disorder

Related articles

• New “catch all” psychiatric disorder could label people who worry about their health as mentally ill (inquiringminds.cc)
• ‘Somatic Symptom Disorder’ – the most ubiquitous mental health diagnosis you never heard of (dxrevisionwatch.com)
• New Disorder Could Classify Millions Of People As Mentally Ill (medicalnewstoday.com)
• Are we over-diagnosing mental illness? (cnn.com)

 

Sloppy Mental-Health Talk Will Intensify Stigma

By Atima Omara-Alwala

WeNews commentator

Monday, February 18, 2013

The current gun-control debate could worsen the mental health stigma that already stops many women of color from seeking help, says Atima Omara-Alwala. It’s necessary to get the facts right on mental illness and those who commit violent acts.

 

 

Credit: Geek2Nurse on Flickr, under Creative Commons (CC BY-NC 2.0)..

(WOMENSENEWS)–Well-meaning activists and elected officials do a huge disservice when they make assumptions about helping the mentally ill only in light of the extreme violence they are supposedly likely to commit.

For women in communities of color, already contending with higher rates of depression and other mental illness, this can be particularly harmful.

Who wants to come forward about your problems when National Rifle Association spokesperson Wayne La Pierre is saying you belong to a trigger-happy lunatic crowd whose names need to be kept on a registry?

Who wants to be lumped together with Adam Lanza?

The horrific massacre of school children and educators in Newtown, Conn., has spurred interest in mental health but the public discourse has spent very little time at the intersection of race and gender.

If we don’t address mental health reforms overall aggressively, the current gun-control debate could bolster a vicious stigma that already blocks many in underserved communities from seeking help.

Clicking through my Facebook and Twitter feeds that awful December day, I saw a torrent of pithy comments on the need to do something about mental illness and gun control in the United States.

It’s a tenuous link to make since an August 2006 study published in the American Journal of Psychiatry shows only 4 percent of those considered mentally ill actually commit violent acts.

I grew up in a black immigrant family intimately affected by mental illness and disability. When I was a child, my favorite cousin, in her late 20s at the time, developed paranoid schizophrenia. Just before we knew she was ill, she came to stay with us, as she always had when visiting.

I was excited to see this cool big sister figure who took me shopping, to the movies and let me play with her makeup. I was shocked at what my pre-teen eyes saw. A healthy, vibrant full figured woman transformed into an emaciated, exhausted version of herself, her thick curly hair now rapidly thinning. Sores covered her once well-kept face.

Grappling With Illness

I will never forget watching my parents grapple with her diagnosis and try to get her help.

As I grew older I saw friends grapple with the byproducts of mental illness: eating disorders to alcoholism and self-injury. In spite of my knowledge and experiences, the national stats are still stunning.

About 26 percent (57.7 million) of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year, according to the National Institute of Mental Health. That number translates into a sobering 1-in-4 adults. Yes, 1-in-4.

Major depressive disorder, or depression, is a leading form of mental disability in people ages 15-44 in the United States and is more prevalent in women, with women suffering two-and-a-half times more likely than men from depression.

The disparity in those suffering from depression widens significantly when you zoom in on female demographics.

Fifty percent more African American women are diagnosed with depression than white women,

according to the National Association for Mental Illness. It’s raised such concern that at the 2007 Congressional Black Caucus Annual Legislative Conference, mental illness and black women were discussed as a major topic because a study from Mental Health America showed a mere 7 percent of black women suffering from depression sought treatment, compared to 20 percent of white women.

The rate of suffering for Latinas is even higher than that of black or white women.

Psychological, biological and environmental factors combine to culminate in mental illness. Traumatic and stressful events, such as a death in the family or divorce or job loss, or even a presumably happy event such as getting married, can contribute to depression.

Unfortunately, the number of those who seek treatment is low, and even lower in communities of color. Here seekers can be more prone to finding mental-health services too expensive; not covered by insurance; or hindered by language and cultural barriers; compounding a larger problem further.

A ‘Weakness’

As a black woman, I am all too familiar with the belief that depression in my community can be especially seen as a “weakness.”

