Status of Mental Health in India: A LEGAL STUDY

Status of Mental Health in India: A LEGAL STUDY

SYNOPSIS

STATEMENT OF PROBLEM

India is currently home to a population of over one billion citizens. A study conducted by the World Health Organization in 2015 shows that one in five Indians may suffer from depression in their lifetime, equivalent to 200 million people. Due to the stigma associated with mental illness, a lack of awareness, and limited access to professional help, only 10-12% of these sufferers will seek help. It is appalling to see the epidemic rates at which mental illnesses are on the rise in India and yet there's a tendency to look at the disease with suspicion and paint mental health as a stigma. With the unprecedented increase in crime rates, corruption as well as surmounting unrest among the population, there is ample evidence to show the need to focus on promoting mental health and psychological well-being today.

RESEARCH OBJECTIVES

1. To study the availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of population.

2. To encourage application of mental health knowledge in general health care and in social development.

3. To promote community participation in the mental health services development and to stimulate efforts towards self-help in the community.
   

RESEARCH QUESTIONS

• 1.      What does it mean to have mental illness?
• 2.      Is “brain problem” or a “mind problem.” How can I figure that out?
• 3.      Who does mental illness affects?
• 4.      What cause mental illness?
• 5.      What are some of the warning signs of mental illness?
• 6.      Can people with mental illness recover?
• 7.      What should I do if I know someone who appears to have the symptoms of mental disorder?
• 8.      What treatment options are available?

RESEARCH METHOD

Methodology” implies more than simply the methods the researcher used to collect data. It is often necessary to include a consideration of the concepts and theories which underlie the methods. The methodology opted for the study on the topic may be Doctrinal.

 Doctrinal research in law field indicates arranging, ordering and analysis of the legal structure, legal frame work and case laws by extensive surveying of legal literature but without any field work.

SOURCES OF DATA

The Secondary sources:

·         Books

1. (1). Dr. Surya Rao Rega, Ph.D (LAW), Lectures on Law of Insurance, Asia Law House, First Edition 2010- 2011, Reprint 2016.
2. .Murthy KSN and Sarma KVS, B Com, ML, PhD, Professor, NALSAR University of Law, Hyderabad. Modern Law of Insurance in India, 5^th Edition 2014, Reprint 2016.
3. (3).Srinivasan’s MN, BSc (Hons), LL B, Advocate, Ex- Legal Adviser, Karnataka Government, Insurance Department, Principles of Insurance Law, 9^th Edition 2009.

·         Website

1.  https://www.weforum.org/agenda/2018/04/5-charts-that-reveal-how-india-sees-mental-health/
2. .https://www.choice.com.au/money/insurance/life/articles/three-glaring-problems-with-life-insurance#mental-health
3. .https://www.psychologytoday.com/us/blog/rethinking-mental-health/201402/the-12-vital-questions-mental-health
4. http://www.thekimfoundation.org/faq.html
5.  https://www.nhp.gov.in/national-mental-health-programme_pg

·         Dictionary-

CONCISE LAW DICTIONARY (LEXIS NEXIS) FIFTH EDITION

CHAPTER 1:

Mental Illness nothing to be ashamed of, but stigma and bias shame us all – William J Clinton.

INTRODUCTION

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.

Over the course of your life, if you experience mental health problems, your thinking, mood, and behavior could be affected. Many factors contribute to mental health problems, including: (1) Biological factors, such as genes or brain chemistry (2) Life experiences, such as trauma or abuse (3) Family history of mental health problems.

