Mental Healthcare Act, 2017: We don’t need Doctors, we need Oswalds

By Siddhi Shubhangi 22 Minutes Read

As a country, India represents the confluence of diverse forms of religion, faith and culture. The Constitution of India, given a chameleon nature by the framers to tackle the issues which often crop up due to the occasional friction between these diverse socio-cultural forces.  With ‘fraternity’ forming the core principle of its existence, the Indian set up is more inclined towards brotherhood, care and concern for one another. The countrymen taking a cue from their Gandhian freedom struggle, have an inclination for harmony over violence.

Discrimination is an aspect which often plaques social discourses on our land; whether it be on the basis of religion, caste, class, gender, region even political preferences. Definitely such a toxic discrimination polity has a toll on its population. It is very difficult for a person to maintain his mental peace where the country’s population still believe in racism, discrimination and male dominance, a country where ‘untouchability’ still exists which can be for any reason, a culture, a religion or even a disease!

This paper tries to elucidate the ground picture of mentally-ill people living in India and the need for the country to address it and find solutions. In the light of the Mental Healthcare Act, 2017, the available redress of the issue as well the loopholes in the law shall be discussed.

Mental Healthcare Act, 2017

The way the citizenry and culture have been insensitive towards the social subaltern has given rise to various questions about our basic sense of humanity. In recent times and before, we have seen the situation of mentally ill patients and the way they are treated. To make their situation better, the legislature came up with a new act called the ‘Mental Healthcare Act, 2017’. The main purpose of introducing this act was to give assistance to the mentally ill people. It was a way forward for giving standard care and protection for people suffering from mental diseases. According to a report by the World Health Organisation, it was found that one out of five persons suffers from a mental disorder in our country. Interestingly we can imagine the background of the social issue against the thematic backdrop of the cartoon series ‘Oswald’ wherein the main character ‘Oswald’, the blue octopus, was a master skills-person (owing to his sheer good nature) to deal with considerably dysfunctional characters in the story. He never made fun of the hyperactive and aggressively competitive Daisy when she couldn’t play the piano. He never laughed or criticized her but instead, he went along with her to a musical instrument shop where he allowed her to try each of the instruments and decide what was best for her. Later that evening, everyone including Daisy could happily enjoy playing a different instrument of their liking. This is a perfect example of how perhaps we should be accepting of the mentally ill individuals.

The 2017 Act happens to appeal more to the mechanical structure than to the humane aspect of issues faces by such people. It happens to have certain loopholes as well. Where on one hand, it talks about care and protection, on the other hand, it lacks in the very first definition of ‘mental illness.’ It defines it as a clinical disease which can be cured through clinical treatment and procedure. Classifying it under the head of ‘clinical’, it happens to favour increase the profit for the corporate medical businesses, the medicine branch where doctors will be prescribing a number of tablets which might not be even required that at the stage. Cases, where some small issues have been exaggerated to the extent it being a life-threatening disorder, are not uncommon within the arena of medical treatment. Often the patients not knowing anything will blindly accept such diagnosis and take those pills, and slowly will get trapped and start having the actual symptoms of some other serious disorder. Their only concern is about money-making and commercialising the entire concept of medicine. Sometimes, what the patients need, is only a person like Oswald, who is optimistic towards life, who can motivate them, listen to their complaints and help them find a way out. We need someone who encourages us to be a better person than what we are.

