Comparison Of Mental Health Legislation Between China And Indonesia Based On WHO Checklist

The prevalence of mental health disorder and psycho-behavioral disorders have dramatically risen in recent days.An individu with psychological is one of the most vulnerable population As a vulnerable population,patients with mental health problem regularly experience denial of their legal and social rights.In the term of healthcare access,insurance,welfare and education,those people are also frequently suffer discrimination.Establishing mental health legislation,will be one of the solution to enhance the lives of mentally ill people.Mental health law offers a legislative framework to tackle important problems such as social support for people with mental health disorder,quality care,increase access to healthcare service,civil right protection,and the protection of rights in some other important areas including housing,education and employment.Progressive legislation is one of an effective way of promoting mental health support service,as well as for promoting and protecting the right of mentally disordered people.Although a country has adopted legislation on mental health,improving the mental health system still needs a great deal of effort.To build good mental health system is not an express outcome.In order to enhance its quality,mental health law needs to be reviewed,updated and amended.In 2005,WHO has put forward the checklist for mental health legislation with the purpose of providing policy guidance on developing mental health legislation based on human right.This checklist helps countries determine whether or not the main elements have already been integrated into their mental health legislation.This checklist,however,is not an absolute set of principles.There are no penalties for the state that doesn’t adhere to the standard.This checklist helps the country to bridge the gap between the mental health legislation with the Universal Declaration of Human Right.Objective:The aim of establishing legislation for mental health is to secure,encourage and enhance the lives and pyschological condition of the people.Creating mental health legislation can be one of the effective tools to give and promote as well as to provide protection for people to get their right to access mental health facilities.Both China and Indonesia have established their mental health legislation,which showed that both countries have put their effort into managing mental health problem.However,the implementation of the mental health law itself does not ensure human rights are respected and enforced Therefore,analyzing mental health legislation is needed to reinsure that the content of mental health legislation provides protection for individuals with mental health disorder.Developing the system of mental health is not like building one night palace,It takes a dedication and determination to enhance the quality of mental health services.The aim of this research is:1)To make comparison mental health legislation China and Indonesia based on the WHO checklist,in order to examine the compliance of the legislation with WHO checklist.2)Giving further advice and suggestions for the improvement of the China and Indonesia mental health systemsMethods:The research is conducted through the methods of literature review and expert interview with two experts from China and Indonesia.Two experts from China and Indonesia who have experience regarding law or health law were interviewed to score the mental health legislation and explain the reasons by using WHO checklist(2005).The expert from Indonesia is a lawyer,and advocates and works as a legal planner and a lecturer of law at several universities.Expert from China is a professor majored in Health Law.This study’s approach is similar to the research that has been done by Kelly and Ricard M,which analyze by a single individual expertBoth experts were asked to evaluate the mental health law and other laws which are related to the mental health based on the WHO checklist(2005),which consists of 177 items,divided into 27 sections(A Preamble and objective,B Definition,C Access to mental health care,D Right of users of mental health services,E Right of families or others carers,F Competence,capacity and guardianship,GVoluntary admission and treatment,HNon protesting patients,I:Involuntary admission(when separate from treatment)and Involuntary treatment(where admission and treatment are combined),J Involuntary treatment(when separate from involuntary admission),K Proxy consent for treatment,L Involuntary treatment in community settings,M Emergency situations,N Determination of mental disorder,O Special treatments,P Seclusion and restraint,Q Clinical and experimental research,R Oversight and review mechanism,S Police responsibilities,T Mentally ill offenders,U Discrimination,V Housing,W Employment,X Social security,Y Civil issues,Z Protection of vulnerable groups,AZ Offences and penalties).This checklist aims at helping countries review the adequacy and appropriateness of current mental health legislation.Based on previous research that has been conducted by Sotelo-Monroy in 2014,We assign numerical values into three possible responses(a)Score 2 if the material is fully covered by the law or not specified in the mental health law,but specified in other laws that related to mental health;(b)Score 1 if the mental health law has provisions,but is not comprehensive(c)Score of 0 if the law does not cover the standard.If(b),clarify why the current law lacks sufficient coverage,and clarify what is lacking or problematic.If(c),clarify why it is not fulfilled in the current legislation(if appropriate,additional details can be added to new pages).If(b)or(c),clarify how/whether to integrate this into the new legislation;Calculation of the presentation of the compliance between each country’s mental health legislation with the WHO checklist is derived from the total score of expert evaluation of each country with WHO checklist,divided by the total maximum score of the compliance of the checklist multiplied by 100%.The WHO checklist consists of 177 items,therefore the total maximum score of the compliance is 354.The formula of the calculation will be Presentation of the complianceThe score of expert evaluation with WHO checklist/Maximum score of the