Open Access Research Article
Economics Of Ageing And Geriatric Mental Health Care: Comparative Analysis Of Laws Across India, Japan, And Malaysia (By-Arghia Namboodiri, Gopika Thakur & Shria Violet Mathangi)
Abstract
Economics Of Ageing And Geriatric Mental Health Care:
Comparative Analysis Of Laws Across India, Japan, And Malaysia
Authored By- 1. Arghia Namboodiri
2. Gopika Thakur
3. Shria Violet Mathangi
Abstract
Due to the
rising global awareness about mental health among people, mental illnesses in
the elderly population have become a cause of concern in the recent years. The
rise in the elderly population of India has brought forward the issue of
geriatric mental health care. Chronic mental health disorders such as dementia
and depression, coupled with socio-economic problems such as financial
dependency, neglect and abuse, makes the elderly a special class of citizens,
with unique needs that need to be addressed satisfactorily. Hence, it becomes
imperative for the Indian government to recognize the needs of the elderly and
address their problems accordingly, by means of passing legislations and policies.
This paper aims
to anatomize the existing problems with the geriatric mental health care
system, by means of conducting a comparative analysis of mental health laws of
India, Japan, and Malaysia. Through this comparative analysis, this paper aims
to understand the shortcomings of the existing legislations and policies.
Furthermore, this critical analysis will help in understanding the changes that
need to be brought about, for the betterment of the geriatric mental health
laws.
This paper was written
in the midst of the COVID-19 pandemic, due to which, the authors could not go
out publicly to conduct research of their own. Hence, this paper follows the
doctrinal research methodology.
Introduction
Geriatric mental
health is a problem spoken about rarely- with majority of a state’s focus on
the working population of the nation since it’s the one that majorly
contributes to GDP. The issues faced by the elderly in our country are normally
brushed aside, and even when considered, the focus is on their physical health.
Society expects the families of the elderly to take care of their needs, but
those who suffer neglect from their own families have nowhere to turn to for
help. They often do not even have the necessary information about the legal rights
they have, to necessitate help from the state.
With the huge
rise in the average ages in countries, the elderly is becoming a larger part of
the population and it is pertinent to understand the needs of the elderly to
provide them with the adequate help they require, while also understanding the
gaps in our current mental health laws. This can be done by comparing our
current laws, with mental health regulations of countries like Japan and
Malaysia which have high aging population rates. Geriatric care is often
expensive, and with the majority of the elderly being retired, their savings
are limited, which makes geriatric care inaccessible to most of the population.
With the
COVID-19 pandemic, the older population are more likely to be hospitalized or succumb
to the virus. They might suffer from more severe breathing difficulties and
have a higher risk of developing severe illnesses due to underlying health
conditions as well. Most of the deaths from COVID-19 occurred in the elderly,
especially those with diabetes, hypertension, or cardiovascular diseases. The
elderly during this time have been prone to stress and anxiety, depression, and
other mental-illnesses due to the issues faced by them and those around them.[i]The
lockdowns have also made it difficult for them to meet their family, and those
going through isolation are at a risk of depression as well. They face
difficulties in accessing healthcare channels due to the rapid digitalization
of service booking. The average counselling session in India with a
mental-health professional ranges from Rs.800 – Rs.2500, which when added up,
makes mental healthcare for the elderly a pressing and expensive issue.[ii]
Part I
I.
Major Challenges Faced By The
Elderly In The Indian Society
The impressive
growth of the Indian society, fueled by industrialization and globalization,
has led to an increase in the life expectancy of the people. The unprecedented
demographic changes have also resulted in an increase in the number of elderly
citizens. According to the Census conducted in 2011, the percentage of the
population above the age of 60 accounted to around 9%, with nearly 104 million
elderly people. It has been estimated that by 2050, the number will rise to 319
million, as the gradual annual increase is seen at 3%. An ageing population, in
any country, is a burden on the natural resources and especially for a country
like India, where its population explosion has already caused a severe scarcity
of resources, such a population boost has led to concerns being raised at many
levels for the government. With the demographic pattern differing across
various states, its unevenness and the complexities are reflected on the levels
of socio-economic development, cultural norms, and political background in the
state.
