Provisions of Mental Healthcare facilities are essential: Madras HC

W.P(MD)No.164820 1. K.R. RAJA it is stated that over 90 Million Indians viz. 7.5% of the country s population are suffering from some form of mental illness. China and USA stand in Nos.2 and 3. In India every 7th person suffers from some form of mental illness. Mental illness is considered as a leading contributor to disease burden and morbidity worldwide and may even result in suicide if left untreated 2.All psychological problems are treatable curable and preventable provided we identify the illness early and initiate the treatment quickly coupled with appropriate rehabilitation. But unfortunately the prevalence of mental illness has doubled in the past 10 years because of the following facts a) Lack of awareness & knowledge about the illness b) Inadequate human resources Inadequate treatment facilities d) Long distance to travel to get the treatment e) High cost of treatment f) Stigma All these above factors contribute to the non compliance of mental health services even for the middle class families which result in a treatable illness becoming untreatable and curable illness becoming incurable 3. A Research “The Burden of Mental Disorders Across the States of India : The Global Burden of Disease Study 1990 2017” published on December 23 2019 at Pages 148 161 of Volume 7 Issue 2 of Lancet Psychiatry concluded as follows “In conclusion mental disorders adversely affect a large proportion of Indians. Given the poor coverage of mental health services the lack of awareness and the stigma attached to mental disorders in the country India needs to invest heavily in mental health services to facilitate prevention where possible and to provide affordable treatment care and rehabilitation as well as to attempt integration of mental and physical health services. The state specific data trends in this report can be useful for mental health policies and programme planning at the individual state level and for India as a whole.” WWW.LIVELAW.IN W.P(MD)No.164820 4. WHO predicts that by the end of this yearapproximately 20% of the Indians will suffer from mental illness. 56 Millions of Indians are suffering from depression and another 38 Millions of Indians are suffering from anxiety disorders. It also estimates that the economic loss in India due to mental health condition during 2012 2013 is 1.03 Trillions of 2010 Dollars. 5. A Survey “National Mental Health Survey of India 2015 2016” conducted by National Institute of Mental Health and Neuro Sciences NIMHANS) Bengaluru in collaboration with the Ministry of Health and Family Welfare Government of India revealed that 10.6% or 150 million Indians suffer from mental disability and need active help. Further 9.8 Millions of teenagers in the age group of 13 17 years suffer from depression and other mental health disorders and they are in need of active intervention 6. In 2019 a study conducted by a British Charity “Mental Health Research UK” found that 42.5% of employees in India s Corporate Companies suffer from depression or anxiety disorder. 7. When such is the given situation on the mental health front only a very negligible amount is being allotted and spent towards mental health. It is stated that India s mental health care budget in 2018 was 528 Million Rupees out of WWW.LIVELAW.IN W.P(MD)No.164820 which 500 Million Rupees was for mental health. In 2019 it is stated to have been reduced to 400 Million Rupees. As per the media reports India actually spent 50 Million Rupees only on mental health. The amount spent on mental health comes to 33 paisa for mental health patient given the number of 150 Million people requiring urgent care. It is reported in Parliament in March 2020 that a sum of 48 Crores Rupees only has been spent on mental health in the year 2018 2019 which approximately comes to Rs.2.40 per patient in a year or approximately 20 paisa per month per patient. 8. The Mental Health Force also is very low in India and it is stated that there are about only 9000 psychiatrists viz. one psychiatrist for every one lakh people alone is available whereas the required number of psychiatrists is three for every one lakh people. It is stated that there is a shortage of 18 000 mental health doctors or psychiatrists and our country requires about 2700 new psychiatrists every year. That apart only 49 child psychiatrists take care of children of the entire country 9. Though the Government understanding the mental health problems passed an Act called “The Mental Healthcare Act 2017” no sufficient awareness programmes have been conducted. The taboo social stigma attached to the persons with mental illness prevents the people to take proper treatment. WWW.LIVELAW.IN W.P(MD)No.164820 Therefore it is required to dispel the stigma attached to the mental illness or taking treatment under a psychiatrist or counselling with a psychologist by anti stigma awareness plans. The people should be sensitised that mental disorder is like any other normal disease which is required to be treated failing which dangerous consequences would follow 10. Though the Government recognised the prevalence of mental disorders on a large scale and the Union of India passed the Mental Healthcare Act 2017 with an aim to provide the mental healthcare services for the persons with mental illness and to ensure that these persons have a right to life with dignity by not being discriminated against or harassed however as stated above there is no sufficient budgetary allocation for the mental healthcare which is required to be increased as one among seven persons is suffering from mental health 11. Though the people are more health conscious the mental health is not identified recognised and physical health alone is taken care of including medical insurance. Unless people s mental health is good and balanced people cannot be normal and cannot lead dignified life. Therefore it is the primary duty of the Governments to concentrate on the mental health of the people by having sufficient number of psychiatrists psychologists mental health workers and hospitals and other required infrastructures. WWW.LIVELAW.IN W.P(MD)No.164820 12. There is only one research Centre in the country in mental health called “National Institute of Mental Health and Neuro Sciences”at Bengaluru which is a dedicated medical institution established in 1925. No such premier institution for mental health has been established after 1925. Every zone should have an institution like NIMHANS. Similarly psychiatry is not a subject in all the medical colleges and hence psychiatry should be introduced in every medical college as the requirement of psychiatrists is more. Similarly only a negligible number of mental hospitals are stated to be functioning in the country and for 130 Crore of population more number of mental health care centres have to be established by the Central Government as well as by all the State Governments. 