The outpatients’ room, MH-6, is sunlit and quiet even though the corridor outside is chock-a-block. A man in his 50s walks in. The air thickens with his high-pitched rapid-fire monologue. A dozen odd patients and attendants rush to witness the spectacle. The middle-aged man from Mysore is proclaiming he is ‘like God’, ‘he could do anything’. But for Dr Sanjeev Jain, placid and empathetic, he is just one of the many patients who need to be admitted to the hospital. Promptly, he is sent for emergency admission.
One in three households will have some kind of mental illness; one in six households will have a serious mental illness that will require hospitalisation for more than two weeks, is the projection for India in three years. One in three such patients will not be able to go back to gainful employment. In this context, the Mental Healthcare Act 2017, passed in April, is highly significant.
The Act defines access to mental health as a right, makes it mandatory for all healthcare facilities to improve psychiatric services, which was not possible otherwise. It will allow any hospital or nursing home to set up psychiatry wards, which also was not possible earlier and healthcare providers avoided psychiatry like the plague even though mental health is the most expensive of all illnesses. Importantly, the Act mandates insurance companies to cover mental health. So what can be possibly wrong about this new Right? It seems it’s a highly fraught decision and there’s a furore in the medical circle.
Dr Jain, who was part of the team that contributed to the Mental Health Policy, which is closely linked to the new Act, is a psychiatrist at the Bengaluru-based National Institute of Mental Health and Neurosciences (NIMHANS). He has also been chronicling the history of psychiatry in South Asia, most recently funded by the European charity Wellcome Trust. And he believes the needs of mental health in India will increase as compared to that of physical health. In the wake of the new Act, we ask him how will things change on the ground.
The Ken: Why do we need a separate law for mental health when most countries have done away with it?
Jain: The range of problems is so large that to expect a law to address those is not fair. Still, let me cite two examples. Right now, we are trying to get treatment for a person who is a senior corporate executive. He is under the delusion that the camera on his computer is spying on him, the satellites are taking pictures and that his children are under threat. He wants to pull them out of school so that he can protect them. There’s no way the family can get him for treatment because he starts talking about his rights and that nobody has any business to call him mad, tells the doctor that he is earning a salary twice that of [the doctor] and wards off his wife saying.