Although there
has been a significant progress in medical sciences, the elderly still suffer
from social, economic, and psychological issues, which are yet to be resolved.
The care for the geriatric population requires the understanding of their needs
and problems as they vary significantly according to age, socio-economic
status, health and living standards and most importantly necessitates the need
to underline the social issues that they continue to face in the current
society. The elderly population face challenges that range across various
aspects of human life.
Medical
Problems
Problems related
to health form a major concern for the elderly as they are more prone to
diseases and physical disorders than the younger generation. Lack of physical
infrastructure such as old age homes, purpose-built care homes or public ramps
has become a major deterrent in providing ease to the elderly. With increasing
longevity and enervating chronic diseases, the access to better infrastructure
at home and in public spaces for the older people is highly necessary. Due to
an inaccessible healthcare system, the older people face the issues of
unattended chronic diseases, ill-developed emergency response infrastructure,
high cost of treatment and medicine, and malnutrition. There are only a few
geriatric services in the public health care system that emphasize on the
geriatrics, addressing their requirements and concerns. The public health
system also lacks in infrastructure, manpower, good quality of healthcare and
proper facilities due to deficient focus on the care of the older people[1].
For a significant portion of the country's elderly, deteriorating health is
worsened by the lack of good quality and age-sensitive health care.
Furthermore, limited access to health services, lack of information, and high
disease management costs put reasonable elder care out of reach for most
seniors, particularly the poor and vulnerable.
Economic
Dependency
According to the
National Sample Survey Organization (52nd round), it was found that
nearly half of the aged people were entirely dependent on others for their
economic needs, while those who were partially dependent estimated to around 20
percent[iii].
Around 85 percent of the elderly depended on their relatives or children for
their daily maintenance. The dependency ratio is increasing and is said to
gradually increase, with larger share from rural areas than the urban areas. In
the report released by National Sample Survey Organization in 2006, it was
observed that the percentage of older males fully dependent for their financial
needs in the rural areas (32 per cent) was higher compared to the urban areas
(around 30 per cent). The situation pertaining to elderly females is much worse[iv].
The social
security provisions and other financial protections like pension are not made
easily available for the elderly if they do not have a work background in the
public sector or organized industries sector. The elders living with their
families are contingent on the economic capacity of the family for their welfare
and security. The welfare of the older people living in poverty, is one of the
most pressing concerns as it raises the risk of abuse and harassment[v].
Moreover, there exists a void in insurance schemes for the older people as they
have very low reach, along with poor pay out. Due to the lack of financial
dependence, the elderly have a low priority for their health, making them more
susceptible to chronic and infectious diseases. The relevancy of old age homes
has become more prominent in the Indian society due to the breakage of the
joint family, migration of the younger generation for job opportunities,
unaffordable housing, economic challenges, and lack of proper care in the
family.
Social
Issues
The
fast-changing socio-economic demographics, advancement of technology, evolution
of the modern society, improved levels of education and establishment of new
forms of organizations have rendered the knowledge and wisdom of the elderly as
obsolete. According to research, it was noticed that individuals at the age of
60 years were unable to realize that they have reached old age. This portrays
their reluctance to accept their declining age (Singh, 2015)[vi].
After retirement, the feelings of loneliness, loss of status and worthlessness
dwells upon the aged as their social life is narrowed down by the death of
their relatives, friends or spouse, loss of work and poor participation in
social activities due to their weak health. They tend to confine themselves
within their homes, centering their social life to the interpersonal
connections of their family members, resulting in isolation and depression, due
to the loss of the social roles they once performed.
II.
