MHC Act 2017 - Parliament Debates

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Uncorrected/ Not for Publication-08.08.2016
( )
SHRI BHUBANESWAR KALITA: What about migrant illegal workers?
MR. DEPUTY CHAIRMAN: It is okay. Now, Shri Jagat Prakash Nadda to
move the Mental Healthcare Bill, 2013.
THE MENTAL HEALTHCARE BILL, 2013
THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT
PRAKASH NADDA): Sir, I move:
That the Bill to provide for mental healthcare and services for
persons with mental illness and to protect, promote and fulfill
the rights of such persons during delivery of mental health
care and services and for matters connected therewith or
incidental thereto, be taken into consideration.
The question was proposed.

(Ends)
DR. T. SUBBARAMI REDDY: I am on a point of order.
MR. DEPUTY CHAIRMAN: What is your point of order?

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DR. T. SUBBARAMI REDDY: Sir, 134 amendments have been proposed by
the Minister and the Government. Why should we have 134 amendments?
In 50 years no Bill had so many amendments. It is happening for the first
time in history. Why couldnt you bring a new Bill? How much time would it
take to consider 134 amendments? It would take, at least, six hours to sit
here and speak on every amendment. I gave notice for ten amendments.
SHRI D. RAJA: Sir, he has a point.
(Followed by 2H/KS)
KS-LP/2H/2.30
MR. DEPUTY CHAIRMAN: Do you want to say something?
SHRI JAGAT PRAKASH NADDA: Not now. Later, Sir. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: Shri Madhusudan Mistry. You have 15 minutes.
Your Party has given 15 minutes.
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83
. This Bill was long overdue,
, finally, it has seen the light of day. Thank you very much for
bringing it.
Sir, the Statement of Objects and Reasons suggests that while this Bill
recognizes that: (i) Persons with mental illness constitute a vulnerable
section of society and are subject to discrimination in our society; (ii)
Families bear financial hardship, emotional and social burden of providing
treatment and care for their relatives with mental illness; (iii) Persons with
mental illness should be treated like other persons with health problems and
the environment around them should be made conducive to facilitate
recovery, rehabilitation and full participation in society.
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MR. DEPUTY CHAIRMAN: Please conclude.
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MR. DEPUTY CHAIRMAN: Please conclude. ...(Interruptions)... Please sit
down.
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SHRI JAIRAM RAMESH: Are you rushing through the Bill, Sir?
MR. DEPUTY CHAIRMAN: Not at all. ...(Interruptions)... His party has four
speakers, and his party has allotted time for each Member.
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...(Interruptions)... Let me complete. So, 15 minutes have been allotted by
his party to him. So, I have to adhere to that. What do you want?
SHRI JAIRAM RAMESH: Sir. Dr. Subbarami Reddy has raised a very
important point.
MR. DEPUTY CHAIRMAN: Yes; I never said it is unimportant.
SHRI JAIRAM RAMESH: Sir, there are 132 amendments; and I hope the
Minister will explain the need for 132 amendments. Many of these
amendments are procedural, I understand. But some of the amendments
are very substantive amendments. And I hope you won't rush through the
Bill.
MR. DEPUTY CHAIRMAN: How do you think that?
: , ..( )... ,
MR. DEPUTY CHAIRMAN: No, no; your speech is over. Now, you don't
speak. That is not fair. No, no. ...(Interruptions)... That is absolutely against
the rule. No, you cannot speak. Your speech is over. Sit down. You cannot
speak. ...(Interruptions)... No, no; you can't do that. Your speech is over.
Now, you don't speak.

94
Jairam Rameshji, why do you go on pre-conceived notions? Nobody
is going to rush through. When the amendment is moved, at that point of
time, you can ask the rationale of the amendment, which the hon. Minister
will certainly clarify to you. Especially when a person like you asks, do you
think the Minister will ignore you? Nobody can ignore you.
SHRI JAIRAM RAMESH: Sir, Dr. Subbarami Reddy is
also...(Interruptions)...
MR. DEPUTY CHAIRMAN: Yes, Dr. Subbarami Reddy's point of order is
very valid. He asked as to why there are 146 amendments. The Minister will
explain it at that point of time.
DR. T. SUBBARAMI REDDY: Sir, it is 50 years' record; no Bill had so many
amendments. This is Mr. Nadda's record.
MR. DEPUTY CHAIRMAN: See, that only shows that the hon. Minister is
amenable to the suggestions from Members and others. So, after drafting
the Bill, whatever opinions and suggestions the hon. Minister got, especially
from Members like you, he is accepting. You should thank him for that. He is
not very adamant that 'no, what Bill I brought, I will stick to that; no change.'
DR. T. SUBBARAMI REDDY: Sir, the Minister is smiling.

95
MR. DEPUTY CHAIRMAN: Yes, the Minister is susceptible. I appreciate
that, I tell you. Now, Dr. Vikas Mahatme.
DR. VIKAS MAHATME (MAHARASHTRA): Hon. Deputy Chairman, Sir,
when we talk about health, we always think of physical health. But I feel this
Bill is very important because the WHO defines health as mental, physical
and social well-being. Sir, it is also very important that whenever we are
mentally healthy, then only we can work fruitfully and meaningfully. We can
contribute to the community when we are mentally healthy. Even if we are
physically healthy, but mentally not healthy, then, our work will not be
fruitful.
(Contd. by 2M-SSS)
SSS-PSV/2M/2.50
DR. VIKAS MAHATME (CONTD.): So, I personally feel that mental health is
more important than physical health and that is why I feel that this Mental
Healthcare Bill is very important and, moreover, it has been brought, nearly,
after three decades. The previous Bill came in 1987 and now it has come in
2016. Sir, many times, we feel and people say, "I am healthy. I am not
mad." ' , mentally healthy ' But this is not true. He
may be suffering from too much stress or anxiety.

96
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, For that, counsellors are there and
caregivers are there and in this Bill, for the first time, the counsellors,
caregivers and mental health professionals are given due respect and due
favour. We have recognised their work. I shall come to the caregivers
afterwards also. If we think of mental disorders, in India, around seven per
cent of our population -- it is not one per cent or less than one per cent -- is
suffering from these mental illnesses. WHO says that 27 per cent of
population of India suffers from depression, and for treating these patients
we have, in India, 5,000 psychiatrists. So, for 125 crore people, for treating
seven per cent of our population, we have only 5000 psychiatrists. For this
reason, the Bill has appropriately considered it necessary to increase the
number of psychiatrists and take the help of mental health professionals.
This has been done for the first time. This includes psychologists and
caregivers. So, what are caregivers actually? Caregivers are persons who
97
take care of mentally ill patients, who need prolonged treatment. Just now,
the hon. Member said that such a patient needs prolonged treatment in the
house also. Then they even support the tobacco, alcohol and drug-
addicted people for deaddiction. This also needs prolonged follow up.
They can be family members, friends, relatives or anybody else. This needs
24-hour monitoring. This Bill, for the first time, recognises the efforts of
these people and has created an environment to train all those who manage
such important problems or diseases. So, this has been included in this Bill
and I congratulate the hon. Minister for that. As far as increasing the number
of psychiatrists is concerned, I have said that the number of psychiatrists,
psychologists and mental health professionals is very less. This Bill provides
support to institutions like the National Institute of Mental Health and
Neurosciences, Bangalore. A similar institute is there in Ranchi, Tezpur and
now six more institutions are being added in different parts of the country,
which will definitely increase the number of psychiatrists and mental health
professionals. These are all called as centres of excellence. So, all six
additional centres of excellence will be created through this Bill. In addition
to this, six additional medical colleges will have mental health professionals,
which is mentioned in this Bill. (Contd. by NBR/2N)

98
-SSS/NBR-VNK/2N/2.55.
DR. VIKAS MAHATME (COTND.): ,
nobody wants to expose his anxiety,
depression, stress, psychosis, schizophrenia or other diseases, because it
has got a social stigma. Family members also do not want to disclose it to
others. ,
, , -
And, to reduce this social stigma, there is a robust system of using the
district hospitals.
? The district hospitals are where all the patients are treated, the
mental health treatment will also be done in those district hospitals. So, this
will relieve you of some part of the stigma, at least. I think, still, we will have
to work on it. But, it will take care of some part of social stigma. Sir, unless
and until there is community participation, we will not be able to provide
proper sustainable mental healthcare. For this, the Bill has taken a proper
care. And, I think, there is a provision in the Bill on Central Mental Health
Authority, State Mental Health Authority and District Mental Health

99
Programme. The District Mental Health Programme will be operational
through PHCs. So, community participation will, automatically, be there.
Sir, I feel, scarcity of mental health professionals will be less once
community starts participating in it. I personally feel, in this Bill, involvement
of voluntary organizations is not given anywhere. I personally have
experience that there are institutions, especially in Maharashtra. There is an
institute for psychological health which is working for the last 25 years in this
field. But, it finds difficult to collaborate with the Government to serve many
more people. I am saying this, because unless and until there is
collaboration it is difficult and, without any financial burden on the
Government, these people want to work. But, it becomes very difficult. I
personally feel that there should be some amendment so that it will take
care of all the voluntary organizations working there.
Sir, any healthcare will not be complete unless and until it supports
research and survey. In this Bill, survey to assess burden of mental illness is
there. This is definitely a major problem that we dont know about the
percentage of diseases in detail. We know that there is around 7 per cent of
mental illness. But, we dont know how much per cent of each disease we
have. Then, we also dont know about addiction. We dont know how
100
many tobacco, alcohol or drug addicts we have. So, all this will be covered
under this Bill as survey. This is very important to know and to plan further
strategy. So, in brief, I would like to inform the hon. Members, through you,
Sir, after nearly three decades, this Bill has revolutionized the mental health.
There will be increase in the number of psychiatrists and quality mental
health professionals. This will establish the Centre of Excellence,
Government Medical Colleges for mental health services. There is a
systematic approach, so that all the Schemes will be implemented nicely.
The Central Mental Health Authority, State Mental Health Authority and
District Mental Health Programme become successful only when there there
is community participation.
All this together, and many other points, in brief, will say that this Bill is
multifaceted, will take care of all the important aspects of mental health and
there are details about the execution.
So, I personally fell, everybody in this House should support this Bill,
so that we take India to a mentally healthy India.
(Ends)
(FOLLOWED BY USY 2O)

101
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(THE VICE-CHAIRMAN (DR. SATYANARAYAN JATIYA) in the Chair).
SHRI A.K. SELVARAJ (TAMIL NADU): Respected Vice-Chairman, Sir, I
thank you very much for allowing me to speak on an important subject,
concerning the patients who are suffering from mental disorders. The Bill
was, originally, introduced in this august House on 19.8.2013, and the same
105
was referred to the Standing Committee on Health and Family Welfare on
20.8.2013 for examination and report within three months.
(Contd. by PB/2Q)
PB-SC/2Q/3.10
SHRI A.K. SELVARAJ (CONTD.): The Committee submitted its report within
the time period. I am happy that the Bill has been taken up now for
consideration and passing.
Now I would like to put forward some of my views and suggestions on
the Bill. Sir, the Government of Tamil Nadu, under the leadership of our
hon. Chief Minister, Dr. Puratchi Thalaivi Amma, had set up a State Mental
Health Authority, Tamil Nadu way back in 1994.
Probably, Tamil Nadu was the first State for setting up of such an
Authority to reduce the burden of mental illness and behavioural disorders of
persons, their families and care-takers, and the Authority was mandated to
regulate, develop and coordinate mental health services and to deal with all
matters which come under the Mental Health Act.
Today, under the dynamic leadership of our hon. Chief Minster, Dr.
106
Puratchi Thalaivi Amma, the State is in the forefront as far as the steps
towards mental health are concerned. Tamil Nadu is the only State that has
at least one psychiatrist in each district, something unique when compared
to other States.
In spite of having taken many steps, the number of psychiatrists in the
country still does not exceed 4,000 and there is a great need to add on the
number of psychiatrists, and there is a need to increase the institutes as well
as the courses at the level of post-graduation in the medical colleges. There
is just one psychiatrist for four lakh Indians and 80 per cent of our districts
do not have even one psychiatrist in public service.
India devotes less than one per cent of its health budget to mental
health compared to 10 per cent, 12 per cent, 18 per cent in other countries.
Ironically it is in urban areas where medication and psychiatrists are available
but in rural areas neither the medication is available nor are the psychiatrists.
The primary health centers don't stock medication, and huge
populations of people with major mental illness do not have access to either
treatment or to medication. Most Government hospitals have relegated

107
their worst wards, with the fewest beds, to mental-illness wards in the most
neglected area, even near the mortuary, and this is the discrimination that is
shown to the mentally-sick people who are discriminated against in
employment and in society. Sir, at least, 5 per cent of our population lives
with a mental illness, which accounts to over 50 million people. These
numbers have a close bearing with the rate of suicides. Nearly half of those
with severe mental diseases are not treated and of those with less severe
versions, nearly 9 in 10, go uncared for. About one in 5 persons in the
country need counselling, either psychological or psychiatric.
Depression, the most prevalent form of mental illness, is estimated to
exist in 3 of every 100 in urban areas like Mumbai, etc., and, of this, one in 3
are severely neurotic.
Thus, India without a massive mental health movement will see a lot of
homeless destitute patients. The burden of mental illness will increase more
rapidly in India than over the next 10 years.
In India, only about one in ten persons with mental health disorders
are thought to receive evidence-based treatment. By 2025, in India, 38.1

