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Monday, December 27, 2010

Soon, insurance cover for the mentally ill

In a first in the country, the treatment of the mentally ill may soon come under the health
insurance cover. This is part of the comprehensive legislation the Union health ministry is
planning to protect the rights of persons suffering from mental illness.

At present, the health insurance schemes do not cover any mental illness, psychosomatic
dysfunction or problems connected to psychiatric conditions, disorganisation of personality or
mind even if it is caused or aggravated by accident.

Under Section 10 — right to equality and non-discrimination — of the proposed Mental Health
Care Act (MHCA) 2010 prepared by the health ministry, persons with mental illness will have to
be treated as equal to persons with physical illness in the provision of all healthcare. Accordingly,
the public and private insurance providers shall make provisions for medical insurance for
treatment of mental illness on the same basis as is available for treatment of physical illness,
failing which will be seen as discrimination.

“Families get wiped away under financial burden and debt while taking care of treatment of
persons with mental illness. Mental health has to be treated like any other illness, hence, it has to
be covered under insurance,” said Dinesh Trivedi, minister of state for health and family welfare.

The draft of the MHCA says the proposed legislation aims to regulate and improve accessibility to
mental healthcare by mandating sufficient provision of quality public mental health services.
Besides banning certain acts like chaining or giving electric shocks without anaesthesia, the
proposed act also encourages people to come forward and report inhuman treatment of such
persons in the neighbourhood.
The ambit of Right to Information will be extended to persons with mental illness and their families
to seek information with regard to their treatment etc and they can make complaints against care
The government has acknowledged that the previous law, Mental Health Act (MHA) 1987, failed
to protect the rights of mentally ill persons. The updated, amended and comprehensive law is
more rights based. It prohibits discrimination of persons with mental illness and aims to ensure
the environment around such persons is conducive to facilitate recovery, rehabilitation and full
participation in society.
Accordingly, such persons need to be provided treatment in a manner which helps them live in
the community and with their families. Long-term hospital-based mental health treatment shall be
used only in exceptional circumstances, for as short a duration as possible, and only as a last
resort when other means have failed.
No person with mental illness can be kept in a mental health facility merely because he/she does
not have a family, is not accepted by them, or is homeless. In such cases, the government will
more restrictive mental health facility, the draft act prescribes.

Similarly, they cannot be subjected to any cruel, inhuman or degrading treatment in a mental
health facility, including the compulsory tonsuring. Patients can be allowed to wear own personal
clothes too.

Besides, electro-convulsive therapy without the use of muscle relaxants and anaesthesia, electroconvulsive
therapy for minors, sterilisation of men or women, and chaining will be prohibited
treatments. In fact, physical restraint or seclusion can only be used when it is the only means to
prevent imminent and immediate harm to person concerned or to others, that too if it is authorised
by the psychiatrist in charge of the person’s treatment.

Every mentally ill person will have a right to make an ‘advance directive’ in writing, specifying the
way he/she wishes to be cared for and treated for a mental illness. This directive can be made by
a person irrespective of their mental illness history. However, it shall not apply to any emergency

Mental illness shall be determined in accordance with nationally and internationally accepted
medical standards of the World Health Organisation.

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