Covid-19 And Its Impact On The
Mental Health Of The Elderly
The geriatric
population of the country is on a steady increase. In 2001, the elderly
population accounted for 7.1% of the total population and it is speculated that
by 2021, the share is to increase by more than 10%[vii].
Along with the challenges associated with social and economic facets and physical
health, the rapid change in demographics as well as family systems have exerted
a psychological burden on the elderly. The psychiatric morbidity in the
geriatric community varies from 8.9 to 61.2%[2].
The disorders most encountered by the Indian geriatric population includes
depression, dementia, mood and anxiety disorders, delirium, alcohol, and drug
abuse, to name a few. The mental health issues in older women, especially in
the rural areas, is higher compared to that of men, as they are susceptible to
greater emotional and financial uncertainties, health problems and social
insecurity[viii].
The mental health issues facedby the elderly population can be effectively
diagnosed and prevented if sought early. However, it is erroneously dismissed
on the assumption that it is the process of ‘normal ageing’[ix].
The
infrastructure of hospitals, in the private and the public sector, are not well
equipped with geriatric units and most often, the cases of elderly are treated
at the general ward or the psychiatric ward. There is an inadequate number of
medical professionals catering to the mental needs of the elderly, with around
4000 psychiatrists for an aged population of 21 million[x].
Inequitable distribution, shortage of staff, unaffordable medication, and
equipment, are some problems faced by public hospitals, while the private
hospitals are largely unregulated, with severe complaints about poor quality of
service and unethical behavior. Moreover, there are no provisions for
insurances that cover mental illnesses in India, while less than 20% of Indians
have any form of insurance[xi].
The impact of
COVID-19 on the healthcare system of India, as well as in other countries, has
had a devastating effect due to its high infection and mortality rates.
However, the most vulnerable sections of the society, who have been majorly
affected by the pandemic are the older adults. According to the report from the
Centre for Disease Control and Prevention (CDC), the chances of the elderly
being hospitalized is around 31-59 percent while the risk of death is around
4-11 percent. Due to the high risk of acute respiratory problems caused by
COVID-19, the elderly face a major threat as it increases their chances of
hospitalization or need for ventilatory support, resulting in greater anxiety,
stress, and various other mental health challenges. Social distancing and
isolation has led to depression, loneliness, feeling of imprisonment, anxiety
about the uncertain future, and other psychological disorders among the elders.
They are least likely to be well-versed with technology, which has become the
only way to maintain a social contact in the current age. The elderly are more
likely to have difficulty in accessing essential medical services and
medication if they live separately from their children or relatives. This is
especially the case if they have worsening pre-existing medical and psychiatric
diseases due to the strict enforcement of Covid restrictions[xii].
The major
drawback faced by the Indian mental healthcare system is the acute shortage of
fund. The Financial Year of 2019 saw a dip in the allocation of budget for the
National Mental Health Program (NMHP), from Rs. 50 crores in FY2018 to Rs. 40
crores, with only Rs. 5 crores each being spent during the years[xiii].
In the Union Budget of 2021-22, the Healthcare budget was increased by 7
percent but out of the total funds allocated, only 0.05 percent was allotted
towards mental health. The NMHP received only 7 percent of the total budget
allotted for mental health, while the majority was distributed between two
institutions, i.e., the National Institute of Mental Health and Sciences
(NIMHANS) in Bangalore and Lokpriya Gopinath Bordoloi Regional Institute of
Mental Health, based in Tezpur[xiv].
The overall budget for NMHP remained to be Rs. 40 crores, like the previous
year, which is very nominal as the country continues to crumble under the
pandemic.
The pandemic has
brought the realization to people that mental wellbeing is as important
physical wellbeing. In the report by the National Institute of Mental Health
& Neuroscience[xv],
it was observed that 1 out of every 20 Indians suffer from some form of mental
health issue, and the numbers have risen significantly during 2020. As there
has been greater discussion and awareness about mental health, the Insurance
Regulatory and Development Authority of India (IRDAI) has instructed insurance
companies to align mental health insurance policies into their insurance
schemes[xvi].