Mental Health America’s 2007 survey found that over half–63 percent–of African Americans believe that depression is a personal weakness. Only 31 percent consider it a medical problem that can be treated. Additional research from the National Association of Mental Illness indicates similar sentiments pervading the Latino and Asian communities.

To be clear I understand why the need for better mental-health treatment has been raised in the context of the Newtown and Aurora, Colo., and other mass shootings. And it’s true that some are homing in on the particular problems of men, who commit up to 94 percent of murder-suicides, according to a 2006 study by the Violence Policy Center.

But we can’t allow the discussion to get sloppy when it comes to mental illness.

Discussing what shifted in the lives of Lanza or Aurora shooter James Holmes to make them killers makes more sense than generalizing about the mentally ill whose percentage of violent crimes against others is low.

Far more frequently, those with mental illness torture and harm themselves.

I would be remiss as a person who has made her living in politics and advocacy if I didn’t use this window, asPresident Barack Obama encouraged, to help “make access to mental health care at least as easy as access to a gun.”

But we must also do our part to not stigmatize those in need so much so that they will not seek the help they need.

Atima Omara-Alwala is a political strategist, progressive and activist of 10 years who has served as staff on eight political campaigns and other progressive causes with a particular focus on women’s political empowerment and leadership, reproductive justice, health care and communities of color. Her writings on the topics have also been featured at Ms. Magazine, RH Reality Check and Fem2pt0. Currently, she isnational vice president of theYoung Democrats of America and serves on the boards of DC Abortion Fund andPlanned Parenthood Metro Washington Action Fund.

 

In search of a revolutionary road #mentalhealth

K. S. JACOB, The Hindu

Psychiatric diagnoses continue to lack the predictive power required of hard science. A new framework is needed to understand mental health, distress and disease

The American Psychiatric Association (APA) will release the fifth edition of its Diagnostic and Statistical Manual (DSM-5) in May 2013. DSM-5 has been years in the making. The process included planning sessions, international research conferences, review of literature, a series of monographs, secondary analysis of data and field trials involving hundreds of scientists and clinicians, drawn from many countries and disciplines, and feedback from the public. Many interest groups — neurologists, psychologists, insurance and pharmaceutical industries, legal and forensic fraternity, military veterans and anti-psychiatry groups — have been watching the process and outcome closely as the DSM has a wide impact. The Indian Psychiatric Society also submitted its views to the APA.

International standard

The DSM-5 has pursued the basic framework adopted by its forerunners, DSM-III and its successors DSM III R, IV and IV TR. DSM III, with its atheoretical approach, objective diagnostic criteria and specific exclusions, was revolutionary at the time of its introduction in 1980. Its focus on standardised diagnosis and on improving inter-rater reliability had a major impact on psychiatric practice and research. It soon became the international standard.

The absence of laboratory tests to diagnose mental disorders forced psychiatry to focus on clinical presentations for this purpose. The lack of pathognomonic symptoms required the discipline to rely on identifying collections of symptoms to define clinical syndromes. Psychiatric classifications include medical conditions (e.g. delirium, dementia and psychiatric manifestations of medical diseases), severe mental disorders (schizophrenia, bipolar disorders, psychotic depression, and stupor) and stress-related conditions (e.g. depression, anxiety and adjustment disorders).

The DSM laid out objective criteria for diagnosis. It offered differential diagnosis in order to distinguish similar conditions. It allowed psychiatrists working around the globe to read from the same page. It facilitated collaboration and comparison. It improved communication, standardised research, increased, and improved the evidence base. A unified language also helped mental health activism.

Despite major advances and significant progress, the DSM has many critics. Most detractors are free with their criticism, without providing comprehensive solutions to the complex issues facing people with mental illness. Defining mental illness is no simple task. A single definition to partition health, illness and disease has proved to be extraordinarily difficult. The diversity of and heterogeneity within these conditions are major challenges. Typically, patients emphasise distress and suffering, while psychiatrists diagnose and treat “diseases.” Mental disorders include both disease and illness. Nevertheless, diagnostic criteria for psychiatric disorders did not bridge the classical disease-illness divide between physicians’ perspectives and patients’ subjective experience of sickness. In fact, the DSM resulted in language, concepts and frameworks, which contrasted starkly with those held by patients, impeding understanding of the illness experience and diminishing the role of patient narratives. In addition, DSM could not overcome the fact that different etiology and pathology can result in similar clinical presentations, and that a particular cause can produce diverse clinical manifestations. Research and specialist interests also increased manifold the number of diagnostic categories.

