Policy debates

The new mental health bill is a step in the right direction, but experts say there are miles to go

Cuts in healthcare budgets and poor district-level healthcare have prompted mental health experts to question how the ambitious provisions will be implemented.

With the Rajya Sabha passing the Mental Health Care Bill, 2013, on Monday, India took a step towards implementing a legislation that recognises the rights of the mentally ill and aims to protect them. The new law, when passed by the Lok Sabha, will replace the archaic Mental Health Act of 1987.

In a first, the bill has an expansive definition of what constitutes mental illness and recognises the right of mentally ill people to affordable and quality healthcare. Mental health experts, however, are sceptical about how these far-reaching provisions will be implemented.

The reform, however, is much-needed. Critics of the 1987 law had said that it was not much better than the British-era Indian Lunacy Act of 1912. The 1912 Act had revamped the system of mental health services and administration in India, according to an article in the journal Mental Health Reviews. The law removed the so-called mental hospitals from the purview of prison and brought them under central supervision. Crucially, the role of specialists, such as psychiatrists, for treating these patients was recognised. However, at the crux of the law was the need to protect the public from the mentally ill who were considered to be potentially dangerous.

“Conceptually this [the 2013 bill] is a very different bill,” said Vikram Patel, mental health expert and co-director at the Centre for Control of Chronic Conditions at the Public Health Foundation of India. “In the previous Act, the emphasis was to protect society from the mentally ill and so the emphasis was largely on coercive, involuntary treatment of people with mental illnesses, barring them from a variety of civic spaces and rights. Now, the emphasis of this bill is highlighting the rights of the mentally ill and protecting them from abuse and discrimination.”

Big ambitions

The new mental healthcare bill defines mental illness as “a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence”.

This is a much more detailed and extensive definition that the one in the 1987 Act, which states that a mentally ill person is one with “any mental disorder other than mental retardation.”

The ambition of the bill is to universalise access to mental healthcare through services run or funded by the government and to ensure affordable, quality access to treatment.

It also gives mentally-ill people the power to determine their treatment by giving them the right to issue advance directives stating how they want to be treated and by nominating representatives to ensure these directives are carried out. Thirdly, the bill mandates that all insurance companies provide medical insurance for the mentally ill on the same grounds that they would issue insurance for physical illnesses.

And, in perhaps of its most crucial features, it decriminalises suicide, which is currently punishable under Section 309 of the Indian Penal Code. According to the bill, anyone who attempts suicide will be presumed to be mentally ill at the time of committing the act, unless proven otherwise.

The bill also bans illegal restraint or seclusion of mentally ill people and the use of electro-convulsive therapy without anaesthesia or on minors. However, it allows of electro-convulsive therapy for minors, after necessary permissions are sought, if the psychiatrist deems it essential.

Questions of implementation

Those working with mentally-ill patients feel that the bill sounds good in theory, but the problem will be implementing these big ideas.

“It is all good to say that we are going to have universal access to mental health but the reality is that the state itself does not know how many beds are available for people suffering from mental illness,” said Paras Sharma, programme coordinator of a free psychological helpline called iCall at the Tata Institute of Social Sciences in Mumbai. “The second thing is that most states are not even aware of the mental health burden.”

The bill suggests that universal mental health care should be achieved by providing proper access to treatment at the district level. However, Sharma, who works with district-level mental health programmes in Maharashtra, questioned how this would happen.

“Maharashtra is probably the only state that has a semblance of a district-level mental health programme, which is running in 13 districts,” he said. “But only four of the 13 districts are being funded by the government. So how can we talk about district-level access to mental health care when there is no funding?” Sharma said that the bill does not provide for any sort of mental healthcare fund.

While the Centre has produced a visionary document, healthcare is a state subject and delivery of services will vary from state to state, said those working in the mental health sector.

Reports of the Ministry of Health and Family Welfare recognise a treatment gap of 50%-70% for mental health care – which means a majority of those who need treatment and medical attention are not receiving it.

And with significant cuts in the funding for healthcare in the last two union budgets, experts are questioning how the universal mental health care will be implemented.

But the problem runs deeper than lack of funds.

“Even the existing money that is given to district mental health programmes is often not spent and the issue is not of money alone,” said Patel. “It is also a question of the technical capacity of governance and of state governments and officers knowing how to use that money in a way that can maximise coverage and quality care.”

The way forward

According to Sharma, the bill is largely biomedical in its outlook – it caters to the mentally ill who are admitted to healthcare facilities but does not look at common mental illnesses for which people seek counselling but do not need to be institutionalised.

"We need to start recognising mental health specialists apart from psychiatrists and social workers," he said. "We need to open up positions and recruit people at the district level."

Sharma expressed concern about the fact that the bill does not mention specific mechanisms to complain against violations of the law or specific penalties for violators.

