Psychiatry

Message from President, Indian Psychiatric Society Mrugesh Vaishnav Indian Journal of Psychiatry 2019 61(10):633-633

Message from Vice President, Indian Psychiatric Society PK Dalal Indian Journal of Psychiatry 2019 61(10):634-634

Message from Hon. General Secretary, Indian Psychiatric Society Vinay Kumar Indian Journal of Psychiatry 2019 61(10):635-635

Mental Healthcare Act (MHCA 2017)- Is a Relook Necessary for Effective Implementation? Om Prakash Singh Indian Journal of Psychiatry 2019 61(10):636-636

Mental Healthcare Act 2017: Preface to the supplement Shahul Ameen, Mahesh Gowda, GS Ramkumar Indian Journal of Psychiatry 2019 61(10):637-639

How right is right-based mental health law? Bevinahalli Nanjegowda Raveesh, Guru S Gowda, Mahesh Gowda Indian Journal of Psychiatry 2019 61(10):640-644 Human rights' frameworks are increasingly being recognized in general, and mental health in particular. Human rights can thus act as powerful catalysts for change in areas such as mental health care that has historically suffered from stigma, discrimination, and loss of dignity of patients. Mental health law in India has evolved over the past few decades, in keeping with improved delivery of care, societal changes, and increasing awareness of a person's human rights and privileges. The new Mental Healthcare Act, 2017 has shifted the focus to a rights-based approach to provide treatment, care, and protection of a person with mental illness compared to previous Mental Health Act 1987. This dynamic shift is to align, harmonize, and fulfill the requirements of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). This article reviews the existing international human rights model of disability and recovery, and the Mysore Declaration, and does a critical review of UNCRPD.

Making the most of Mental Healthcare Act 2017: Practitioners' perspective Vijaykumar Harbishettar, Arun Enara, Mahesh Gowda Indian Journal of Psychiatry 2019 61(10):645-649 The Mental Healthcare Act (MHCA) 2017, after parliamentary approval in 2017, came into effect from May 29, 2018. It is rights-based and empowers the patients to make their own choices unless they become incapacitous due to mental illness. There is much emphasis on the protection of human rights of persons with mental illness. The act provides a framework and regulation on how a person with mental illness should be treated. The experts, on multiple occasions, have debated on whether the act is a boon or a bane for the practitioners in India. The MHCA 2017 brings about more impetus on documentation, unlike the previous acts. With the act in place, clear documentation with reasons for decisions made and care given are important for good practice. Although this may potentially raise the cost of care, this will ensure a safer practice of psychiatry and will prove beneficial for the patients and the psychiatrists. To comply with the provisions of the act, one will have to modify the manner in which one carries out the day-to-day practice. Regular training through workshops is required to understand the practical implications of different provisions of the act. Furthermore, regular peer group meetings may give a sense of support and an opportunity to learn from one another and help find solutions to difficult aspects. Overall, following this and adapting to the new act may bring uniformity in practice. This article aims to explore ways to leverage the MHCA 2017 from the practitioner's perspective.

Cost estimation for the implementation of the Mental Healthcare Act 2017 Suresh Bada Math, Guru S Gowda, Vinay Basavaraju, Narayana Manjunatha, Channaveerachari Naveen Kumar, Arun Enara, Mahesh Gowda, Jagadisha Thirthalli Indian Journal of Psychiatry 2019 61(10):650-659 The Mental Healthcare Act, 2017 (MHCA) was a step that was essential, once the Government of India ratified the United Nations Convention on the Rights of Persons with Disabilities in 2007. The MHCA looks to protect, promote, and fulfill the rights of persons with mental illness (PMI) as stated in the preamble of the Act. Further, there is an onus on the state to provide affordable mental health care to its citizens. In India, mental health has always been a lesser priority for lawmakers and citizens alike. The rights-based MHCA looks to overhaul the existing system by giving prominence to autonomy, protecting the rights of the mentally ill individuals, and making the State responsible for the care. The decision to make all this happen is commendable. The annual health expenditure of India is 1.15% of the gross domestic product, and the mental health budget is <1% of India's total health budget. This article systematically analyses and describes the cost estimation of the implementation of MHCA 2017, and it is not an estimation of mental health economics. The conservative annual estimated cost on the government to implement MHCA, 2017 would be 94,073 crore rupees. The present study estimation depicts that investing in the implementation of MHCA, 2017 by the government will yield 6.5 times the return on investment analysis benefit. If the State is not proactive in taking measures to implement the MHCA, the rights promised under this legislation will remain aspirational.

Mental Healthcare Act 2017 – Aspiration to action Suresh Bada Math, Vinay Basavaraju, Shashidhara Nagabhushana Harihara, Guru S Gowda, Narayana Manjunatha, Channaveerachari Naveen Kumar, Mahesh Gowda Indian Journal of Psychiatry 2019 61(10):660-666 There is no health without mental health. Recently conducted National Mental Health Survey quoted a prevalence of 13.7% lifetime and 10.6% current mental morbidity. To address this mammoth problem, an aspirational law was enacted titled “Mental Healthcare Act, 2017” (MHCA 2017). The act is progressive and rights based in nature. The whole dedicated Chapter 5 on “Rights of the person with mental illness” is the heart and soul of this legislation. However, the act mainly focuses on the rights of the persons with mental illness (PMI), only during treatment in hospital but is not equally emphatic about continuity of treatment in the community. The act fails to acknowledge and foster the role and contribution of family members in providing care to PMI. Although there are many positive aspects to the MHCA 2017, it may impact adversely on the mental health care in India. This article focuses on the shortcomings and challenges of the act and also makes attempts to offer alternatives considering the available resources and ground reality. Concepts such as “Advance directives” and “Nominated representatives” appear to be very attractive, idealistic, and aspirational, but not evidenced based in the Indian context considering the resources. The act fails to make an impact even after 22 months to attain the goal, and will require pervasive efforts to fulfil a purpose that directs its development. This law needs to be amended as per the local resources and requirements of the society.

Consent in current psychiatric practice and research: An Indian perspective Furkhan Ali, Gopi Gajera, Guru S Gowda, Preeti Srinivasa, Mahesh Gowda Indian Journal of Psychiatry 2019 61(10):667-675 Consent is a process that allows for free expression of an informed choice, by a competent individual. The consent is considered as one of the important components of health-care delivery and biomedical research today. Informed consent involves clinical, ethical, and legal dimensions and is believed to uphold an individual's autonomy and the right to choose. It is very important in Indian mental health care as the Mental Healthcare Act (MHCA) 2017 mandates informed consent in admission, treatment, discharge planning, and research intervention/procedures. In 2017, the Indian Council of Medical Research laid down the National Ethical Guidelines for BioMedical and Health Research involving Human Participant for research protocols, which the MHCA advocates. This article gives an overview on the evaluation of consent in clinical practice and also highlights the approach and challenge in psychiatric practice in India.