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《2013年精神卫生保健法案》:批判性评估

The mental health care bill 2013: a critical appraisal.

作者信息

Narayan Choudhary Laxmi, Shekhar Shivendra

机构信息

Department of Psychiatry, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India.

出版信息

Indian J Psychol Med. 2015 Apr-Jun;37(2):215-9. doi: 10.4103/0253-7176.155634.

Abstract

The Mental Health Care Bill - 2013 has been introduced in Rajya Sabha and is now waiting for enactment. The Bill entails unprecedented measures to be undertaken by the Government ensuring everyone right to access mental health care and treatment from services run or funded by the Government. The Government is to meet the man-power requirement of mental health professionals according to international standard within a period of ten years. Various rights of persons with mental illness have been ensured. All the places where psychiatric patients are admitted and treated including the general hospital psychiatry units (GHPU) are to be registered as mental health establishments. Unmodified ECT has been banned and ECT to minors can be given only after approval from the Mental Health Review Board. This article advocates for exemption of GHPU from the purview of the Bill, taking into consideration impediment created in the treatment of vast majority of psychiatric patients who retain their insight into the illness and seldom require involuntary admissions. It is also advocated to reconsider ban on unmodified ECT and restriction placed on ECT to minor which are very effective treatment methods based on scientific evidence. In our country, family is an important asset in management of mental illness. But requirement of seeking approval from the Board in many of the mental health care decision may discourage the families to be proactive in taking care of their wards. The Board and Mental Health Authorities at the central and the state levels are authorized to take many crucial decisions, but these panels have very few experts in the field of mental health.

摘要

《2013年精神卫生保健法案》已提交至 Rajya Sabha(印度议会联邦院),目前正等待颁布。该法案要求政府采取前所未有的措施,确保每个人都有权获得由政府运营或资助的服务所提供的精神卫生保健和治疗。政府将在十年内按照国际标准满足精神卫生专业人员的人力需求。精神疾病患者的各项权利已得到保障。所有收治和治疗精神病患者的场所,包括综合医院精神科病房(GHPU),都要注册为精神卫生机构。未经改良的电休克治疗(ECT)已被禁止,对未成年人进行ECT治疗须经精神卫生审查委员会批准。本文主张将GHPU排除在该法案的范围之外,考虑到绝大多数对疾病有自知力且很少需要非自愿住院治疗的精神病患者在治疗中面临的障碍。还主张重新考虑对未经改良的ECT的禁令以及对未成年人ECT治疗的限制,这些都是基于科学证据的非常有效的治疗方法。在我国,家庭是精神疾病管理中的一项重要资产。但在许多精神卫生保健决策中寻求委员会批准的要求可能会使家庭不愿积极照顾其患者。中央和州一级的委员会及精神卫生当局有权做出许多关键决策,但这些小组在精神卫生领域的专家很少。

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