Kerala’s Mental Healthcare Model

Why in news?

Kerala has always boasted of European standards in healthcare but mental healthcare remains a blind spot.

What are the issues?

• In February 2022, an inmate was murdered by another at the mental health centre in Kozhikode.
• On the directions of the Kerala HC, the district judge conducted an inspection and reported many violations.
• Recently, a suo motu case was registered by the State Human Rights Commission on the inhuman treatment being meted out to patients at the Government Mental Health Centre in Thiruvananthapuram.

What did the inspection expose?

• The latest intervention exposed the deplorable conditions at the Thiruvananthapuram facility where patients were found locked up in cells with tin roofs and closed windows.
• Patients are being treated like prisoners and live amid dirt.
• There has been gross violation of patient rights guaranteed by the Mental Healthcare Act, 2017.
• Infrastructure inadequacies to insufficient number of staff were cited as the reasons of the pathetic conditions.
• Efforts to constitute review boards were initiated by the state mental health authority only this month.
• The authority which was formed in January 2021 met only once so far though the law mandates that the body should meet at least four times a year.

According to a survey by the Indian Council of Medical Research (ICMR) 7.5% of the total country’s population is hit by mental illness.

What does the Mental Healthcare Act, 2017 provide for?

• The Mental Healthcare Act 2017 aims to provide mental healthcare services for persons with mental illness.
• It ensures that these persons have a right to live life with dignity by not being discriminated against or harassed.
• New definition of mental illness- Earlier, Mental illness was defined as any mental disorder and seldom as mental retardation but the new act provides a broader definition.
• Rights for persons with mental illness- It includes
  • Right to obtain mental health care
  • Right to live with dignity
  • Non-discrimination
  • Rights of confidentiality
  • Right to protection from barbaric and demeaning treatment
• Advance directive- A person with mental illness shall have the right to make an advance directive that states how he/she wants to be treated for the illness and who his/her nominated representative shall be.
• The advance directive should be certified by a medical practitioner or registered with the Mental Health Board.
• Mental health authority- The Bill provides power to the government to set-up the Central Mental Health Authority at national-level and State Mental Health Authority in each State.
• Mental health treatment- The Bill also specifies the process and procedure to be followed for admission, treatment and discharge of mentally-ill individuals.
• Decriminalization of suicide- This is a milestone judgement which annulled Section 309 IPC which punishes person attempting to perform suicide.
• Abolishment the barbarous treatments- It affirms that a person with mental illness shall not be subjected to electroconvulsive therapy (ECT) therapy without the application of muscle relaxants and anaesthesia.
• Electro-convulsive therapy for minors is prohibited.
• Chaining in any manner or method is banned.
• Mental health review boards- Section 73 of the Act mandates the constitution of mental health review boards.

WHO noted in a report in 2017 that there are less than two mental health professionals for every 100,000 people in the country.

What initiatives were taken regarding the mental health?

• De-stigmatizing Awareness- Organizations like The MINDS Foundation, Manas Foundation, The Banyan, Aasra, etc. are key in de-stigmatizing mental health in India.
• NMHP- The government of India launched the National Mental Health Programme (NMHP) in 1982 to focus mainly on increasing the reach of minimum mental health services for the poor.
• The Mental Health Care Act- It mandated affordable mental health care, the right to make decisions and informed consent, the right to live in a community and the right to confidentiality.
• Tele-health Initiatives- The Government of India has proposed to launch a National Tele Mental Health Program.
• Community-based Approaches- Sangath, an NGO provides affordable mental healthcare by strengthening state and private sector services by training the community.
• MANODARPAN is an initiative of the Ministry of Education to provide psychosocial support to students for their mental health and well-being.
• Rehabilitation- Ministry of Social Justice & Empowerment has launched the 24x7 Toll-Free Mental Health Rehabilitation Helpline “KIRAN” to provide relief and support to persons with Mental Illness.

What is the need of the hour?

• The inmates of mental hospitals are the most vulnerable section in the health sector.
• They are voiceless and they don’t have voting rights.
• Sincere effort is needed from the state government to implement the act in its true spirit.

References

1. https://www.newindianexpress.com/opinions/editorials/2022/apr/15/state-of-mental-healthcare-a-blemish-on-kerala-model-2442164.html
2. https://blog.ipleaders.in/all-need-know-about-mental-healthcare-act/
3. https://borgenproject.org/improving-mental-health-in-india/
4. https://vikaspedia.in/health/mental-health/manodarpan-initiative
5. https://vikaspedia.in/news/24x7-tollfree-mental-health-rehabilitation-helpline-kiran-18005990019-launched