Hi all, A very thorough and comprehensive report on the consultation which
was heldby the Union Health Ministry about the new Mental health act. You will
notice that most of those who were represented in this consultation are the
ones who also took leading part in the new draft of the persons with
Disabilities act 2011. But Mr. Bakshi has been gracious enough to keep those of
us in the loop unlike in the past. The groups which oppose direct ECT(in the
guise of human rights) so that consumption of pills will increase have
succeeded.But then drug MNCs are powerful with kind regards.
"Greatness lies not in never falling but in rising everytime we fall"Captain
Johann samuhanand, BANGALORE INDIA91 80
42023252 www.captainjohann.blogspot.com
Dear Group,
The Ministry of Health and Family Planning organised on Tuesday, the 22nd
March, 2011 National Consultation on Mental Health Care Bill, 2010 (released
on 6th December 2010) at National Institute of Health and Family Welfare,
Munirka, New Delhi. This followed the Regional Consultations held at 5
Centers following the release of the Second Draft amendments to MH Act on
23rd May 2010.
There were about 50/60 participants; half of them were officials from the
State and Central Governments and Government Mental Health Institutions.
There were also heads of various bodies connected with disabilities and
officials from the Ministry of Social Justice and Empowerment. The other
half consisted of heads of NGOs, representatives of caregivers and user
survivors and psychiatry professionals. The ministry did not circulate any
list of participants. The key participants whom I could identify and
recollect were, Poonam Natrajan, Chairperson National Trust, Dr. Sudha Kaul
chairperson New Disability Law Drafting Committee, Dr. P. Satish Chandra,
Director and vice chancellor NIMHANS Bengalaru, Dr. Nimesh Desai Head of the
Institute of Human Behaviour and Allied Sciences Delhi, Srilata Juwa
Chairperson, Centre for Disability Studies and Action TISS Mumbai, Vandana
Gopikumar founder Trustee the Banyan Chennai, Rukmini Pillai, Founder
Trustee Torchbearers New Delhi, Dr. Anirudh Kala, Founder Past President
Indian Association of Private Psychiatry, Bhargavi Davar, Founder Managing
Trustee Bapu Trust Pune, Dr. Thara, Director SCARF Chennai, Dr. M.
Thirunavukkarsu, President Indian Psychiatric Society, General Ian Cardozo,
Chairman Rehabilitation Council of India, Dr. Achal Bhagat, Founder Trustee
Sarthak New Delhi, Akhileshwar Sahay Founder, Whole Mind India Foundation,
Nirmala Srinivasan Founder Trustee ACMI Bengalaru, Ratnaboli Ray, Founder
and Managing Trustee Anjali Calcutta and Mukul Goswami Founder Managing
Trustee of Aasha Deep Gawhati.
The Consultations began with Mr. Keshav Desiraju A.S. MHFW, making opening
remarks and Ms. Shalini Prasad, J.S. MHFW giving a background. Thereafter
Dr. Jaya Sagde made a section wise power point presentation of the MHCB
2010. Dr. Jagdish Kaur from the office of the Director General Health
Services in a power point presentation highlighted the provisions of the
Mental Health Act 1987 and the changes made in the MHCB 2010.
After the above presentations, the participants were asked to give chapter
wise comments. NAAJMI represented by Bhargavi, two survivors, Lavanya and
Reshma and Ranaboli, was critical of the Draft Bill. Bhargavi labeled the DB
as Mental Illness Bill. She was of the view that DB was not UNCRPD
compliant. Dr. Bhagat also echoed the same views. Dr. Kale, the A.S.
himself, I and one more participant asked as to where specifically the DB
was not UNCRPD Compliant. Lavanya in particular was critical of
psychiatrists. Dr. Kala protested and requested the A.S. to stop
participants from making such attacks which he did.
Many participants expressed satisfaction with the DB and complimented the
Ministry and the Drafting Team of Dr. Soumitra Pathare and Dr. Jaya Sagade.
Some of the important points made by the participants were as under:
· Rights of the Persons with Disability Bill 2011 (Draft for
Discussion) had many provisions which were at variance with the provisions
in the DMHCB 2010. This needed to be sorted out. All the 4 disability acts
should be in harmony. The A.S. pointed out that for coordination purpose the
authorities responsible for different disability acts were requested to
attend the Consultation. Accordingly Mrs. Poonam Natrajan (Chairman National
Trust), General Cardozo (Chairman Rehabilitation Council of India) and Dr.
Sudha Kaul (Chairman Disability Act Drafting Committee) were present. The
Ministry of Social Justice and Empowerment which is the concerned ministry
is also represented. The Director MSJE assured that harmony amongst the
various Disability Acts would be brought about.