                                          Now these psychiatric symptoms are common in general population in both sides of the globe. These symptoms – worry, tiredness, and sleepless nights affect more than half of the adults at some time, while as many as one person in seven experiences some form of diagnosable neurotic disorder. A large number of adult patients (10.4 – 53%) coming to the general OPD are diagnosed mentally ill. However, these patients are usually missed because either medical officer or general practitioner at the primary health care unit does not ask detailed mental health history. Due to the under-diagnosis of these patients, unnecessary investigations and treatments are offered which heavily cost to the health providers. Similarly to how one would treat diabetes with medication and insulin, mental illness is treatable with a combination of medication and social support. These treatments are highly effective, with 70-90 percent of individuals receiving treatment experiencing a reduction in symptoms and an improved quality of life. With the proper treatment, it is very possible for a person with mental illness to be independent and successful.

Now from the above discussion we can understand that mental health can affect daily life, relationships, and even physical health. Mental health also includes a person's ability to enjoy life - to attain a balance between life activities and efforts to achieve psychological resilience.

Indian Legal Systems refers to the system of law operative in India. In the ancient days, there was a distinct tradition of law, which had a historically independent school of legal theory and practice. Law as a matter of religious prescriptions and philosophical discourse has an illustrious history in India

CHAPTER 2:

Mental Illness

2.1 What does it mean to have mental illness?

Mental illnesses are health conditions that disrupt a person’s thoughts, emotions, relationships, and daily functioning. They are associated with distress and diminished capacity to engage in the ordinary activities of daily life.  Mental illnesses fall along a continuum (A continuous nonspatial whole or extent or succession in which no part or portion is distinct or distinguishable from adjacent parts) of severity: some are fairly mild and only interfere with some aspects of life, such as certain phobias. On the other end of the spectrum lie serious mental illnesses, which result in major functional impairment and interference with daily life. These include such disorders as major depression, schizophrenia, and bipolar disorder, and may require that the person receives care in a hospital. It is important to know that mental illnesses are medical conditions that have nothing to do with a person’s character, intelligence, or willpower. Just as diabetes is a disorder of the pancreas, mental illness is a medical condition due to the brain’s biology. 

2.2 Is “brain problem” or a “mind problem”. How can I figure that out?

The mind–body problem is a philosophical problem concerning the relationship between thought and consciousness in the human mind and the brain as part of the physical body. It is distinct from the question of how mind and body function chemically and physiologically since that question presupposes an interactionist account of mind-body relations

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2.3 Who does mental illness affects?

Mental illness does not discriminate; it can affect anyone, regardless of gender, age, income, social status, ethnicity, religion, sexual orientation, or background.  Although mental illness can affect anyone, certain conditions may be more common in different populations. For instance, eating disorders tend to occur more often in females, while disorders such as attention deficit/hyperactivity disorder is more prevalent in children. Additionally, all ages are susceptible, but the young and the old are especially vulnerable. Mental illnesses usually strike individuals in the prime of their lives, with 75 percent of mental health conditions developing by the age of 24. This makes identification and treatment of mental disorders particularly difficult, because the normal personality and behavioral changes of adolescence may mask symptoms of a mental health condition. 

Parents and caretakers should be aware of this fact, and take notice of changes in their child’s mood, personality, personal habits, and social withdrawal. When these occur in children under 18, they are referred to as serious emotional disturbances (SEDs).

2.4 Who cause mental illness?

Although the exact source of mental illness is not known, research points to a mix of genetic, biological, psycho social, and environmental factors as being the root of most conditions. In the case of Jackson v. Indiana (406U.S. 715 (1972).)

Since this combination of causes is complex, there is no sure way to prevent mental illness. However, we can reduce our risk by practicing self-care, seeking help when we need it, and paying attention to early warning signs.

2.5 What are the laws regulating treatment of persons with mental disorders?

Relationship between psychiatry and law most often comes into play at the time of treatment of (Person with mental disorder) PMI. Treatment of PMI often involves curtailment of personal liberty of psychiatric patients. Most of the countries in the World have laws regulating treatment of psychiatric patients. Though there are elaborate descriptions of various forms of mental disorders in various treatises in Ayurveda the care of mentally ill in the asylums in India is a British innovation After the takeover of the administration of India by the British crown in 1858, a large number of laws were enacted in quick succession for controlling the care and treatment of mentally ill persons in British India These laws were

• The Lunacy (Supreme Courts) Act, 1858
• The Lunacy (District Courts) Act, 1858
• The Indian Lunatic Asylum Act, 1858 (with amendments passed in 1886 and 1889)
• The Military Lunatic Acts, 1877.