108
million peoples life will be lost to mental illness which will be an increase of
23 per cent compared to the previous figures. The mentally-ill patients are
also discriminated against in giving insurance facilities. The insurance
companies do not provide medical insurance to the people who are
admitted in hospitals with mental illnesses.
(Contd. by 2r/SKC)
SKC/2R/3.15
SHRI A.K. SELVARAJ (contd.): Admission to a good hospital is out of
reach for some because of this. It is sad that a patient in the ICU is billed a
few lakhs of rupees, but there is no insurance just because it is mental
illness. We need to look into this urgently and Clause 21(2) of the Bill must
be made tough by suitably amending it.
Generally, people desire that their medical treatment should always be
a secret, to be disclosed only to their near and dear ones and to their
doctor. However, Clause 23(2) of the Bill deals with the right to secrecy in
respect of a person with mental illness. Any ambiguity in the Clause would
defeat the purpose of this Clause to keep as confidential all such information
109
that has been obtained during care or treatment by health professionals
providing care or treatment to a person with mental illness. Therefore, in
order to maintain that secrecy, this important Clause should be carefully
framed with clear intentions so as to avoid conflict and confusion at the
implementation stage.
It is a well-settled and generally accepted norm that only professionals
in the relevant field can come up with valid suggestions and solutions to a
field related or relevant to him or her. Clause 80 provides for setting up of a
Mental Health Review Board and Clause 81 provides for composition of the
Board. Therefore, both the members of the Mental Health Review Board
proposed under the above Clause should be Psychiatrists; as a Psychiatrist,
being a specialist, is better equipped to protect the interests of the patient.
The Standing Committee, in its Report on the proposed Bill, has
suggested many things which can be incorporated and implemented, so
that the country can take care of a growing number of mentally ill patients.
Sir, with this, I conclude and I support the Bill.
(Ends)
110
SHRI AHAMED HASSAN (WEST BENGAL): Sir, on August 6, 2001, a fire
broke out in an asylum in Yervadi, Tamil Nadu. More than 25 patients were
burnt alive. They could not escape the blaze as they had been chained to
posts or beds. The Supreme Court stated that the Mental Health Act, 1987,
is not at all implemented by the concerned authorities and there is a failure
on the part of the Central and State Governments to implement the 1987
Act. Thus, there is an urgent need to introduce and implement sweeping
reforms in this regard in the country.
Sir, the National Human Rights Commission has conducted detailed
studies of patients in mental health institutions and the conditions they live
in. They found numerous instances of cruel treatment and people being
chained, being beaten and being denied any kind of dignity.
Sir, there are around 4,000 psychiatrists in India and many of them are
in private practice. Thus, there is a huge shortage of psychiatrists in the
public sector and in the rural areas. This has led to a large number of
people requiring mental healthcare remaining undiagnosed. As per NCRB
data, 1,31,666 people had committed suicide in India in 2014. Depression is
the leading cause of suicides around the world and needs to be treated by
healthcare professionals.
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Sir, there is a need to eliminate the social stigma associated with
mental disorders. Access to mental health services in India continues to be
a major challenge as up to 40 per cent of the patients travel more than 20
kilometres to have access to the District Mental Health Programme services.
(CONTD. BY KSK/2S)
skc/gs -- KSK/ASC/3.20/2S
SHRI AHAMED HASSAN (CONTD.): Coming to the Mental Healthcare Bill,
2013, it has some good provisions. Any person, with or without mental
illness, can make an Advance Directive (AD) stating how he or she wishes
to be treated for a future mental illness and also how he does not wish to be
treated. Such an AD can also be challenged by families, professionals, etc.
De-criminalization of suicide is a much-needed reform. A person
attempting suicide shall be considered to be under severe stress and will not
be liable to be prosecuted under Section 309 of the Indian Penal Code. The
Government should provide care, treatment and rehabilitation to all such
persons.
The Bill states that it is the obligation of the Central and State
Governments to build halfway homes and community caring centres, among
other things, for the mentally-ill persons. Such services should be

112
affordable, of good quality and available without discrimination. This Bill
also provides protection to patients from cruel, inhuman and degrading
treatment. In this new Bill, some treatments, currently being practised, will
be prohibited, most importantly, the Electro-convulsive Therapy (ECT),
given without anaesthesia, and the practice of chaining patients to their
beds.
However, there are some issues with the Bill, which I would like to
raise. The provision of appointing a nominee, and then all subsequent
decisions being taken by the nominee, may lead to damaging the goodwill
and bonding in a family. Furthermore, a person can only be admitted to a
mental healthcare facility after being reviewed by the MHRC. This might
cause undue delay in the treatment and it will make the entire process more
complicated. These reasons might discourage families from playing a
proactive role in seeking treatment.
Sir, the MHRC has six Members, out of which, only one is a
psychiatrist and another is a mental healthcare professional. This will lead
to crucial decisions being taken in the field of mental health by non-experts.
The Bill allows for ECT on minors, in case the psychiatrist advises it,
with the consent of the guardian and prior permission of the Board.
113
However, due to its extreme side effects and its controversial practice in the
treatment of mental illness in minors, a blanket ban on ECT for minors
should be implemented, as recommended by the World Health
Organisation.
Sir, it is surprising that the Bill provides for only one District Board for
the eight North-Eastern States of India, covering an area of 2,62,230 square
kilometres. This would make it inaccessible to a majority of the people in
these States, who face difficulties in connectivity.
I would urge upon the Government to look into these issues and make
the necessary changes so that India gets a progressive law on mental
healthcare, which would work towards raising awareness and eradicating
the stigma attached to the mentally-ill people.
(Ends)
THE VICE-CHAIRMAN (DR. SATYANARAYAN JATIYA): I am here to
remind that word-to-word reading is not allowed. I am not going to disturb
anybody, but according to the Parliamentary etiquette, word-to-word
reading is not allowed. So, please note this. Now, Shrimati Kahkashan
Perween.
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(Ends)
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SHRI D. RAJA (TAMIL NADU): Sir, India is one country, which has the
largest number of mentally ill persons. But there is no proper data. The
reason is the social stigma, where cases go unreported. Sir, the
Government spending, on healthcare, in general, and on mental healthcare,
in particular, is very low. The Standing Committee, noted and I quote:
Public healthcare is a State subject. States will have to incur expenditure
to implement the provisions of the Bill. However, the Financial
Memorandum of the Bill does not provide for the necessary allocation.
Therefore, the Committee recommended that since States are under

124
financial constraints, the Central Government must ensure funds to States
for the implementation of the Bill. I do not know whether the Centre is
willing to extend financial assistance to the State Governments, if at all, the
Centre has the conviction to implement this Bill.
Sir, the Bill repeals the Mental Healthcare Act, 1987. That, amongst
other things, provided details regarding guardianship of mentally ill persons
and management of their property and other decisions. The Mental
Healthcare Bill, the present Bill, does not include any provision related to
guardianship of mentally ill persons. These are all provided in the other Bill,
that is, Right to Persons with Disabilities Bill. Sir, the Health Minister should
take note of it. These have been provided in the Right to Persons with
Disabilities Bill, which is pending before the Rajya Sabha. We do not know
when the Government will bring that Bill before the House. The issue is that
if this Bill is passed, there will be a legal vacuum with no provisions in law for
guardianship of mentally ill persons.
(Contd. by DC/2Y)
-BHS/DC-KLG/3.45/2Y
SHRI D. RAJA (CONTD.): In such a situation, is it proper to pass this Bill in
haste? The Government must think over it. Sir, the Bill contains 136
125
clauses. The Minister has moved 134 amendments and my good friend, Dr.
T. Subbarami Reddy, has moved five amendments. If you put everything
together, it becomes a new Bill. The Government should have brought a
new Bill and referred it to a Select Committee for further scrutiny. So, we
are trying to do something in haste. The Government should think as to
whether it is proper.
Sir, we have the Medical Council of India. We have the Dental Council
of India. But, why not have a Mental Health Council of India? I am
suggesting this to the Government. I do not think there is any separate
Department for mental health. There is a separate Department for
Homoeopathy. There is a separate Department for Ayurveda. But, is there
any separate Department for mental health? Why cant the Government
think of having a separate Department or, say, a Mental Health Council of
India? Sir, amongst the people who are affected by mental sickness and
mental illness, many are poor people living in rural parts of our country.
They have no access to mental healthcare and, here, comes the role of
Central Government and State Governments. They must have adequate
mechanism to provide access to the poor people to enable them mental

126
healthcare. I think, the Government will have to think over on many such
issues before passing this Bill in haste. Thank you.
(Ends)
( ): , ,
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127
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-KLG/PSV-KR/2Z/3.50
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communities
, interaction
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128
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psychiatrist , , ?
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psychiatrists , counsellors , clinical
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129
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rehabilitation centers , homes -
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130
, homes , ,
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-PSV/VNK-KS/3A/3.55
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15-15, 16-16
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reality , ,
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131
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132
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( )
DR. PRABHAKAR KORE (KARNATAKA): I thank you, Mr. Vice-Chairman,
Sir, for giving me this opportunity to speak on this very important and long-
overdue Mental Healthcare Bill, 2013. The psychiatrists, particularly, had
been waiting for this law for a very long time. Actually, the Mental Health Act
had come into force in 1987 but it could neither do much to protect the
rights of persons with mental illness nor did it help the doctors much. After
that, we had the United Nations Convention on the Rights of Persons with
Disabilities, which was ratified by the Government of India in October, 2007.
This Convention has made it obligatory on the Government to align the
policies and laws of the country with the Convention to protect the rights of
persons with mental illness. Now, my Government has brought before the
House this detailed Bill. I am especially thankful to the Government of India
and I wholeheartedly support this Bill.

133
Mr. Vice-Chairman, Sir, the mental healthcare is the most neglected
area in the country. According to a Psychiatrists Conference held here,
more than 20 crore people are mentally ill in our country. Out of those 20
crore, two crore people are very serious.
(CONTD. BY RSS-MCM/3B)
RSS/MCM/3B/4.00
DR. PRABHAKAR KORE(CONTD.): Out of them, two crore people are very
serious. They require various types of treatment inside the hospital as well
as outside the hospital. In fact, I do not want to go into the details of this Bill
which the hon. Minister has brought forward in this House. My colleagues
have spoken at length about this Bill. I think, there are so many factors
which are responsible for the mental illness of these patients. They are
biological factors, life experience like trauma or abuse, family health
problems. Sometimes, there is an example of a lady who is quite normal
before delivery, but after delivery, she has to undergo this treatment. There
are many examples of such mental patients. This is a typical problem and
the medical care facilities in this respect in this country are very, very limited.
For instance, in Banglore, there is one hospital where patients suffering from
134
this problem come from the whole of India, and even to get an appointment
from the doctor, it takes a lot of time. This is the problem. Nowadays, many
children are suffering from this disease and so many children need treatment
as in-patient and out-patient. So, compared to the magnitude of this illness
in this country, the number of psychiatrists in this country is very minimal.
Forget about Taluka or a small place, there are no psychiatrists even at the
district level at some places. Due to the absence of these doctors even at
the district level, people suffering from this disease are the worst sufferers.
In every district, there is a department. But if you visit the department at the
district level, you will find that there is no psychiatrist, there is no doctor. If
the doctor is available, then there is absolutely no facility available in the
hospital. And once a person pays a visit to such hospitals, after seeing the
atmosphere of these hospitals, he himself becomes a mental patient. This is
the situation prevailing in these hospitals. So, I request the hon. Minister to
think of starting a separate department for mentally ill patients, separate
from the district hospital in every district. Why don't you think on those lines
because there are so many problems in the district hospitals? They have a
medical college, they have the department where the patients are admitted,
there is a common place. These patients sometimes go to the general

135
wards. But, the patients in the general wards, don't want to go to these
mentally ill patients. They say that this is a mental hospital. So, this is a very
serious problem. So, I request the hon. Minister to give a thought to this
problem and set up a separate mental hospital for these patients as is the
case with the tuberculosis patients, for whom, we have a separate
tuberculosis hospital in small places and at the district level, you can also
have a separate hospital for mentally ill patients on those lines which will not
affect the other patients....(Interruptions)
SHRIMATI RENUKA CHOWDHURY: May I intervene? First of all, our own
perception of what is mental illness and disease, that needs to be
understood. Unless they are absolutely maniac or they are in a maniac
state or mental disease is not a contagious disorder, isolating them
aggravates the condition. It is important that people remain in normal
atmosphere and it is supposedly the normal people who should be actually
knowing how to conduct themselves with them. That is very important.
Tuberculosis is a contagious disease. That is why we keep patients in
isolation. But, in this, you cannot afford to do that. You have to keep them
integrated with normal society, and woman post-delivery, known as

136
postnatal depression, is a temporary phase because harmones change
after delivery.
(CONTD. BY 3C)
-RSS/RL-DS/4.05/3C
SHRIMATI RENUKA CHOWDHURY (CONTD.) : That cannot be listed as a
mental illness. It is not a mental illness. It is a normal cyclical change of a
delivery. So, we must understand that. I am just pointing it out because no
decision should be taken....
THE VICE-CHAIRMAN (DR. SATYANARAYAN JATIYA) : Okay, please.
SHRIMATI RENUKA CHOWDHURY : Sir, just a moment. While I am on this,
I would like to draw the Ministers attention that it is not just these issues
about doctors, lawyers, etc. What you need, Sir, is someone who will
actually execute the legal rights of these citizens because your mental
hospitals are full of normal women, who are thrown in there, saying that they
are mentally challenged, to deprive them of their properties. And a person,
who is actually challenged, to whom do they go to in this country to see that
their rights are protected? If something happens to the parents of a