Little regard for context

The difficulty in separating disease from distress is a major challenge. The DSM system emphasised symptom counts to identify psychiatric categories, with little regard for the context (e.g. psychosocial stress, personality, and coping). This strategy improves reliability of diagnosis for non-psychotic conditions associated with psychosocial adversity, but also includes people with normal responses to such difficulties. Psychiatry tends to reify diagnosis, making abstract concepts concrete. Psychiatric practice transmutes clinical syndromes (collection of symptoms) into diseases.

The DSM III also suppressed etiological debates about mental disorders and placed them on the back burner. The biomedical model, which undergirds the approach, became dominant, annihilating psychological, behavioural and social conceptualisations. However, the APA argued that reliable diagnoses would result in the recognition of underlying neurobiological substrates and facilitate etiological research; it would lead to the development of new and more effective treatments.

However, the frequent revisions of the DSM, with minor changes often based on limited evidence, also prompted debates on the motivation of the APA. The numerous minor and major disagreements with World Health Organisation’s International Classification of Diseases (ICD) -10 diagnostic categories supported the argument that most changes were arbitrary as there was no agreement among international experts. The DSM had to contend with many charges including medicalising normal reactions, lowering diagnostic thresholds to create spurious “epidemics,” creating new categories without evidence, using medication responses to define categories and playing into the hands of the pharmaceutical industry.

Challenges to diagnosis

Defenders of the DSM argue that its primary purpose is to enable psychiatrists to reliably identify individuals who seek clinical attention, and to facilitate communication among clinicians and researchers. The field of psychiatry has to grapple with the current state of knowledge with its inherent limitations. The lack of laboratory diagnosis, poor understanding of genetic basis and psychological vulnerability, and the need to provide categorical diagnosis for phenomena which lie along a spectrum (e.g. depression, anxiety, cognitive impairment and substance misuse) are difficult challenges.

The most ardent supporters of the DSM acknowledge its imperfections but argue that it reflects our current understanding and state of the science. They contend that DSM-5 is not an attempt to define normal and that being normal is not the same as not having a DSM-5 diagnosis. They argue that having a psychiatric diagnosis is not the same as being insane or crazy, stigmatising labels, which do not apply to the vast majority of people with a DSM diagnosis. They suggest that prescribing medication for any condition in preference to time and labour-intensive psychological interventions is dependent on many factors, including the economic realities of medical practice, and does not necessarily imply medicalising normality.

Pressure from user groups

The use of a single set of criteria, useful to psychiatrists working in specialist settings, in other locations (e.g. definitions for legal use and for reimbursement, in primary care and across cultures) is not without problems. There was also pressure from patient and user groups, as any changes to the DSM-IV categories in the new revision would have affected their claims for disability support and health insurance. Consequently, there were demands to enlarge and to reduce the diagnostic net from different quarters.

A close examination of the DSM-5 suggests the maintenance of status quo. Psychiatric diagnoses and theories, with their technical language, operational criteria, elaborate classificatory systems and empirical data continue to lack the predictive power required of hard science. Its diagnostic systems and models do not explain many aspects of mental health and illness. Human cognition, emotion and behaviour are complex, interconnected and under a variety of influences (e.g. genetics and biology, psychological, social and cultural forces), whose effects cannot be teased out under controlled experimental conditions.

Nevertheless, psychiatric treatments help millions of people lead productive lives. The DSM process and consultation was elaborate and transparent, seeking opinions and evidence from people with diverse backgrounds. Despite its shortcomings, it does reflect the current state of the science. Psychiatry, at this moment in time, has been compared to biology before Darwin and astronomy before Copernicus.

Thomas Kuhn in his book The Structure of Scientific Revolutions described three stages: (i) normal science (routine scientific work) within existing paradigms and a dedication to solving puzzles, (ii) serious anomalies produced by research, which leads to a crisis, and finally (iii) resolution of the crisis by the creation of a new paradigm. Psychiatry today, with its attempt at solving the clinical puzzles and its many anomalies, is awaiting a paradigm shift, which will not only clarify these complex issues but will also provide for a new framework, insight and understanding. Psychiatric research, despite its current attempts at testable conjectures and refutations, is still within a paradigm that seems inadequate for the complexity of the task. Psychiatry awaits its new dawn.

