It is unfortunate people having ver-very poor understanding of mental health are opining and writting. This is how democarcy is being enjoyed by many in our country.
Abdul Mabood -- Snehi -An Organization for Psychosocial Support and Mental Health Care B-347, Vasant Kunj Enclave, B-Block, New Delhi-110070 India P: +91-11-65418181, 65978181 M: +91-9582208181 Email: [email protected] [email protected] Website: www.snehi.org ----------------------------------------------------------------------------------------- Mental Health: The fundamental right of every human being. Child Mental Health is an essential Child Right. Prevention is root of cure. Mental health is not only a health issue. It is a social and development issue. On 19 April 2011 09:09, Admin <[email protected]> wrote: > Dated: March 24th 2011 > > Shri. Ghulam Nabi Azad > Hon’ble Health Minister > Government of India > Nirman Bhavan, > New Delhi -110108 > > *Reference: Revision of Mental Health Act 1987 & Mental Health Care Act > 2010 ( draft )* > > Dear Shri Azad ji, > > This needs your esteem, kind and personal attention. > > I am writing this note on behalf of the Disease Management Association of > India – ( DMAI)- The Population Health Improvement Alliance . DMAI works > with all the stake holders in the entire continuum of care, for improving > the population health of the nation . Over the last few years, we have > worked with different stake holders to help define the right priorities in > healthcare for the policy makers & the care providers . > > Through this note , I am drawing your attention to the revision of the > mental health act of 1987 and the proposed Mental Health Care act 2010 > (Draft). The process of revision of the Mental Health Act 1987 was initiated > about a year back, to make it compliant to the United Nations Convention on > the ‘Rights of Persons with Disability’. Disability includes persons with > long term mental illness. This convention advocates equal rights for all > disabled persons. > > Dr Saumitra Pathare ( a private psychiatrist) and Dr. Jaya Sagade (a > lawyer) of Pune were in charge of conducting the regional consultations on > behalf of the Ministry. Over the last one year, there have been 5 regional > consultations with various stakeholders. The major stakeholders consulted > have been users, care providers, professional bodies in mental health, > mental health institutions and state government representatives. However, it > is to be noted that, the Medical Council of India, other specialties of > modern medicine, and professional organizations of general health field, > have not been consulted. This is important, as the changes which are evident > in the draft bill have far reaching consequences in terms of the way the > modern medicine is taught and practiced currently. > > DMAI- The Population Health Improvement Alliance, is surprised with the > outcome of the consultations , and that there was hardly any discussion on > the final outcome to patients due to the significant changes which are being > brought in terms of the ‘mental health’ field of practice of medicine by way > of promulgating this act. Proposed changes are likely to cost human lives , > as persons who have not been trained to be physician (Clinical Psychologist, > Psychiatric Social Worker, Psychiatric Nurse), will be entrusted with the > role of independent examination, diagnosis and admission of patients in > mental health facilities. Currently, this role rests with a Psychiatrist who > is a medical doctor (MBBS) trained in Psychological Medicine. In modern > system of medicine ,only a physician (M.B.B.S )can diagnose a patient, as > only he has received training in all the specialties such as Medicine, > Surgery, Eye, ENT, Obstetrics & Gynecology, Pediatrics, Orthopedics, > Radiology, Dentistry, Dermatology, Anesthesiology, Pharmacology, Preventive > and Social Medicine, Pathology, Microbiology, Physiology, Biochemistry, > Anatomy etc. , which essentially means, covering all the systems of the > body. Unfortunately, Human body cannot be compartmentalized and however we > may wish, but we cannot have an Eye specialist who has studied only ‘Eye’ > and not done MBBS ( as a basic general qualification and set of skills > covering the entire human body system) to examine each and every system of > human body. Similarly, we cannot have a Psychologist who has no training of > the subjects studied at MBBS level, to diagnose mental disorders by only > doing psychological examination!!!! > > Only an MBBS trained doctor with the proper understanding of the entire > human body system and its functioning, can do a detailed psychological > evaluation and come to a diagnosis of whether the patient has a > psychological illness or it is some physical illness, which is presenting > itself as a psychological illness. In cases of latter, appropriate referral > is required and any delay may even be fatal. S/he can also order various > tests and imaging and interpret them for aiding in his diagnosis. After a > diagnosis is arrived at, s/he can plan and provide physical treatment (ECT), > pharmacological treatment or psychological