137
retarded child, then the child is on the road. That is what we need to look
at. Thank you, Sir.
DR. PRABHAKAR KORE: Sir, I agree with the suggestion that there should
be a separate Department in hospital. But what I am saying is that all
illnesses are not serious. But some of the mentally ill patients in the night
disturb the other patients, especially, in nights, by their violent activities. I
know that when they are out of the hospital, they need four to five people to
protect them. But this affects the other patients. That is why I am saying
this, and not that I am against them. As I told you, there are more than 20
crores of people who are affected by this illness, but not all are very serious
patients. The condition of some of the patients is serious and they have
some kind of problems but they are not going for treatment to hospitals. At
the same time, I would like to bring to the notice of the Minister to the issue
of doctors. There are so many private hospitals and NGOs that have been
established in districts and at smaller places in my State, Karnataka. But, in
places where they are not getting sufficient funds, as the patients are not
able to pay the hospital fees because the background of most of the
patients is very poor, even when anybody starts a private hospital there, it is
very difficult to maintain it also. So, I just request the hon. Minister that
138
when some of the NGOs and even some of the maths, I mean, the Swamijis,
are doing a very good job in providing treatment to the poor people, why
doesnt the Government support them and give them some aid so that they
are able to do their job efficiently.
With these words, I want to give some suggestions to the
Government. Firstly, as the hon. Member stated about serious patients who
need care, there are also so many normal patients also who require
treatment after every one week or ten days. So, rehabilitation centres are
very much needed. Unless and until every district has a rehabilitation
centre, this problem of mental illness cannot be solved. So, I request that in
every district there should be a rehabilitation centre where these patients
can be treated. There should also be a separate Rehabilitation Department.
Also, Sir, there is a need for bringing about certain regulations for effective
implementation of this Bill. For example, a child who requires shock
treatment may sometimes have to be given anesthesia for this treatment.
But, as per the law, a child cannot be given anesthesia unless a child is
suffering from a major disease or an emergency treatment is required. So,
you have to incorporate such a clause in the new Bill. There are some
patients who fall ill after getting poor treatment and this is also a big
139
problem. So, you have to look into this thing. And in the Bill, you have
made provision for State Committee, District Committees, and Taluka
Committee. I welcome these Committees. I only request you to see to it
that non-professional persons are not put on the job; you must appoint
qualified doctors like a psychiatrist. These patients could be working in
private sector and living in areas where there are no Government hospitals
with psychiatrists present there.
(CONTD. BY TDB/3D)
TDB-SC/3D/4.10
DR. PRABHAKAR KORE (CONTD.): So, my request is, at least, two such
persons should be there in the Committee who can guide the Committee for
the treatment. Sir, I have already said about the nursing home problems.
There are no trained nurses and trained helpers. That is a very big problem;
and to work in that scenario, people are not coming forward. So, I request
that the Government should, at least, train some people in this Department
where they can work with people suffering from mental illness.
Sir, before I conclude my speech, I have one more point which is very
important. Sir, there should be a rehabilitation centre for mentally retarded
people, drug addicts and people suffering from serious mental illness. For
140
these people, we need a very good rehabilitation centre in every district. Sir,
with these words, I support and welcome the Bill. Thank you, Sir.
(Ends)
SHRIMATI KANIMOZHI (TAMIL NADU): Sir, at the outset, I welcome this
Bill. In spite of things which have been pointed out -- and there are a
number of amendments and other things -- I am happy that, at least, now
this Bill has come before the House. We have been waiting for a very long
time for this Bill. I would like to congratulate our LoP, who was the Health
Minister, for initiating this, and the present hon. Minister for Health for
bringing in this Bill. Sir, it is a very progressive Bill. Sir, this Bill is a very
ambitious Bill. It puts a great financial burden and responsibility on the
Central and the State Governments.
Sir, according to the WHO, India spends a meagre 0.06 per cent of its
total health budget on mental healthcare. With this budget, what does the
Minister actually plan to do or promise to do? Sir, as many hon. Members
here have pointed out, our country has shortage of psychiatrists. We have
one psychiatrist per three-and-a-half lakh people. We cannot increase this
number overnight. This whole programme relies very heavily on the present
public healthcare system as they have not got a different infrastructure put
141
into place for mental healthcare as yet. I think we should start having
continuous training for the existing doctors in the PHCs and the nurses. This
is not the best. But, at the moment, for the present, I think they may be able
to identify the problem. It is very important to identify the problem when
there is depression or need for mental healthcare. I think identifying it is very
important, especially in a developing nation, where there is acute poverty.
The distress from poverty, in many cases, has been read as depression or
mental health issues. We cannot legislate poverty and do away with it. But
many patients who are distressed are depressed because of that. They do
not have the energy or do not have the will power even to assess the welfare
schemes given by the State Government to them. So, it is very important for
the doctor to identify these patients. The doctors should be trained enough
to identify these patients. In many cases, there are medicines given to
PHCs, but the doctors are not used to prescribe these medicines; they don't
know how to prescribe these medicine. In spite of medicines being
available, it does not reach the people when they need it. So, I think, there
should be continuous training of doctors till the time we are really able to
142
meet the ideal target of psychiatrists needed in our country. I think that
should be taken into consideration and it should be looked into.
(Contd. by 3E-SSS)
SSS-GS/3E/4.15
SHRIMATI KANIMOZHI (CONTD.): Sir, you are trying to set up boards,
bring in new people, but already, you have a lot of financial constraints and
not much of Budget allocation is there. Is it possible to use the social
workers, who are already there in the healthcare system, to be included to
support this? The Bill does not talk about disability allowance.
(MR. DEPUTY CHAIRMAN in the Chair.)
Already when there are people with physical disabilities, support does
not reach them and you need a doctor to certify the percentage of disability
they have. In these cases, it is very tricky and very difficult to identify that
because in many cases, these people are not able to work, and it is a great
financial burden to take care of these patients by the family. So, definitely,
we should think about giving an allowance to these people. The important
thing is to reintegrate these people into the society. It is not just enough to
actually treat these people, to give them medication. That is not enough.
You should give them the confidence. You should show them the way to
143
take care of themselves. Shrimati Renuka Chowdhury also spoke here. She
brought up a very important point that many parents are worried about the
future of their children. Once they are no more, there is nobody to take care
of their children. There is no support today. We see that sometimes there is
zero support in the society for patients with mental illness. We even think of
tying them up or chaining them up. It is okay if there is no injury or harm to
them. Do you think that it is perfectly all right? There are instances where
they take these patients to temples and other places of worship, but even
they do not have the medical wherewithal to support them. They also do
the same thing of tying them up or keeping them chained. This is the way
our society treats these people. I think, we should put in a proper system
very fast to take care and to solve this issue. I appreciate that you are
talking about advance directive in this Bill, but then, we have to take it very
cautiously also. In India, there are a lot of family and social pressures. A
person cannot make the right choice even when he is in a mental state to
make a choice about how they should be treated and who should take care
of them. A woman and her family cannot name somebody else. She can't
name somebody outside her family. She is expected most probably to
name her in-laws or her husband even if she knows that they will not give
144
her the best treatment. So, in a situation like this, I think we have to
approach this very cautiously. Yes, this is a very progressive idea, an
advanced directive and the patient can decide. Not many people are
educated enough to know which is the best for them also. I think, we have
to approach this advanced directive and psychiatric care in a very, very
cautious way though it is a very good thing. In our circumstances, I think, it
can be a double-edged weapon. I appreciate the step taken to
decriminalise suicide. It is the need of the hour and I really support it. I
think, one of the most important things that we should be looking at is to
reintegrate them back into the society to support themselves and give them
back their dignity. That is what this Bill should be working towards. Thank
you, Sir.
(Ends)
(Followed by NBR/3F)
-SSS/NBR-ASC/3F/4.20.
SHRI JAIRAM RAMESH: Sir, I am on a point of order.
Sir, this is a very serious Bill. Please take my point very seriously.
MR. DEPUTY CHAIRMAN: Is the point of order serious; or, Bill is serious?
145
SHRI JAIRAM RAMESH: Sir, if you look at Clauses 57 and 77, a doubt arises in
my mind whether this Bill is a Money Bill. How did you allow this Bill to come?
Under which definition of Money Bill you gave a ruling on Friday and disallowed...
MR. DEPUTY CHAIRMAN: I did not give anything.
SHRI JAIRAM RAMESH: ...a Private Members Bill? By that same definition, this
Bill is a Money Bill. How can you have a *?
MR. DEPUTY CHAIRMAN: Let me first clarify. Let me first correct. I did not
define a Money Bill. I am no authority to define a Money Bill. My ruling was, to
decide whether a Bill is Money Bill or not is the prerogative of the hon. Speaker.
That is all what I said.
SHRI JAIRAM RAMESH: But, Sir, you referred the Bill to the hon. Speaker!
MR. DEPUTY CHAIRMAN: Yes. I referred the Bill to the Speaker.
SHRI JAIRAM RAMESH: Why did you not refer this Bill to the Speaker?
SHRIMATI RENUKA CHOWDHURY: There is a doubt on this. Call the hon.
Finance Minister.
SHRI JAIRAM RAMESH: So, call the hon. Finance Minister and get clarification.
*Expunged as ordered by the Chair.

146
SHRI K. RAHMAN KHAN: Sir, once a Bill is introduced, objection should
have been taken before introduction of that Bill. After a Bill is introduced, it
cannot be treated as Money Bill.
SHRI JAIRAM RAMESH: At any stage.
MR. DEPUTY CHAIRMAN: No. There is a rule saying that at any stage an
objection can be raised.
SHRI K. RAHMAN KHAN: What was the Government doing then? At the
time of introduction what the Government had done?
SHRI JAIRAM RAMESH: Sir, my request is: Call the hon. Finance Minister
and Leader of the House and get us a clarification why this Bill is not a
Money Bill and how the Andhra Pradesh Reorganisation (Amendment) Bill
became a Money Bill?
MR. DEPUTY CHAIRMAN: And, you want to make it a Money Bill?
SHRI JAIRAM RAMESH: No, no. I am confused with the confused ruling.
SHRIMATI RENUKA CHOWDHURY: Sir, we are not getting the Special
Category Status because of treating that as a Money Bill. Now, the House
seeks your indulgence, as my colleague has said, to clarify this. I request
Mr. Jaitley to come and clarify this.
SHRI JAIRAM RAMESH: Sir, I respect what you say.

147
MR. DEPUTY CHAIRMAN: My ruling was that...(Interruptions)...
SHRI JAIRAM RAMESH: Sir, the point is...(Interruptions)...
MR. DEPUTY CHAIRMAN: Are you raising a serious objection?
SHRI JAIRAM RAMESH: Yes, Sir.
SHRIMATI RENUKA CHOWDHURY: Yes, Sir.
SHRIMATI VIPLOVE THAKUR: We are serious, Sir.
SHRIMATI RENUKA CHOWDHURY: We want to know why that was a Money Bill
and why this is not a Money Bill.
SHRI JAIRAM RAMESH: I want to know why *?
SHRIMATI RENUKA CHOWDHURY: We want to know whether money for this is
coming from the Consolidated Fund of India or not.
SHRI D. RAJA: Sir, all Bills are Money Bills, if you go by that definition. All Bills are
Money Bills. Whether this House has the power to discuss such Bills is the issue.
SHRI JAIRAM RAMESH: Sir, you gave a ruling on Friday. You disallowed AP Bill.
MR. DEPUTY CHAIRMAN: Why do you want to make a self-goal? Jairam
Rameshji is on a self-goal.

148
SHRI JAIRAM RAMESH: Sir, on Friday, you disallowed me from speaking. You
disallowed a Private Members Bill. And, now, you are saying that this is not a
Money Bill. This is a complete *
MR. DEPUTY CHAIRMAN: Jairamji, I disallowed you from speaking, because, at
that point of time, discussion on the Bill was over and that was the time for voting.
That is number one.
Secondly, I am nobody to decide whether a Bill is Money
Bill...(Interruptions)...
SHRI MADHUSUDAN MISTRY: How did you decide then? ...(Interruptions)...
SHRI JAIRAM RAMESH: Sir, there is a dispute.
SHRI MADHUSUDAN MISTRY: Any money going from the Consolidated Fund of
India is a Money Bill...(Interruptions)...
SHRIMATI KANIMOZHI: We dont want you to send this Bill back to hon.
Speaker...(Interruptions)...
SHRI JAIRAM RAMESH: Sir, Article 110 of the Constitution says that in case of a
dispute, the decision of the hon. Speaker is final. There is a dispute. We are
saying that this is a Money Bill. You refer it to the hon. Speaker and get a ruling.

149
MR. DEPUTY CHAIRMAN: You know when was this Bill introduced?
SHRI JAIRAM RAMESH: Why did you refer a Private Members Bill and you
are reluctant to send this Bill to hon. Speaker?
MR. DEPUTY CHAIRMAN: No, no. You cannot question all those.
Jairamji, you should understand one point. As per the Constitution, a
Private Members Bill or any other Bill is a Bill. With regard to the
Government Bill, the person moving the Bill is Minister. But, he is also a
Member. So, Bill means, whether it is Private or Government, it is same for
the Chair and is same as per the Constitution. So, that question does not
arise.
Secondly, why did I give that ruling at that time? I need not explain it
to anybody. But, I need not explain it to you also. But, however,...
SHRI JAIRAM RAMESH: But, the question I am raising is, by the definition
of the hon. Leader of the House, on Friday, this Bill is a Money Bill. The
Government does not think that this is a Money Bill. We think that it is a
Money Bill. There is a dispute. Therefore, according to Article 110, you are
bound to refer this to the hon. Speaker.

