ABSTRACT
India has an enormous burden of mental illness. In spite of the recognition of this population of people living with mental illness, the treatment gap continues to be about 83%. In order to meet this vast unmet need and in the view of aligning the mental health legislation with the international standards and the UN-Convention on the Rights of Persons with Disabilities, the Mental Healthcare Act 2017 was passed and enforced recently. The provisions in the act have been controversial from its conception. Now after the enforcement of the act, all mental health professionals (MHPs) have a legal binding to follow the provisions in the law. The MHPs are accountable to the statutory bodies - the Central Mental Health Authority, State Mental Health Authority (SMHA), Mental Health Review Board, and finally, the High Court or the Supreme Court. The Mental Healthcare Act (MHCA) and relevant articles/documents obtained pertaining to MHCA and their evaluation were reviewed, the major focus being on the role of statutory/regulatory bodies. Furthermore, an attempt was made to summarize the previous experiences in inspection of mental health establishments by SMHA of Karnataka. We concluded that the MHCA will have both positive and negative aspects. Many of the provisions in the law may appear unclear and unrealistic by many practitioners. However, it becomes precautionary for the MHPs to be well equipped with the MHCA and be acquainted with the requirements of the statutory bodies for ensuring a safe practice. The outcome of the implementation of the act will become evident only with time.
ABSTRACT
INTRODUCTION: Mental Healthcare Act (MHCA) 2017 is an act passed to regulate and provide mental health care and services. The act considers psychiatrists as one of the main mental health providers. Liabilities are prescribed under various chapters of MHCA 2017. It is imperative for practitioners to be completely aware of and follow the rules as per MHCA 2017, now that the rules are already framed. MATERIALS AND METHODS: A thorough review of MHCA 2017, Central Mental Health Rules, and State Mental Health Rules 2018 was done. In addition, related scientific articles were accessed in PubMed and Google Scholar using keywords such as mental health legislation, law, and mental health. Relevant articles were reviewed to arrive at suggestions. OBSERVATIONS: Important liabilities are around the domains of registration of professionals and institutions, maintenance of records, promoting the rights of the persons with mental illness during treatment, and following the provisions of MHCA 2017 during admission and discharge. Punishment for contravention of provisions of the Act or rules or regulations made thereunder is clear and stringent and may vary from fine to imprisonment. SUGGESTIONS: Mental Health Professionals should understand the provisions of MHCA 2017 along with the rules and regulations made under this act. Please maintain basic medical records of all outpatients and inpatients and basic report of psychological assessments and release it upon request by the patient or nominated representative.
ABSTRACT
Mental Healthcare Act (MHCA) 2017 was gazetted on April 7, 2017. It repeals the Mental Health Act, 1987, and it can be implemented only after the state rules are formed. The central government has already published three sets of rules. This article was written with an objective to review how to make rules and regulations for the state as per MHCA, 2017. All sections of MHCA 2017 and the mental health rules previously made by different states according to the Mental Health Act 1987 were reviewed. Google and PubMed searches were done to review the implementation of their respective mental health acts by different countries and states in the past. Go through Central/State Mental Health Rules, 2018, framed by the central government. Try to adapt it for the state. A meeting on MHCA 2017 should be conducted, including all stakeholders who will give their suggestions about changes to be made. Frame an initial draft and discuss it with the stakeholders and finalize the draft. Discuss the draft in state mental health authority meetings and submit the draft to the government. The Department of Legislation and Parliamentary Affairs can be consulted. The draft should be sent to the central government's Ministry of Health and Family Welfare for approval. According to MHCA 2017, state rules can be formed in relation to the aspects mentioned under Sections 121 and 123. The state government should make notification of the rules and then implement them.
ABSTRACT
BACKGROUND: Beta-thalassemia major is a chronic disorder of blood, having an extensive impact on the affected child. It involves lifelong therapeutic regime, with repeated blood transfusions. With improved life expectancy, due to improved medical management psychosocial aspects of thalassemia are gaining importance. OBJECTIVE: To assess the behavioral problems in multi-transfused thalassemic children and psychosocial factors affecting them. SETTING: The study was conducted in a tertiary care level hospital and research institute catering mainly to a population of low socioeconomic status. DESIGN: The study was a cross-sectional study involving 50 multi-transfused thalassemic children of age 5-10 years. MATERIALS AND METHODS: Fifty multi-transfused thalassemic children, aged 5-10 years, not suffering from any other major medical illness, were included. Child Behavior Check List (Achenbach) (CBCL) was used to collect data from each parent regarding the child's behavior. Parental Attitude Scale (Rangaswamy 1989) was applied. Descriptive statistical analysis was used with analysis of variance (ANOVA) and Student's t test to find the significance of data. RESULTS: The CBCL total scores were high in 32% patients, indicating the presence of behavioral problems. Higher CBCL scores were found in children of older age group, those with poor school performance, whose mothers' education was more than eighth standard, had history of death of thalassemic relative in family, greater duration of diagnosed illness, poor pre-transfusion hemoglobin level, and who had longer periods of school absenteeism. CONCLUSIONS: Behavioral problems are common in multi-transfused thalassemic children. Early diagnosis and intervention of behavioral problems in these children would make them cope with thalassemia better.