treatment. The role of > psychiatric nurse, clinical psychologist or a psychiatric social worker is > to assist him by nursing the patient, helping him in psychological > interventions, helping him in psycho-social interventions respectively. But > the patient is under the overall care of a psychiatrist who is the leader of > the mental health team. All the three categories of personnel work under the > supervision of a psychiatrist . > > A clinical psychologist, PSW ( Psychiatric Social Worker ) or a > psychiatric nurse is not trained to be a physician. They have not studied > the human body as an MBBS doctor and cannot do detailed physical or systemic > examination, investigations and imaging like a psychiatrist. They are in no > position to independently examine, diagnose and advise admission of patient. > A PSW and Clinical psychologist have not general training in other subjects > of modern medicine. Just by talking to patient, how can a Clinical > Psychologist or PSW diagnose a mental disorder? They will be severely > restricted by their inability to do general and systemic examination and > order and interpret investigations and imaging. A Psychiatry examinee will > fail in his examination if he did not touch the patient for examination ; > however bright drug treatment he may formulate for the patient ; as without > a general and systemic examination, a person cannot make a diagnosis of > mental disorder. In many cases special investigations and imaging also has > to be ordered and interpreted. As per the diagnostic criteria for mental > illness, a mental disorder can only be diagnosed after ruling out that the > signs and symptoms are not better accounted for by a medical illness or > use/abuse of a substance. In this scenario, without proper validation of the > reason for the particular condition , what is the validity of diagnosis of > mental disorder by a Clinical Psychologist, PSW or a Nurse ? Even the quacks > believe that they can diagnose and treat independently. Each such claim > needs to be examined objectively in line of their competence and current > practice related to their vocation. > > In modern system of medicine, which is regulated by MCI, there is no > specialization known as Clinical Psychology, PSW or Psychiatric Nursing. The > mandate of ‘Rehabilitation Council’ is limited to rehabilitation of persons > with disability and practice of modern medicine under Rehabilitation Council > is neither required nor allowed. If at all, new independent specialties such > as Clinical Psychology, PSW and Mental Health Nursing without any > supervisory role of a Psychiatrist is being planned for modern medicine > system, then the whole modern medical system (MCI, Indian Medical > Association, Other Medical Specialties) must be consulted . > > If we go as per the draft, it means that Clinical Psychology, PSW and > Mental Health Nursing personnel are as much a specialist as a psychiatrist > and can independently examine , diagnose, admit and treat patients with > mental disorders. > > It is not understandable why a psychiatrist has to do MBBS (study the whole > human body) and then specialize in Psychiatry while for the other persons > they need to study only psychology or social work and yet be assumed to be > qualified to examine the whole body, diagnose, admit and treat patients > (albeit without medicines) . The demand to prescribe medicines by non > psychiatrist is also going around (and may be later on this will be also be > made possible.) There is no institution in the country where a Clinical > Psychologist, PSW, Mental Health Nurse examines patients independently, > diagnoses a mental disorders, admits patients and treats them. This amounts > to practice of Psychiatry under the modern system of medicine and would > invite penal provisions of MCI. The sole aim of drafters is to get the bill > through and take credit for drafting the bill rather than have a healthy > development of the sector. Nowhere in the country there is a Clinical > Psychology ward, PSW ward or Psychiatric Nursing ward. The decision to admit > is taken by the leader of the mental health team who is a Psychiatrist and > it is the Psychiatrist who is overall responsible for treatment of a patient > with mental disorder. > > One of the reasons given by the people behind the draft of the Mental > Healthcare Act 2010, for giving the role of independent examination, > diagnosis and admission in bill, is the shortage of psychiatrist in the > country. But if we go by the definition of psychiatrist in the bill which is > the same as that in the previous Act, ‘an MBBS qualified person with > experience and training in Psychiatry can be designated a psychiatrist’ for > the purpose of the Act. > > At present , there are about 8 lac medical practitioners in the country and > these can potentially be designated as psychiatrist. So where is the > shortage for the purpose of the Act ? The only purpose which could be served > by giving an independent examination, diagnosis and admission to Clinical > Psychologist, PSW, Mental Health Nurse in the bill is to later on claim that > if they are capable of