150
MR. DEPUTY CHAIRMAN: No. I told you that it is only a self-goal, because
do you know when this Bill was introduced. You know. A Cabinet in which
you were also a Member cleared this Bill and it was introduced in the House.
SHRI JAIRAM RAMESH: Sir, I will tell you why...(Interruptions)...I will tell
you why...(Interruptions)...The Government of which I was a part did not
want to completely bypass and subvert the Upper House which is what this
Government has been doing. That is why I have raised this question. By
the definition of the hon. Leader of the House, this Bill is a Money Bill.
MR. DEPUTY CHAIRMAN: The Leader of the House has not defined that as
Money Bill.
SHRI JAIRAM RAMESH: Sir, he defined it.
MR. DEPUTY CHAIRMAN: No. He only raised an objection.
(Followed BY USY 3G)
HMS-USY/3G/4.25
SHRI JAIRAM RAMESH: Sir, he defined it on Friday. ...(Interruptions)...
He defined it on Friday. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: No, he raised an objection.
...(Interruptions)... He raised an objection. ...(Interruptions)... Are you
raising an objection? ...(Interruptions)...

151
SHRI JAIRAM RAMESH: Yes, I am raising an objection.
...(Interruptions)...
MR. DEPUTY CHAIRMAN: Okay. Then, please sit down. I will tell you.
...(Interruptions)... You are raising an objection ...(Interruptions)... You are
raising an objection whether this Bill is a Money Bill or not.
...(Interruptions)... That is the point. ...(Interruptions)... Did you read my
ruling of that day? Do you remember it?
MR. DEPUTY CHAIRMAN: Fully remember?
MR. DEPUTY CHAIRMAN: Okay. Then, I will read it out to you.
...(Interruptions)... I will read it out to you. ...(Interruptions)... Since Jairam
Rameshji is a very serious Member, a Member with a lot of potential and
knowledge and ...(Interruptions)... Please listen to me. ...(Interruptions)...
Listen to me. ...(Interruptions)... I am reading it for your benefit. I read, You
know the matter was raised by the hon. Leader of the House that it is a
Money Bill. Now, you are raising an objection. But, please see the last
paragraph of my ruling. I read, Since the matter is not free from doubt.....
152
SHRI JAIRAM RAMESH: Yes, the matter is not free from doubt.
MR. DEPUTY CHAIRMAN: For whom? Let me make it clear. I quote, Rule
186, sub-clause 8, If the Chairman has any doubt.... The doubt is for the
Chair. ...(Interruptions)... Please listen to me. ...(Interruptions)... When
you raise a matter, if the Chair has a doubt ...(Interruptions)... Let me
complete, please. ...(Interruptions)... If you could convince the Chair by
way of your argument, and if the Chair feels that there is some substance in
what you are saying and it may be a Money Bill, only then does the Chair
refer it. ...(Interruptions)... But, you could not convince me.
...(Interruptions)... I have no doubt. ...(Interruptions)... I have no doubt.
SHRI JAIRAM RAMESH: Sir, if you want me to convince
...(Interruptions)... If you want me to convince you, I will convince you.
MR. DEPUTY CHAIRMAN: But, I have no doubt. ...(Interruptions)... I
have no doubt. ...(Interruptions)...
SHRI JAIRAM RAMESH: Sir, please look at clause 57 and clause 77.
Expenditure from the Consolidated Fund of India is ...(Interruptions)...

153
THE MINISTER OF STATE IN THE MINISTRY OF PARLIAMENTARY
AFFAIRS (SHRI MUKHTAR ABBAS NAQVI) : Hon. Deputy Chairman has
already given his ruling. doubt
..( ). Hon. Deputy Chairman has given his ruling.
...(Interruptions)... Now, you are disturbing the House. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: Jairam ji, I have no doubt. ...(Interruptions)...
SHRI MADHUSUDAN MISTRY: Sir, not only this Bill, if you read the
Financial Memorandum of this Bill ...(Interruptions)... Sir, you please read
the Financial Memorandum of the Bill. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: No, I need not read that. ...(Interruptions)...
There is no need of reading that. ...(Interruptions)... I need not read that.
SHRI MADHUSUDAN MISTRY: However, the expenditure, whether
recurring or not recurring, will be made out of the Consolidated Fund of
India. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: All right. ...(Interruptions)... Okay.
...(Interruptions)... Mistryji, please listen to me. ...(Interruptions)... Please
listen to me. ...(Interruptions)...

154
: logic discuss
logic discuss
..( ).. ,
close
MR. DEPUTY CHAIRMAN: Now, listen to me, please. ...(Interruptions)... I
will come to you. ...(Interruptions)... Listen to me. ...(Interruptions)...
Rule 186(7) says, On a Bill being introduced in the Council, at a subsequent
stage, if any objection is taken that the Bill is a Money Bill, within the
meaning of Article 110, and should not be proceeded within the Council, the
Chairman shall, if he holds the objection valid...... ...(Interruptions)...
(Contd. by 3h PK)
PK-LP/3H/4.30
MR. DEPUTY CHAIRMAN: Here, I don't hold the objection valid.
..(Interruptions).. I don't hold the objection valid. Okay, now proceed.
Next is, Mr. Rajeev Gowda. ..(Interruptions).. I don't hold the objection
valid. A little bit of tamasha is also good.

155
SHRI JAIRAM RAMESH: No, no, Sir, it is *.
MR. DEPUTY CHAIRMAN: The words * are expunged. That is an
aspersion on the Chair.
SHRI JAIRAM RAMESH: Sir, aspersion is not on you; it is on the
Government.
MR. DEPUTY CHAIRMAN: Okay. Now, Shri Rajeev Gowda.
PROF. M.V. RAJEEV GOWDA (KARNATAKA): Sir, as I rise to speak on
the Mental Healthcare Bill, 2013, my mind goes back to a childhood
memory. I was a young child and I saw a naked woman with a young boy
throwing stones at her. I asked the person who was with me as to what
was going on. The older boy, who was with me, said, "She is a hoochi",
which means she is a mad woman, and that woman is running away. That
is the kind of treatment the poor people with mental illness get and this is
the situation all over the country and they are still suffering in various parts.
This Bill is a humane Bill. This Bill is a part of the UPA's efforts to empower
people with rights, and in this case, it empowers those with mental illness
with the right to dignity, the right to treatment, the right to autonomy and to

156
make their own choices with regard to their treatment. Sir, for this, I want
to congratulate Shri Ghulam Nabi Azad, the Leader of the Opposition now,
and who was the then Health Minister, who had the foresight to bring
forward this Bill and also to make India's legislation in consonance with the
UN Convention on the Rights of Persons With Disabilities. Sir, we are
worried about the growth of infectious diseases, we are worried about the
growth of non-transmissible diseases like diabetes, heart diseases and
things of that sort. But the other ticking time bomb in this country is mental
illness. Today, we don't really have exact numbers on the nature and the
extent of mental illnesses of different sorts, but, fundamentally, there are
numbers that are out there. One such number says that mentally ills in
India already constitute 6.5 per cent, and by 2020, just in the next four years,
that percentage may go up all the way to 20 per cent of Indians. We are
living in a much more stressful world. We are living in a world where
economic pressures are causing innumerable stresses on people and also
on families. We are living in a world where urbanisation is seeing millions of
people seeking migration and difficulties of adjusting to a new situation. We
are seeing families change from being a support system to people being on
their own. Even more importantly, Sir, what we are seeing today is the rise
157
of hate speeches towards different communities and people being targetted
in such a way that people growing up in these communities wonder what
have they done to incur this hate and to be the targets. This will cause
stress and mental illness in its own way.
Sir, our Constitution talks about our desire to provide equality of
opportunity. But equality of opportunity will not happen if a person does
not have the capacity to fully utilise his or her potential. And, the kinds of
mental illnesses that we have talked about today-- depression, anxiety,
bipolar disorders, schizophernia -- all these are barriers to people being able
to fulfil their own potential. Sir, there are many, many good things in this
Bill, and one of the most important is the fact that it decriminalises suicide.
Other speakers have also spoken about that. When a person attempts to
take his or her own life, that person is crying for help. That person is not
some one who should be treated as a criminal and thrown behind bars. We
need to reach out to them and find a way to overcome the problems that
have caused that kind of action. So, in this context, the Health Minister is
not here -- but the other Ministers may please convey -- media has an
important role to play. We need to urge the media to develop some kind of
a code of conduct for itself. Everyday, in every newspaper, on the second

158
or third page, you will find stories about people committing suicide. When
other people, who are vulnerable, who are wavering on how to cope with
their own crisis, when they see such stories, that can break them and cause
them to indulge in a copy-cat act. So, I urge upon the Health Minister to
reach out to the media and suggest to them that just like they cover
communal clashes in a much more temperate manner, they should also find
a way to not stress upon suicides the way they do currently, which creates
a signalling effect that might affect numerous others.
(Contd. by PB/3J)
PB/3J/4.35
PROF. M.V. RAJEEV GOWDA (CONTD.): Sir, when we think about
suicides, there is so much that can be done in terms of outreach, in terms of
counselling, in terms of prevention. Shri Nadda is the President of the
NIMHANS institution. I am the Rajya Sabha Member in that institution, and
we have spent time together talking about how much more the institution
needs to do in terms of outreach, in terms of counselling, and this is
something that needs to be done in the particular context of farmers
suicides as well. We know that sometimes crops are failing, we know that
people are under stress. If we reach out to the banks ahead of time, we may
159
find out who is unable to pay. There are so many early warnings that we can
catch. But we dont have the infrastructure, the personnel, the will to go out
there and prevent problems from occurring in the first place. We must
change that.
Sir, this Bill asked for a lot of infrastructural investment and that is
something which, of course, makes us question whether it is a Money Bill or
not. But the good thing about this infrastructure investment is that a lot of
this infrastructure is not a separate mental hospital but an integration of
mental care facilities with general hospitals which is a good thing which
removes the stigma associated with mental illness. Sir, the biggest need --
and many speakers before me have mentioned this -- is community
rehabilitation centres. These are not hospitals but these are in-between
homes which allow people to find a way to settle down as they move from
treatment back into the community, back into the bosom of their family. We
need many more of these sorts of institutions out there. But, most
importantly, when we talk about infrastructure, we need human resources.
That is the crucial infrastructure. Our count of psychiatrist to the general
population is point two per hundred thousand. This is really, really
inadequate, and that is at the doctor level. But what about at the mental
160
health nurses level? What about training others to be more sensitive to
mental health issues? Others have already spoken about this. But you start
with the auxiliary nurse midwife in the villages and sensitize her how to deal
with children who might have problems. Actually, we need tremendous
curricular innovation, we need short programmes, long programmes,
various training initiatives that will ensure that teachers in schools are
sensitized to adolescents and their own problems and that they can prevent
them from being bullied, from breaking down and mental illnesses cropping
up and worsening the situation. So, there is a tremendous amount of work,
amount of curriculum, amount of training that needs to be done across
domains to ensure that counselling becomes an integral part of every
school, every college. We have to therefore reach out to the voluntary
organizations. There are numerous NGOs. Instead of going after NOGs, we
should go to them, request them to scale up their operations, do more in
this sector, help the older people cope with mental illness. Whenever there
are disasters, whenever there are crisis situations, natural disasters, people
are in deep trouble, and we need measures to ensure that they also get
counselling and other kinds of support. During exam time, we need much
more ramping up of suicide hotlines and other kinds of measures that will
161
help teens cope with the pressures that we, the parents, put on them.
...(Time-bell)...
Sir, there are many other good things in this Bill like the advance
directive. On the nominated representative, we have issue of how families
get integrated when somebody exploits the patients. These are all issues.
Families themselves need tremendous counselling and support because
taking care of people with mental illness is very stressful, and for those who
have to cope with suicide tendencies, it is even much more devastating and
many are not able to do so.
Sir, there is one other issue about the kind of treatment directives that
are mentioned in this Bill versus judgement of doctors themselves. That is
something that must be enumerated as we go forward.
(Contd. by 3k/SKC)
SKC-SCH/3K/4.40
SHRI PROF. M.V. RAJEEV GOWDA (contd.): When that happens, then,
this humane Bill, this wonderful, positive, rights-oriented Bill, which was
piloted initially by Shri Ghulam Nabi Azad and now, gives the honour to Shri
Nadda to take it forward to completion, would strengthen the mental health

162
of all Indians and unleash our potential, so that we can be a transformative
people going forward. Thank you, Sir.
(Ends)
MR. DEPUTY CHAIRMAN: So, Jairam Rameshji, now I have understood
why you opposed it, because this was first piloted by Shri Ghulam Nabi
Azad. ...(Interruptions)...
SHRI JAIRAM RAMESH: He referred to Ghulam Nabiji. I didnt take
objection to that at that time.
MR. DEPUTY CHAIRMAN: Then, I stand corrected. Now, Shri Husain
Dalwai. Your Partys time is over. If you finish your speech in three minutes,
I can allow it.
SHRI HUSAIN DALWAI: Okay, Sir.
MR. DEPUTY CHAIRMAN: All right, then. Go ahead.
( ) : , ,

163
, , mental illness
prevention
, Mental illness -
, mentally
ill stress anxiety mental illness
psychological development ,
mental disorder ,
Ministry of Health
, Ministry of HRD
- ,
, ,
,
164
Corporate Sector , mental tension
12-12, 14-14
Ministry of Home Affairs
, - suicide Mental
illness suicide , ?
, electric shock
, anesthesia , ,
infrastructure ,
anesthetist ...( )...
caregiver definition , ,
- -
mentally ,
illness , ,
Caregiver

