TOPIC: General Studies 2
- India and its neighborhood relations.
- Bilateral, regional and global groupings and agreements involving India and/or affecting India’s interests.
- Effect of policies and politics of developed and developing countries on India’s interests, Indian diaspora.
Why “looking east” and “acting east” is important?
There was a recent regime change in Nepal and this call for a renewed diplomatic engagement.
As soon as the military government prepared for a democratic transition and to diversify its external relations — away from its dependence on China — the US moved quickly to lift some of the sanctions it had imposed on Burma. Following the US lead, Japan and European powers checked into Yangon.
Now, with Burma’s first democratically elected government, the above major players including China are on the race extending outreach to Burma.
It is time that India also should join the race for vigorous commercial engagement with both the neighbours (Nepal and Myanmar).
For some decades now, India’s strategic opportunities have been mostly in the east. Even though we have policies such as “look east” and “act east”, India has failed to reap the maximum benefit. However, China figures prominently in the great game to the east
India and Nepal
- Nepal’s recent regime change was seen as a big political gain for India, however Nepal insists on a “balanced policy” towards both Delhi and Beijing.
- Delhi no longer has a free hand in Kathmandu and Beijing’s capacity to influence the internal politics of Nepal has significantly increased in recent years. China has always had a larger influence in Burma’s domestic politics.
India and Myanmar
- With Burma’s first democratically elected government, India has considerable potential to emerge as an influential force in Burma. But it has to contend with China’s power in Myanmar too.
- In Burma, Suu Kyi chose Beijing as the first port of call among the major powers, despite the fact that China was the strongest supporter of the military regime in the last three decades.
On both fronts, we have one common factor called “China”. India is also easily distracted by the endless provocations on its west. (Especially China’s deeper involvement with Pakistan)
Myanmar and China
Geography guarantees an enduring role for Beijing in Burma.
One of the major outcomes of Suu Kyi’s Beijing trip was – China’s commitment to bring three rebel groups in northern Burma that have long had ties to Beijing to the peace process. Settling the conflict with the minority groups is at the top of Suu Kyi’s political agenda.
In return Suu Kyi has set up a commission to review the Chinese dam projects on Burma’s border (that were in conflict earlier), supported Beijing’s Silk Road initiatives, and chosen to be silent on the South China Sea dispute.
What India should do?
Although geography gives India many advantages in both Nepal and Burma, Delhi has been unable to reinforce it with other instruments such as economic diplomacy.
China’s ability to deliver large quantities of aid and implement major infrastructure projects on short order makes it an attractive partner for both Kathmandu and Yangon.
- If India is to become an assertive regional player in Asia, it has to work toward developing policies that would improve and strengthen it domestically, which will encourage more confidence in its ability to lead the region and be an important global player.
- Competition with China should also be considered and taken seriously. China’s growing influence in the region would lead to a more one-sided dynamic in the region. China has asserted itself through its soft power as well as through its trade and economic relations with Myanmar by taking up large infrastructure projects in the country.
- India on the other hand needs to use its soft power more effectively, and at the same time strengthen itself domestically and regionally.
India, in contrast, has acquired an unenviable reputation in both Nepal and Burma for “all talk and no actions”. India needs a plan for vigorous commercial engagement with both neighbours.
There are several advantages that India has over China with regard to Myanmar. One is the democratic process, which results in different governments at the center and states through free and fair elections. There is also the respect for institutions that are strong enough to hold the country together. Finally, cooperation in different multilateral forums such as ASEAN and BIMSTEC strengthen the relationship between the two countries. Apart from these reasons, India has sent a clear signal that while economic ties are important, it is keen to build a holistic relationship and is prepared to assist in institution building in Myanmar.
While the basic foundation for the relationship between India and Myanmar has been laid by previous governments, the onus is on the present Indian administration to demonstrate that it can take the relationship to a higher level. It can also become a strong regional player through a more proactive approach, cement India’s place in the region and grow into a powerful, global country.
Connecting the dots:
- Myanmar is India’s bridge east, and an important ally for growing its regional power. Comment.
- Why “looking east” and “acting east” is important for India? Discuss.
TOPIC: General Studies 2
- Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
- Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections.
Mental Healthcare Bill 2013
- The Mental Health Care Bill has been passed in Rajya Sabha in August 2016.
- It is sought to replace the Mental Health Act, 1987.
- It provides for protection and promotion of rights of persons with mental illness during the delivery of health care in institutions and in the community.
- There is no official estimate of India’s population suffering from mental illness.
- In 2005, it was estimated that 6-7% of country’s population is suffering from some form of mental illness.
- Out of them, 1-2% are having an acute condition of mental disorders such as schizophrenia and bipolar disorder.
- Nearly 5% of the population suffered from common mental disorders such as depression and anxiety.
