'Ambiguity in mental health law can be misused against substance abuse victims'

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The husband drinks half a bottle of whisky everyday, and his wife disapproves of his behaviour. She fears the violence that ensues at home, post the drinking session. The husband's medical tests also show liver issues due to alcohol abuse. His family wants him to stop drinking completely, and when he doesn't do so, they forcefully admit him to a mental health facility.

Does the admission of the husband to a mental health facility—without his consent—constitute a violation of his rights? It does, according to an article published on March 11 in the Indian Journal of Psychiatry, the official publication of the Indian Journal of Psychiatry. 

In the article, authors use  this hypothetical example to delve into implications of the Mental Healthcare Act, 2017 on people suffering from substance use disorder (SUD). 

According to authors Ravindra Rao, Mohit Varshney, Shalini Singh, Alok Agrawal and Atul Ambekar, in cases such as these, the Mental Healthcare Act, 2017, could be misused to admit a patient suffering from substance abuse disorder (such as the one mentioned) without his consent. 

The authors, who belong to the department of Psychiatry, National Drug Dependence Treatment Centre, AIIMS, Delhi, argue that the problem lies in the ambiguous language that the law uses, that brings all those who are suffering from substance abuse disorder under the ambit of the mental illness, and thereby, various provisions under the mental health law. 

The definition of those suffering from “mental conditions associated with the abuse of alcohol and drugs,” used in the law purportedly implies that substance abuse disorder comes within the ambit of mental illness, they say.

In a case such as this, the problem is compounded because the the husband has not named anyone as his “nominated representative” nor has he made an “advanced directive”—as provided in the new law—because he does not believe that he is suffering from mental illness. His wife becomes the nominated representative in this case, and hence can admit him to a mental health institution, the authors say. 

Thus, the authors conclude, that the law which was “brought in force precisely for protecting the rights of people with mental illness, may be used to violate the rights of this individual”. 

In cases of substance use, instead of hospital admission, outpatient treatment in primary care settings would be more effective.

In context of the outrage against involuntary treatment of those suffering from substance abuse disorder, as well as UN agencies releasing a statement "specifically asking the member states to close down such facilities, undertake necessary legal reforms and ensure the implementation of voluntary, evidence informed, and rights-based health and social services,” the authors argue that India shouldn't have a law that allows such a practice. 

The authors also suggest a few ways to counter the problem—remove “addiction and addiction treatment” from the ambit of the new law. Countries such as the United Kingdom, many Australian states, and New Zealand) have kept substance abuse disorder out of mental health law, and have enacted "separate laws" for addiction and its treatment. The second way, they say, to include only some types of substance abuse disorders by introducing gradation in the definition. 

Given that the law already in place, the authors contend that since state governments were yet to notify specific rules to implement the Act, there was still room to make these changes.