13. It is stated that the Government does not have the centralised portal on treatment for the mental disorders and only they have patient based data from three Central Institutes of Mental Health. In regular intervals surveys of the prevalence of mental disorders across India have to be conducted and appropriate remedial measures have to be taken. 14. When such is the given scenario about the mental health the present Public Interest Litigation has been filed seeking a writ of Mandamus directing the respondents to set up a Medical Wing either in Trichy Central Prison or WWW.LIVELAW.IN W.P(MD)No.164820 Madurai Central Prison exclusively to provide mental health care facilities to the prisoners with mental illness and with round the clock availability of treatment by Psychiatrists Clinical Psychologists Psychiatrist Social Workers Mental Health Nurses and other Para Medical Staffs like Institute of Mental Health set up in a Central Prison as per Section 103 and other relevant provisions of the Mental Healthcare Act 2017 in accordance with law within the time stipulated by this Court 15. It is contended by the petitioner that there is no exclusive Medical Wing in Trichy Central Prison or Madurai Central Prison to provide mental health care facilities to the prisoners with mental illness as per Section 103 of the Mental Healthcare Act 2017. 16. Apart from the prayer sought for by the petitioner as mentioned above this Court would like to expand the scope of the writ petition to give comprehensive directions to the Central Government Medical Council of India and the State Government to identify the patients at the earliest by diagnosing the disease to give proper treatment by improving the infrastructures like establishment of hospitals increasing the number of psychiatrists psychologists psychiatrist social workers and allocation of more funds towards mental health including the conduct of regular surveys. WWW.LIVELAW.IN W.P(MD)No.164820 17. Due to change in lifestyle and growth in economy and increase in the standard of living the lifestyle got changed and consumption of alcohol also increased. It is stated that the youngsters including the school children have been addicted to alcohol and drugs. Alcohol and drugs also contribute to the mental illness which is required to be addressed appropriately. Similarly many families are breaking away because of lack of mental adjustment or behavioural problems due to psychological disorders. It is evident from the number of cases coming before this Court. Therefore it is the need of the hour to have a Psychiatry Department in every District Headquarters Hospital and a Psychiatrist in every Taluk Level Hospital. 18. Any psychiatric treatment will not be complete without rehabilitation. So rehabilitation is an essential component in psychiatric treatment. For a country like India community based rehabilitation is the only alternative to address this issue. Many people will not come forward to start the rehabilitation services because it is not a profit making venture and therefore they should be encouraged. Steps have to be taken by the Governments i) to improve the man power ii) to increase mental health service provision platforms iii) to make basic mental health care easily accessible to the WWW.LIVELAW.IN W.P(MD)No.164820 common man iv) to reduce the treatment cost v) To reduce and overcome the stigma 19. Therefore this Court suo motu impleads Union of India represented by its Secretary Ministry of Family and Health Welfare New Delhi Union of India represented by its Secretary Ministry of Finance New Medical Council of India New Delhi University Grants Commission New Delhi National Institute of Mental Health and Neuro SciencesHombegowda Nagar Bengaluru Karnataka.Indian Psychiatric SocietyPlot No.43 Sector 55 Gurugram Harynana 122 003Is it a fact that one in seven persons of India s population is suffering from mental illness as stated by WHO b) Whether any survey is being conducted by the Government or Government Hospitals Health Organisations regarding the mental health of the India s population regularly c) When such survey was conducted lastly d) What are all the leading mental disorders among the people e) Whether sufficient number of mental hospitals are available in India f) If not why not the Central Government State Governments establish one mental hospital in each District or in each Zone of every State g) Why not the respondents increase the number of Institutes offering psychiatry psychology in higher studies h) Why not the Central Government establish premier Institutes like National Institute of Mental Health and Neuro Sciences WWW.LIVELAW.IN Bengaluru in each Zone of the country namely North East West and W.P(MD)No.164820 Is it a fact that only 50 Million Rupees have been spent for the mental healthcare in 2019 j) Why not the Central Government increase the allocation of funds towards mental health especially when one in seven persons of the population of the country is stated to be suffering from mental illness k) What is the required strength of psychiatrists psychologists and or psycho health workers in India l) Why not the Governments sensitise the people about the mental illness and remove the taboo social stigma