(Professor K.S. Jacob is on the faculty of the Christian Medical College, Vellore. The views expressed are personal)

Related articles

• Rejuvenating Abolitionism of Psychiatric Labels – Even Some Establishment Psychiatrists Embarrassed by New DSM-5 (madinamerica.com)
• Why the Newest Psychiatric Diagnostic Bible Will Be a Boon for Big Pharma (conservativeread.com)
• DSM-5 Boycott Launched! (madinamerica.com)
• Bad News: DSM 5 Refuses To Correct Somatic Symptom Disorder (psychologytoday.com)

 

#India- Acute shortage of mental health care staff #humanresources

SPECIAL CORRESPONDENT, The Hindu Jan 14, 2013

India faces an acute shortage of mental health care professionals, including psychiatrists, considering the high prevalence of mental health disorders.

Studies suggest that approximately 13 per cent of the entire population may actually be suffering from some kind of mental disorder — 10 per cent with minor ailments such as stress, anxiety and depression while the remaining with serious disorders such as schizophrenia. Alcoholism and psychotropic addiction are also included in this.

According to a Mental Health Survey carried out by the Directorate General of Health Services in 2002, there were only about 2,219 psychiatrists in the country, against the required 9,696. The number of clinical psychologists was 343, against the desired 13,259. Similarly, psycho-social workers available were only 290, against the required 19,064, while the number of psychiatric nurses was not available, though over 4,000 such trained nurses were required then. Also, while there were about 21,000 beds for mental health patients in the government sector, the number was just about 5,100 in the private sector.

The country has 43 government mental health facilities, though a huge number of private facilities, known as psychiatric nursing homes, have come up. Delhi alone has 16 such facilities. The State governments are authorised to register these private facilities.

The number of psychiatrists and nurses may have marginally gone up since then and the number of patients too would have gone up substantially.

“I think we need to address mental health issues, both by addressing demand for and supply of services, and by services I mean evidence-based medical and psycho-social interventions that can address a wide range of mental health problems, including their prevention,” said Dr. Vikram Patel, eminent mental health expert and Professor, London School of Hygiene and Tropical Medicine.

This required multiple actions, from awareness building in communities and in the health workforce, to the creation of new community-based human resources skilled in providing psycho-social interventions and building capacity of primary health workers for delivery of medical interventions, he told The Hindu.

There is a huge debate going on in the country over the nature of treatment that must be provided to people with mental disorders. While a majority believes it should be home and community based — considering the condition of mental homes and public facilities — there are others who believe institutional care is also required, particularly for women, as people with mental health issues are often disowned by families and hence vulnerable to exploitation.

Keywords: mental health, public healthcare, psychiatrists, Mental Health Survey

 

#India-Train judges handling sex crimes in psychiatry #Vaw #Justice

 

DHNS
BANGALORE : The judiciary, especially judges handling cases related to sexual abuse against women, must have basic training in psychiatry and mental illness to handle the sensitivity of the subject, said the Indian Psychiatric Society president Prof Indira Sharma.


At the 65th annual national conference of Indian Psychiatric Society which began here on Thursday, Prof Sharma said, “It is unfortunate to hear cases about sexual abuse of women with mental illness. There is a need to relook into the judicial aspect of handling such cases,” she added.


Prof Sharma said there was no standard mental health policy in place and made out a case for having one. Referring to the recent Delhi gang-rape incident, she said there is a need to frame elaborate guidelines on handling rape victims and recommended that the amended anti-rape law be called the Jwala Act.


Prof Norman Sartorius, former director, Mental Health, World Health Organisation, Geneva, said due to rapid urbanisation and globalisation, the number of people suffering from mental illnesses has increased over the years. “It is unfortunate to hear that today’s world which measures everything in terms of economics has also tagged health as a commodity wherein you pay more, you get more even in terms of cure for illness,” he added.