This allows for psychological illnesses, mental ailments and stress, and neural
diseases to be covered under insurance policies, like any other physical
ailment. The steps taken by IRDAI are very crucial towards the development of a
healthcare ecosystem where people suffering from a mental illness are relieved
of the burden of huge financial cost that are required for their healthy
treatment and wellness[xvii].
Over the past
few decades, the Indian government has passed the following legislations and
policies for geriatric mental health care.
III. Indian
Laws And Regulations On Geriatric Mental Health
Traditionally,
in the Indian society, the elderly are cared for, by their children or other
family members. Geriatric care, be it mental or physical, was provided in the
homes of the elderly or of their children. However, there has been a steady
decline in the care of the senior citizens by their children, due to the
development in socio-economic norms and the fast-paced lives that their
children now lead.
The need for
mental health laws began to be recognised globally, and countries, including
India, started drafting their own laws for the betterment of the mental health
of its older citizens.
Reforms Of 1982
The Indian government began focusing on mental
health in 1982, by participating in the World Assembly Conference in Vienna.
Following this Conference, India adopted the United Nations International
Plan of Action on Ageing. This Plan of Action helped the government in
focussing on certain areas of geriatric mental health care that needed more
attention. This included providing protection and care to the elderly
population of India, while simultaneously trying to help them cope with the new
socio-economic developments in the country. [xviii]
Furthermore, the National Mental Health Programme (NMHP) was introduced in
1982. The objective of the NMHP was to reduce the mortality rate that stemmed
from untreated mental illnesses. This was to be achieved by means of ensuring
accessibility and availability of mental healthcare to all citizens, especially
to the underprivileged and vulnerable sections of the society. [xix]
Mental Health
Act, 1987
This Act superseded
the Indian Lunacy Act, 1912 and was introduced to ensure that patients with
mental health issues have the power to exercise their rights. Furthermore, this
Act intended to protect the citizens from being illegally detained in
psychiatric facilities, without any sufficient cause. The Act also aimed to
provide State-funded legal aid to the mentally ill persons, in special
circumstances[xx].
National
Policy On Older Persons, 1999
India introduced the National Policy on Older Persons in January
1999. This Policy defined “senior citizens” as people who are above the age of
60. Furthermore, this Policy directed the state governments to make their own
laws and policies for the welfare of the elderly population[xxi].
Since caring
for the elderly became the responsibility of the states, various schemes were
introduced at the state levels to improve the condition of geriatric care in
India. Along with that, changes were brought about at the national level as
well, with the introduction of pension and insurance schemes[xxii].
Maintenance And Welfare Of Parents And Senior Citizens
Act, 2007
While it does not specifically mention mental health, the
Maintenance and Welfare of Parents and Senior Citizens Act, 2007 still confers multiple duties over the states
to ensure the welfare of the elderly. First and foremost, Section 19 of the Act[xxiii]
requires the states to have an old age home in every district, which would have
the capacity to house at least one hundred and fifty senior citizens, who are
destitute and are not able to provide for themselves. Furthermore, Section 20
of the Act instructs the state governments to ensure that there are facilities
that would cater to the needs of the elderly who are suffering from terminal
and degenerative diseases.[xxiv]
National Policy On Senior Citizens, 2011
This Policy makes provisions for the development of special
programmes which aim to increase awareness of mental health of the senior
citizens and for the early detection and care of degenerative diseases such as
Alzheimer’s and dementia.[xxv]
Mental Health Care Act, 2017
The Union government felt that the Act of 1987 was not enough to
cover all the issues relating to the treatment of mental illnesses. Hence, this Act came into force in 2018, as
an effort to secure the rights of the people who suffer from mental illnesses.
The Mental Health Care Act, 2017 superseded the Mental Health Act, 1987[xxvi].
