Repeal the century old Lunacy Act

In Bombay a century ago, colonial magistrates passed a new law to govern all of India. Today, in a nation that used to be part of India, the Lunacy Act of 1912 stills stands – a relic of the Victorian era, and quite possibly the oldest active mental health law in the world. Replacing it could improve the personal wealth of every Bangladeshi.

The Lunacy Act was well-written and progressive in its own time. It declared, for instance, that "European military lunatics… detained in any asylum," must be treated until a doctor "applies for his transfer to the military… authorities." In an era pre-dating  modern science, the law defied imperialistic, pseudo-scientific racism by regarding Europeans as equal to South Asians.

In 2013, of course, this mental health law is an old relic, wholly lacking insight into human rights and modern knowledge about the mind. The states it once governed have mostly replaced it: Indian in 1987, Pakistan in 2001. They keep pace with the world: according to the World Health Organisation, 76 percent of countries with a mental health policy have approved or updated it since 2005.

Bangladesh last passed a small update to the 1912 Lunacy Act in 2006. But the antique act needs a total replacement, too, and so far this hasn't happened. For three decades, Bangladeshi legal and mental health professionals have been working on the passage of a new law — national authorities have recently completed a new draft, in fact — without getting the political support necessary to pass the law.

It's not because Bangladesh doesn't need a new law. Legislation is a first step towards improving access to mental health care – and people in Bangladesh do need that. One in every six Bangladeshis (16 percent) has a mental health condition that could be diagnosed and treated, according to Bangladesh's National Institute of Mental Health. This is roughly the same as most populations around the world — mental illness is utterly common here and everywhere else. Many Bangladeshis suffer depression, mental health's "common cold;" anxiety, sometimes related to the country's political upheavals; and other conditions that reduce quality of life. Mental disorders are stigmatized worldwide, but they are concerns for many ordinary people with families and jobs – and people who know those people, at home, in the workplace and in communities.

Yet, like their Victorian-era ancestors, today's Bangladeshis cannot access modern mental health care. There are only 123 psychiatrists in Bangladesh to serve the 26 million people who could benefit from their care. Since psychiatrists cannot possibly serve over 200,000 people each, only a few people receive mental health services. This is especially true because of the government devotes only 0.5 percent of the national health budget to mental health.

Ironically, not spending money on care is an enormous financial drain on society. Paying for mental health care can also result in lower overall medical costs. For example, treating depression at a cost of a few taka per day can reduce heart disease, a condition biologically related to depression which can result in complex care costing a million taka or more. Economists call this a "cost offset:" spending some money now to avoid spending much more in the future.

Cost offsets are true even for those who don't end up needing heart surgeries. People with untreated mental illness are more prone to have accidents and need charitable assistance; while many are good employees, they are also often less effective at work than healthier colleagues. The increased productivity, reduced illness, and fewer accidents that come from appropriate access to therapies and medications are financial wins for society overall. Even ensuring the human rights of mentally ill people has an economic benefit. Helping people avoid discrimination, abuse and neglect – in other words, a variety of intentionally inflicted harms that often reduce people's well-being – means avoiding the increasing costs that come from making sick people sicker.

Bangladesh doesn't need to improve mental health care out of pity for ill people, in other words. Nor does the country need mental health policy because the World Health Organization says so. Rather, every Bangladeshi's economic fortune hinges on the wellness of the one in six people who need mental health care, and that is why Bangladesh must replace the outdated Lunacy Act of 1912.

Actually, economic wellness is one reason the developed world has chosen to improve access to mental health care. The high-income countries of North America and Europe, where mental illness is also utterly common, have a median gross national income 76 times greater than low-income countries. Yet they spend 200 times as much on mental health care as low-income countries do. In other words, the gap in spending between the developing world and the developed world is more than twice what could be expected from income differences alone. The gap suggests that wealthier countries, given an opportunity to try mental health care, have found it is worth the price. From the foundation of improved mental health, other opportunities for economic well-being are easier to pursue.

The new mental health act draft makes it possible for Bangladesh to try it too. Mental health does not require advanced technologies or fancy medicine, but rather social workers and psychologists who help people through low-tech methods. Bangladesh could easily replicate that in a culturally competent, resource-appropriate way. A solid beginning includes legally enforceable protections for persons with mental illness, updated licensing and regulation standards for mental health facilities and professionals, and attention to human rights. The law includes all of this; it is a starting point for developing adequate and well-funded services accessible to everyone.
The new draft is a vast improvement over the old Lunacy Act in almost every respect – except one. It reinvigorates an idea the old magistrates of Bombay, by chance, got right so long ago. It's the same one that the World Health Organization pursues today. It is simple: people in Bangladesh should be treated as equal to Europeans.

As a person of European descent who has come to help advance mental health care in Bangladesh, I believe whole-heartedly that Bangladeshis are equal to anyone else. My work here based on my desire for your collective well-being – financial, physical, mental and spiritual – and for a new museum showpiece: the 1912 Indian Lunacy Act finally repealed.

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M. Sophia Newman is an American writer living in Dhaka