Briefing about the recommendations sent to Justice Verma committee on amending laws against sexual abuse, Dr R Raghuram, Head, Department of Psychiatry, Kempegowda Institute of Medical Sciences, said rape victims should be counselled regularly in tandem with the legal process.


The four-day conference will witness a host of lectures by psychiatrists from across the world and will be attended by over 3,000 delegates including psychiatrists and clinical psychologists.

Related articles

• #India Fix the Rape Problem #Vaw #Justice #womenrights (kractivist.wordpress.com)

 

Sanction pension to mentally challenged person: Madras High Court #good news

CHENNAI : Coming to the rescue of a mentally affected person who was denied disability pension, the Madras High Court has directed the authority to sanction the pension in three months.

Disposing of a writ petition filed on behalf of him, Justice N. Paul Vasanthakumar concurred with petitioner’s counsel that the mentally affected individual was also entitled to get ‘Physical Disability Pension.’

The Judge also pointed out that the government had removed income limit for receiving such pension.

The writ petition was filed on behalf of C. Rajamani (46) of Jodukuli village in Salem district by his brother C. Saravanan, contending that Rajamani was denied pension even after authorities had issued Disability Certificate stating that he had mental disability to the extent of 65 per cent.

An application, submitted by him to Special Tahsildar, Social Security Scheme, Omalur, on June 28, 2010 seeking grant of pension, was rejected on the ground that his mother was getting pension and that the applicant had landed property.

M.R. Jothimanian, counsel for the petitioner, submitted that the income limit mentioned earlier was removed by the government from the financial year 2010-2011 and therefore the petitioner was entitled to get such pension.
When the petitioner again submitted an application, it was rejected on the ground that being a mentally disabled person, the petitions did not come in the category of ‘Physically Disabled Person.’

The counsel also submitted that the issue was clarified by the Deputy Director of State Commissionerate for Physically Disabled Persons, through his proceedings in 2012 stating that “if a person is mentally disabled, he is also entitled to get Physical Disability Pension.”

The counsel further said that the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 also defines that physical disability includes ‘mental illness’ and therefore, the petitioner was entitled to get ‘Physical Disability Pension’ at the rate of Rs.1,000 per month.

After hearing the submissions, Mr. Justice Paul Vasanthakumar said, “Considering the said submission and having regard to the Certificate issued by the District Disabled Rehabilitation Officer, Salem, and in the light of the order dated June 28, 2010 removing the income limit, the impugned orders cannot be sustained.”

Setting aside the impugned orders, the Judge directed the Special Tahsildar to sanction pension to the petitioner within three months.

The court also permitted Mr. Saravanan to get pension on behalf of him, after getting orders in the Original Petition which was already filed in the District Court, Salem for appointing him as a guardian.

 

source: The hindu

Related articles

• #India- Enabling the disabled (kractivist.wordpress.com)
• #iNDIA- Mental Health Law Reform: Challenges Ahead (kractivist.wordpress.com)

 

#INDIA- Mental Health Law Reform: Challenges Ahead

Posted on December 23, 2012by jilsblognujs

by Aditya Ayachit

Mental disorders are complex physiological infirmities of the nervous system. While they continue be the tough riddles in the field of medical research, they pose even more daunting challenges in the socio-economic and legal contexts. In recent times the mental health laws across the world have undergone a significant change. A policy of segregation has been abandoned in favor of a policy of integration and protection. Theprima facie reason for this shift appears to be the increasing influence of the Human Rights discourse over laws and policy making. Thus, a new mental healthcare paradigm has emerged which advocates that the mentally ill are not objects of charity or social protection but are subjects with rights and States and the International bodies are under an obligation to provide them with the means of enforcing these rights.The international consensus about the new paradigm was strongly conveyed by the near unanimous acceptance of theUnited Nations Convention on the Rights of Persons with Disabilities 2006(commonly known as the Disability Convention’) and Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (or simply the MI Principles).

