June 18, 2013: Last Thursday, the Union Cabinet cleared the Mental Health Care Bill. When it was first seen in 2012, the draft law was touted as the great hope for a rights-based approach to mental health care in India.
Generally, there is growing recognition of the burden of mental health problems and its massive economic costs. Apart from the direct costs of mental health care, there are massive indirect costs related to the loss of productivity of individuals who are unwell, the burden that is placed on families with mentally ill members, and the costs borne by justice systems and the wider social welfare systems outside of health care. It is said to constitute ten per cent of the global disease burden and there are also concerns that globalisation and natural disasters have led to an increase. Momentum behind the reform of mental health law, policy, and care has continued to grow around the world and the region in this context.
In May this year, China’s first ever mental health law came into effect, aiming to recognise the human rights of people with a mental illness. The legislation is expected to tackle issues such as the abuse of mentally ill people and unjustified compulsory hospitalisation. Work is also happening across the Asian region to develop partnerships and share best practices in the care of the mentally ill. India is an important part of Asia Australia Mental Health, an initiative that “partners academic, government, health sector community and peak bodies in Asia and Australia to improve mental health services and outcomes in the Asia Pacific region.” One of their projects is a partnership between the University of Melbourne and the Ministry of Health and Family Welfare, which has been running pilot community mental health projects around India since 2011.
Mental health is also receiving its share of attention in the Commonwealth. The theme of the Commonwealth Health Ministers Meeting held on May 19, the eve of the Sixty-Fifth World Health Assembly, was “Mental Health: Towards Economic and Social Inclusion”. The statement made by the Chair following that meeting underscored the need for increased mental health care and access to care in low and middle income countries (of which India is one), and the importance of continued reform in mental health care and policy. A key output of the seven-day World Health Assembly was a resolution about the “global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level”, supporting the World Health Organisation’s comprehensive 2013-2020 Mental Health Action Plan.
One of the important aspects of WHO’s Mental Health Action Plan are the targets it proposes, as a way of measuring progress. These include “a 20% increase in service coverage for severe mental disorders and a 10% reduction of the suicide rate in countries by 2020”. Whilst both these indicators would represent impressive progress for India, an examination of the suicide rate in this country is enough to demonstrate the importance of the issues of mental health care and access. India had a suicide rate of 11.2 per 100,000 in 2011, which amounts to over 135,500 people taking their own lives every year. This is above the world average and, disturbingly, has only been increasing since at least the mid-2000’s. If the WHO’s goal was to be achieved in India, the number of lives saved would be huge, not to mention the relief from the devastation and loss suffered by so many families.
Given its population and presence in the Asian region, India should step up and take a lead role in promoting best-practice mental health care and policy. The changes in approach and policy needed to start this are embodied in the Mental Health Care Bill. It would be ideal if India could go to the Commonwealth Heads of Government Meeting in November 2013 with this new law in the books.
(Tennille Duffy is part of the faculty on myLaw.net.)