165
, Dr. Anand Nadkarni,
Mental Hospital
infrastructure , human resource ,
involve ...( )...
, - ,
- mental stress cases
(3l/KLG )
skc/sch -- KSK/KLG/4.45/3L
( ): 1992
, ,
, -
, , , ,
, ,
, ( )
166
MR. DEPUTY CHAIRMAN: Now, all those who gave their names in time
have spoken, but I have three requests which were received after the
discussion had started. If they can adhere to the time limit of three minutes,
I can allow them.
SHRI T.K. RANGARAJAN: Mr. Narayanan has also given his name.
MR. DEPUTY CHAIRMAN: That is what I am saying. Mr. Narayanans
name also came after the start of the discussion. The rule is the same for
everybody. It is equal to all. I can allow them on the condition that they will
adhere to the time limit of three minutes. Shri D.P. Tripathi - not present.
Shri C.P. Narayanan, please finish within three minutes. ...(Interruptions)...
SHRI T.K. RANGARAJAN: Please give the balance time to Mr. Narayanan.
MR. DEPUTY CHAIRMAN: See, the name was given after the discussion
had started. Therefore,...(Interruptions)... Kerala means, I can even
reduce by one minute. ...(Interruptions)...
SHRI C.P. NARAYANAN: You can reduce everything. I dont mind.
MR. DEPUTY CHAIRMAN: Take three minutes.
SHRI C.P. NARAYANAN(KERALA): Sir, I want to mention two
experiences in connection with this Bill. One is that in 2002, some NGOs in
167
Kerala, with the help of experts, conducted a study about the eight-year old
children in schools. We took a sample of 6,000 children. When we made a
study, the finding was that about 80-83 per cent of the children had some
kind of stress or strain, and more than 30 per cent of that was classified as
severe, and 13-15 per cent of the children showed suicidal tendencies. This
analysis showed that the sources from where these children had these
stresses and strains were the classrooms and their families. I am
mentioning this in connection with this Bill. In this Bill, the Government is
trying to observe the findings of the UN Conventions regarding such people,
and along with that, the Government is trying to provide facilities in various
hospitals. These things are good. But what we find is that in our earlier
feudal society, this was considered a stigma. I know about so many
children whose names were not given when the Panchayats used to make
studies regarding the people having various kinds of ailments. This was so
because it was considered that mentioning about a family member having
some kind of mental problem might create difficulties for his/her brothers
and sisters in getting employment, marriage, etc. That was the kind of
approach the society had, not in very old days, but in the recent past also.
So, this is the situation. As many of my learned colleagues have said, we

168
should not simply concentrate on work in the hospitals only. A sufficient
kind of awareness has to be created among the people. We know certain
cases of such ailments. Unless their parents and family members, and even
their colleagues, take care of them, their ailments cannot be cured fully.
Patients, who have been treated by the doctors and who have been found
to be satisfactorily taken care of, all of a sudden, may develop bursts of
such diseases.
(Contd. by 3M GSP)
GSP-PSV/3M/4.50
SHRI C.P. NARAYANAN (CONTD): We have to take care of this. ...(Time-
bell) I conclude by saying one more thing. If it is to be done, not only the
Health Department has to take care, the other departments, the Education
Department, the local bodies, the Women and Child Development
Department, have also to take care of it, and sensitize people so that from
the time the ailment is recognized to the time when the ailments have been
treated, and, even after that, people who have got a weak mind, they are
properly treated. Thank you. (Ends)
SHRI T. G. VENKATESH (ANDHRA PRADESH): Mr. Deputy Chairman, Sir,
I thank you for giving me this opportunity to speak on such a significant

169
legislation. On behalf of the Telugu Desam Party, I welcome this
Government's move of bringing in this important legislation, that is, the
Mental Healthcare Bill.
Mr. Deputy Chairman, Sir, mental health is one of the most neglected
areas in our country. Lifestyle factors such as lack of physical exercise,
unhealthy eating habits, inappropriate use of technology and increased
working hours contribute to increasing rates of depression, anxiety
disorders, suicides and substance abuse in working professionals. As per
NCRB data, farmers and housewives are two categories of people in which
suicide rates are high. It is disheartening to know that suicide is the second
largest cause of death in the youth of India. I hope, this legislation will lead
to establishment of more research centres in future, to study, understand
and tackle these avoidable deaths.
There is a shortage of mental health professionals in India. Present
data shows that there are only 4,000 psychiatrists, 1,000 psychologists and
3,000 social workers for the whole country. Only, 1,022 college seats are
available for mental health professionals. The existing infrastructure is totally
inadequate considering the point that five per cent of the Indian population,
which translates to fifty million, suffer from some sort of mental illness.
170
We welcome the Government's plans to define rights of persons with
mental illness and registering the establishments of State and Central Mental
Health Authorities, which are of immediate importance.
Mr. Deputy Chairman, Sir, this Government has also brought the first
ever National Mental Health Policy in 2014. However, the implementation
has been slow, and I hope this Bill provides necessary thrust required to fast
track the implementation.
Sir, as per the NCRB Report, 2014, around twelve per cent of the total
suicides in the country were reported from Andhra Pradesh. Most of them
were farmers and students. I would request the hon. Minister to take
necessary steps to take forward both the implementation of the Bill as also
the Mental Health Policy by allocating more budget in the next financial year.
(Time-bell) Sir, I wish to say one more thing. The percentage of suicides in
Andhra Pradesh is almost 200 per cent of the average. Sir, somehow, the
Government of India is postponing the special status Bill for the last two
years. If this continues, the percentage of suicides in Andhra Pradesh may
increase by another 100 per cent. My request is that the Government may
implement special status also. Thank you.
(Ends)
171
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-PSV/VNK-SK/3N/4.55
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173
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174

175

()
SHRI A. NAVANEETHAKRISHNAN: Sir, I just want to have one
clarification.
MR. DEPUTY CHAIRMAN: No, no; clarification will be after reply, not now.
SHRI A. NAVANEETHAKRISHNAN: I want to ask him so that he can clarify
it during the reply.
MR. DEPUTY CHAIRMAN: Without reply, how can you seek clarifications?
SHRI A. NAVANEETHAKRISHNAN: Sir, the question which I want to raise
has not been raised by any Member.
SHRI S. MUTHUKARUPPAN: Sir, there is a doubt in the Bill itself.
..(Interruptions).. It is a legal aspect.
SHRI A. NAVANEETHAKRISHNAN: It is a legal aspect ..(Interruptions).. I
would like to have a clarification through you, Sir. There is nothing wrong in
176
it. In clause 124, there is an amendment moved by the hon. Minister in
which the term 'mental illness' ..(Interruptions)..
MR. DEPUTY CHAIRMAN: When that amendment is moved, you raise it at
that time.
SHRI A. NAVANEETHAKRISHNAN: I wish to correct it.
MR. DEPUTY CHAIRMAN: Yes, you do it at that time.
SHRI A. NAVANEETHAKRISHNAN: Okay, Sir.
Pp 177 onwards will be issued as supplement.

177
-VNK/MCM-YSR/3O/5.00
THE MENTAL HEALTH CARE BILL, 2013 (CONTD.)
( ) : ,
, 2013 , 16
concerns show
, 2013
concerns
valuable suggestions ,
complex situation individual
, problem ,
society social angle
impact
, - safeguards ,
rightful
conducive environment
approximately 6-7 per cent people suffer
from some type of mental illness and acute mental illness, 1-2 per cent
, ,

178
, 1987 ,
, -
, 2013 , patient
centric ,
interest safeguard ,
, ,
consultation , the story started
in 2010,
, ,
, academia ,
, deliberations care givers
, service users ,
Bill
humane approach It talks about caregivers and
community-based rehabilitation. institutional admissions

179
discourage community-based treatment ,
, concern
abandon
, need based ,
electroconvulsive treatment
muscle relaxant
anaesthesia
, , under medical advice only
, hygiene
, ,
mechanism strengthen ,
accountability statutory authorities like the Central
Mental Health Authorities and the State Mental Health Authorities

180
, advanced directives,
, at this stage also, we can give advanced
directives ,
, advanced directives
nominated representatives , nominated
representatives , cultural background , tastes
, habits , interests ,
, , priorities ,
inclinations ,
(3P/DS )
DS-BHS/5.05/3P
( ) : mentally ill persons rights
safeguard Right to access to mental health -
Right to mental health ,
National Mental Health Programme NHM
District Mental Health Programme financially support ,

181
Right to community living - stigma
, integrate ,
separate separate ,
Right to community living Right to
protection from cruel and inhuman treatment - cruel
and inhuman treatment , legally facilitate
Right to equality and non-discrimination,
Right to information, Right to confidentiality,
, mentally ill person empower
interests safeguard
Recognition of role of caregivers - caregivers role recognize
Who will be a caregiver? What type of facility, is he going to give?
How is he going to take care of the person? Caregivers
Central Mental Health Authority State Mental Health Authority
representation , statutory provision ,
caregivers
mental illness define
institutions
institutions -
182
mental illness define mental
healthcare ? International standards mental healthcare ,
determine a person is
mentally ill or not, define -
, define ,
, mental illness define ,
mental illness define , define
internationally recognised procedure ,
recognise
, planning the design to implement the Mental Health
Programme; Mental health programme ,
More checks on involuntarily admissions -
checks , involuntarily admissions
30 mental institutions
maximum 90 days under the strict
guidance and directions of the psychiatrist.
, Community living
, community
183
living what type of facilities the State Governments will have to
provide. Homes, half-homes ,
In due course, how
we are going to translate and implement, State
Mental Authorities mandate
electroconvulsive therapy
adults
, anesthesia muscle relaxation
(3 / )
-BHS/DC-SC/5.10/3Q
( ) : Psychosurgery ,
psychosurgery Psychosurgery reasons
District Board approve
, District Board approve
Mental Healthcare Bill meaningful
135 amendments reason Reason it is a

184
continuous process. It started in 2010. 2013
2014 introduce ,
introduce
Standing Committee , Standing Committee 25
amendments - amicus curiae
recommendations , recommendations
, , civil societies - Standing
Committee 25 amendments , 4 amendments ,
1, inter-ministerial consultations 5
13 substantive amendments , they are 48. These are
substantive amendments, which we have accepted. We have, practically,
accepted all the recommendations of the Standing Committee.
recommendations , ,
consequential Psychiatrist Mental Health Officer,
Mental Health Worker - word , - amendment
terminology - use , -
135 amendments , ,

185
NIMHANS 1 , 2015 , about the finding
of the mentally ill persons 6 zones NIMHANS
exhaustively
, there is a shortage of
staff. But we are trying our level best to get over this problem. You will be
happy to note post-practitioner psychiatry 1:1
ratio , 1:3 500 , 1,500
Associate Professor
enhance
definition of mental illness , according to WHO
standards
concerns , intimate wide
consultation progressive
patient, , direction
patient , rights protect ,
individual right , mentally

186
ill person ,
( )
MR. DEPUTY CHAIRMAN: Okay. Thank you. ...(Interruptions)... What is
this? ...(Interruptions)...
: ,
MR. DEPUTY CHAIRMAN: Okay. Mr. Mistry, only one question.
: , clarification
- 18 40
population affected , ,
symptoms , ,
, family,
awareness , ?
SHRI JAGAT PRAKASH NADDA: In the National Mental Health Programme,
we are doing that awareness programme. ...(Interruptions)...
(3- )
187
KR/GS/3R/5.15
( ): ,
MR. DEPUTY CHAIRMAN: Please reply at the end because there are two or
three Members who want to seek clarifications.
SHRI T.K. RANGARAJAN: Mr. Deputy Chairman, Sir, Section 133
empowers the State Authority to make regulations. Can you prescribe any
timeframe? Suppose the State Authority doesnt implement it in a
prescribed time, say, six months or seven months or one year, then, what
will you do?
PROF. M. V. RAJEEV GOWDA: The Government is actually backing this
Bill; see the poor turnout on the side of the Treasury Benches. Lots of Rajya
Sabha Members and heavyweight Cabinet Ministers have not shown up,
and we are about to pass this Bill. Why is there no support?
..(Interruptions)..
MR. DEPUTY CHAIRMAN: No. That is no clarification. Dr.T. Subbarami
Reddy.
DR. T. SUBBARAMI REDDY: Sir, while welcoming the Bill, I want to bring
one important issue to the notice of the hon. Minister. There are cases
188
where family members of a good person, mentally perfect person, take him
to the doctor mischievously and show him as if he is a patient due to
internal disputes. Then, they join hands with the Superintendent of the
hospital also. You must give warning to the Superintendent or in charge of
the hospital that if they intentionally admit a good person and perfect
person,....
MR. DEPUTY CHAIRMAN: If it is an amendment, you say at that time.
DR. T. SUBBARAMI REDDY: What action are you taking against those who
are showing good persons to the doctors as mentally ill persons in
connivance with hospital authorities?
MR. DEPUTY CHAIRMAN: If it is an amendment, you can speak at that
time. Mr. Jairam Ramesh.
: ,
MR. DEPUTY CHAIRMAN: Sit down, sit down. That is irrelevant. ,
No, that is enough. That is enough.
: , 133 , it is up to the State to
decide how long they are going to take. But we want that it should be done
as fast as possible. (Ends)