Daniel Amen, in his TEDx Orange Coast speech[1], has talked about the importance of understanding someone’s brain rather than punishing them. He mentioned about conducting almost 83,000 brain scans, where he found that in most cases mild traumatic brain injuries are the major reasons for the psychiatric illness which ruins peoples’ lives in a longer-term. It is not observed specifically and hence no one gets themselves treated. The general perception of Indian system is that firstly they consider it as a shame to consult a psychiatrist because people look down at you and secondly, they ignore it because, for them, psychiatrists are consulted only in case of depression, anxiety and insomnia. Daniel came forward with an idea to understand the brain rather than actions. He came up with a brain smart program which deals in reversing the brain damage. He mentioned a few cases where once their brain got treated through extra care, attention and support, the mental illness reduced tremendously. A case where a teenage girl suffering from ADHD who used to fight with parents, cut herself and get low grades, was transformed into an emotionally stable person and her grades changed drastically to first grade, only through brain rehabilitation program where we understand brains and treat them with care. We should not throw darts in the dark at such people; rather we need to understand what they really want.  A lady suffering from dementia was declared to be admitted to the asylum by the doctors when her husband decided to take her to a brain rehab program. Four years later, that lady got her memory back with a better condition of her brain.

Furthermore, other provisions in the act look like it is copied from West which talks about Nominated Representative (NR) and Advance Directive (AD)[2]. These two concepts can never fit in India society, where still most of the patients are taken care of by their own families. As per the Act, the first preference is given to NR who is someone out of the family. Indian society has not been westernised up to a level where they need an NR. The other concept is AD which cannot be applied as we cannot expect the patients themselves to know the medical technicalities of their own problem. AD is a concept which allows the patients to choose how they want to be treated. In a country like India, where women and girls living in conventional family structure are not even allowed to go out, how will they get treated? In research, it was found that mental sickness takes birth much before the actual symptoms are seen. Mentally ill patients are treated worse than a criminal as they are locked up in a room, chained and brutally treated. It is unfortunate to see how mental illness is equated with dangerousness. The author would like to place Oswald in such a situation because these patients are not required to be chained and beaten; instead, they need love, care and concern from their families, friends and society. They do not want to be discriminated. Like Oswald, we should also try to include them in society, make them participate in our own activities, help them to learn new things which can deviate their mind from depressing thoughts.

The doctors also need to be more kind, more understanding of each case. They should promote friendly surrounding; encourage the families to treat the patients with extra love. The doctors should be more inclined towards helping and listening to such patients. We need to spread an intensive awareness program and start educating people from the grassroots level where they understand the need to care for mentally ill patients. We need more Oswald than we need doctors if we have to address this issue in its seriousness. In the cartoon, Oswald was shown growing tomatoes in his garden for which he gets one plant, later next morning he sees his tomatoes are half-eaten, so he couldn’t taste them. He again goes to a shop and buys two more of them. Later again the same thing happens. He was sad about it, but never got angry on the caterpillars that ate all of his tomatoes! At last, he gets a total six plants where four of them he keeps in the garden and two he takes inside his home for himself. This is the exact way how we should be sharing and caring towards our society. It might not be necessary to do, but once we get into the habit of being like Oswald, our nations get better in every way. Like Oswald, we should think about ourselves and society and make ways which would benefit both of us.

Brutality around the world

Recently, a Public Interest Litigation[3] was filed for the betterment of in-mates of asylum, where 22 mentally-ill patients were kept in chains in the name of certain divine treatment which later the Hon’ble Supreme Court said that it cannot be termed as divine as it is absolutely inhuman. Chaining people violates their right under Article 21 of the Indian Constitution, and in no case, such an act can be allowed in India. The patients were the victims of societal norms and superstitions which still prevail in our society. However, these patients were released from chains and sent to their families. India needs kinder human beings who actually think what is morally corrects and what is inhuman, instead of blindly following the old meaningless traditions. Similarly, in a recent case[4], where it was found that the hospital authorities have locked the mentally disabled patients in a storeroom of the hospital and are treated in a very inhuman manner where no proper clothing and no food is given. A similar case was found in Orissa[5], where a girl who went mentally unstable at age of 15, was locked in a small room by her family because she was a threat to society and the family could not get her treated due to financial crunch.

