IMA highlights deficiencies in the new Mental Health Bill 2016 passed by the Parliament

IMA highlights deficiencies in the new Mental Health Bill 2016 passed by the Parliament The Lower House of the Parliament passed the new Mental Healthcare Bill 2016 on Monday. The Upper House had already passed the Bill in August last year. · It clearly spells out clearly government’s responsibility. · It decriminalizes attempt to suicide. · It has made the mentally ill eligible for insurance cover etc The Bill has some very good provisions (as above) and it has been enacted by the Parliament, it suffers from some fundamental inconsistencies and poor drafting. Submissions have been made in detail to the Hon’ble Health Minister by the Indian Psychiatric Society. Some of the fundamental problems with the Bill are as mentioned below 1. Definition of mental illness: Mental illness is defined as “substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behavior, capacity to recognize reality and ability to meet ordinary demands of life” · This definition is at variance with that of National Mental Health Policy. · As per the definition, even serious mental illnesses like Depression and Delusional Disorder cannot be considered as mental illnesses. Common mental illnesses like Panic Disorder, Obsessive compulsive disorder also cannot be considered as mental illnesses, whereas these illnesses can be very disabling. Hence, the provisions of the act can benefit only a small portion of people with mental illnesses (PMI). · The act states that all PMI should be admitted as “Independent” as per Section 65(2). How can this be possible? A person who suffers from grossly impaired judgement and not able to meet ordinary demands of life will be in no position to seek voluntary admission. 2. Mental Health Establishment Section 2(1) (P): As per the definition, even a general hospital psychiatric unit (GHPU) will be deemed to be a Mental Health Establishment and therefore needs to be registered as such. · Singling out mentally ill in this fashion goes against the vision of National Mental Health Policy, which envisages full integration of psychiatric services in mainstream medicine. · As per the definition, practically all hospitals will be deemed to be Mental Health Establishments because mental illnesses and physical illnesses frequently coexist. For example, a person who gets into a hospital for Diabetes may have Depression and will need psychiatric treatment. · It will not be possible for the State mental health authority to regularly monitor all hospitals and other establishments 3. Mental Health Nurse Section 2(1)(q): As per the definition even a nurse with diploma in general nursing is mental Health Nurse and can be registered as a mental health professional (Section 55). A mental Health professional can admit patients and send them on leave. A Psychiatrist who had undergone rigorous training for 10 years is sought to be equated with person with 3 years training in nursing! Giving responsibilities to people who have no adequate knowledge and skill will create havoc in mental health care service. 4. Advance Directive (Section 5): It is almost impossible for a common man (Future Psychiatric Patient) to determine what treatment he should have or should not. Psychiatric knowledge is limited even in medical graduates. 5. Nominated Representative (Section 14): In our country, family members take the major responsibility of caring for mentally ill. Bringing a third party into the decision making process is against the culture of our country. Even the WHO Mental Health Act and Convention on the Rights of Persons with Disabilities (CRPD) advocate culturally consistent laws for member states. 6. Section 18(1) (3) Not Consistent with section 2(1)(s). 18(1)(3) section states that every person should have access to mental health care, whereas section 2(1)(s) even excludes people suffering from common mental illnesses and even some serious mental illnesses. 7. State Mental Health Authority: In our country, we have one psychiatrist for more than 3 lakh people. This small number of psychiatrists is shouldering enormous responsibilities. Psychiatrists who are experts in the field are not adequately represented in the State Mental Health Boards. At least 4 psychiatrists including 2 private psychiatrists should be included as members. 8. Central Mental Health Authority: At least 4 psychiatrists as above should be included as members. 9. Electro Convulsive Therapy (Section 94(3)): This is a treatment NOT a punishment as depicted in films. It is lifesaving in certain psychiatric conditions. High voltage current is directly applied to the chest without anesthesia in cardiac emergencies. Surgeons routinely apply electric current to burn tissues during operation to stop bleeding. Why special restrictions are placed on psychiatrists? It would be in the best interests of patients if treatment decisions are left to specialists. 10. Community Care: The bill deals with institutional care. Provisions for Community care are not there in it at all. DRAFTING ERRORS The Bill is studded with errors. For example: · In the index at the beginning of the Bill “Mental Health Commission” is mentioned. There is NO Mental Health Commission in the Bill. · Section 103 quoted as emergency treatment whereas it is section 94, which actually deals with emergency treatment. · There are many more such errors Conclusion This bill is a Legal cum Professional document. Enormous difficulties will arise in implementing the present bill. People particularly in the vast rural areas of country will be at a disadvantage in getting access to mental health care. The Indian Psychiatric Society, the premier body of Psychiatrists in our country, is prepared to sit with concerned officials to sort out the lacunae in the bill. Summary The Mental Health Care (MHC) Bill may end up ruining the mental health sector in the country. The MHC Bill proposes to bring the General Hospital Psychiatry Units (GHPUs) under its purview. The general hospitals mostly treat people with depression, anxiety, phobias, sexual dysfunctions, adjustment and stress disorders, etc, before any disability sets in. “If we are trying to put these everyday life events into legal framework, people will not seek treatment and some of them may even commit suicide, ultimately leaving the Bill a disaster.” GHPU attached to teaching hospitals, general hospitals, and to some major private hospitals was the biggest revolution in psychiatry in the last 50 years. It has de-stigmatized psychiatric treatment by bringing mental health care from the confines of the mental hospitals to the doorsteps of the common man. Moreover, the MHC Bill is modelled on certain Western Bills. Various clauses in the Bill like ‘nominated representatives’ and ‘advance directives’ are completely alien to the Indian family ethos. Dr KK Aggarwal National President IMA & HCFI With contributions from: Dr (Prof) Roy Abraham Kallivayalil, National Vice-President, IMA and Dr RN Tandon Hony Secy Gen IMA With detailed inputs from: Dr Prof Brig MSVK Raju, President, Indian Psychiatric Society