The Act of 2017 has taken many
landmark steps for the advancement of mental health laws in India. First and
foremost, the Act defines mental illness as “a
substantial disorder of thinking, mood and perception, orientation, or memory
that grossly impairs judgment, behaviour, capacity to recognize reality or
ability to meet the ordinary demands of life, mental conditions associated with
the abuse of alcohol and drugs.”[xxvii]
The Act also banned
sterilisations, and electroconvulsive therapy and called for the
decriminalisation of suicide. The Act also provides every person right to
access mental health care. Furthermore, it aims to protect these people from
inhumane treatment and allows them to choose their mode of treatment, provided
that they are legally eligible to make these choices[xxviii]. [xxix]
Iv. Critical Analysis Of Geriatric Mental Health Laws
Although many policies and laws have been passed for the betterment
of mental health in India, there are no specific laws that address the mental
health problems faced by the senior citizens of India.
First and
foremost, the existing statutes do not efficiently cover all the problems that
the elderly face and this, in turn, could be counter-productive to their mental
health issues. For instance, Section 20 of the Maintenance and Welfare of
Parents and Senior Citizens Act, 2007 does not define the term “degenerative
disease”. Degenerative diseases could either be physically degenerative, such
as Spinal Muscular Dystrophy or neurodegenerative, such as dementia. The
vaguely worded statues leave room for ambiguity and misinterpretation. For
instance, if the Act only covers physically degenerative diseases, then the
senior citizens, with persisting mental conditions, who are looking for relief under this
statute, would be denied the aid that they are seeking.
Secondly, the
declining mental health care among the senior citizens is an issue of extreme
significance, especially during the COVID-19 pandemic. In a survey conducted by
a Delhi-based NGO, Agewell Foundation, it was found that out of a group of 5000 elderly citizens, 63% had
developed symptoms of depression, while 82.4% of people complained of
developing anxiety over their health. The fear of the virus, coupled with the
loneliness of self-isolation and quarantine had left 70.2% of the people
suffering from sleeplessness or nightmares[xxx].
Hence, it
becomes imperative to ask - is there a need for a separate statute or policy
for geriatric mental health care?
Geriatric
mental health care is a matter of great concern. While the existing statutes
and policies are pivotal for the promotion of mental health awareness in India,
there still exists a need for a more focussed statute or policy, which only
deals with problems faced by the elderly.
Firstly, on a
legal front, tribunals should be set up to specifically deal with cases of
elder abuse or neglect. Although regular Courts do deal with such cases, it may
take a long time for the matter to be resolved, which would ultimately cause
the aggrieved senior citizens to be in constant anxiety and stress. The
establishment of such tribunals would ensure fast-tracking of these cases to
provide relief to the elderly in the quickest way possible.
Secondly,
elderly helplines should be established, whereby the senior citizens can
acquire knowledge about the law, which would help them understand their rights.
Thirdly, mental
health institutions, which specialise in geriatric care, should be established.
All the personnel in these institutions should be specifically trained in
managing and treating elderly patients. Furthermore, the facility of “Ageing in
Place”[xxxi]should
be made available to the senior citizens, as a means to sustain dignity of
living in old age.
Additionally,
provisions for establishment of elders associations should be made, whereby
senior citizens can come together and discuss their problems more openly. These
associations should be formed at district levels to ensure that all the elderly
citizens can access them. These associations should also specifically aim to
help the elder citizens, who fall below
the poverty line. These associations must aim at making the elderly comfortable
enough to share their problems. This can be done by creating a buddy system where
two adults are assigned to each other, to talk about the problems that they
might be facing. This would encourage socialisation and would also shed light
on other issues that the elderly might be facing, be it physical,
mental, or
legal. This, in turn would help the concerned authorities take necessary
actions to solve these problems.
Furthermore,
geriatric mental health care should also be extended to other oppressed groups
of the society, who have been ridiculed and subjugated for ages. For instance,
before decriminalisation of homosexuality, queer people were subjected to
violence from the society, the police, at the hands of doctors as well as their
own families. This problem of non-acceptance, queer-phobia and trans-phobia can
cause long-lasting psychological problems in people such as depression, anxiety
disorders and in some extreme cases, suicidal thoughts[xxxii].