Patel, who feels that the new mental health bill is one of the most well thought-through policy documents in recent times, was worried about how it may be diluted going forward.

“We need a very strong accountability system involving the civil society that follows the implementation of the bill, like we have for the Right to Information Act,” said Patel. “What I am hoping is that in every state, you will see groups of consumers, civil society members and mental health professionals coming together to ensure that the state is implementing it in the letter and spirit of the law.

We welcome your comments at letters@scroll.in.
Sponsored Content  BY 

How technology is changing the way Indians work

An extensive survey reveals the forces that are shaping our new workforce 

Shreya Srivastav, 28, a sales professional, logs in from a cafe. After catching up on email, she connects with her colleagues to discuss, exchange notes and crunch numbers coming in from across India and the world. Shreya who works out of the café most of the time, is employed with an MNC and is a ‘remote worker’. At her company headquarters, there are many who defy the stereotype of a big company workforce - the marketing professional who by necessity is a ‘meeting-hopper’ on the office campus or those who have no fixed desks and are often found hobnobbing with their colleagues in the corridors for work. There are also the typical deskbound knowledge workers.

These represent a new breed of professionals in India. Gone are the days when an employee was bound to a desk and the timings of the workplace – the new set of professionals thrive on flexibility which leads to better creativity and productivity as well as work-life balance. There is one common thread to all of them – technology, tailored to their work styles, which delivers on speed and ease of interactions. Several influential industry studies and economists have predicted that digital technologies have been as impactful as the Industrial Revolution in shaping the way people work. India is at the forefront of this change because of the lack of legacy barriers, a fast-growing economy and young workers. Five factors are enabling the birth of this new workforce:

Smart is the way forward

According to the Future Workforce Study conducted by Dell, three in five working Indians surveyed said that they were likely to quit their job if their work technology did not meet their standards. Everyone knows the frustration caused by slow or broken technology – in fact 41% of the working Indians surveyed identified this as the biggest waste of time at work. A ‘Smart workplace’ translates into fast, efficient and anytime-anywhere access to data, applications and other resources. Technology adoption is thus a major factor in an employee’s choice of place of work.

Openness to new technologies

While young professionals want their companies to get the basics right, they are also open to new technologies like Augmented Reality, Virtual Reality and Artificial Intelligence. The Dell study clearly reflects this trend — 93% of Indians surveyed are willing to use Augmented/Virtual Reality at work and 90% say Artificial Intelligence would make their jobs easier. The use of these technologies is no longer just a novelty project at firms. For example, ThysenKrupp, the elevator manufacturer uses VR to help its maintenance technician visualize an elevator repair job before he reaches the site. In India, startups such as vPhrase and Fluid AI are evolving AI solutions in the field of data processing and predictive analysis.

Desire for flexibility 

A majority of Indians surveyed rate freedom to bring their own devices (laptops, tablets, smartphones etc.) to work very highly. This should not be surprising, personal devices are usually highly customized to an individual’s requirements and help increase their productivity. For example, some may prefer a high-performance system while others may prioritize portability over anything else. Half the working Indians surveyed also feel that the flexibility of work location enhances productivity and enables better work-life balance. Work-life balance is fast emerging as one of the top drivers of workplace happiness for employees and initiatives aimed at it are finding their way to the priority list of business leaders.

Maintaining close collaboration 

While flexible working is here to stay, there is great value in collaborating in person in the office. When people work face to face, they can pick up verbal and body language cues, respond to each other better and build connections. Thus, companies are trying to implement technology that boosts seamless collaboration, even when teams are working remotely. Work place collaboration tools like Slack and Trello help employees keep in touch and manage projects from different locations. The usage of Skype has also become common. Companies like Dell are also working on hi-tech tools such as devices which boost connectivity in the most remote locations and responsive videos screens which make people across geographies feel like they are interacting face to face.

Rise of Data Security 

All these trends involve a massive amount of data being stored and exchanged online. With this comes the inevitable anxiety around data security. Apart from more data being online, security threats have also evolved to become sophisticated cyber-attacks which traditional security systems cannot handle. The Dell study shows that about 74% of those surveyed ranked data security measures as their number one priority. This level of concern about data security has made the new Indian workforce very willing to consider new solutions such as biometric authentication and advanced encryption in work systems.

Technology is at the core of change, whether in the context of an enterprise as a whole, the workforce or the individual employee. Dell, in their study of working professionals, identified five distinct personas — the Remote Workers, the On-The-Go Workers, the Desk-centric Workers, the Corridor Warriors and the Specialized Workers.

Dell has developed a range of laptops in the Dell Latitude series to suit each of these personas and match their requirements in terms of ease, speed and power. To know more about the ‘types of professionals’ and how the Dell Latitude laptops serve each, see here.

This article was produced by the Scroll marketing team on behalf of Dell and not by the Scroll editorial team.