doing these jobs, then this means that they can > practice their trades independently under the modern system of Medicine. > This would mean they will be physicians of mental disorders just like a > psychiatrist. > > The inclusion of Clinical Psychologist, PSW, Mental Health Nurse for > purpose of independent assessment, diagnosis, admission to a mental health > facility should be deleted and replaced by ‘psychiatrist’ (an MBBS qualified > doctor with some training/experience in psychiatry). After this, there will > not be a need for defining mental health professional in the Act. If at all > it has to be defined, then Clinical Psychologist and PSW shall be designated > as Assistant Mental Health Professional as in the present legislation > (Section 22 of State Mental Health Rule 1990) and their role clearly > specified as being- to assist a psychiatrist. > > Further, the supervision and review of the decision of a psychiatrist by a > Clinical Psychologist, PSW, Mental Health Nurse in the mental health review > commission is not feasible as review is to be done by practitioner of the > same specialty i.e. Psychiatrist. Thus, the provision of Psychiatrist in the > review commission should be made mandatory. > > In a multidisciplinary team such as a mental health team, each team member > has a specific role. If everyone will do the same role, which is to > independently examine, diagnose and admit, then there could be no team > functioning. Rather the role of each mental health person should be > clarified in the Guidelines /Rules clearly, so that there is good team > functioning and the public is well informed and is not misguided by > manipulative persons. Can we imagine a similar provision for a Nurse > specializing in Medical, Surgical, OBG, Cardio-thoracic nursing to > independently examine, diagnose and admit patients in Medical, Surgical or > OBG, Cardio-Thoracic ward respectively? Then why should we consider similar > provision for Clinical Psychologist posted with Neurology department? > > Psychiatry is a medical discipline as any other discipline. If Clinical > Psychologist, PSW and Psychiatric Nurse want to independently examine , > diagnose, admit and treat patients without even having the training and > skills for the same and government wants to allow the same, then they should > be allowed to start their own wards to do so and be responsible for their > decisions. If we allow such changes to be brought, this would mean that a > Psychiatrist too does not need to do MBBS. Then all the specialties of > modern medicine should have direct specialization rather than first spend > 5.5 years to be a General doctor. Human body cannot be divided in a > compartments. All organs and systems are interrelated. A stroke can present > itself as a depression in a mental health facility. What skill a > psychologist or a PSW has to diagnose it without doing a full neurological > examination or relevant investigations. They will treat for depression while > the patient will die. In my view , compartmentalised knowledge is dangerous > for the medical profession and defeats the basis of evidence based medicine > > We are trying to make Clinical Psychologist, PSW and Mental Health Nurse > into Physicians in mental health by giving the role of a Physician to them > under the new draft bill on the pretext of shortage of Psychiatrist. > However, there are less than a 1000 Clinical Psychologist and PSW both > combined in the country. Further, there is no dearth of Psychiatrist under > Mental Health Act, as Govt. can very well designate MBBS doctors with some > experience in Psychiatry as Psychiatrist (as per the definition and > provision in current legislation and the draft Bill). So even the > assumptions for the shortage of psychiatrists is not a right justification > for this act > > The role given to Clinical Psychologist, PSW and Psychiatric Nurse in the > draft bill is ; independent examination of patients, diagnosis , admission > and then review of decisions taken by a Psychiatrist. Instead of this, in > the draft bill, the role of a Clinical Psychologist and PSW- as a > rehabilitation professional , and Psychiatric nurse – as a specialized > nurse, should have been clarified and focused. > > The position of a Psychiatrist as a mental health team leader should be > reiterated and the decision of a psychiatrist should only be reviewed by a > board having a psychiatrist. These rules could further be clarified In the > draft bill psychiatric social worker and clinical psychologist has been > mentioned as mental health professional just like a psychiatrist. However, > In section 22 of the State Mental Health Rules’1990 (the existing > legislation) the PSW and Clinical Psychologist are referred to as Assistant > mental health professional. The change in the draft bill under consideration > has been done with a view to make their role fit for independent > examination, diagnosis, admission to a mental health facility by the > drafters, without any regard to the impact of this on the patient care and > safety. If they are full-fledged professionals (as they claim) who can > diagnose, admit and