Coverpage / Cusp The Journal-Issue 1- VIOLENCE - Vol1 No1-Article index 4 / Author : Bhargavi V Davar

Narratives of Coercion:
Law as a social determinant of clinical interactions in mental hospitals

Bhargavi V Davar

The purpose of this paper is to show the impact of a custodial / penal law on client-provider interactions in the mental health sector. Law is the macro environment within which the mental health system works. Mental hospitals , an over-determined mode of service provision in the country , have been instituted and regulated by the Mental Health Act , 1987. The Act is a peculiarity of the health sector. Unlike health care patients , who are distal from the universe of law and courts , psychiatric patients become medico- legal subjects the moment a psychiatric diagnosis is received. The MHA provides liberally for involuntary commitment into a mental hospital; the legal format and process of commitment is more like an arrest , and less like a critical health admission. The police have a role to play in mental hospital commitments , which is another peculiarity. The implications of having a penal law in a health sector has been critically examined ( most notably by Dhanda , 2000 ) . Through the punitive legal devices enshrined in the Act , psychiatric patients become high risk for state coercion , particularly involuntary incarceration and treatment .

Custodialisation of people living with a mental illness is more than just law. It is an outlook and an attitude created in community care giving by the extant medico legal environment. A study ( Cremin , 2007 ) situating the place of law in non - institutional or private settings ( General Hospital Psychiatric Units and Rehabilitation Centers , for example ) showed that this environment is a great barrier to developing voluntary community mental health services. The MHA has influenced not only hospital administration but also the working contexts of care giving staff working therein. A picture of the dangerous and incapable mentally ill patient who has to be managed by force is perpetrated by the MHA , which the staff are expected to maintain. The law sets up expectations from care giving staff contrary to their own professional skills and ethics.

India , the reform of the mental hospitals has always been seen as a legal matter settled by the higher courts ( Dhanda , 2000 ) , the human rights commission ( NHRC , 1999 ) or as public administrative measures by the Mental Health Authorities , the police and prison commissionerates , and other public machinery. Mental hospitals have not been mainstreamed in social science research , public health , and management literature , barring a few exceptions ( Mission Report , 2003 ) .

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