The Mental Health Care Bill, 2013

-         In line with UN Convention on People with Disabilities 2007 which India ractified

Rights of persons with mental illness:  Every person shall have the right to access mental health care and treatment from services run or funded by the government.  -         The right to access mental health care includes affordable, good quality of and easy access to services. -         Persons with mental illness also have the right to equality of treatment, protection from inhuman and degrading treatment, free legal services, access to their medical records, and complain regarding deficiencies in provision of mental health care.

Advance Directive: A mentally-ill person shall have the right to make an advance directive that states how he wants to be treated for the illness during a mental health situation and who his nominated representative shall be.  -         The advance directive has to be certified by a medical practitioner or registered with the Mental Health Board.  -         If a mental health professional/ relative/care-giver does not wish to follow the directive while treating the person, he can make an application to the Mental Health Board to review/alter/cancel the advance directive.

Central and State Mental Health Authority: These are administrative bodies are required to (a) register, supervise and maintain a register of all mental health establishments, (b) develop quality and service provision norms for such establishments, (c) maintain a register of mental health professionals, (d) train law enforcement officials and mental health professionals on the provisions of the Act, (e) receive complaints about deficiencies in provision of services, and (f) advise the government on matters relating to mental health

Mental Health Establishments: Every mental health establishment has to be registered with the relevant Central or State Mental Health Authority.  In order to be registered, the establishment has to fulfill various criteria prescribed in the Bill.

The Bill also specifies the process and procedure to be followed for admission, treatment and discharge of mentally ill individuals.  -         A decision to be admitted in a mental health establishment shall, as far as possible, be made by the person with the mental illness except when he is unable to make an independent decision or conditions exist to make a supported admission unavoidable

Mental Health Review Commission and Board: The Mental Health Review Commission will be a quasi-judicial body that will periodically review the use of and the procedure for making advance directives and advise the government on protection of the rights of mentally ill persons.  The Commission shall with the concurrence of the state governments, constitute Mental Health Review Boards in the districts of a state.  The Board will have the power to (a) register, review/alter/cancel an advance directive, (b) appoint a nominated representative, (c) adjudicate complaints regarding deficiencies in care and services, (d) receive and decide application from a person with mental illness/his nominated representative/any other interested person against the decision of medical officer or psychiatrists in charge of a mental health establishment

Decriminalising suicide and prohibiting electro-convulsive therapy: A person who attempts suicide shall be presumed to be suffering from mental illness at that time and will not be punished under the Indian Penal Code.  Electro-convulsive therapy is allowed only with the use of muscle relaxants and anaesthesia. The therapy is prohibited for minors

Jai Gau mata

Repeated attacks on Dalits and Muslims on issue of slaughteringof cows by so called “Gau Rakshak” dals	Eg: Dadri (UP) incident & Una (Guj.)
Art 48: The State shall endeavour to organise agriculture and animal husbandry on modern and scientific lines and shall, in particular, take steps for preserving and improving the breeds, and prohibiting the slaughter, of cows and calves and other milch and draught cattle	This is a DPSP, though individual states have made laws to prohibit cow slaughter : it does not ban consuming beef or sale purchase of cows & bulls.
Traditional work of Muslims & Schedule Caste people have been affected = slaughter houses closed + whole supply chain affected	Big part of rural & informal economy affected; unemployment in most backward sections of society
Farmers also affected = old/disabled animals as liability + loss of income	Gau rakshaks black mailing & looting farmers, traders etc in liason with police = corruption
Criminalisation of Politics & politicization of criminals	Further marginalization of SCs & Muslims
Way the inquiry and action taken by police and Judiciary is unsatisfactory	This could lead to social alienation + rise to naxalism (as in Bihar)
Need for strong action against such criminals	Updating Atrocities act + its proper implementation
In Guj counter agitation & riots by Valmiki community + refusal to clean carcass again	Eradication of Manual scavenging + skill upgradation of existing scavengers for other employments

Road Safety

On Road Safety

-         400 Road deaths take place in India every day (nearly one accident per min. & one death every 4 min due to speeding)

-         Blame is almost entirely on Driver every time but sorry state of Roads have not been addressed esp potholes and enchrochments.

-          Multiple actors like municipal corp, state highways & national highways = blame game.

-         There is lack of road safety data for effective management & mitigation of accidents (like Mumbai – pune Expressway accidents)

-         There is lack of accountability from any of the agencies for maintainance +local police never conduct detailed enquiry on Road accidents.

-         There is lack of provisions like CCTV, emergency medical centres & ambulances etc even on National Highways (they only collect toll)

-         Need for comprehensive reforms in road safety from both National & State gov. = review of laws relating to roads safety and infrastructure should be reviewed by expert panel.

-         Systematic corruption in transport depts. From vehicle certificate granting to license should be curbed urgently.

-         Centre should act on virtual monopoly held by automobile comp = raise the cost of maintenance & affecting quality of vehicles.

*Motor Vehicle (Amendment) Bill, 2016

Healthcare

Public Healthcare Issues

-         Lesser people opting for public healthcare facilities from 6% to 68% in last 1 decade have opted for prvt sector leading to

a.     More people going under poverty every year for medical expenses nearly 23% due to out of pocket expenditures.

b.    Expensive tertiary healthcare facilities cropping up in Urban areas – nontransparent + many unethical practices eg: Kidney rackets etc.

c.     Rural Urban Migration for treatment of diseases

-         In last 20 yrs GDP spending on Healthcare has been increased only 1.1% to 1.4%, while China spends 3% & US 8.3% = (poor suffering the most)

-         Indias public Healthcare policy has worked well in areas like reducing maternal & Infant mortality, eradicating polio but failed to combat Tuberculosis & non-communicable diseases.

-         Solutn: a. Improving public health Infrastructure esp upgrading nurses skills (linking it to skill India) in Rural areas.

b. Ethical treatment should be given to patients in Public hospitals.

c. Increasing budgetary allocations on healthcare + ppp models + R&D.

d. Proper instructions of laws to medical practitioners to avoid “blame games”.

e. An affordable healthcare legislation like US or Universal Healthcare on lines of Right to Food Act.

- There is gradual weaking of National Health Mission (NHM) which focused on public health Infrastucture other than tertiary sector esp prog for prevention of vector bourne diseases & TB.

- Allocations for “ Family Welfare Scheme” also reduced

- Budget is primarly focused on promoting, procuring and distributing contraceptives + other materials for Information, education & communication.

= but, death of women during private stearlization camp in Chattisgarh – IEC without proper Infra is nothing

-         Tertiary care sector is growing rapidly at cost of primary and secondary healthcare of India.

-         Alleged programmes like water sanitation, ICDS & MNREGS also neglected.

-         Doctors/ lakh populatn is 45 while desirable is 85 & auxillary nurse and midwives (ANM’s) available is only 75 per lakh population whereas the desirable number is 255.

Government initiatives wrt rising healthcare costs :

-         Increase spending on public health : Government is trying to increase public expenditure on health from current level of 1.2%of GDP to 2.5% by 2017 and to 3% by 2022.

-         Rashtriya swasthya bhima yojana , a smartcard based cashless health insurance scheme has been modified and transferred to Ministry of Health and Family Welfare from Ministry of Labour.

-         Greater access has been created to medicines, vaccines and technology through adequate price controls and price regulation, especially on essential drugs.

-         Centre is trying to set up National Health Regulatory and Development Authority as a nodal agency to supervise + redress over public health sector in India.