Youth led emotional support and suicide prevention helplines have recently gained traction for bridging the gap between mental health professionals and people in need of help. They operate through volunteers who attend calls from people suffering from a wide range of emotional or psychological issues. The caller may remain anonymous and the call itself is not recorded for the purpose of maintaining confidentiality and, presumably, to tackle the social taboo surrounding mental health. The volunteers converse with the callers as a "friend in need" and provide emotional support.
With an increasingly progressive and aware young generation, these services are important in a country facing paucity of qualified mental health professionals. The question is – to what extent are these services regulated and whether the service providers are legally accountable for their actions.
In Bangladesh, the Mental Health Act 2018 ("MHA 2018") governs registration of mental hospitals where any sort of treatment (including consultation) must be given under the supervision of a psychiatrist or a person who is licensed under the MHA 2018.1 Since the helplines operate from a remote location without the need of a hospital, their registration under the current legal regime is not possible. Furthermore, these service providers do not represent themselves as psychiatrists or psychologists who are licensed to provide mental health treatment. The callers speak with volunteers who do not provide any psychological consultation and only lend an ear to the callers' distress. This creates a line of defense against any legal regulation hinged on the technicality that the MHA 2018. 1 does not cover emotional support and suicide prevention services. However, this argument is short lived.
The wide definitions of "mental illness"2 and "mental disorder"3 given in the MHA 2018 cover a range of issues. This means regardless of whether the caller is having an emotional breakdown or an anxiety attack, they may be suffering from a mental illness or a mental disorder as defined in the MHA 2018. Therefore, when any service provider actively engages with such psychologically distressed persons, they are breaching the provisions of the MHA 2018. In other words, they are dealing with the same group of vulnerable persons that the MHA 2018 was promulgated to protect. However, due to lack of registration, these services are not regulated by the law. This indicates an overwhelming need to amend the MHA 2018 whereby such remote service providers can undertake registration and operate under a legal regime.
In the absence of any regulation, to what extent is this service model capable of avoiding accountability? While these services have been hailed as a timely initiative, the flip side is considering whether the service providers will take liability for the actions of their callers. For instance, if someone is standing on a ledge and calls the helpline, the volunteer's task is only to listen to the caller's woes. If, in an unfortunate course of events, the caller makes a fatal jump from the ledge, then how far can the volunteer and/or the service provider avoid responsibility? Without any legal registration and any record of the call, there is hardly any evidence safeguarding them from criminal liability.
This issue is exacerbated by the eligibility of the volunteers to attend calls from such distressed and vulnerable persons. Although the volunteers supposedly receive training, there is no legal guideline about the content or extent of such training. Even if properly trained, these volunteers are not in a position to provide services as they are not a licensed professional under the MHA 2018. Similar organisations in the United Kingdom, such as Campaign Against Living Miserable (CALM), only allow professionals to attend calls while volunteers carry out other promotional activities.4
In my opinion, the services provided through these volunteers are necessary and are filling a void in providing mental health support to the public, particularly the youth. However, these organizations, in their current state are unregulated and are ripe for criminal prosecution should any unfortunate incident occurs and a caller, for instance, ends their life after talking to the volunteer. Organizations offering such services should take the necessary precautions in order to ensure that they are protected. Keeping records of calls is a must and volunteers must be instructed to forward calls to a licensed professional/psychologist if at any time during the call they feel that the caller is suffering from a mental illness (as defined under the MHA 2018). However, organizations providing these services often take a very staunch approach when it comes to maintaining confidentiality and refuse to leave any trail of their calls. While I appreciate that point of view, I also believe that if an organization wishes to continue and have their image untainted, it is important to follow the law of the land and be compliant in order to ensure that they do not face criminal prosecution. Organizations are encouraged to seek legal advice in order see how their procedures and policies can be structured in order ensure compliance with the law.
1 Section 7 read with section 2(6) and 2(17) of the MHA
2 Section 2(15) of the MHA 2018
3 Section 2(16) of the MHA 2018
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