189
MR. DEPUTY CHAIRMAN: The question is:
That the Bill to provide for mental healthcare and services for persons
with mental illness and to protect, promote and fulfill the rights of
such persons during delivery of mental healthcare and services
and for matters connected therewith or incidental thereto, be
taken into consideration.
The motion was adopted.
MR. DEPUTY CHAIRMAN: We shall now take up clause-by-clause
consideration of the Bill. In Clause 2, there are six Amendments;
Amendment (Nos.5, 6,7,8,9 and 10) by the Minister. Mr. Minister.
CLAUSE 2 DEFINITIONS
SHRI JAGAT PRAKASH NADDA: Sir, I move:
(5) That at page 2, after line 18, the following be inserted, namely:-
"(ba) "Authority" means the Central Mental Health Authority

or the State Mental Health Authority, as the case may be;".
(6) That at page 2, line 20, for the words, bracket and figures
"Commission under sub-section (1) of section 80", the words
bracket and figures "State Authority under sub-section (1) of section
80 in such manner as may be prescribed;" be substituted.
(7) That at page 2, for lines 30 to 39, the following be substituted,

190
namely:-
"(ii) having a Post-Graduate degree in Psychology or Clinical

Psychology or Applied Psychology and a Master of Philosophy in
Clinical Psychology or Medical and Social Psychology obtained after
completion of a full time course of two years which includes
supervised clinical training from any University recognised by the
University Grants Commission established under the University Grants
Commission Act, 1956 and approved and recognised by the
Rehabilitation Council of India Act, 1992 or such recognised
qualifications as may be prescribed;" .
"(na) "mental healthcare" includes analysis and diagnosis of a

person's mental condition and treatment as well as care and
rehabilitation of such person for his mental illness or suspected
mental illness;".
(9) That at page 4, for lines 9 and 10, the following be substituted,
namely:-
"(iii) a professional having a Post-Graduate degree

(Ayurveda) in Mana Vigyan Avum Manas Raga or a Post-Graduate
degree (Homeopathy) in Psychiatry or a Post-Graduate degree
(Unani) in Moalijat (Nafasiyatt) or a Post- Graduate degree (Siddha)
in Sirappu Maruthuvam;".

namely:-
191
"(w) "psychiatric social worker" means a person having a

Post-Graduate degree in Social Work and a Master of Philosophy in
Psychiatric Social Work obtained after completion of a full time
course of two years which includes supervised clinical training from
any University recognised by the University Grants Commission
established under the University Grants Commission Act, 1956 or
such recognised qualifications, as may be prescribed.'.
The questions were put and the motions were adopted.
Clause 2, as amended, was added to the Bill.
Clause 3 was added to the Bill.
MR. DEPUTY CHAIRMAN: In Clause 4, there are two Amendments;
(Amendment Nos.11 and 12) by the Minister. Mr. Minister.
CLAUSE 4 CAPACITY TO MAKE MENTAL HEALTH CARE AND TREATMENT

DECISIONS

namely:-
"4.(1) Every person, including a person with mental illness shall

be deemed to have capacity to make decisions regarding his mental
healthcare or treatment if such person has ability to-
(a) understand the information that is relevant to take a

192
decision on the treatment or admission or personal assistance; or
(b) appreciate any reasonably foreseeable consequence of a

decision or lack of decision on the treatment or admission or personal
assistance; or
( c) communicate the decision under sub-clause (a) by means

of speech, expression, gesture or any other means.".
(12) That at page 5, lines 33 to 35, be deleted.
MR. DEPUTY CHAIRMAN: In Clause 6, there is one Amendment (No.13) by
the Minister.
CLAUSE 6 MANNER OF MAKING ADVANCE DIRECTIVE

namely:-
"6. An advance directive shall be made in the manner as may

be specified by the regulations made by the Central Authority".
The question was put and the motion was adopted.

193
MR. DEPUTY CHAIRMAN: In Clause 8, there is one Amendment (No.13) by

the Minister.
CLAUSE 8 REVOCATION, AMENDMENT OR CANCELLATION OF

ADVANCE DIRECTIVE
(14) That at page 6, in lines 35 and 38, the words, bracket and figure
"sub-section (1) of be deleted.
Clauses 9 and 10 were added to the Bill.
(Continued by 3S/KS)
KS/3S/5.20
MR. DEPUTY CHAIRMAN: We shall now take up Clause 11. In Clause 11,
there is one Amendment (No. 15) by Shri Jagat Prakash Nadda.
CLAUSE 11 POWER TO REVIEW, ALTER, MODIFY OR

CANCEL ADVANCE DIRECTIVE

194
(15) That at page 7, in lines 7 and 9, for the word may, the word
shall be substituted.

CLAUSE 12 REVIEW OF ADVANCE DIRECTIVES
(16) That at page 7, in lines 29, 31 and 34, for the word Commission,
the words Central Authority be substituted.

Clauses 13 to 17 were added to the Bill.
there are three Amendments (Nos. 17, 18 & 19) by Shri Jagat Prakash
Nadda.
CLAUSE 18 RIGHT TO ACCESS MENTAL HEALTH CARE

195
(17) That at page 10, line 13, after the word "accommodation", the words
"as may be prescribed" be inserted.
(18) That at page 10, line 16, after the word "services", the words "as
may be prescribed " be inserted."
(19) That at page 11, lines 24 to 27, be deleted.

CLAUSE 19 RIGHT TO COMMUNITY LIVING
"(1A) Where it is not possible for a mentally ill person to live with
his family or relatives, or where a mentally ill person has been
abandoned by his family or relatives, the appropriate Government
shall provide support as appropriate including legal aid and to facilitate
exercising his right to family home and living in the family home.".

196
there are two Amendments (Nos. 21 and 22 ) by Shri Jagat Prakash Nadda.
CLAUSE 21 RIGHT TO EQUALITY AND NON-DISCRIMINATION
(21) That at page 12, line 28, for the words "health services", the
word "illness" be substituted.
namely:-
"(2) A child under the age of three years of a woman receiving

care, treatment or rehabilitation at a mental health establishment shall
ordinarily not be separated from her during her stay in such
establishment:
Provided that where the treating Psychiatrist, based on his

examination of the woman, and if appropriate, on information
provided by others, is of the opinion that there is risk of harm to the
child from the woman due to her mental illness or it is in the interest
and safety of the child, the child shall be temporarily separated from
the woman during her stay at the mental health establishment:
Provided further that the woman shall continue to have access to

the child under such supervision of the staff of the establishment or
her family, as may be appropriate, during the period of separation.
(3) The decision to separate the woman from her child shall be
reviewed every fifteen days during the woman's stay in the mental
197
health establishment and separation shall be terminated as soon as

conditions which required the separation no longer exist:
Provided that any separation permitted as per the assessment of

a mental health professional, if it exceeds thirty days at a stretch,
shall be required to be approved by the respective Authority.
(4) Every insurer shall make provision for medical insurance for
treatment of mental illness on the same basis as is available for
treatment of physical illness.".
The questions were put and the motions was adopted.

there are two Amendments( Nos. 23 and 24) by Shri Jagat Prakash Nadda.
CLAUSE 23 RIGHT TO CONFIDENTIALITY
namely:-
"(e) release only such information as is necessary to prevent

threat to life;".
198
(24)That at page 13, line 32, for the word "Commission", the words
"Central Authority" be substituted.

there are three Amendments (Nos. 25, 26 and 27) by Shri Jagat Prakash
Nadda.
CLAUSE 25 RIGHT TO ACCESS MEDICAL RECORDS
namely:-
"25.(1) All persons with mental illness shall have the right to
access their basic medical records as may be prescribed;".
(26) That at page 14, in lines 1 and 6, for the word "psychiatrist", the
words "mental health professional" be substituted.
(27) That at page 14, line 6, the words "or her" be deleted.

199
there are two Amendments (Nos. 28 and 29) by Shri Jagat Prakash Nadda.
CLAUSE 26 RIGHT TO PERSONAL CONTACTS AND

COMMUNICATION
(28) That at page 14, lines 10 and 11, for the words "of the day subject to
the rules of such mental health establishment", the words "subject to
the norms of such mental health establishment" be substituted.

CLAUSE 27 RIGHT TO LEGAL AID
(30) That at page 14, line 29, after the words duty of, the following be
inserted, namely:-
"magistrate, police officer, person in charge of such custodial

institution as may be prescribed or".
200
(31) That at page 14, line 29, for the word "psychiatrist", the words
"mental health professional" be substituted.

there are three Amendments (Nos. 32, 32 and 34) by Shri Jagat Prakash
Nadda.
CLAUSE 28 RIGHT TO MAKE COMPLAINTS ABOUT

DEFICIENCIES IN PROVISION OF SERVICES
(32) That at page 14, in line 33, the words, "or her" be deleted.
(33) That at page 14, in line 36, for the word "psychiatrist", the words
namely:-
"(b) the concerned Board and if not satisfied with the response;
(c) the State Authority.".

(FOLLOWED BY RSS/3T)
201
RSS/3t/5.25
there is one Amendment (No.135) by Dr. T. Subbarami Reddy. Mr. Reddy,
are you moving the Amendment?
DR.T. SUBBARAMI REDDY: I am satisfied with the reply of the Minister.
Hence, I am not moving the Amendment.
there is one Amendment (No. 136) by Dr. T. Subbarami Reddy, and one
Amendment (No.31) by the hon. Minister. Mr. Reddy, are you moving the
Amendment?
CLAUSE 31 - APPROPRIATE GOVERNMENT TO TAKE MEASURES AS

REGARD TO HUMAN RESOURCE DEVELOPMENT AND TRAINING, ETC
DR. T. SUBBARAMI REDDY (ANDHRA PRADESH): Sir, I move:

202
(136). That at page 15, line 27, for the word "ten", the word "five" be
substituted.
The question was put and the motion was negatived.
MR. DEPUTY CHAIRMAN: Now, Mr. Minister.
(35) That at page 15, lines 29 to 31 be deleted.
there are two Amendments (Nos.137 and 138) by Dr. T. Subbarami Reddy
and three Amendments (Nos.36 to 38) by the hon. Minister. Mr. Reddy, are
you moving the amendment?
DR. T. SUBBARAMI REDDY: No, Sir.
MR. DEPUTY CHAIRMAN: Now, Mr. Minister.

203
CLAUSE 34 - COMPOSITION OF CENTRAL AUTHORITY
(36) That at page 16, after line 10, the following be inserted ,namely:-
"(ga) such other ex-officio representatives from the relevant Central

Government Ministries or Departments;".
(37) That at page 16, after line 27, the following be inserted,namely:-
"(o) two persons representing areas relevant to mental health, if

considered necessary." .
(38) That at page 16, line 28, for the words, brackets and alphabets
"clauses (h) to (n)", the words, brackets and alphabets "clauses
(h) to (0)" be substituted.
there is one Amendment (No. 39) by the hon. Minister.
CLAUSE 35 - TERM OF OFFICE, SALARIES AND ALLOWANCES OF

CHAIRPERSON AND MEMBERS

204
(39) That at page 16, line 30, for the words, brackets and alphabets
"clauses (h) to (n)", the words, brackets and alphabets
"clauses (h) to (0)" be substituted.
there is one Amendment No. (139) by Dr. T. Subbarami Reddy and two
Amendments (Nos. 40 and 41) by the hon. Minister. Mr. Reddy, are you
moving the Amendment?
DR. T. SUBBARAMI REDDY: No, Sir.
there are two Amendments (Nos.40 and 41) by the hon. Minister.
CLAUSE 46 - COMPOSITION OF STATE AUTHORITY
"(da) such other ex-officio representatives from the relevant State

205
Government Ministries or Departments;".
(41) That at page 20, line 3, for the word "Superintendent", the word
Head" be substituted.
MR. DEPUTY CHAIRMAN: In Clause 52, there is one Amendment (No. 42) by the
hon. Minister.
CLAUSE 52 - OFFICERS AND OTHER EMPLOYEES OF STATE AUTHORITY
(42) That at page 21, line 14, for the word "Director", the words
"Deputy Secretary" be substituted.
(Continued by 3U)
-RSS/RL-LP/5.30/3U

206
CLAUSE 63- ACCOUNTS AND AUDIT OF STATE AUTHORITY
(No. 43) That at page 24, lines 33 to 37 be deleted.

there are two Amendments (Nos. 44 and 45) by the hon. Minister.
CLAUSE 65- REGISTRATION OF MENTAL HEALTH ESTABLISHMENT
(No. 44) That at page 25, after line 8, the following be inserted, namely:-
"Provided that the Central Government, may, by

notification, exempt any category or class of existing mental
health establishments from the requirement of registration under
this Act.".
(No. 45) That at page 25, in lines 30, 32, 34 and 35, the word "Central"
be deleted.

207
there are three Amendments, Amendments (Nos. 46 and 47) by hon.
Minister & Amendment (No. 140) by Dr. T. Subbarami Reddy.
CLAUSE 66- PROCEDURE FOR REGISTRATION, INSPECTION AND

INQUIRY OF MENTAL HEALTH ESTABLISHMENTS
DR. T. SUBBARAMI REDDY (ANDHRA PRADESH): Sir, I want to draw the
attention of the Minister to the sub-clause 14, which says, As soon as the
mental health establishment submits the required evidence of the mental
health establishment having complied with the specified minimum
standards, the Authority shall give public notice and display the same on its
website for a period of thirty days. I am saying that it should be 45 days.
You should give more time; thats all. Therefore, I am moving the
Amendment.
Sir, I move:
(No. 140) That at page 26, line 14, for the words "forty-five days", the
words thirty days" be substituted.