Similarly, there are other groups of people in India who have been subjugated
throughout history. An example of this would be the historical mistreatment of
minority groups such as Dalits, Scheduled Castes, Scheduled Tribes, etc. These
groups have been at the centre of many incidents of hate crimes over the years.
So, there is a need for focussed efforts to improve the mental health conditions
of the elders of these minority communities. [xxxiii]
Part II
This section of the paper focusses
on the international comparative analysis of the Indian geriatric mental health
law with the laws of Japan and Malaysia.
I.
JAPAN & MALAYSIA: OVERVIEW OF THE ELDERLY POPULATION
Due to its high
life expectancy, Japan has one of the highest elderly populations in the world.
According to the World Population Prospects 2019, published by the United
Nations Populations Division[xxxiv],
28.2% of Japan’s population is over the age of 65. The population of the
elderly has been steadily growing over the past few decades, with the 1970s
reporting that only 7.1% of the population was over the age of 65.[xxxv]
With the
increase in the elderly population, there has also been an increase in the
National Medical Expenditure, which forms a part of the GDP. In the 1970s, the
National Medical Expenditure was calculated at 3.3%, which increased to 7.9% in
2016[xxxvi].
As compared to
Japan, in Malaysia, only 7% of the population is over the age of 65[xxxvii],
due to the high life expectancy and reduced birth rates. While 7% seems to be
less in comparison to the other developed and developing countries, this
statistic is expected to grow further. It is estimated that by 2040, 14.5% of
the Malaysian population would be over the age of 65[xxxviii].
Hence, it is of extreme importance to discuss geriatric health care in
Malaysia.
It is vital to
note here that Malaysia, in 2018, witnessed a historic change in its
government. In Malaysia’s 14th general elections, Barisan Nasional,
the party which had formed the government for the past 62 years, was voted out.
The appointment of the new Prime Minister, who was 93 years old at the time of
his appointment in 2018, brought up the topic of ageism and geriatric care[xxxix].
Following the appointment
of the new Prime Minister in 2018, Malaysia has actively supported and launched
initiatives regarding geriatric health care.
Japan and
Malaysia are medically advanced nations and have many different policies that
help in addressing the physical aspect of geriatric care. However, mental
health of the elderly still remains an important topic that needs to be
addressed in both, Malaysia and Japan.
Statues And
Regulations In Japan Dealing With Mental Health
Mental health
reforms kicked off earlier in Japan than it did in most nations, with the Law
of Confinement and Protection of the Mentally Ill (1900). Though it was a
massive step forward in recognizing mental health issues in the country, it
also made it legal to confine mentally ill people at home. Only after the
Mental Hygiene Law of 1950 did the practice of home imprisonment of the
mentally ill end. It necessitated medical treatments for people with mental
disorders in hospitals. This was followed by a revision of the Mental Hygiene
Law in 1965 which focused on community based mental health services and
required each prefecture/district to have at least one community mental health
center. The Mental Health Act of 1995 was
the first act to
recognize that mental illness is a disability and it provided for stricter
criteria for involuntary hospitalization, which was done to give people with
mental disorders, the same treatment as those with physical disabilities.[xl]
The National
Health Insurance Act was then passed in 1958, which entailed that every
Japanese person can be covered by health insurance, including both physical and
mentalillnesses.[xli]
Act on Mental
Health and Welfare for Mentally Disabled Persons (1950, Law no. 123) was
enacted to provide mentallydisabled people with proper medical care, ensure
proper social rehabilitation is done and to facilitate their participation in
society. It provided for measures such as the establishment of mental health
& welfare centers in all districts, as well as mental institutions and
private hospitals. It also made it necessary for the establishment of
rehabilitation institutions for mentallydisabled people, which would contain
training facilities and workshops to adjust them back to their daily lives, as
well as provide welfare homes and industries. It also enabled medical fees to
be partly covered by government funds and designated promotion centers for social
participation.