India is a signatory to the Disability Convention. However, it has failed to bring its laws and institutions in tune with the standards set by the convention. To fulfill its commitments under the Disability Convention, 2006 and MI principles of 1991, India needs a major overhaul of its disability laws and policies dealing with mental health care. The Ministry of Health and Family Welfare (MHFW) recently came out with the Mental Health Care Bill 2012 responding to this formidable legislative challenge. The reactions to this bill were mixed with some groups lauding provisions decriminalizing attempted suicide by a mentally ill person, ensuring the availability of insurance for treatment of mental illness at par with physical illness and prohibition of certain medical procedures like the Electro Convulsive Therapy (in case of minors), Sterilization and Chaining, while others opposing the bill on the ground that its provisions curtailed patient autonomy and liberalized the laws for involuntary admissions to mental institutions. This post does not aim to comprehensively review the bill. Rather, it attempts to map the issues that the Bill appears to address and contrasts the status quo with the regime the bill seeks to establish.

Few Mental Health Practitioners and Institutions in India

A recent statistic from the MHFW indicates that about 7 percent of the Indian Population suffers from some form of mental disorder. Another startling statistic is that 90 percent of these disorders remain untreated. The leading cause behind this paradox is the acute shortage of mental health institutions and qualified mental health practitioners in India. Our large and populous country of 1.2 billion people has about 40 mental health institutions, 3,500 psychiatrists, 500 clinical psychologists, 300 psychiatric social workers and 1,000 psychiatric nurses to treat its mentally ill citizens. In addition to this, most of the institutions and practitioners are located in urban areas. This creates a serious problem in a country like India where over 70 percent of the population lives in rural areas.

According to the National Family Health Survey, the private medical sector remains the primary source of health care for the majority of households in both urban areas (70 percent) and rural areas (63 percent) of India. While private players contribute immensely to the health care industry, it remains the case that they generally shy away from investing in mental health institutions.  This is mainly due to low policy priority given to mental health sector, strict licensing requirements under the Mental Health Act 1987 and the lack of any special incentive for investing in this sector. Today in India, government health policies mainly focus on communicable diseases like HIV/AIDS, malaria and tuberculosis or on child malnutrition or on reproductive healthcare. Mental healthcare rarely finds mention in the policy. This underscores the importance of this sector and makes the investment environment in such services unattractive and discouraging.

Another factor that reduces the likelihood of private investment in mental health care is the strict licensing regime set up by the Mental Health Act 1987; the legislation that currently governs the mental health sector. This Act lays down a complicated procedure of issuing a non-transferable and non-heritable license to a person who wishes to open a mental healthcare institution. The act further discriminates between government established institutions and privately maintained institutions by exempting the government institutions from the statutory requirement of obtaining a license. If private participation is to be encouraged, this system of licensing needs to be rationalized.The Mental Health Care Bill 2012 goes a long way in this regard. The bill replaces the stringent licensing system with a simpler system of registration. The registration unlike a license is not linked to a particular person and is freely transferable for instance on the sale of the institution. It also allows the institution an appeal to the High Court if the grant of registration or renewal of registration or cancellation of registration is refused by the appropriate authority. While the bill seeks to relax the laws governing the setting up of mental health institutions it must ensure via its provisions that this does not in any way affect the quality of health care provided in these institutions. The issue of quality of health care will be taken up further in this post.

To ensure that rural areas also benefit from private investment, the incentives given to invest in rural areas could be greater than those given for investment in urban areas. Another way in which the presence of mental health facilities in rural areas can be increased is by proper implementation of the District Mental Health Program which was initiated by the Government of India in 1996. Currently, the program is under implementation in only 123 of the total 657 districts of the country. A proper implementation of the program would go a long way towards ensuring that rural areas have adequate mental care facilities in near vicinity.