treat patients, why do they need to be defined as such > in the Act. At no place in the draft bill their role has been mentioned > separately. At all places they are bunched as mental health professional > with no individual roles. At no place it is mentioned that they will > function under the supervision of a psychiatrist. If they independently > examine, diagnose and admit patients they are then deemed to have an > independent role. This will increase the role conflict which is already very > high in the mental health team. So much so that at some places there is no > team work. In Kerala High Court, there is a case going on, to allow clinical > psychologist to independently practice in community to treat patients of > mental disorders. > > This is a serious issue and needs to be taken up strongly so that untrained > people are not given the role of a physician i.e. to practice independently > to treat patients. > > DMAI insists that the Medical Council of India, Indian Medical Association > & patient groups & DMAI needs to be taken in confidence and consulted, as > independent examination, diagnosis and admission and also treatment by > psychological or psycho-social means is practice of psychiatry under modern > medicine and could not be allowed to be done by persons who do not even have > a MBBS degree, in view of patient safety and care. > > All health personnel shall work within the limits of their competence. In > section 43 and 45 of the draft bill related to admission in a mental health > facility: a mental health professional (i.e. Clinical Psychologist, PSW, > Psychiatric nurse) has a role to examine a person suspected to be mentally > ill independently, assess mental illness and its severity and advise > admission. This is a role which goes beyond their competence. There are > already instances of Clinical Psychologist practicing treatment of mental > disorders independently as isolated examples. There is growing demand from > clinical psychologist to allow them to practice independently the treatment > of mental disorders. This change in the draft bill will allow them to be > recognized as persons who can independently examine, diagnose, and admit > patients, which will substantiate their claim to practice independently in > community rather than under the supervision of a psychiatrist. It’s > altogether different matter that they are not trained to examine and > diagnose mental disorders as it requires ruling out other physical disorders > as well and it requires a person to be a physician to do that. In section 22 > of the draft bill : Constitution of district panels of mental health review > commission , two members could be mental health professionals (i.e. Clinical > Psychologist, PSW, Psychiatric nurse) which may not include a psychiatrist > if he is not available, but then how the commission can judge the decision > of a psychiatrist if no psychiatrist is in the commission? One needs to have > knowledge of psychiatry to assess the correctness of the decision of a > psychiatrist in a particular case. Provision of a psychiatrist in the review > commission should be mandatory rather than being replaced by > non-psychiatrist personnel Mental disorders are medical disorders and should > not be treated by non-medicos . > > I am quite sure that you will intervene and ensure that the corrective > measures are taken to address the lacunae in the bill Also, > > DMAI- The Population Health Improvement Alliance has initiated a ‘NCD > Policy of India’ initiative, and would be glad to have the views of the > ‘Ministry of Health’ involvement on the initiative > > I am quite convinced that committed leadership will take cognizance of this > note and take measures to implement the suggestions after a debate with all > the stake holders in the continuum of care. > > Should you need any assistance at my end, do let me know. > > With best regards > > Rajendra Pratap Gupta > > CC. Dr.Manmohan Singh, Sonia Gandhi ,Rahul Gandhi , Dr.Syeda Hameed, > Dr.Murli Mahohar Joshi , Montek Singh Ahluwalia ,Shri Dinesh Trivedi , > Sitaram Yechury, Members of Parliament , Sam Pitroda , Secy-Health & Family > Welfare , GOI, Dr.K.Srinath Reddy, Debasish Panda , Secretary (ME) > Governors , MCI DGHS,MOHFW, Dr.Sudhir Gupta , CMO, NCD-MOHFW ,Dr. Suman > Sinha, Psychiatrist, IMA , Chief Minister’s of States > > > http://rajendragupta.wordpress.com/2011/03/30/mental-healthcare-act-2010-needs-revisions/ > > > -- > You received this message because you are subscribed to the Google > Groups "Mental Health Advocacy (Reform) India" group. > To post to this group, send email to [email protected] > To unsubscribe from this group, send email to > [email protected] > For more options, visit this group at > http://groups.google.com/group/MhaReformIndia?hl=en > ------------- > 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 > -- You received this message because you are subscribed to the Google 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] For more options, visit this group at http://groups.google.com/group/MhaNewsViewsIndia?hl=en ------------- 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