CHAPTER 3:

Warning Signs of Mental Illness

3.1 What are some of the warning signs of mental illness?

Symptoms of mental health disorders vary depending on the type and severity of the condition. The following is a list of general symptoms that may suggest a mental health disorder, particularly when multiple symptoms are expressed at once.

·         Eating or sleeping too much or too little

·         Pulling away from people and usual activities

·         Having low or no energy

·         Feeling numb or like nothing matters

·         Having unexplained aches and pains

·         Feeling helpless or hopeless

·         Smoking, drinking, or using drugs more than usual

·         Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared

·         Yelling or fighting with family and friends

·         Experiencing severe mood swings that cause problems in relationships

·         Having persistent thoughts and memories you can't get out of your head

·         Hearing voices or believing things that are not true

·         Thinking of harming yourself or others

·         Inability to perform daily tasks like taking care of your kids or getting to work or school

3.2 Can people with mental illness recover?

When healing from mental illness, early identification and treatment are of vital importance. Based on the nature of the illness, there are a range of effective treatments available. For any type of treatment, it is essential that the person affected is proactive and fully engaged in their own recovery process.

Many people with mental illnesses who are diagnosed and treated respond well, although some might experience a return of symptoms. Even in such cases, with careful monitoring and management of the disorder, it is still quite possible to live a fulfilled and productive life.

3.3 What should I do if I know someone who appears to have the symptoms of mental disorder?

We must encourage those with symptoms to talk to their friends and family members and seek the counsel of a mental health professional. The sooner the mental health condition is identified and treated, the sooner they can get on the path to recovery. 

If we know someone who is having problems, don't assume that the issue will resolve itself. Let them know that we care about them, and that there are treatment options available that will help them heal. Speak with a mental health professional or counselor if we think our friend or family member is experiencing the symptoms of a mental health condition. If the affected loved one knows that you support them, they will be more likely to seek out help. Uma Manickam v. The Inspector of Police (14^th September 2007.)

3.4 What treatment option is available?

Just as there are different types of medications for physical illness, different treatment options are available for individuals with mental illness. Treatment works differently for different people, so it is important to find what works best for them.

3.5 What is National Mental Health Program (NMHP)?

Recognizing that Persons with mental illness constitute a vulnerable section of society and are subject to discrimination in our society; Families bear disproportionate financial, physical, mental, emotional and social burden of proving treatment and care for their relatives with mental illness; Persons with mental illness should be treated like other persons with health problems and the environment around them should be made conducive to facilitate recovery rehabilitation and full participation in society.

The Government of India launched the National Mental Health Programme (NMHP) in 1982, keeping in view the heavy burden of mental illness in the community, and the absolute inadequacy of mental health care infrastructure in the country to deal with it. The district Mental Health Program was added to the Program in 1996. The Program was re- strategized in 2003 to include two schemes, viz Modernization of State Mental Hospitals and Up-graduation of Psychiatric Wings of Medical Colleges/General Hospitals. The Manpower development scheme became part of the Programme 2009.

 The three main component of NMHP

• 1.      Treatment of mentally ill.
• 2.      Rehabilitation.
• 3.      Prevention and promotion of positive mental health.

Mental Health Care Act 2017

The Mental Health Care Act 2017 was passed on 7 April 2017 and came into force from July 7, 2018.  The law was described in its opening paragraph as “An Act to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfill the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto. “ This Act superseded the previously exiting the Mental Health Act, 1987 that was passed on 22 May 1987.