Poor Quality of Mental Health Institutions

The second core issue in this area is the unacceptable quality of medical care provided to the mentally ill in the existing mental health institutions in our country. It would not be an overstatement to say that the patients who receive mental health treatment in India are treated in a most inappropriate and inhuman way in our mental institutions. The institutions usually resemble prisons where the mentally ill are debased and deprived of their dignity. They are made to live in unacceptable living conditions and are shackled down in chains for long hours. They are fed unhygienic prepared unwholesome meals, are subjected to painful medical procedures without their consent, are regularly beaten and in some cases are also subjected to sexual assault. Sometimes they are sterilized on the basis of a medical myth that sterilization cures mental disability. In essence, the patients never receive adequate treatment. Rather the treatment aggravates their condition and makes them sick and infirm for life completely eliminating any hope of rehabilitation or a chance of leading a normal life (see here and here for more). Any mental health care legislation must develop a structured mechanism for ensuring that our mental health institutions do not fall short of the internationally accepted standards of treatment and care. The Mental Health Act 1987 and the State Mental Health Rules 1990 provide detailed safeguards to ensure that the health institutions meet the statutory standard. While building upon this legacy, any new legislation must incorporate the minimum standards laid down in the Disability Convention of 2006 and the MI Principles of 1991. Further, steps must be taken to bring government maintained institutions under the purview of these regulatory procedures. It may be noted here that the Mental Health Act 1987 is quite inconsistent with the principles and safeguards laid down in the aforesaid international instruments and as government hospitals are deemed to be licensed institutions under the act, it is unclear whether the procedures laid down for revocation of license in cases of non-compliance are applicable against  government facilities.

Consent of the Mentally Ill Patients

Another aspect that would have to be substantially addressed in mental health legislations is with respect to consent of the patient to receive treatment. It is a cardinal principle of medical science that no one may be subjected to any medical procedure without his/her express consent and such procedure may not continue after the person has withdrawn his consent. Mental Healthcare raises complex questions regarding consent. The Mental Health Care Bill 2012 provides innovative solutions to the problem of consent. The bill allows persons to register an ‘advance directive’ with the appropriate mental health board. An ‘advance directive’ is a legal document containing details of the kind of treatment a person wishes to receive or does not wish to receive in the event of mental illness. It also contains the details of the person’s nominated representatives who are entitled to give consent on the person’s behalf when he is not in a position to give consent. The bill provides procedures for amendment or cancellation of advanced directives and also gives powers to the Central or State mental health board to review advance directives and to suspend or amend them in some special cases (for instance when the advance directive has been made under force, coercion, undue influence etc. or when it was made without proper knowledge). While many groups are touting advance directive as a foolproof solution to the problem of consent, it remains to be seen how this statutory tool would operate in real life. This provision has been opposed on the grounds that it would be susceptible to gross misuse especially in rural areas where the patients are illiterate and are not aware about their rights.

Rehabilitation and Social Awareness

Another issue that the bill attempts to address is rehabilitation and social awareness. These concepts are inter-related. The extent to which a patient can be restored back in his life (family, community and occupation) depends on the social understanding of mental illness and the attitude of the society towards the mentally ill. A society which rejects the mentally ill or which despises them cannot possibly assist in rehabilitation of the patient. As societal attitudes are shaped to a large extent by education, an awareness program which aims towards creating social understanding about mental illness can directly assist in making the society more suitable for rehabilitation of the patient. Mental Health Act 1987does not contain any provisions regarding social education or patient rehabilitation. The Mental Health Care Bill 2012 addresses this lacunae and creates an obligation on the Central and State governments to spread awareness about mental illness and its appropriate treatments. The Bill lays emphasis on lowering the stigma associated with mental illness so that a patient’s rehabilitation in the society may be facilitated. It may be noted here that a proper implementation of the aforesaid provisions may go a long way in debunking the long standing myths about mental illness (like mental illness is caused due to demonic possession or that mental illness is incurable) and make the society a better place for the mentally ill.

Human well-being in a country cannot be ensured unless its citizens are physically and mentally fit. Mental health is prone to neglect because it is difficult to detect, difficult to cure and also difficult to explain to the people. The Mental Health Care Bill 2012 appears to be a commendable effort towards addressing the long standing problems encountered by patients and practitioners alike in the sector of mental healthcare and restoring the long lost dignity of the mentally ill.

Image Courtesy: here, here, here, here and here

(Aditya Ayachit is an Assistant Editor with the Journal of Indian Law and Society)

Related articles

• Mental health legislation must be more therapeutic, humane (thehindu.com)

 

Don’t we have the right to get married too? #disability

By Ranjitha Gunasekaran Source : SIFY

Last Updated: Fri, Dec 07, 2012

Bhagya (name changed) falters as she tells me what happened when she said she wanted to get married.