208
(No. 46) That at page 27, line 4, for the word "thirty", the word "forty-
five" be substituted.
(No. 47) That at page 27, lines 12 to 15, the following be substituted,
namely:-
"(19) Notwithstanding anything contained in this section, if

the Authority has neither communicated any objections received
by it to the mental health establishment under sub-section (15),
nor has passed an order under sub-section (18), the
registration shall be deemed to have been granted by the
Authority and the Authority shall provide a permanent certificate
of registration".
MR. DEPUTY CHAIRMAN: I shall first put the Amendment (No. 140) moved
by Shri T. Subbarami Reddy to vote.
The question was put and the motion was negatived.
MR. DEPUTY CHAIRMAN: I shall now put the Amendments (Nos. 46 and
47) moved by the hon. Minister to vote.

209
CLAUSE 67- AUDIT OF MENTAL HEALTH ESTABLISHMENT
(No.48) That at page 27, lines 44 and 45, the following be substituted,
namely:-
"(7) The Authority may cancel the registration of a mental
health establishment if recommended by the Board to do so".

there are two Amendments (Nos. 141 and 142) by Dr. T. Subbarami Reddy.
Are you moving?
DR. T. SUBBARAMI REDDY: Sir, I am satisfied with the reply, so I am not
moving them.

210
CLAUSE 70- CERTIFICATES, FEES AND REGISTER OF MENTAL

HEALTH ESTABLISHMENTS
(No. 49) That at page 28, after line 34, the following be inserted, namely:-
"(3A) Any change of ownership of the mental health

establishment shall be intimated to the Authority by the new
owner within one month from the date of change of ownership."

(Contd. by TDB/3W)
TDB-AKG/3W/5.35
there is one Amendment (No.50) by the hon. Minister.
CLAUSE 73 - CONSTITUTION OF MENTAL HEALTH

REVIEW COMMISSION

211
CLAUSE 74 - COMPOSITION OF COMMISSION
(51) That at page 29, clause 74 be deleted.
CLAUSE 75 -QUALIFICATIONS FOR APPOINTMENT OF PRESIDENT

AND MEMBERS OF COMMISSION

212
CLAUSE 76 - SELECTION COMMITTEE
(53) That at pages 29 and 30, Clause 76 be deleted.
CLAUSE 77 - TERM OF OFFICE, SALARIES AND ALLOWANCES OF

PRESIDENT AND OTHER MEMBERS
(54) That at page 30, Clause 77 be deleted.

213
CLAUSE 78 - VACANCIES, ETC., NOT TO INVALIDATE PROCEEDINGS

OF COMMISSION
CLAUSE 79 - STAFF OF COMMISSION
there are two Amendments; Amendment (Nos.57-58) by the hon. Minister.
CLAUSE 80 - CONSTITUTION OF MENTAL HEALTH REVIEW BOARDS

214
namely:-
"CHAPTER XI
MENTAL HEALTH REVIEW BOARDS
80.(1) The State Authority shall, by notification, constitute

Boards to be called the Mental Health Review Boards, for the
purposes of this Act.
(2) The requisite number, location and the jurisdiction of the

Boards shall be specified by the State Authority in consultation with
the State Governments concerned.
(3) The constitution of the Boards by the State Authority for a

district or group of districts in a State under this section shall be such
as may be prescribed by the Central Government."
namely:-
"(4) While making rules under sub-section (3), the Central

Government shall have regard to the following, namely:-"
there are three Amendments; Amendment (Nos.59-61) by the hon.
Minister.
215
CLAUSE 81 - COMPOSITION OF BOARD
(59) That at page 31, line 10, for the figure "81", the figure and bracket
"81(1)" be substituted.
namely:-
"( c) two members, of whom one shall be a psychiatrist and the other
shall be a medical practitioner;"
(61)That at page 31, after line 20, the following be inserted, namely:-
"(2) A person shall be disqualified to be appointed as the chairperson or
a member of a Board or be removed by the State Authority, if he-
(a) has been convicted and sentenced to imprisonment for an offence

which involves moral turpitude; or
(b) is adjudged as an insolvent; or
(c) has been removed or dismissed from the service of the

Government or a body corporate owned or controlled by the
Government; or
(d) has such financial or other interest as is likely to prejudice the

discharge of his functions as a member; or
(e) has such other disqualifications as may be prescribed by the

216
Central Government.
(3) A chairperson or member of a Board may resign his office by notice in

writing under his hand addressed to the Chairperson of the State Authority
and on such resignation being accepted, the vacancy shall be filled by
appointment of a person, belonging to the category under sub-section (1)
of section 81".
CLAUSE 82 - DISQUALIFICATION AND REMOVAL
(62) That at pages 31 and 32, Clause 82, be deleted.

217
CLAUSE 83 - TERMS AND CONDITIONS OF SERVICE OF

CHAIRPERSON AND MEMBERS OF BOARD
(63.) That at page 32, line 15, for the words "president of the
Commission", the words "Chairperson of the State Authority" be
substituted.
there are three Amendment; Amendment (Nos.64-66) by the hon. Minister.
CLAUSE 84 - DECISIONS OF COMMISSION AND BOARD
(64,)That at page 32, line 19, for the word "Commission", the word
"Authority" be substituted.
(65)That at page 32, in the marginal heading, for the word "Commission",
the word "Authority" be substituted.
(66)That at page 32, line 23, for the word "Commission", the word

218
CLAUSE 86 - PROCEEDINGS BEFORE COMMISSION AND BOARD TO

BE JUDICIAL PROCEEDINGS
(67.) That at page 32, for lines 36 to 38, the following be substituted,
namely:-
"86. All proceedings before the Board shall be deemed to

be judicial proceedings within the meaning of sections 193, 219
and 228 of the Indian Penal Code."
(Followed by 3X-SSS)
-TDB/SSS & NBR & SCH & KLG/5.40 & 5.45.
MR. DEPUTY CHAIRMAN: We shall, now, take up Clause 87 of the Bill.
There is one Amendment (No. 68) by the Minister.

219
CLAUSE 87 -- MEETINGS
namely:-
87. The Board shall meet at such times and places
and shall observe such rules of procedures in regard to
the transaction of business at its meetings as may be
specified by regulations made by the Central Authority..
The question was put and the motion was adopted

Clause 87, as amended, was added to the Bill
Clause 88 was added to the Bill
There are two Amendments. One Amendment (No. 143) by Dr. T.
Subbarami Reddy. And, another one Amendment (No. 69) by the Minister.
Dr. Subbarami Reddy, are moving?
DR. T. SUBBARAMI REDDY (ANDHRA PRADESH): Sir, I am satisfied with
the reply. So, I am not moving the amendment. Now, Amendment (No. 69)
by Shri Nadda.
CLAUSE 89 POWERS AND FUNCTIONS OF COMMISSION

220

There are two Amendments (Nos. 70 & 71) by Minister.
CLAUSE 90 COMMISSION TO APPOINT EXPERT COMMITTEE TO

PREPARE GUIDANCE DOCUMENT
(70) That at page 34, line 1, for the word Commission, the words
Central Authority be substituted.
(71) That at page 34, in the marginal heading, for the word
Commission, the words Central Authority be substituted.
The questions were put and the motions were adopted

There are four Amendments (Nos. 72 to 75) by Minister.
CLAUSE 91 POWERS AND FUNCTIONS OF BOARD

221
(72) That at page 34, line 14, for the word "psychiatrists", the words
namely:-
"(2) Where it is brought to the notice of a Board or the

Central Authority or State Authority, that a mental health
establishment violates the rights of persons with mental illness,
the Board or the Authority may conduct an inspection and
inquiry and take action to protect their rights.".
(74) That at page 34, line 30, for the word "Commission", the word
namely:-
"(4) If the mental health establishment does not comply

with the orders or directions of the Authority or the Board or
willfully neglects such order or direction, the Authority or the
Board, as the case may be, may impose penalty which may
extend up to five lakh rupees on such mental health
establishment and the Authority on its own or on the
recommendations of the Board may also cancel the registration
of such mental health establishment after giving an opportunity
of being heard.".

222
There are two Amendments (Nos. 76 and 77) by Minister.
CLAUSE 92 APPEAL TO HIGH COURT AGAINST ORDER OF

COMMISSION OR BOARD
(76) That at page 34, line 37, for the word Commission, the word
Authority be substituted.
(77) That at page 34, in the marginal heading, for the word
Commission, the word Authority be substituted.

There are three Amendments (Nos. 78 to 80).
CLAUSE 93 GRANTS BY CENTRAL GOVERNMENT TO COMMISSION
(78) That at page 34, for lines 43 to 45, the following be

substituted, namely:-
Grants by 93. (1) The Central Government may, make to the
Central Central Authority grants of such sums of money as the
223
Government Central Government may think fit for being utilized for the
purposes of this Act. .
(79) That at page 35, line 2, for the word president, the word
Chairperson be substituted.
(80) That at page 35, in lines 3 and 6, for the word
Commission, the words Central Authority be
substituted.

CLAUSE 95 INDEPENDENT ADMISSION AND TREATMENT
(81) That at page 35, in lines 19, 21 and 23, for the word
psychiatrist, the words mental health professional be
substituted.
(82) That at page 36, line 3, for the word psychiatrist, the words
mental health professional be substituted.

224
CLAUSE 96 ADMISSION OF MINOR
(83) That at page 36, in lines 8 and 40, for the word psychiatrist,
the words mental health professional be substituted.
(84) That at page 36, line 16, the words or her be deleted.

CLAUSE 97 DISCHARGE OF INDEPENDENT PATIENTS
(86) That at page 37, line 20, the words or her be deleted.

225
There are three Amendments (Nos. 87 to 89) by Minister.
CLAUSE 98 ALLOTMENT AND TREATMENT OF PERSONS WITH

MENTAL ILLNESS, WITH HIGH SUPPORT NEEDS, IN MENTAL HEALTH
ESTABLISHMENT, UP TO THIRTY DAYS (SUPPORTED ADMISSION)
(87) That at page 37, line 32, for the world psychiatrist, the words
(88) That at page 38, in lines 19, 32, 34, and 41, for the word
substituted.
(89) That at page 39, in lines 1, 5, 7, 19 and 22, for the word
substituted.

There are five Amendments (Nos. 90 and 94) by Minister.
CLAUSE 99 ADMISSION AND TREATMENT OF PERSONS WITH

MENTAL ILLNESS, WITH HIGH SUPPORT NEEDS, IN MENTAL HEALTH
226
ESTABLISHMENT, BEYOND THIRTY DAYS (SUPPORTED ADMISSION

BEYOND THIRTY DAYS)
(91) That at page 40, in lines 3, 40 and 46, for the word
"psychiatrist", the words "mental health professional" be
substituted.
(92) That at page 40, for lines 33 and 34, the following be
substituted, namely:-
"(11) Every person with mental illness admitted under this

section shall be provided treatment, after taking into account -
(a) an advance directive; or
(b) informed consent of the person with the support from

his nominated representative subject to the provision of sub-
section (12).".
(93) That at page 40, line 43, the words "or her" be deleted.
(94) That at page 41, in lines 3 and 5, for the word "psychiatrist",
the words "mental health professional" be substituted.

227
CLAUSE 100 LEAVE OF ABSENCE
(95) That at page 41, line 10, for the figure, bracket and words 100.
(1) The Medical officer or psychiatrist, the figure and words
100. The medical officer or mental health professional be
substituted.

There is one Amendment (No.97) by Minister.
CLAUSE 101 ABSENCE WITHOUT LEAVE OR DISCHARGE

namely: -
101. If any person to whom section 112 applies absents

himself without leave or without discharge from the mental
health establishment, he shall be taken into protection by any
228
Police Officer at the request of the medical officer or mental

health professional in-charge of the mental health establishment
and shall be sent back to the mental health establishment
immediately..

There is one Amendment (No. 98) by Minister.
CLAUSE 102 TRANSFER OF PERSONS WITH MENTAL ILLNESS

FROM ONE MENTAL HEALTH ESTABLISHMENT TO
ANOTHER MENTAL HEALTH ESTABLISHMENT

CLAUSE 103 EMERGENCY TREATMENT

229
(99) That at page 42, in lines 29 and 31, the words herself or be
deleted.

SHRI JAIRAM RAMESH: Sir, this very amendment was proposed in the
CAMPA Bill. The word informed consent was objected to. But, now, this
very word is used as an amendment to this Bill. I am glad that you have
accepted the concept of informed consent. And, I hope, you use this in
other Bills also.
AFFAIRS (SHRI MUKHTAR ABBAS NAQVI): Okay. It is a good
suggestion.
CLAUSE 104 PROHIBITED PROCEDURES
(100) That at page 43, line 14, for the word consent, the words
informed consent be substituted.
230

CLAUSE 105 RESTRICTION ON PSYCHOSURGERY FOR PERSONS

WITH MENTAL ILLNESS

There are six Amendments (Nos. 102 to 107) by the Minister.
CLAUSE 106 RESTRAINTS AND SECLUSION
(102) That at page 43, for line 24, the following be substituted,
namely:-
"106. (1) A person with mental illness shall not be subjected to

seclusion or solitary confinement, and, where necessary,
physical restraint may only be used when,-" .
231
(104) That at page 43, in lines 29, 32, 33, 35, 36 and 40, the words
"or seclusion" be deleted.
(105) That at page 43, in line 39, the words "seclusion or" be deleted.
(106) That at page 44, in lines 1 and 6, the words "and seclusion" be
deleted.
(1 07) That at page 44, line 3, for the word "Commission", the words
"Central Authority" be substituted.

