Bangladesh needs a Mental Health Care Act that ensures that the patients are properly informed and listened to

During the Covid-19 pandemic, people had to deal with anxieties, loneliness, frustration, and suicidal thoughts more than ever. Social distancing, closedown of public and educational institutions, restriction on movements by quarantine and isolation, struggling financial condition, etc have led to overwhelming mental pressure and deteriorating mental health conditions.

A recent study revealed that suicide claimed more lives than the coronavirus in Bangladesh between March, 2020 to February, 2021. Suicide mortality rate is about 45% higher in the year 2020 than the previous year. Poor mental health literacy, lack of recognition, lack of mental health facilities, skilled mental health care professionals, inadequate financial resources, limited research, etc are some of the barriers to execute mental health policies in Bangladesh.

The government’s attempt to address the issue of mental health crisis in Bangladesh resulted in the Mental Health Act, 2018, replacing the age-old controversial Lunacy Act of 1912. Despite being one of the newest laws, some of the provisions of the Mental Health Act, 2018 of Bangladesh appear to be vague and restrictive in nature. To overcome the inadequacy in the existing law, a draft, National Mental Health Policy, has been approved by the Ministry of Health in 2019, awaiting endorsement by the Cabinet.

A National Mental Health Strategic Plan 2020- 2030 has also been drafted, anticipating implementation over the next decade. Although enacting the Mental Health Act 2018 was a major milestone for Bangladesh, there are a few loopholes in the present Act that are in need of being rectified.

The title of the act, ie, the Mental Health Act, 2018 does not rightly address the primary objective behind its enactment — to treat, to protect the dignity, to address the right to property, and to rehabilitate the persons suffering from mental illness. Hence, changing the title into “Mental health care Act, 2018” would be the right approach in addressing the issue.

Section 2(7) of the Act provides a brief and less specific definition of “consent for treatment” and therefore needs reformation. Reference can be made to Section 2(i) of The Mental health care Act, 2017 of India which states that, “informed consent is consent given for a specific intervention, without any force, undue influence, fraud, threat, mistake or misrepresentation, and obtained after disclosing to a person adequate information including risks and benefits of, and alternatives to, the specific intervention in a language and manner understood by the person.”

Section 6 of the Act recognizes the right to health, property, dignity, education, etc of a person suffering from mental illness. However, the section does not specify these rights. Moreover, no elaboration has been made on the infringement of these rights. India on the other hand, in Chapter V of their Mental health care Act, 2017 provided an exhaustive list of rights such as — right to access mental health care, right to community living, right to protection from cruel, inhuman, and degrading treatment, right to confidentiality, right to legal aid, right to make complaints about deficiencies in provision of services, etc.

Section 11 to Section 15 of the Act provide the process of admission for treatment of persons suffering from mental illness but do not address the process of emergency holding of a person who attempts to leave and emergency powers of a medical practitioner who is unable to obtain consent from the patient or his/her guardian. Reference can be made to Chapter III of The Mental Health Ordinance, 2001 of Pakistan for a more specific view on assessment and treatment of patients.

Although rehabilitation of a mentally ill person has been referred under Section 18 and Section 19 of the Act, these Sections do not include community support despite its effectiveness. Reference can be made to Section 7 of The Mental Health Ordinance, 2001 of Pakistan which states that, “Community based mental health services shall be set up for providing mentally disordered persons, their families and others involved in their care with guidance, education, rehabilitation, after care and preventive measures and other support services on an informal basis.”

The section further explains the term “community” which includes family, home, workplace, educational institutions, and other places where care and after care can be provided on an informal or voluntary basis.

Section 23 of the Mental Health Act, 2018 of Bangladesh imposes imprisonment for a term of 1 year or fine up to Tk 3 lakh or both for purposefully issuing false certificates on mental illness and imprisonment for a term of 3 years or fine up to Tk 5 lakh or both for carelessness or mismanagement during the treatment of patients. However, this section fails to provide prohibitive measures against the malpractice of traditional healers, village quacks, and unqualified medical practitioners which causes inhumane discrimination, human rights violation, and the tragic and unnecessary deaths of patients.

The mental well-being of the survivors of rape and sexual assaults should also be addressed in the Act. These victims experience severe mental trauma which leads to anxiety, depression, and post-traumatic stress disorders. Hence, effective mental health services to support these victims should be introduced.

Recently, icddr,b has developed a web-based online platform for providing virtual mental health counselling services to both health care professionals and Covid-19 patients. From July 2021 till October, 2021, as many as 1,693 Covid-19 patients and 1,443 health care providers have received counselling services under this initiative.

Additionally, Kaan Pete Roi, Moner Jotno Mobile E, Moner bondhu, and Moner Dakter are some of the mental health help and support helplines from which people can seek assistance and counselling over the phone or online. These platforms can significantly increase mental health awareness among the patients, health care workers, and general people. Hence, subsidiary guidelines and policies should be introduced in order to regulate and facilitate these platforms.

Bangladesh needs a Mental Health Care Act that ensures that the patients and their guardians are properly informed and listened to. Addressing the issues prevailing in the present Act is likely to enable the patients to have a meaningful involvement in their care.

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