Amend the Mental Health Care Act 2017: A Survey of Indian psychiatrists (Part 2)

Background:Information about the experience of practicing psychiatrists with the use of the Mental Health Care Act (MHCA), 2017, India, after 5 years of its promulgation has not been available.Aim:The present study was carried out to understand the experience of the practicing psychiatrists in using and complying with the MHCA 2017 and to bring out the problems and suggested reforms, if any, in various provisions of the MHCA 2017.Methods:An online survey by practicing psychiatrists of Indian Psychiatric Society on the various sections and provisions of the MHCA 17 was carried out through structured and open-ended responses. This paper presents the qualitative analysis of the open-ended responses.Results:There were 600 respondents, who gave a total of 1239 (range 116-154) responses to eight open-ended questions about various provisions of the MHCA. Qualitative analysis revealed that most respondents opined for keeping the General Hospital Psychiatry units exempted from inclusion as the mental health establishment, thus treating physical illness at par with the mental illness; a separate stand-alone law for mental illness perpetuates stigma, asked for a larger representation of psychiatrists in the State Mental Health Authority and Mental Health Review Boards. Most respondents opined that the provisions of capacity assessment, nominated representative, and advance directive are a hinderance in treatment and should be amended; treating psychiatrists and family/caregiver's consent should suffice for supported admission, just like in other disciplines of medicine; and MHCA 2017 needs major amendments/repeal to make it convenient for patient care. Any unauthorized places/centers where persons with mental illness are kept should come under regulatory control of the state mental health authorities.ConclusionThe survey has highlighted several deficiencies and operational difficulties in the current Act that hinder the delivery of mental health care to patients with mental illness in the country and need amendments.