The Law for the
Welfare of Mentally Retarded Persons (1960. Law No. 37) further made it
necessary for counselling to be provided by social welfare and rehabilitation
centers as well as the provision of technical aids, living space and
specialized facilities. It also contained provisions for in-house services like
helpers, short stay programs and more. People suffering from mental
disabilities are also provided handbooks from welfare centers that enable them
to easily access these services. [xlii]
The 1973
Amendment of the Act on Social Welfare for the Elderly made health care free
for almost every person aged 70 and above, which was later changed in the 1982
Public Aid for the Aged Act, which made insurers also liable to cover the fund
along with the government. The 1990 amendments to the eight welfare acts made
municipalities obligated to create healthcare plans for the elderly. The
Long-Term Care Insurance Act of 1997 also covered care for the elderly and
reduced caregiver burden. The 2006
Health Care Reform Act then established a brand-new medical care system only
for people aged 75 and above, making it easier for them to access healthcare.[xliii]
Despite all
these measures, the COVID-19 pandemic led to worsened mental health in the
elderly with an increase in depressive moods and apathy.[xliv]
Statues And
Regulations In Malaysia Dealing With Mental Health
The Malaysian
Mental Health Act, 2001 which came into effect after the Mental Health
Regulations of 2010 is the most important mental health act in the country,
which lists out the framework for the delivery of comprehensive care,
rehabilitation, treatment, protection, and control of those suffering from
mental disorders. It deals with the establishment of government and private
psychiatric hospitals, nursing homes and community centers.[xlv]
This Act
encourages treatment in community centers rather than in institutional settings
and prompts the private sector to aid more in providing mental health
care. The Malaysian Mental Health
Framework of 2002 helped implement mental health services in the country by
describing comprehensive services for every age group such as mental health
promotion, treatment, and prevention of mental disorders as well as
rehabilitation of the mentally ill in hospitals and community centers.
The National
Operational Plan of Action for Comprehensive Integrated Community Mental Health
Services of 2002 required the formation of a national technical committee
consisting of health, labor, welfare, and housing directors to implement
strategies, strengthen community mental health services, and to transfer
services from mental hospitals into community centers.
The National
Mental Health Policy was formed back in 1998, and also focused on advocacy,
prevention, rehabilitation, and treatment, and stated that accessibility, human
resource training as well as community participation were necessary for mental
health development.[xlvi]
The laws still
fail to properly deal with all geriatric mental health issues, guardianship of
the elderly, determination of mental capacity, treatment centers and more.[xlvii]
Further, with the pandemic, depression, anxiety, and a higher mental health
burden have become major cause for concern amongst the elderly.[xlviii]
II.
Analysis And Suggestions
In India and
Malaysia, senior citizens or the elderly are defined as people over the age of
60, whereas in Japan it stands for people aged 65 or above. In India,
state-funded aid for mental healthcare isn’t available, though there are
multiple mental healthcare rehabilitation helplines, while countries like Japan
offer government and insurance funded mental healthcare schemes for the
elderly. Since India is a larger country, both in terms of geographical area
and population than both the countries used in this analysis- it is necessary
to spread out mental health care facilities even more. Setting up community
mental healthcare centers in every district like Malaysia did would not only
make healthcare facilities accessible even in the most remote areas, but also
increase social awareness about geriatric mental health problems. There is also
a need for more financial aid or reduced fees for the elderly for availing
mental healthcare services. It could also be provided by their healthcare
insurance schemes.
India could also
set up a national technical committee to look after the functioning of
community mental healthcare centers, similar to what Malaysia has implemented.
