Uvais N A, Joag Kaustubh
Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, India.
Centre for Mental Health Law & Policy, Indian Law Society (ILS), Pune, India.
Glob Ment Health (Camb). 2024 Mar 19;11:e39. doi: 10.1017/gmh.2024.31. eCollection 2024.
Informed by the UN Convention on the Rights of Persons with Disabilities, the Indian government replaced the 1987 Mental Health Act with the transformative "Indian Mental Healthcare Act, 2017" (IMHCA 2017), which gained presidential approval on April 7, 2017. While the new act aligns with CRPD guidelines, emphasizing the promotion, protection and realization of complete and equitable human rights, legal capacity, equality and dignity for persons with mental illness, it has faced diverse criticism from various stakeholders, particularly psychiatrists. This study systematically explores the critiques and apprehensions expressed by psychiatrists regarding the IMHCA 2017 using available published resources and assesses these criticisms within the context of CRPD guidelines.
We conducted a scoping review of the literature, using two search engines like PubMed and Scopus. The review covered academic publications, reports and documents from both national and international sources, authored by psychiatrists and psychiatric organizations, related to the IMHCA 2017. The primary search term "IMHCA 2017" was used without temporal restrictions. Publications authored by mental health professionals from India and around the world were included in the final analysis. Through qualitative analysis, key themes reflecting psychiatrists' viewpoints were identified. These themes, marked by substantial criticism, were then assessed in accordance with the guiding principles of the CRPD, including its optional protocol and general comments.
The study analyzed 33 manuscripts discussing criticisms and concerns about IMHCA 2017. Manuscript types included opinion papers (60.6%), original research articles (21.21%), review articles (9.09%), editorials (6.06%) and comments (3.03%). All but one article were authored by psychiatrists, with five by non-Indian authors and the rest by Indian psychiatrists. Most articles were published in the Indian Journal of Psychiatry (75.76%), with some in other journals. About 54.55% critically scrutinized act provisions, while 45.45% highlighted positive aspects. The analysis identified seven prominent criticism themes: clinical apprehensions, lack of clarity and comprehensiveness, feasibility challenges, neglect of caregivers, mistrust toward psychiatrists, crises in general hospital psychiatry units and ideological reservations.
Each theme was critically assessed in the context of CRPD guidelines, and corresponding recommendations were formulated.
在《联合国残疾人权利公约》的影响下，印度政府用具有变革性的《2017年印度精神卫生保健法》（IMHCA 2017）取代了1987年的《精神卫生法》，该法案于2017年4月7日获得总统批准。虽然新法案符合《残疾人权利公约》的指导方针，强调促进、保护和实现精神疾病患者的完整和平等的人权、法律行为能力、平等和尊严，但它面临着来自各利益相关者，特别是精神科医生的各种批评。本研究利用现有的已发表资源，系统地探讨了精神科医生对IMHCA 2017表达的批评和担忧，并在《残疾人权利公约》指导方针的背景下评估了这些批评。
我们使用PubMed和Scopus等两个搜索引擎对文献进行了范围综述。该综述涵盖了由精神科医生和精神科组织撰写的、来自国家和国际来源的学术出版物、报告和文件，与IMHCA 2017相关。主要搜索词“IMHCA 2017”在无时间限制的情况下使用。来自印度和世界各地的精神卫生专业人员撰写的出版物被纳入最终分析。通过定性分析，确定了反映精神科医生观点的关键主题。这些以大量批评为特征的主题随后根据《残疾人权利公约》的指导原则进行评估，包括其任择议定书和一般性意见。
该研究分析了33篇讨论对IMHCA 2017的批评和担忧的手稿。手稿类型包括意见书（60.6%）、原创研究文章（21.21%）、综述文章（9.09%）、社论（6.06%）和评论（3.03%）。除一篇文章外，所有文章均由精神科医生撰写，其中5篇由非印度作者撰写，其余由印度精神科医生撰写。大多数文章发表在《印度精神科杂志》（75.76%），也有一些发表在其他杂志上。约54.55%的文章对法案条款进行了严格审查，而45.45%的文章强调了积极方面。分析确定了七个突出的批评主题：临床担忧、缺乏清晰度和全面性、可行性挑战、对照顾者的忽视、对精神科医生的不信任、综合医院精神科病房的危机以及意识形态上的保留意见。
在《残疾人权利公约》指导方针的背景下对每个主题进行了严格评估，并制定了相应的建议。