Rivers declared as living beings…Shouldn’t air be accorded a similar status?

Rivers declared as living beings…Shouldn’t air be accorded a similar status?

In the first of its kind unique decision, the New Zealand parliament passed a bill on March 15 granting a river the same legal rights as a person recognizing it as a living entity. The Whanganui River has been regarded as “an indivisible and living whole” and recognized in their traditions and customs by the local Maori tribe ‘Iwi’, who had struggled to get recognition of the river as an ancestor for more than a century. Two representatives of the river, one from the Maori community and one from the govt, have also been appointed. This decision acknowledged the spiritual connection between the Whanganui Iwi (tribe) and its ancestral river. Just few days later, the Uttarakhand High Court also declared the rivers Ganga and Yamuna as living entities, citing the reference of the case in New Zealand, and accorded them same constitutional and legal rights as a human being, including the right to life. The High Court said that both the rivers have been regarded sacred for centuries. Our ancestors have worshipped nature in all its forms as is evident from the history of India. The five elements of nature - Prithvi (Earth), Jal (Water), Agni (Fire), Vayu (Air) and Aakash (void) – have been depicted as celestial beings or deities in our mythology and ancient scriptures including the Rigveda. The Rivers Ganga and Yamuna have been held sacred since ancient times. They have not only provided physically as source of water but have also provided spiritual sustenance. But, these rivers are now on the verge of losing their existence because of pollution. Human waste, agricultural waste, industrial waste are being dumped into the river without proper treatment. Air pollution too has been making headlines recently. The quality of air has deteriorated over the years, often to dangerous toxic levels that are hazardous to health. Vehicular emissions, fuel wood or biomass burning, crop burning, industrial emissions, construction activities, burning of waste etc. are some of the important sources of air pollution all of which are man-made sources. That there is a need for controlling the air pollution cannot be more emphasized. Recognizing these rivers as a human being means that polluting the rivers would legally amount to harming a human being. And, a case can now be filed against those polluting the rivers. This judgement of the Uttarakhand High Court has paved the way for further such judgements. Shouldn't there be a similar judgement recognizing air as a living entity and give it a legal voice?

Do CPR for 30 mins before transporting cardiac arrest victims to hospital

Do CPR for 30 mins before transporting cardiac arrest victims to hospital Quite often we read about people collapsing due to a cardiac arrest. Former President APJ Abdul Kalam collapsed while he was addressing students in Shillong. He was immediately rushed to the hospital but could not be revived. More recently, Mr E Ahamed, a Member of Parliament collapsed in the Parliament after he suffered cardiac arrest and passed away. Such instances bring CPR or cardiopulmonary resuscitation back into the spotlight. The first instinct is to immediately rush a person to the hospital when you see somebody collapse suddenly. But at times, a first responder CPR may help revive the person until medical help arrives or a defibrillator is available. According to a story reported at WPRI on Thursday (Feb 16, 2017), there has been a major change in prehospital protocol policy in Rhode Island, USA for First Responders for the management of victims of cardiac arrest. “Starting March 1, as dictated by the Rhode Island Department of Health, emergency response personnel will be required to conduct 30 minutes of cardiopulmonary resuscitation, or CPR, on cardiac arrest victims before transporting them to the hospital.” The American Heart Association (AHA) has published updated Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in October 2015 in the journal Circulation, with some updates while continuing to emphasize on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression (avoid leaning on the chest between compressions), minimizing interruptions in compressions, and avoiding excessive ventilation. · The recommended chest compression rate have been updated to 100-120/ min from the earlier at least 100/min. · The recommendation for chest compression depth for adults is at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm). The earlier recommendation was at least 2 inches (5 cm). · Chest compression should be started first before rescue breaths (C-A-B rather than A-B-C). The single rescuer should begin CPR with 30 chest compressions followed by 2 breaths. While these updated AHA guidelines have refrained from recommending a duration of resuscitation, it does state as follows: “While investigators can define neither an optimal duration of resuscitation before the termination of efforts nor which patients may benefit from prolonged efforts at resuscitation, extending the duration of resuscitation may be a means of improving survival in selected hospitalized patients.” The premise of a successful cardiopulmonary resuscitation (CPR) is earlier the better and longer the better. When you come across a victim of cardiac arrest, three simple rules must be followed: Call the ambulance, check if the person is breathing or has a pulse and if not, then start chest compressions and continue for at least 30 minutes till medical help arrives. Don’t stop CPR too soon …