The directors appointed in the committee can be from healthcare, welfare,
legal, labor and housing backgrounds and they would have to look into the
efficiency of community healthcare centers in different states. They would also
be responsible for organizing and conducting awareness drives, workshops, and
setting up training facilities. The community healthcare centers would ensure
an increase in job opportunities for specialized caretakers, psychiatrists, and
other healthcare workers, thereby increasing employment as well. A separate state budget can be allocated for
mental healthcare too.
PART III
Conclusion
The youth
population across the world is on a steady decline, with the population of the
aged increasing at an alarming rate, from 12 percent in 2015 to 22 percent by
2050. With such a growing population of the older generation, the physical
challenges faced by them need to be properly addressed and recognized, and
appropriate care needs to be provided for their rehabilitation. Most
importantly, the issue of mental health needs to be openly discussed, as it is
still stigmatized in our society and is often overlooked and unidentified by
healthcare professionals as well as the elders themselves. This would help in
eliminating the reluctancy that the elderly face to seek relief. Massive
demographic changes, a growing vulnerable population of female older adult population,
rapid changes in the family structure and lack of adequate social benefits are
some of the big challenges faced by the Indian society.
Problems in the
geriatric psychiatry such as lack of training opportunity, inadequate chronic
care disease models, lack of geriatric care awareness and insufficient
distribution of medical resources continue to remain prevalent. Although social
security schemes of the government are in place, they lack the coverage that
was aimed while formulating them. Such plans and schemes are required to be
reformed and reframed, so that they not only cover the people in need but also
ensure that the benefits are suitably enjoyed. A mental healthcare ecosystem
that focuses on bolstering training and research, raising awareness among the
professionals as well as the public, and developing a program based on
community rehabilitation are the need of the hour. Innovation and changes in
health, economic and social programs are the paths that will help in building
an effectual and successful healthcare ecosystem in India.
With COVID-19
affecting the entire world, India needs to take steps to strengthen its
healthcare system, by studying the positive measures followed in countries such
as Japan and Malaysia, as discussed above. The health regulatory laws in India,
although widely enforced, lack the force in their execution. The extensive laws
on mental health in the two discussed countries, can serve as an inspiration
for Indian legislators to
adopt the
provisions that best serve the interests of our population, while framing the
laws.
India still has
a long way to go, in terms of building a robust healthcare system, that equally
emphasizes on both physical and mental healthcare issues. A shift in the mood
of the public is being observed, as there has been an increase in the
acceptance, sensitization, and acknowledgement of mental illnesses.
Published Paper
Author Details
Author Name: Arghia Namboodiri, Gopika Thakur & Shria Violet Mathangi
Title: Economics Of Ageing And Geriatric Mental Health Care: Comparative Analysis Of Laws Across India, Japan, And Malaysia
DOI Link:: https://www.doi-ds.org/doilink/06.2022-66516874/Arghia Namboodiri, Gopika Thakur & Shria Violet Ma
Email Id: Arghia Namboodiri- n.arghia@gmail.com, Gopika Thakur- gopikathakur16@gmail.com
&
Shria Violet Mathangi- shriaviolet@gmail.com
Article Information
Economics Of Ageing And Geriatric Mental Health Care: Comparative Analysis Of Laws Across India, Japan, And Malaysia (By-Arghia Namboodiri, Gopika Thakur & Shria Violet Mathangi)
Authors: Author Name: Arghia Namboodiri, Gopika Thakur, Shria Violet MathangiTitle: Economics Of Ageing, Geriatric Mental Health Care: Comparative Analysis Of Laws Across India, Japan, Malaysia, Gopika Thakur, Shria Violet Ma Email Id: Arghia Namboodiri- n.arghia@gmail.com, Gopika Thakur- gopikathakur16@gmail.com, Shria Violet Mathangi- shriaviolet@gmail.com
- Journal IJLRA
- ISSN 2582-6433
About Journal
International Journal for Legal Research and Analysis
- AbbreviationIJLRA
- ISSN2582-6433
- AccessOpen Access
- LicenseCC 4.0
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