The modern way: mental health law can be used to strengthen (शक्ति बढ़ाना) primary care
MARCH 30, 2017 

The government should use the new mental health law to strengthen primary care

The passage of the Mental Healthcare Bill in the Lok Sabha, putting it on course to become law and repealing (निरस्त) the Mental Health Act of 1987, will potentially ( सम्भवतः) help India catch up (पकड़ो) with the advances made in the field by other countries. India urgently (तुरत) needs to make a transition (परिवर्तन) from old-fashioned approaches (दृष्टिकोण) to providing (उपलब्ध कराना) care for those suffering (कष्ट) from mental illnesses, something that China, for example, has achieved through state-led policy reform. Even the sketchy (अधूरा) studies on the nature of care available to Indians indicate (इशारा करना) that in terms of population coverage the new law faces a big challenge. The country’s grossly (काफी) inadequate (अपर्याप्त) base of professional resources is evident (प्रकट) from its ratio of 0.3 psychiatrists (मनोचिकित्स्क) for 100,000 people with marginally higher numbers taking independent private practitioners (चिकित्सक) into account, compared (तुलना) to China’s 1.7. Then there are massive deficiencies (भारी कमी) in the availability (उपलब्धता) of trained clinical psychologists (मनोचिकित्सक)  and psychiatric (मनोविकृती सम्बन्धी) social workers. Evidently (स्पष्ट रूप से ), the National Mental Health Programme has not been sufficiently (पर्याप्त) funded within the health budget; neither has capability been built in most States to absorb the meagre allocation.  (अल्प आवंटन को अवशोषित करना ) delayed though it is, the new legislation (कानून) can bring about change with its positive features. The important provisions (प्रावधान) relate to the recognition (मान्यता) of the right to medical treatment (उपचार), decriminalisation of attempted (पहल) suicide (आत्महत्या), explicit acceptance (स्पष्ट स्वीकृति) of agency of people with mental illness (मानसिक बीमारी) and their freedom to choose treatments, prohibition (निषेध) of discrimination (भेदभाव) and regulation  (विनियमन )of establishments (स्थापना) working in the field.

Raising effective (प्रभावकारी) primary and district-level coverage of mental health services for the general population, without requiring people to travel long distances to see a specialist and get medicines, should be a priority. Since the base of psychiatrists is low in relation to the need, the use of trained general practitioners as the first line of contact assumes (रूप धारण करना) importance. Some studies show many of them are not confident enough with their training to detect, diagnose and manage mental illnesses. With a concerted effort, (ठोस प्रयास,) primary care physicians can be trained to help people with mild (सौम्य) and severe problems, ranging from anxiety disorders (घबराहट की बीमारी) to depression (उदास), psychoses (मनोचिकित्सा) and conditions (शर्ते) arising from alcohol and substance abuse (मादक द्रव्यों का सेवन). Being able to get professional counselling will reduce the complications (जटिलताओं) arising from extreme stress (अत्यधिक तनाव), often the trigger for suicide. Extending(विस्तार) health insurance cover is also a step forward,trigger for suicide since out-of-pocket expenditure has risen along with the expansion (विस्तार) of the private sector in this sphere, just as for other ailments (तत्व). The provision in the new legislation prohibiting seclusion (एकांत) of patients, something that is frequently resorted to in asylums, and the general use of electro-convulsive (उत्तेजित) therapy must be welcomed. Modern treatment approaches (दृष्टिकोण) rely more on family and community support. The new Central and State regulatory (विनिमायक) authorities (प्राधिकरण) should speedily weed (खरपतवार) out shady non-governmental rehabilitation (पुनः प्रतिष्ठा) organisations (संगठन) in this field.