Duffy Richard M, Kelly Brendan D
Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Science, Tallaght Hospital, Dublin, D24 NR0A Ireland.
Int J Ment Health Syst. 2017 Aug 18;11:48. doi: 10.1186/s13033-017-0155-1. eCollection 2017.
India is revising its mental health legislation with the Indian Mental Healthcare Act 2017 (IMHA). When implemented, this legislation will apply to over 1.25 billion people. In 2005, the World Health Organization (WHO) published a Resource Book (WHO-RB) on mental health, human rights and legislation, including a checklist of 175 specific items to be addressed in mental health legislation or policy in individual countries. Even following the publication of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (2006), the WHO-RB remains the most comprehensive checklist for mental health legislation available, rooted in UN and WHO documents and providing the most systematic, detailed framework for human rights analysis of mental health legislation. We sought to determine the extent to which the IMHA will bring Indian legislation in line with the WHO-RB.
The IMHA and other relevant pieces of Indian legislation are compared to each of the items in the WHO-RB. We classify each item in a binary manner, as either concordant or not, and provide more nuanced detail in the text.
The IMHA addresses 96/175 (55.4%) of the WHO-RB standards examined. When other relevant Indian legislation is taken into account, 118/175 (68.0%) of the standards are addressed in Indian law. Important areas of low concordance include the rights of families and carers, competence and guardianship, non-protesting patients and involuntary community treatment. The important legal constructs of advance directives, supported decision-making and nominated representatives are articulated in the Indian legislation and explored in this paper.
In theory, the IMHA is a highly progressive piece of legislation, especially when compared to legislation in other jurisdictions subject to similar analysis. Along with the Indian Rights of Persons with Disabilities Act 2016, it will bring Indian law closely in line with the WHO-RB. Vague, opaque language is however, used in certain contentious areas; this may represent arrangement-focused rather than realisation-focused legislation, and lead to inadvertent limitation of certain rights. Finally, the WHO-RB checklist is an extremely useful tool for this kind of analysis; we recommend it is updated to reflect the CRPD and other relevant developments.
印度正在通过《2017年印度精神卫生保健法》（IMHA）修订其精神卫生立法。该立法实施后，将适用于超过12.5亿人口。2005年，世界卫生组织（WHO）出版了一本关于精神卫生、人权和立法的资源手册（WHO-RB），其中包括一份175项具体内容的清单，供各国在精神卫生立法或政策中加以处理。即使在《联合国残疾人权利公约》（CRPD）（2006年）发布之后，WHO-RB仍然是现有的关于精神卫生立法最全面的清单，它以联合国和世卫组织的文件为基础，为精神卫生立法的人权分析提供了最系统、详细的框架。我们试图确定IMHA在多大程度上能使印度立法与WHO-RB保持一致。
将IMHA及其他相关印度立法与WHO-RB中的各项内容进行比较。我们以二元方式将每个项目分类为一致或不一致，并在文本中提供更细致的细节。
IMHA涵盖了所审查的WHO-RB标准中的96/175项（55.4%）。若将其他相关印度立法考虑在内，印度法律涵盖了118/175项（68.0%）标准。一致性较低的重要领域包括家庭和照料者的权利、行为能力和监护、不抗议患者以及非自愿社区治疗。预先指示、支持性决策和指定代表等重要法律概念在印度立法中有明确表述，并在本文中进行探讨。
从理论上讲，IMHA是一部高度进步的立法，尤其是与其他接受类似分析的司法管辖区的立法相比。连同《2016年印度残疾人权利法》，它将使印度法律与WHO-RB紧密保持一致。然而，在某些有争议的领域使用了模糊、晦涩的语言；这可能代表着以安排为重点而非以实现为重点的立法，并导致对某些权利的无意限制。最后，WHO-RB清单是进行此类分析的极其有用的工具；我们建议对其进行更新，以反映CRPD及其他相关发展情况。