in the minds of the general public about the persons with mental illness and also the treatment for mental illness through Audio Video programmes by conducting awareness m) Why not the data for co ordinated action be collected by the Central Government and the State Government in the interest of the people suffering from mental illness n) Why not the Governments have one Department for Psychiatry in each District Headquarters Hospital and have at least one Psychiatrist in each Taluk Level Hospital WWW.LIVELAW.IN W.P(MD)No.164820 o) Why not Central Government engage the services of Foreign Psychiatrists Psychologists to teach and train medical students p) What steps Government has taken to establish the rehabilitation services q) What are the incentives given for starting the rehabilitation services r) What steps Government has taken to promote community based s) Do we have sufficient rehabilitation professionals to manage rehabilitation homes t) What is the Government budget for rehabilitation u) What is the status of insurance coverage of mental illness v) What are the steps taken to promote school mental health and community based mental health services 22. The above queries have to be answered in the next hearing. All the respondents are directed to give their response at the earliest in the next date of hearing viz. 09.12.2020 23. Notice to the newly impleaded respondents 8 and 9 returnable by 09.12.2020. Private notice in all possible modes including email is permitted WWW.LIVELAW.IN 24. List the matter on 09.12.2020 in the motion list. W.P(MD)No.164820 N.K.K. J.) (B.P. J 27.11.2020 Note: In view of the present lock down owing to COVID 19 pandemic a web copy of the order may be utilized for official purposes but ensuring that the copy of the order that is presented is the correct copy shall be the responsibility of the advocate litigant concerned WWW.LIVELAW.IN W.P(MD)No.164820 W.P(MD)No.164820

Summary: The effects of mental illness are often felt only by those suffering from it. Except for extreme cases, they do not manifest themselves in physical symptoms. This has led to it being deeply stigmatized and not talked about. Though we are still a long way from giving our mental health and welfare the importance they deserve, proactive action like this is a step in the right direction was held while disposing of a Writ Petition filed in public interest regarding the mental health of Tamil Nadu’s prisoners in the case of KR Raja vs State of Tamilnadu,WP(MD) 16484/2020 were division bench of the Madras HC was shocked to discover that India is the most depressed country in the world.  According to a report by the World Health Organization (WHO), over 90 million Indians suffer from some form of mental illness. The petitioners filed the WP praying that a writ of Mandamus be issued to mandate that a mental healthcare facility be set up either in Madurai or Trichy Central Prison. It was found that several prisoners there suffered from different forms of metal illness, but they were unable to receive treatment due to the complete lack of facilities. The bench looked into mental illness and rightly opined that almost all mental ailments were treatable, curable and preventable if the illness was diagnosed early and treated, and the patient was then appropriately rehabilitated. However, the incidence of mental illness in the country has nearly doubled over the past 10 years, largely due to a lack of awareness and the stigma surrounding it. Other reasons the Court found for these alarming rates of mental illness are high costs of treatment, lack of treatment facilities and an insufficiency of human resources. It was found that India’s mental healthcare budget in 2018 was Rs.52,80,00,000/-, but this was reduced to Rs.40,00,00,000/- in 2019. It has been noted that the actual amount spent by the Govt. on mental health was a mere fraction of the budget, Rs.5,00,00,000/-. The division bench made some concerning discoveries. “The amount spent on mental health comes to 33 paisa for mental health patient, given the number of 150 million people requiring urgent care. It is reported in Parliament in March 2020 that a sum of 48 Crores Rupees only has been spent on mental health in the year 2018-2019, which approximately comes to Rs.2.40/- per patient in a year or approximately, 20 paisa per month per patient.” Furthermore, there is only one specialized mental healthcare research facility in the country, NIMHANS. The numbers of mental health professionals are also below the required levels; only one psychiatrist is available for every lakh of the population even though the recommended ratio is 3:1,00,000. The Government passed the Mental Healthcare Act in 2017 but a lack of awareness programs coupled with stigma around the subject meant that this legislation has largely flown under the radar. The bench agreed that it was essential for a mental healthcare facility to be set up in the Trichy and Madurai Central Prisons in accordance with S.103 of the Mental Healthcare Act. In consideration of how often the subject is overlooked, they decided to extend the scope of the petition beyond Tamil Nadu to issue directions to the Central Government, State Governments and Medical Council of India to “identify the patients at the earliest by diagnosing the disease to give proper treatment by improving the infrastructures, like, establishment of hospitals, increasing the number of psychiatrists, psychologists, psychiatrist social workers and allocation of more funds towards mental health, including the conduct of regular surveys.” Looking into the prevalence of fresh cases, the Court held “it is the need of the hour to have a Psychiatry Department in every District Headquarters Hospital and a Psychiatrist in every Taluk Level Hospital.” They also stated that rehabilitation was essential to treatment, but as it is not a profit-making venture, private players would be hesitant to enter the market. The onus would thus fall upon the Government to take the necessary steps to establish and promote rehabilitative infrastructure. Click here to read more