WHO check list compliance ×100%To analyze the legislation’s compliance with the WHO checklist,we divided the compliance into 4 levels,the highest(75-100%),moderate(50-74%),low rate(25-49%),and a very low rate(below 24%).Results:1.The results of the study show that the highest compliance that China’s mental health law followed WHO Checklist consists of(A)Preamble and Objective,(C)Access to mental health care,(D)Right of users mental health service,(G)Voluntary admission and treatment,(H)Non protesting patients,(N)Determination of mental disorder,(S)Police responsibilities,(U)Discrimination,(W)Employment,(X)Social security,(AZ)offenses and penalties.Meanwhile,components with moderate compliance consist of(B)Definitions,(E)Right of families and others carers,(I)Involuntary admission(when separated from treatment)and involuntary treatment(where admission and treatment are combined),(J)Involuntary treatment(when separated from involuntary admission),(K)Proxy consent,(M)Emergency situations,(P)Seclusion and restraint,(Q)Clinical and experimental research,(Y)Civil issues.The low rate compliance consists of(F)Competence,capacity and guardianship,(L)Involuntary treatment in community settings,(R)Oversight and review mechanism.Lastly,the very low rate compliance consists of(O)Special treatments,(T)Mentally ill offenders,(V)Housing,(Z)Protection of vulnerable groups2.The results of the study show that the highest compliance that Indonesia’s mental health law followed WHO Checklist consists of(B)Definition,(C)Access to mental health,(U)DiscriminationComponents with moderate compliance consist of(D)Right of users of mental health services,(T)Mentally ill offender,(Y)Civil issue and(AZ)Offence and penaltiesFurthermore,components with low rate compliance consist of(A)Preamble,(E)Right of families or other carers,(I)Involuntary admission(when separated from treatment)and involuntary treatment(where admission and treatment are combined),(K)Proxy consent for treatment,(M)Emergency situation,(N)Determination of mental disorder,(O)Special treatment,(Q)Clinical and experimental research,(S)Police responsibilities,(V)Housing,(W)Employment),(Z)Protection of vulnerable groups(protection of minors,protection of women,protection of minorities)Meanwhile,components with very low rate compliance consist of(F)Competence,capacity and guardianship,(G)Voluntary admission and treatment,(H)Non protesting patients,(J)Involuntary treatment(when separated from involuntary admission),(L)Involuntary treatment in community settings,(P)Seclusion and restraint,(R)Oversight and review mechanism,(X)Social securityConclusions:1.The legislation often depends on the circumstances of each country,and significant variation between countries.However,every country has its own characteristic in terms of its political,economic,geographical and cultural condition.Therefore,certain provision maybe need to to be considered when implemented in each country.To be able to create good mental health system,each country needs to consider its own characteristic,so it can implement any policy well in its own society2.China needs to give concern on the defining the protocol for regulation of affair for mental health disorder,on strengthening the independent body’s role in monitoring the involuntary therapy and enrollment,on protecting the right of individuals with mental health issues inside or outside mental health facilities,on strengthening any relevant policies or legislation to protect mental disorder patients from abuses in the use of several kind treatment,for example major medical treatments,psychosurgery,ECT and other irreversible treatment,establish relevant policies or legislation to guarantee basic life of patients with mental disorders,for example the stipulation of providing subsidized housing schemes such as halfway or long stay residences supported for people with mental health problems3.Meanwhile,Indonesian mental health law needs to give focus on encouraging family and guardian in the involvement of admission and decision on care for patients that suffer from mental health problem,on the mechanism for voluntary and involuntary admission treatment,on establishing a specific emergency treatment mechanism and procedure such as the time limit for emergency admission,on establishing the clear level of professional standard for determining mental health disorder,on establishing the mechanism of specific medical intervention and of seclusion and restraint for mental health disorder,mechanism of conducting research and clinical experiment,on strengthening role of police responsibility,on improving the provision of protection for employee with mental health disorder,on improving the provision of government support in providing social security,and on improving relevant policies to protect those vulnerable groups such as women,children,and minorities.4.The research was conducted by individual analysis of experts from China and Indonesia.Both of the experts are competent in health law and formation of law.This method of research had been conducted by Kelly[16]and Ricard M[20].In the previous study,Kelly used this approach to evaluate the law of mental health in English,Welsh and Irish.Meanwhile,Ricard M used this approach to examine the legislation of mental health in India Even though the method of individual analysis has been used in previous research,it may create a biased in the study.By using the method that has been suggested by the WHO,it can broaden the spectrum of view in evaluating the legislation.As a result,it can decrease the subjectivity in the study.However,this research purpose is to give an overview on compliance of mental health legislation in China and Indonesia with the WHO checklist.Furthermore,this research is intended to yield suggestions and stimulation for further study to carry out multidisciplinary,broaden consideration method to be able to enrich the content.It is also suggested to evaluate the whole country5 s legal system comprehensively,as every country has its characteristic of the legal system.To able to carry out a comprehensive study,the knowledge of each country socio-culture,legal and political system,need to be one of the considerations.By this kind of approach,it can produce a better suggestion to enhance the quality of the mental health legislation.