Reshaping mental health legislation in Bangladesh
Bangladesh is party to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Under this Convention, an array of obligations is imposed on state parties. These obligations include duty to provide suitable training regarding disability issues to those involved in the administration of justice, a concrete programme to help people with disabilities and their careers, and general obligations on states to raise awareness of disability issues. But regrettably, mental health has been one of the most disregarded sectors within the Bangladesh legal system ever since its independence.
According to the National Mental Health Survey of Bangladesh 2018-2019, 16.8% of adults and 13.6% of children in Bangladesh suffer from mental health illnesses, which represents a country-wide prevalence of 21.5 percent. The lack of knowledge and taboo surrounding mental health conditions are further obstacles to receiving mental health care in the country. In light of this, Bangladesh launched its first-ever National Mental Health Policy (NMHP) in 2022. In order to secure the rights of those with mental illnesses, the controversial Lunacy Act of 1912 has been replaced by the Mental Health Act 2018 (MHA). However, the Act has several shortcomings.
Section 6 of the MHA elucidates that matters related to health, property, dignity, education, and other rights of people affected by mental illness need to be ensured. However, given the present state of mental healthcare and the scarcity of mental health professionals, these rights cannot be adequately realised.
Despite experiencing similar socioeconomic realities with Bangladesh, India appears to have a much more progressive mental health legislation than us. Unlike the mental health legislation of India, the MHA does not include a provision for an 'advance directive,' which would allow people to designate how they 'wish to be' and 'wish not to be treated'. Electroconvulsive therapy for minors is outright forbidden under section 95(1)(b) of the Indian Mental Health Act 2017. Even for adults, the therapy has been administered while using safety precautions. The Act of Bangladesh should likewise contain such a clause.
Counselling is a sine qua non to guarantee universal mental health support. However, as per the MHA, mental illness is a medical condition that can only be managed by medical interventions. The specifics of patient confidentiality concerns and associated responsibility of medical professionals for breaching patient privacy are also not clearly covered in the Act. As was found by the WHO-AIMS study on the mental health system in Bangladesh, there is no human rights review committee to look into the frequent abuses of people's human rights caused by mental illness.
To uphold the principles of equality and non-discrimination, the Act should include a clear provision that people with mental illnesses have a right to receive the same level of care as patients who are physically ill at the time of treatment, including emergency services, ambulance services, etc. Moreover, the patient or his/her guardian should have the right to be informed of all aspects of the treatment for which he/she undergoes, including details on any side effects. By allowing the adoption of NMHP in all districts, the Act can better implement the right to mental health treatment. Only if all these concerns are satisfactorily addressed, can the rights of people with mental health illnesses be truly upheld in Bangladesh.
The author is a student of the Department of Law, University of Chittagong.