“Do you know what my parents asked me? They said, ‘Yevan irrukkan unnai kattikrathuku?’ (Who is there to marry you?) I was so upset. I went into a long depression,” she recalls, over tea.

Bhagya has a disability. She has cerebral palsy. Still, she completed her school and college education. She says her parents have always been supportive – her father quit his job to take care of her — but she cannot get over how they reacted when she expressed her interest in marriage.

“They just started using bad language and getting frustrated with me. I am talking to them about something important in my life. Who else will I speak to about this?” she asks.

Bhagya’s experience is not unusual.

“The view of disabled women is as asexual beings,” S.S. Smitha, the co-founder of Tejas (an advocacy group of disabled women), explains. “Caregivers of so many women do not even consider marriage for them and often treat the woman as a child,” she says.

The result of this attitude is often a profound lack of information and knowledge about the woman’s own sexuality.

Even Smitha, a 32-year-old well-travelled activist, did not consider the issue of sexual health and well-being until she attended a session on the subject at the Women’s Institute of Leadership in Disability earlier this year. The experience inspired her to organise a cross-disability workshop on sexuality and women’s rights in Chennai early this week. Bhagya was one of the 25 disabled women who participated.

At the workshop, others echoed Bhagya’s views. Punitha Suresh, from The Banyan, spoke of how women with mental illness were dissuaded from getting married.

The reasons given for these attitudes of the caregivers often seemed to stem from a flawed belief that the children of persons with disabilities will also be born disabled.

Then there is the overprotective concern of some caregivers who worried that the woman will not be looked after well, or will be ill-treated.

Chaitali (name changed) pointed out that the caregivers often viewed the young women as still little girls or children. “Other than asking who will marry us, even when we do have male friends, people tend to frame that relationship in terms of a brother-sister bond,” she said.

This of course is once a male friend has been found – Bhagya had earlier raised the question of how disabled women were supposed to socialise and meet people to begin with.

Ranjini K Moorthy, an activist, who was facilitating the session on reproductive and sexual health summed up the situation: “We are seen as sexless human beings who are expected to live life without experiencing sexuality, dissuaded from marriage, socialisation is not encouraged and our relationships are desexualised.”

Life is not rosy for married disabled women either. One hearing impaired woman said her husband found her gestures embarrassing and refused to visit public places with her.

Another said her husband had married her for her money. “We are told not to marry disabled men but when we marry an able-bodied person, there are gaps in understanding and the marriage doesn’t work out,” a woman said.

The belief that their children too might be born with a disability had led at least one participant to be forced into an abortion.

Ranjini and others said they had heard of disabled women being given hysterectomies, sometimes without their informed consent.

To underline how prevalent this view of disabled women as asexual was, Smitha later told me that some parents and caregivers left with their wards when they were told the sessions were for the women alone – even though the women themselves were interested in attending.

“The question is one of information. Crucial information is not reaching disabled women because we are seen as asexual. The view is ‘this information is not applicable to my daughter’s life’,” she said. (Another barrier to information reaching the women is accessibility, something that Tejas tried to address with material in braille or as visuals, etc.)

Disabled women, especially in India, already have to make their peace with having a limited control over their bodies and lives. Some have to get accustomed to being carried, sometimes by strangers.

Some are not allowed to grow their hair to make life simpler for their caregivers. Many choose not to do things that interest them so that their caregivers are not inconvenienced.

But perhaps one of the greatest of indignities that women with disabilities endure has to be friends, family, doctors, teachers making assessments of and decisions for them on the most personal and intimate aspects of their lives: “Can she have a relationship? Will anyone want to marry her? Can she have children? How will she take care of them?”

Image credit: thebanyan.org

Ranjitha Gunasekaran studied English and Mass Communications before joining The New Indian Express reporting team in 2006, covering urban local bodies and heritage. She left the paper to help the Communications department of The Banyan, an NGO which works with destitute mentally ill women before rejoining the Express Weekend section. She covered gender, mental health, development and edited the paper’s Sexualities section, the first of its kind in the country. She headed the Weekend section from August 2010 to April 2011 before leaving to help ideate on and launch a daily school edition of the newspaper. She loves dogs and food and has written about the latter for the Express lifestyle magazine, Indulge, from 2009. She quit her job in October to focus on her writing.