Such tales of deplorable condition and treatment of the mentally ill are in no dearth. On looking at such instances, the author is of the opinion that perhaps the Act does not address the issue where its germane roots are most prominent, i.e, the social stigma against such mentally ill persons as well as providing standard care to them. As a member of society, it is our duty to look after them, to understand their behaviour and to help their families financially. The court has time and again suggested the authorities to come up with amendments, but there is no improvement till date. What we can do is to educate ourselves, understand their condition and make efforts to make people understand. A human being is a social creature, he tends to mimic the society, so why not start with a positive initiative and help these mentally ill in developing their mental faculties and affording them a degree of social acceptability. If we look at the World Happiness Report of 2020[6], Finland is declared as the happiest country in the world with a 7+ rating. They believe in living in a place where people trust and look out for each other. The key elements of social unity according to the report, are:

connectedness to other people, having good social relations and having a focus on the common good.

On the other hand, India has been in the top ten of the least happy countries with a 4.0 rating, according to the 2020 report.

The entire country can improve if we start with awareness drives from the grass route level. We need to motivate people and transform them into thinking for the betterment of the mentally ill. There is no one else who is going to help us to make our country better. It is the people who make it better. Irrespective of the different ventures the government makes for the betterment of their condition, we can also play a part by living up to our human fundamental duties enshrined in our Constitution in Part 4 under Article 51A. We can take initiative and help these people emotionally and mentally. We should try to understand their mindset to find solutions to their problems. The civil society needs to press upon the authorities to extend the fundamental duties with respect to taking care of mentally ill people in our society. I would state that there is no need for specific legislation for taking care, but a simple and basic duty can be prescribed and encouraged for all the citizens. The authorities should look after that the duty is performed and responsibilities are taken by each member of society[7]. This reminds us of Oswald, who always tries to understand his fellow neighbours like he did try to understand when Henry was sad about flying. He wanted to fly but he couldn’t, it was Oswald who considered his thoughts, and tried and approached everyone in the park and ensured that he was able to fly. Nevertheless, with the bubble made by Egbert and Leo, Henry finally could fly and that made Oswald happy. If we also start functioning in the same way, our country will be mentally and emotionally stable. No matter one’s attributes, all humans have a basic right to life and dignity which is trampled every time such a stigma and discrimination is not countered. Mental health is the wealth of the country.

Conclusion

Just like Oswald, if every person of the country strives to become the best version of himself when it comes to tolerance and humane treatment of others, much of the problems can be solved. We should accept the uniqueness of a person and stop judging and discriminating them from our society. Oswald always believed in unity in diversity. He is never rude to people. India, has a rich tradition of tolerance, can reignite their original ethos where we decide a mid-way for any situation.

Individuals should understand the importance of kindness and softness and try to adhere to the same. People should be sensitized and educated more on their fundamental duties and they should be encouraged to perform them in the spirit of the letter and well-being. Mentally ill patients need more love than they need medicines. If only we can have more Oswald like people in our community, it would perhaps help us more than any piece of crafted legislation.

[1] Daniel Amen, ‘The most important lesson from 83,000 brain scans’, TEDx Orange Coast, available at Source Link

[2] Dr. Savita Malhotra, ‘Mental Healthcare Act: A step in the right direction, but ‘loopholes’ remain’, The Hindu, (Sep.2, 2020) available at Source Link.

[3] ’22 mentally-ill inmates of Badaun asylum handed over to family members’, Press Trust of India, available at Source Link.

[4] Nolan Pinto, ‘Mentally disabled patients found locked in store room in Karnataka hospital, authorities deny allegations’, available at Source Link.

[5] ‘Orissa: Mentally ill girl locked for 20 years’, Hindustan Times, available at Source Link.

[6] World Happiness Report, 2020 available at Source Link

[7] AIIMS Students; Union v. AIIMS, 1 SCC 428 (2002).

Siddhi Shubhangi

Siddhi is pursuing BBA.LLB from Symbiosis Law School, Hyderabad. She writes about different aspects related to law and society. Through her writings, she wishes to connect with the readers and wants to spread legal understanding and updates. She has previously worked with various advocates and law firms. She is keenly interested in civil matters, IP laws and human rights issues happening around and wishes to contribute to a better society. Apart from law, she is passionate about painting. She always looks forward to learn new things in life.