Human Rights and Adherence to Treatment in Patients with Severe Mental Illness: Mental Healthcare Act 2017 Perspective

Abstract

Background: Mental Healthcare Act (MHCA) has been implemented on May 29, 2018. Patients with mental illness show high rates of medication nonadherence as well as human rights violation. Hence, it is important to study the impact of this new law on persons with mental illnesses (PMI) and the human rights awareness with emphasis on the two modes of admissions, i.e., supported and independent. Aim: Influence of MHCA, 2017 on medication adherence in patients with severe mental illness (SMI) admitted under-supported and independent category and its correlation with human rights awareness of PMI. Material and Methods: Patients diagnosed with SMI (NIMH definition, 2006) were admitted to the psychiatry ward. Baseline sociodemographic, psychopathology severity, global functioning, adherence rates, insight, and human rights awareness were assessed. Patients were divided into independent and supported groups. Weekly assessments were done during admission, subsequent assessments were done post discharge at week 1 and week 6. It was a prospective follow-up in design. Results: A total of 65 patients were included. The emotional needs dimension of human rights showed P < 0.01 at baseline as well as final follow-up. Statistically significant correlation was seen in human rights awareness and adherence at baseline in the independent admission group (IAG). Medication Adherence Rating Scale (MARS) score and Clinician Rating Scale score were lower (4.29 ± 2.13; 4.06 ± 1.73 and 3.38 ± 1.98; 3.26 ± 1.91) in supported admission group (SAG). Insight showed a statistically significant higher value in IAG than SAG (12.80 ± 7.26 and 8.18 ± 6.96) at baseline. Conclusion: No significant difference could be seen in illness specifiers and adherence patterns between the two groups. Findings reflect statistically lower fulfillment of emotional needs in SAG and positive correlation between medication adherence and human rights awareness. Therefore, adherence is an important determinant of human rights awareness.