Two years after the Mental Healthcare Act was passed, the state government has finally drafted mental healthcare rules which, for the first time, identify rights of mentally ill patients. The draft rules await the nod of the state health ministry.
As of now, the state government follows the Mental Health Act, 1987. In 2017, the new Mental Healthcare Act was passed and was enforced in May 2018. The new rules focus on patients’ rights, treatment infrastructure upgradation and rehabilitation of patients who have recovered.
With the Act mandating one psychiatrist per 100 patients, Maharashtra will now need to plug massive vacancies on posts of psychiatrists. At least 60 posts of psychiatrists, officials said, need to be filled in four mental hospitals in Thane, Pune, Ratnagiri and Nagpur.
The state public health department has amended certain rules from the central Act. While the Mental Healthcare Act gives a patient the right to get admitted or discharged from a mental healthcare institution, the Maharashtra government has incorporated a condition that patient’s wish must be corroborated through clinical assessment by two psychiatrists.
“This is to ensure that a person does not forcefully seek hospitalisation for vested purposes,” Dr Sadhana Tayade, joint director at Directorate of Health Services (DHS), said.
Following the concept of living will, the rules provide a unique provision for advanced directive to decide guardian, treating doctor and whether she/he wants electroconvulsive therapy (ECT) to treat any future mental illness. For children, ECT therapy will require approval from a district review board.
“We are in process of setting up 14 district review boards across Maharashtra,” said Dr Nitin Bhalerao, in-charge of mental health in the state. A district review board will consist of a district judge, a psychiatrist, a recovered mentally ill patient and a social worker, and will look after patients’ rights and rehabilitation.
The new rules also focus on rehabilitation through half-way homes, rehabilitation into society and rehabilitation through government shelter homes. At least 251 patients have been shortlisted in all four mental hospitals for rehabilitation through the social justice and special assistance department. The 215 patients selected are ones who do not have a family willing to accept them and have recovered enough to live independently.
In a period of nine months, they will be moved to either old-age homes or women’s shelter homes.
“These patients will be kept in a separate ward for three months in mental hospital in phase I. They will undergo counselling and preparation to live outside mental institution,” an official said. In phase II, the patients will be shifted to shelter homes under social justice department. In the last phase, they will be provided vocational training and skill development, but will continue to live in shelter homes unless they can earn on their own and wish to move out.
The state government is also in the process of developing half-way homes with Tata Institute of Social Sciences to rehabilitate patients back to society.