· There was concern expressed about the total legal capacity being
assumed for care receivers. The right given to a care receiver to appoint
his or her nominated representative to manage his or her affairs would
damage the institution of family care givers. An arrangement where the
family provided shelter and met all expenses including the cost of medicines
and an outsider taking decisions on behalf of the care receiver would not
work and could lead to some families abandoning the care receivers and they
would end up on the streets.
· The title of the act needed to be expanded to include mental
health services and allied matters also.
· The criticism of the current MHA 1987 to be diluted.
· The preamble should contain a reference to provision for all
round support to the families providing care to the family members with
mental illness.
· The natural guardian should be the default care giver.
· In the definition of family, natural guardian should be mentioned
first and then persons related to the care receivers.
· The language used in defining Mental Health Facility for which
registration is required should be modified so that there is no ambiguity
about excluding Day Care Centres from Mental Health Facility.
· The insistence on informed consent of the patient for treatment
even where the patient has come willingly for the treatment is unwarranted.
Even a G.P. does not inform about the details of the medication prescribed,
how it would help, what would be the side effects etc. before starting the
treatment. A psychiatrist is busier and has no time for such explaining. A
mental patient has disturbed mental condition and therefore he or she cannot
understand such explanations. This provision should therefore go.
· For ECT, there is no provision of informed consent. As the ECT
would require general anaesthesia and an electric convulsion therapy,
consent of the patient or his or her family care giver should be taken as it
is taken for surgeries.
· The ban on ECT for children had no medical reasons.
· Children below 12 years of age are not a risk to themselves or to
the community and therefore should not be admitted in a mental health
facility.
· Psych surgery should be banned; with atypical medicines available
there is no need for psych surgery or at least it should be stated that it
would be given in the rarest of the rare cases.
· There was some opposition to imposition of penalties for mental
health facilities.
· There were some opinions against such elaborate machinery at
Central and district Level s. Some others wanted that there should be some
set up at state level also.
· Some felt that maximum 90 days stay in a mental health facility
was inadequate as there was need for longer stay for most of the patients.
It was explained that cycle of 90 days can be renewed as many times as
necessary.
· There should be no requirement for informed consent from NR in
Emergency Treatment as there would be no time for completing such
formalities.
· There should be no ban on ECT as a part of emergency treatment as
in emergencies such treatment is required. Only such treatment should be
given by a qualified psychiatry professional.
· While fixing different norms for mental health facilities under
different categories and in different areas, some minimum standards must be
prescribed.
· All details and implementation should come under rules as it is
easier to change rules at the government level. For amending the law it is
necessary to go to the Parliament. The other view was that states take very
long to make rules, so all that is required should come in the act itself.
· There was a view that the provision of Advance Directive was not
implementable. Even persons with no mental illness seldom make a will. So
how do you expect a person with mental illness to be as smart as to make
advance directive presuming that it would be needed when his or her support
needs would be high.
· The general view was that the competence was very well defined in
the draft bill. But some felt that by including such definitions in the act,
the mentally ill’s basic rights will be adversely affected. Further the role
of a medical practitioner will be reduced to deciding competence and issuing
competence certificates.
On the whole the consultations were conducted efficiently and in a smooth
way. The participants were encouraged by the A.S. to express their views and
those who wanted to speak for the first time were given the floor in
preference to those who had spoken before. Dr. Soumitra intervened and
clarified whenever required. Some of the participants were speaking in
general terms and some were seeking provisions which already existed. This
was indicative that they had not done enough home work and the DB was not
read carefully. There were only a few participants who pointed out
specifically as to what needed to be deleted, modified, substituted or
added. The J.S. requested the participants to give in writing, on the sheet
provided to them, what their views were which could not be expressed during
the Consultations for want of time. What I was not able to present was
voluminous, so I handed over to J.S. my file in which I had indicated the
changes required.
What I have narrated above is what I recollect, without the help of any
written notes. It is just an account by a participant. There is bound to be
some subjectivity, some unintended inaccuracies, omissions or wrong
understanding. The intention is only to brief the members of the group, who
were not participants in the Consultations.
We now look forward to the Final Draft Bill as it would go to the
Cabinet/Law Ministry. Let us hope it has a smooth sailing and becomes the
first of the disability bills to become a law.
Amrit
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Groups "Mental Health Advocacy (News 'N Views) India" group.
To post to this group, send email to [email protected]
To unsubscribe from this group, send email to
[email protected]
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Affiliated Groups : MENTAL HEALTH ADVOCACY INDIA
[email protected]
Discussions on mental health law / policy / plan monitoring / human rights etc
[email protected]
India-specific news and views related to mental health
[email protected]
Information and support to carers of people with mental health issues
[email protected]
Mutual support and sharing of experiential knowledge, skills and social
learning amongst peers