- WHO: estimates that 1 in 4 persons will be affected by some form of mental illness once in their lifetime.
- World Mental Health Day- 10th October
- A Technical Committee on Mental Health was constituted by NHRC which submitted its report (Mental Health Care in India: Old Aspirations, Renewed Hope) in 2014-15.
- According to the report, states such as Jammu & Kashmir, Jharkhand, Karnataka, Tripura, Telangana, Haryana and Andhra Pradesh, as well as Union Territories such as Daman & Diu and Andaman & Nicobar-
- Had deficient services for treating mental health
- Had failed to update information on mental health
- Major findings
- Incomplete or insufficient information from most states on their mental health services
- Inadequate estimations of states’ mental health needs
- Poor documentation of registration for mental health services in states
- Very low patient registrations
This shows the dismal state of affairs in taking care of persons with mental illness.
Examples of some states and UTs to have an overview of the mental healthcare scenario:
- Population= 4.93 crore
- Has no record of the number of individuals with mental illness
- There are no government-run halfway homes, no longstay rehabilitation facilities, no mental health plan and no counselling in jails.
- 3rd populous state of India
- Population= 10 crores
- Has: 28 psychiatrists in the government sector + 3 psychiatrists in the private sector
Andaman and Nicobar
- Population: 37 lakh
- 30,000 mental health patients
- 2 psychiatrists at 1 government hospital
- There is no in-patient service, longstay rehabilitation facilities or government-run halfway homes.
The Mental Healthcare Bill, 2013
- Indian Psychiatric Society (IPS) is the representative body of psychiatrists in India since 1948
- IPS has always remained forefront in the struggle for betterment of conditions of mental asylums (as they were called then) and also for the human rights of persons with mental illness.
- After due deliberations, the IPS prepared and presented a draft Mental Health Bill in 1950 to the government for consideration. Various reasons stalled its enactment which later started in 1970s.
- Finally the Mental Health Act, 1987 was passed which came into operation after notification in 1993.
- In 2007, Government of India ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCPRD).
- The signatory countries are required to change their laws to give effect to the rights of persons with mental illness.
- To its effect, the Mental Health Care Bill, 2013 was first introduced in the Rajya Sabha in 2013, which has now been passed and Lok Sabha has to take it up.
Meaning of Mental Illness
- Bill defines mental illness as “a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life.”
- It includes mental conditions associated with alcohol and drug abuse, but does not include mental retardation, as it is a result of incomplete mental development of the person.
Charting out treatment for oneself
Right to select a representative, who will design the mode of treatment according to which the person will be treated if he/she gets diagnosed with a mental illness.
- The person will be a nominative representative.
- The person will be aware of likes and dislikes of the person having mental illness.
Prioritising the interests of the patients
- Earlier act was focused on regulation.
- The new bill is ‘patient-centric’ which ensures safeguarding of patient’s interests.
- Aims to ensure that the treatment and rehabilitation of people with mental illness is carried out “in a manner that does not intrude on their rights and dignity”.
Bans the use of electric shock therapy
- Children with mental illness will not be treated via electroconvulsive therapy (ECT)
- ECT is a procedure, done under general anaesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure
- Permitted to use on adults after they have been given anaesthesia and muscle relaxants.
Access to healthcare
-Without any discrimination for affordable and good quality mental health services
- Guarantee to every person the right to access mental health care and treatment from the government.
- Includes affordable, good quality, easy access to services such as minimum mental health services in every district.
- They will have right to equality of treatment and protection from inhuman and degrading treatment.
Need for infrastructure and psychiatrists
- Barely one psychiatrist is available for every 4 lakh population.
- As per Directorate General of Health Services report (2002), a ratio of 1 psychiatrist per 100,000 population is desirable
- Half-way homes, sheltered accommodations, supported accommodations, child and old-age mental health services etc. are also to be established.
- Government has been assigned duties to take measures to address human resources requirement of mental health services.
- All the medical officers in public health establishments and in jails are to be trained to provide basic and emergency mental health care.
- The act decriminalises attempt to suicide and places it under the ambit of mental illness.
- In case of suicide, the person will be presumed, unless otherwise proved, to have severe stress at the time of the attempting suicide
- Hence, the person will not be liable to be prosecuted under section 309 of IPC
- Instead of punishing people who attempt suicide, the government will help them and offer mental health care facilities.
- Every insurance company shall provide medical insurance for mentally ill persons on the same basis as is available for physical illnesses.
- It provides for establishment of a State Mental Health Authority and a Central Mental Health Authority
- Also provides for a Mental Health Review Commission to regulate the sector and register institutions.
- It will plan, design and implement programmes for promotion of mental health and prevention of mental illnesses
- It will create awareness about mental health, particularly programmes to reduce stigma which are to be adequately funded.
- The provisions of the Act are to be given wide publicity through public media.