3.6 How Mental Health is related to Indian Contract, Hindu Marriage, Testamentary Capacity?

Indian Contract - According to Indian Contract Act, 1872, any person of sound mind can make a contract. Section 12 of the Act stipulates that a person is said to be of sound mind for the purpose of making a contract, if, at the time when he makes it, he is capable of understanding it and of forming a rational judgment as to its effect upon his interest. A person, who is usually of unsound mind, but occasionally of sound mind, may make a contract when he is of sound mind. A person, who is usually of sound mind, but occasionally of unsound mind, may not make a contract when he is of unsound mind. It means a PMI who is currently free of the psychotic symptoms can make a contract, whereas a person who is currently intoxicated or delirious cannot make a contract.

Hindu Marriage - Under Hindu Marriage Act, 1955, conditions in respect of mental disorders, which must be fulfilled before the marriage is solemnized under the Act, are as follows.

1. Neither party is incapable of giving a valid consent as a consequence of unsoundness of mind.
2. Even if capable of giving consent, must not suffer from mental disorders of such a kind or to such an extent as to be unfit for marriage and the procreation of children.
3. Must not suffer from recurrent attacks of insanity.

Testamentary Capacity - Testamentary capacity is the legal status of being capable of executing a Will, a legal declaration of the intention of a testator with respect to his property, which he desires to be carried into effect after his death. Indian Succession Act, 1925 (sec 59), stipulates among other things:

CHAPTER 4:

Case Study

4.1 Jackson v. Indiana, 406 U.S. 715 (1972)

Held - Mentally ill criminal defendants who are incompetent to stand trial cannot be indefinitely committed on that basis alone. The nature and duration of civil commitment must bear a reasonable relationship to the purpose of the commitment.

4.2 Uma Manickam v. The Inspector of Police 14^th September 2007

Fact of the case -  the mentally ill person is suffering from mental disorder of such a nature and degree that his treatment in the psychiatric hospital or, as the case may be, psychiatric nursing home is required to be continued for more than six months, or

it is necessary in the interests of the health and personal safety of the mentally ill person or for the protection of others that such person shall be detained in a psychiatric hospital or psychiatric nursing home, he may make an application to the Magistrate within the local limits of whose jurisdiction the psychiatric hospital or, as the case may be, psychiatric nursing home is situated, for the detention of such mentally ill person under a reception order in such psychiatric hospital or psychiatric nursing home, as the case may be.

Provided further that if any relative or friend of the mentally ill person enters into a bond, with or without sureties for such amount as the Magistrate may determine, undertaking that such mentally ill person will be properly taken care of and shall be prevented from being any injury to himself or to others, the Magistrate may, instead of making a reception order, hand him over to, the care of such relative or friend.

                                                                  

CHAPTER – 5

CONCLUSION & SUJJESTION

This is not always because of abuse or wrongdoing. Many times the treatment of Person with mental Illness involves a curtailment of their liberty and also the affixing of responsibility for their long-term care on to someone else, taking away their freedom of movement or expression. Laws must also determine the competency or dangerousness of PMI, especially when it comes to determining personal responsibility for actions.

But PMI face many threats unconnected to their treatment. These threats arise from various quarters – including family members, caregivers, friends, institutions and other communities and people in society – who may abuse or take advantage of these individuals in some way.

Therefore, there is a need for protective mechanisms to ensure that affected individuals get proper attention and care and defined policies and provisions are implemented to protect the rights of this vulnerable group. The Constitution of India guarantees a person’s right to life and personal liberty, including their right to move freely and their freedom of expression. Like most of the countries in the world, India has laws that regulate the treatment of psychiatric patients, or the mentally unsound. A few case-specific sub-sections of various Acts deal with mental illness, but like the matter of divorce in the Hindu Marriage Act, they are more for the benefit others than those with PMI. But very few Acts are directly for the benefit or rights of those with PMI –and they have various deficiencies as well.

Thanks & Regards