Issues relating to development and management of Social Sector/Services relating to Health
Development processes and the development industry the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders
Mental Health Care Law
Mental health care is a critical health concern and with a long drawn demand for a law that is real to current times it was important to approach the subject with care. The government should use the new mental health law to strengthen primary care. The area affects multiple concerns as India is at crucial stage of demographic transition.
The passage of the Mental Healthcare Bill in the Lok Sabha, putting it on course to become law and repealing the Mental Health Act of 1987, will potentially help India catch up with the advances made in the field by other countries.
India urgently needs to make a transition from old-fashioned approaches to providing care for those suffering from mental illnesses.
Something that China, for example, has achieved through state-led policy reform.
Even the sketchy studies on the nature of care available to Indians indicate that in terms of population coverage the new law faces a big challenge.
The country’s grossly inadequate base of professional resources is evident from its ratio of 0.3 psychiatrists for 100,000 people (with marginally higher numbers taking independent private practitioners into account), compared to China’s 1.7.
Then there are massive deficiencies in the availability of trained clinical psychologists and psychiatric social workers.
Evidently, the National Mental Health Programme has not been sufficiently funded within the health budget;
Neither has capability been built in most States to absorb the meagre allocation.
Benefits of the new law:
Delayed though it is, the new legislation can bring about change with its positive features.
The important provisions relate to
The recognition of the right to medical treatment, decriminalisation of attempted suicide.
Explicit acceptance of agency of people with mental illness
Their freedom to choose treatments, prohibition of discrimination and regulation of establishments working in the field.
Need for more focus:
Raising effective primary and district-level coverage of mental health services for the general population, without requiring people to travel long distances to see a specialist and get medicines, should be a priority.
Since the base of psychiatrists is low in relation to the need, the use of trained general practitioners as the first line of contact assumes importance.
Some studies show many of them are not confident enough with their training to detect, diagnose and manage mental illnesses.
With a concerted effort, primary care physicians can be trained to help people with mild and severe problems, ranging from anxiety disorders to depression, psychoses and conditions arising from alcohol and substance abuse.
Being able to get professional counselling will reduce the complications arising from extreme stress, often the trigger for suicide.
Extending health insurance cover is also a step forward, since out-of-pocket expenditure has risen along with the expansion of the private sector in this sphere, just as for other ailments.
The provision in the new legislation prohibiting seclusion of patients, something that is frequently resorted to in asylums, and the general use of electro-convulsive therapy must be welcomed.
Modern treatment approaches rely more on family and community support.
The new Central and State regulatory authorities should speedily weed out shady non-governmental rehabilitation organisations in this field.
The arrival of the much needed legislation though delayed gives hope and strength to efforts. Mental health issues can be silent killers that can rob the nation silently making it a future that is hazy and dark. It is important o have holistic and due concern over the issue from the root.
Connecting the dots:
Critically analyse the impact of the new mental health care law can have on the health fabric of the country especially with increasing cases of depression and non-communicable diseases.
ENVIRONMENT/ SCIENCE AND TECHNOLOGY
TOPIC:General Studies 3
Conservation, environmental pollution and degradation
Indigenization of technology and developing new technology.
Science and Technology- developments and their applications and effects in everyday life
A clean up Act
The decision of Supreme Court on disallowing sales of Bharat Stage III vehicles from April 1 is a welcome message that short-term economic considerations cannot supersede public health concerns.
However, this decision is not a surprise considering the mood of SC in recent past on the issue of pollution caused by automobiles.
Time and again the court has clearly indicated that it will not hesitate to write out drastic orders and directions to help improve the air quality.
For instance, in 2016, it cracked down on diesel vehicles in the national capital region, disallowing registration of cars of over 2000-cc engine capacity.
Trying to mislead and gain
Now, SC has come out strongly against vehicle manufacturers for interpreting a government notification in a manner that favoured them even if it meant putting more polluting vehicles on the road.
The dispute was whether the cut-off date of April 1 for stoppage of vehicles with BS-III engines applies to the manufacture or sale of vehicles.
This was because the fate of inventory of over 96,000 commercial vehicles and 6 lakh two-wheelers fitted with BS-III engines was hanging. The industry warned of massive losses if these vehicles were not allowed to be sold.
But the SC bench ignored it and clearly said that health of millions of citizens is more important than the commercial interests of a few manufacturers.
The wrong attitude
The timetable for transition to BS-IV was known for a long time. It was repeatedly emphasised in various forums, and reiterated by the Parliamentary Standing Committee on Petroleum and Natural Gas in its review of the Auto Fuel Policy nearly two years ago.
Hence, the industry should have planned its production in a manner that left little inventory of the older BSIII vehicles as of the cut-off date. But instead it followed a short-sighted approach and continued to produce the cheaper BS-III versions in an effort to sell as many of them as possible before the deadline.
This decision has a precedent seven years ago when the shift from BS-II to BS-III norms was carried out with a relaxation of deadlines often stretching across months.
Hence it was thought that similar conditions would prevail which would allow them to garner more profits.
Even the centre is to share some of the blame for not expediting the process of transition to upgraded fuel standards and assured industry of a business-as-usual approach on a sensitive issue such as automotive emissions.
The contradictory fact is that vehicle manufacturers are already equipped and meeting the higher norms in the bigger cities.
Why upgraded version
Passenger vehicles compliant with Bharat Stage-III emission norms vary widely from Bharat Stage-IV compliant engines, depending on the size of the car and whether they are petrol or diesel versions.
There is no difference in appearance from outside but they differ in electronics, sensor system, the engine’s ability to process low-sulphur fuel and their “after-exhaust” system that determines emissions.
Though passenger cars today were designed to comply with BS-IV emission standards, the heavy commercial vehicles which are built with BS-III employed a mechanical fuel pump and used fuel less efficiently which influenced subsequent emissions of nitrous oxide, carbon monoxide and particulate matter.
BS-IV engines also require that the sulphur content of the fuel they use be less than 50 part per million (ppm) whereas BS-III ones can run on 350 ppm fuel. The transition can lead to substantial reductions in particulate matter emissions. For instance, from new trucks, the emissions can dip by 80% and from cars by half.
Effect on air quality
As a result of the non-adherance to government and SC order, over eight lakh BS-III vehicles will have to be either upgraded or sold abroad. This is miniscule compared to 19 crore vehicles on Indian roads today.
However, it is highly unlikely that court’s uncompromising approach will have a significant impact on reducing air pollution. Also, with increasing number of cars, the pollution is not expected to decrease significantly.
But the message send out is clear. According to research, three years ago, 30% to 50% of total on-road emissions came from vehicles older than 10 years, or about 17% of the fleet.
Thus, the manufacturers are required to adjust to the new reality should serve as a reminder that they, and the fuel companies, must prepare for the next big deadline: an upgrade to the BS-VI standard by April 1, 2020.
The judgement is a wake up hammer for centre and industry for failing to act in the larger public good. It is now imperative to shift to cleaner fuel.
Liquidating obsolete inventory poses a challenge for manufacturers, but it can be met through exports, technology upgrades or reuse of dismantled parts.
The centre has the responsibility to fulfil the objective of the Supreme Court’s order for cleaner environment is met and the ‘one fuel, one country’ goal for BS-IV is achieved.
There is one dark area wherein vehicle manufacturers alleging that the higher grade fuel is not available outside the metros. This would not just defeat the purpose of superior emission norms but also lead to problems for vehicle owners, as using BS-III grade fuel in BS-IV vehicles could lead to under-performance by the vehicle.
Connecting the dots:
What are BS emission norms? Critically examine the current issues surrounding it.
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