- Government officials including police officers and other officers are to be given periodic sensitization and awareness training on the issues.
- There is provision of emergency admission on any bed in the country up to a period of 72 hours.
- The psychiatric treatment, except electro-convulsive therapy (ECT), can be initiated by any registered medical practitioner, if there is danger to patient’s health or the patient is violent or suicidal.
- This provision fills a major lacuna overlooked in the previous law which made transporting a disturbed patient illegal, except under court order.
Thus, various stakeholders including academia, experts and political establishment were consulted while formulating the Bill, which focuses on community based treatment.
- The central and state governments have to ensure access to mental health services in every district.
- This is to include outpatient and inpatient services, hospitals, and community-based rehabilitation establishments.
- However, the financial memorandum of the Bill does not estimate the expenditure required to meet the obligations.
- Nor does it details out the sharing of expenses between the central and state governments.
- Inadequate funding can affect the implementation of mental healthcare law.
Guardianship rules not mentioned
- The bill does not address issues related to guardianship of mentally ill persons
- Rights of Persons with Disabilities (RPD) Bill, 2014: specifies the provisions related to guardianship of mentally ill persons. (it is pending in Parliament)
- However, 1987 Act had provisions related to appointment and removal of a guardian, and his powers and duties.
Penalties not defined
- The bill does not prescribe specific penalties for non-compliance
- General punishment of up to 6 months or a penalty of up to Rs 10,000, or both, is provided.
General Hospital Psychiatry Units (GHPU)
- Any health establishment where persons with mental illness are admitted or kept in for care, such have to be registered as Mental Health Establishment (MHE).
- It will be bound by all the rules framed under the Bill by the Mental Health Authorities.
- Though it is different from licence required under the 1987 Act, it will still have to fulfil the stiff norms and guidelines framed by the authorities.
- The GHPU are very important assets in psychiatric care as they are easily accessible and people get benefit from these units without any feeling of stigma.
- Requirement of registration as MHE for all GHPU would have a dampening effect on their establishment and hardly anyone would be interested in opening them.
Ban on unmodified ECT and restrictions on ECT to Minors
- ECT is very useful while treating many acute and chronic psychotic conditions, many of which occur for the first time during childhood and adolescence. (Unmodified ECT refers to the administration of ECT without the prior administration of a muscle relaxant).
- It seems to be based on popular perception and sentiment rather than scientific evidence.
- If ECT is banned, it will be not available at small and remote places, where anaesthetic support is not available even for routine surgery.
- Severe restriction has been placed on the use of ECT to minors in the Bill, where prior approval from the Mental Health Review Board has to be obtained. This also appears to be based on sentiments than science. ECT is used during emergencies and is considered as life-saving procedure, and thus, to get prior approval of Board does not fit in.
- It is widely opposed by IPS and other professional associations of psychiatrists as according to them, any idea of prescribing or prohibiting any particular form of treatment in mental health legislation is anachronistic and improper.
Marginalization of families of persons with mental illness
- Family is a very important asset in management of mental illness.
- In many cases, family will have to move to the Mental Health Review Board to get approval of mental health decisions and involuntary admissions.
- Provisions of nominated representatives and advance directives has also put limitation on the role of the families as it may damage goodwill and bonding in the families.
Non-experts given power to take decisions
- Mental Health Review Board, which has six members out of which only one is a psychiatrist, is vested with vast powers to take decisions in respect of mental health care
- Mental Health Authorities both at central and state levels which have been assigned duties to set norms and standards, to register and to keep a close eye on functioning of the MHE, have only two or three psychiatrists among more than twenty official and non-official members.
- Thus, crucial decisions in the field of mental health in the hands of non-experts is visible.
- Elaborate regulatory and appellate provisions of admissions in MHE will constitute a lot of clerical and paperwork in the management of MHE.
- The treating psychiatrist will have to cope with a great burden in this respect in his day to day functioning.
- Private psychiatrists will have to also do a lot of paperwork due to various provisions like advance directive, nominated representatives and requirement of approval from the Board for taking many of the treatment decisions.
- As a result, private psychiatrist may be less willing to take up psychiatric cases requiring paper works and formalities.
- Ultimately, the person with mental illness will suffer.
- The new bill has unprecedented measures aimed towards sea change measures with respect to treatment for the mentally ill across the country and particularly the underprivileged.
- But, care has to be taken that Bill does not create impediments in psychiatric treatment of the patients.
- The patients of psychiatric disorders constitute only a small group. Yet, it has to be ascertained that proper mental healthcare facility is availed by all the patients without any stigmatic feeling and hindrance.
- Families give the best support in management of mental illnesses and thus, measures should be taken that they are not marginalised.
Connecting the dots:
- The Constitution of India envisages right to live and right to equality of all the citizens of the country. Critically evaluate the provisions of Mental Healthcare Bill 2013 in that respect.
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