(CONTD. BY USY 3Z)

USY/3Z/5.50
There are two Amendments (Nos. 108 and 109) by the Minister.
CLAUSE 108 RESEARCH
(108) That at page 44, in lines 34 and 37, for the word health, the words
mental health be substituted.
232
"(5) The person with mental illness or the nominated

representative who gives informed consent for participation in
any research under this Act may withdraw the consent at any
time during the period of research.".
MR. DEPUTY CHAIRMAN We shall, now, take up Clause 109 of the Bill.
CLAUSE 109 DUTIES OF POLICE OFFICERS IN RESPECT OF

PERSONS WITH MENTAL ILLNESS

233
MR. DEPUTY CHAIRMAN We shall, now, take up Clause 111 of the Bill.
CLAUSE 111 CONVEYING OR ADMITTING PERSON WITH MENTAL

ILLNESS TO MENTAL HEALTH ESTABLISHMENT BY MAGISTRATE
SHRI A. NAVNEETHAKRISHNAN (TAMIL NADU): Sir, I strongly oppose
these Amendments. ...(Interruptions)... The original Act itself intends that
the persons ...(Interruptions)...

234
MR. DEPUTY CHAIRMAN: Which Amendment are you opposing, 112 or
113?
SHRI A. NAVNEETHAKRISHNAN: Both, Sir. ...(Interruptions)... A
person with mental illness cannot be kept in prison. That is the objective of
this Act. But by making these Amendments, the whole purpose will be
defeated. I may please be permitted to read the proviso. I read, Provided
that transfer of a prisoner with mental illness to the psychiatric ward in the
medical wing of the prison shall be sufficient to meet the requirements
under this section: Provided further that where there is no provision for a
psychiatric ward in the medical wing, the prisoner may be transferred to a
mental health establishment with prior permission of the Board.
MR. DEPUTY CHAIRMAN: So, you are opposing!
SHRI A. NAVANEETHAKRISHNAN: Yes, Sir. I urge upon all the hon.
Members to kindly go through this. ...(Interruptions)... I may please be
permitted to read Clause 4. ...(Interruptions)... No, no. Persons with
mental illness cannot be kept in prison. ...(Interruptions)...
SHRI JAIRAM RAMESH: What is your policy in Tamil Nadu?
235
SHRI A. NAVANEETHAKRISHNAN: No; no. It is everywhere.
MR. DEPUTY CHAIRMAN: So, you are opposing the Amendment.
SHRI A. NAVANEETHAKRISHNAN: Yes, Sir. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: I am putting it to vote. Dont worry.
SHRI A. NAVANEETHAKRISHNAN: One minute, please. I may be
permitted to draw the kind attention of the House. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: No, you call the attention of the Minister.
...(Interruptions)... He is to either accept it or reject it.
...(Interruptions)... Your point is that they cannot be put in jail.
SHRI A. NAVANEETHAKRISHNAN: Exactly, Sir. ...(Interruptions)... The
Amendments contemplate that inside the prison itself the medical health
establishment has to be there. I strongly oppose it. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: Okay; okay. You can oppose.
236
SHRI A. NAVANEETHAKRISHNAN: Sir, it is against the person who is
suffering from mental illness. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: Agreed. You can oppose.
...(Interruptions)... You can oppose, no problem. ...(Interruptions)...
There are two amendments; Amendment (Nos. 112 and 113) by the Minister.
CLAUSE 112 PRISONERS WITH MENTAL ILLNESS.
"Provided that transfer of a prisoner with mental illness to the

psychiatric ward in the medical wing of the prison shall be sufficient to
meet the requirements under this section:
Provided further that where there is no provision for a psychiatric

ward in the medical wing, the prisoner may be transferred to a mental
health establishment with prior permission of the Board.
(lA) The method, modalities and procedure by which the

transfer of a prisoner under this section is to be effected shall be such
as may be prescribed".
"(5) The appropriate Government shall set up mental health

237
establishment in the medical wing of at least one prison in each State

and Union territory and prisoners with mental illness may ordinarily be
referred to and cared for in the said mental health establishment.
(6) The mental health establishment set up under sub-section (5)

shall be registered under this Act with the Central or State Mental Health
Authority, as the case may be, and shall conform to such standards and
procedures as may be prescribed."
SHRI A. NAVANEETHAKRISHNAN: Excuse me, Sir. The amendments
are inhuman. ...(Interruptions)... Medical health establishment must be
located outside the premises. ...(Interruptions)...
SHRI JAIRAM RAMESH: You ask for division. ...(Interruptions)...
SHRI A. NAVANEETHAKRISHNAN: Yes, Sir. I ask for division.
...(Interruptions)... I ask for division. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: No, no. This should not be by provocation.
...(Interruptions)... You should have asked it at that time itself.
...(Interruptions)... You explain. ...(Interruptions)... You explain.
...(Interruptions)... It has already been carried out. ...(Interruptions)...

238
SHRI A. NAVANEETHAKRISHNAN: No; no. The purpose of the Bill is
totally defeated because of this amendment. ...(Interruptions)... The object
of the Bill is totally defeated. ...(Interruptions)...
(Contd. by 4A PK)
PK-VNK/4A/5.55
MR. DEPUTY CHAIRMAN (CONTD.): No problem. That is accepted.
..(Interruptions).. Mr. Navaneethakrishnan, you have made your point.
...(Interruptions).. The Minister wants to explain something.
...(Interruptions).. You sit down; the Minister will explain. Mr.
Navaneethakrishnan, listen to the Minister. Don't be guided by Mr. Jairam
Ramesh; be guided by the Minister.
SHRI JAGAT PRAKASH NADDA: Sir, the purpose of the Amendment (No.)
112 is to ensure that in prisons, a special facility is created.
MR. DEPUTY CHAIRMAN: Yes.
SHRI JAGAT PRAKASH NADDA: So, that facility is to be created.
MR. DEPUTY CHAIRMAN: Now, listen. You understand that mentally-
challenged people will be given special facilities in jails like separate room,
separate food and separate treatment. So, why do you worry? Everything
239
will be provided. ..(Interruptions).. Anyhow, the Amendments are
adopted.
SHRI A. NAVANEETHAKRISHNAN: No, no. It is inhumane.
MR. DEPUTY CHAIRMAN: I shall now put Clause 112, as amended, to
vote.
MR. DEPUTY CHAIRMAN: We shall now take up Clause 113 of the Bill.
There is one Amendment (No.114) by Shri Jagat Prakash Nadda.
CLAUSE 113 - PERSONS IN CUSTODIAL INSTITUTIONS
(114)That at page 46, after line 36, the following be inserted, namely:-
"(2) The medical officer in charge of a mental health establishment shall be

responsible for assessment of the person with mental illness, and the
treatment required by such persons shall be decided in accordance with the
provisions of this Act.".

MR. DEPUTY CHAIRMAN: In Clause 114, there is one Amendment

240
(No.115) by Shri Jagat Prakash Nadda.
CLAUSE 114 - QUESTION OF MENTAL ILLNESS IN JUDICIAL PROCESS
namely:-
"114. If during any judicial process before any competent court, proof
of mental illness is produced and is challenged by the other party, the
court shall refer the same for further".
MR. DEPUTY CHAIRMAN: In Clause 116, there is one Amendment (No.
116) by Shri Jagat Prakash Nadda.
CLAUSE 116 - PENALTIES FOR ESTABLISHING OR MAINTAINING

MENTAL HEALTH ESTABLISHMENT IN CONTRAVENTION
OF PROVISIONS OF THIS ACT

241
(116) That at page 47, in line 17, for the words "knowingly serves", the
words "knowingly serves in the capacity as a mental health
professional" be substituted.
MR. DEPUTY CHAIRMAN: In Clause 119, there are two Amendments (Nos.
117 and 118) by Shri Jagat Prakash Nadda.
CLAUSE 119 - POWER TO CALL FOR INFORMATION
(117) That at page 48, in lines 11 and 12, the words "or the Commission" be
deleted.
(118) That at page 48, in line 15 and 17, for the word "Authority", the words
"State Authority or the Board" be substituted.

242
MR. DEPUTY CHAIRMAN: In Clause 123, there are two Amendments
(Nos.119 and 120) by Shri Jagat Prakash Nadda.
CLAUSE 123 - SPECIAL PROVISIONS FOR STATES IN

NORTH-EAST AND HILL STATES
(119) That at page 50, in line 13, for the words "president of the
Commission", the words "Chairperson of the Central Authority"
be substituted.
(120) That at page 50, in line 14, for the words "a single Board", the
words "one or more Boards" be substituted.
(Contd. by PB/4B)
PB/4B/6.00
MR. DEPUTY CHAIRMAN: Now, I shall take up Clause 124. There are two
Amendments; Amendment (Nos. 121 and 122) by Shri Jagat Prakash
Nadda. ...(Interruptions)...
SHRI A. NAVANEETHAKRISHNAN: Sir, I oppose it because ...
MR. DEPUTY CHAIRMAN: Why?

243
SHRI A. NAVANEETHAKRISHNAN: Sir, I may be permitted to read the
Amendment. It says, Notwithstanding anything contained in Section 309 ...
MR DEPUTY CHAIRMAN: You say why you oppose it.
SHRI A. NAVANEETHAKRISHNAN: Just a minute, Sir. It says,
Notwithstanding anything contained in Section 309 of the Indian Penal
Code any person who attempts to commit suicide shall be presumed,
unless proved otherwise, to have severe stress and shall not be tried and
punished under the said Code. It is a major intrusion into Section 309 of
the IPC because there is a presumption that only because of the severe
stress, he has made an attempt to commit suicide. Now, what is severe
stress is not defined in the Bill. This is very, very important.
...(Interruptions)... Severe stress is not defined in the Act. So, without a
clear cut definition as to what is meant by severe stress, the presumption is
invalid, and also in the entire Act, the phrase mental illness alone is defined
in the Bill and not severe stress.
MR. DEPUTY CHAIRMAN: Mr. Minister, do you have to say something on
this?
SHRI JAGAT PRAKASH NADDA: Sir, it was earlier mental illness which
was removed because of the recommendations of the Standing Committee,

244
and the Standing Committee said that it should be severe stress, and it will
be defined accordingly.
MR. DEPUTY CHAIRMAN: Okay. ...(Interruptions)... It is on the
recommendations of the Standing Committee. ...(Interruptions)... That is
okay. ...(Interruptions)...
DR. K. KESHAVA RAO: Sir, he has raised an objection that severe stress
is not defined. It is true. The Standing Committee wanted ...
MR. DEPUTY CHAIRMAN: He has said why he has brought it.
DR. K. KESHAVA RAO: But the Minister should now promise that in the
rules, he would bring it. Under the subordinate legislation, he can bring this
as severe stress. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: Yes, yes. That he can do. That he can do.
SHRI JAGAT PRAKASH NADDA: That we will do, Sir. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: Okay. It will be provided in the Rules.
SHRI A. NAVANEETHAKRISHNAN: No, it cannot be dealt with in the Rules.
...(Interruptions)... There must be a ... ...(Interruptions)...

245
MR. DEPUTY CHAIRMAN: Okay. You are opposing the Amendment.
Fine. All right. You can oppose. ...(Interruptions)...
SHRI A. NAVANEETHAKRISHNAN: Sir, we oppose it and we press for
division also. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: Yes, Mr. Nadda, you move the Amendments.
CLAUSE 124 PRESUMPTION OF MENTAL ILLNESS IN CASE OF

ATTEMPT TO COMMIT SUICIDE BY PERSON
(121) That at page 50, for lines 39 to 42, the following by substituted,
namely:
124(1) Notwithstanding anything contained in section 309 of the

45 of Indian Penal Code any person who attempts to commit suicide
1860 shall be presumed, unless provided otherwise, to have severe
stress and shall not be tried and punished under the said
Code..
(122) That at page 50, in line 4, for the words mental illness, the
words severe stress be substituted.

246
MR. DEPUTY CHAIRMAN: Now, I shall take up Clause 125. There is one
Amendment (No. 123) by Shri Jagat Prakash Nadda.
CLAUSE 125 BAR OF JURISDICTION
(123) That at page 50, line 47, for the word Commission, the word
Authority be substituted.
MR. DEPUTY CHAIRMAN: Now, I shall take up Clause 126. There is one
Amendment (No. 124) by Shri Jagat Prakash Nadda.
CLAUSE 126 - TRANSITORY PROVISIONS
(124) That at page 51, in lines 5 and 6, for the words, scheme for the
smooth implementation of the provisions of this Act, the words
necessary transitory schemes be substituted.

247
MR. DEPUTY CHAIRMAN: Now, I shall take up Clause 127. There are two
Amendments; Amendment (Nos. 125 and 126) by Shri Jagat Prakash
Nadda.
CLAUSE 127 CHAIRPERSON, MEMBERS AND STAFF OF AUTHORITY

COMMISSION AND BOARD TO BE PUBLIC SERVANTS
(125) That at page 51, line 7, the word, President be deleted.
(126) That at page 51, line 8, the word Commission be deleted.
MR. DEPUTY CHAIRMAN: Now, I shall take up Clause 128. There are
three Amendments; Amendment (Nos. 127, 128 and 129) by Shri Jagat
Prakash Nadda.
CLAUSE 128 PROTECTION OF ACTION TAKEN IN GOOD FAITH
(127) That at page 51, line 11, the words or President be deleted.
(128) That at page 51, line 11, the word Central be deleted.
248
(129) That at page 51, line 12, the words or the State Authority or the
Commission be deleted.
(Followed by 4C/SKC)
SKC/4C/6.05
MR. DEPUTY CHAIRMAN: We shall now take up Clause 130. In Clause
130. There are two amendments (No. 130 and 131) by Shri Jagat Prakash
Nadda.
SHRI JAIRAM RAMESH: Sir, before the Minister moves the Amendment, I
have a point. Sir, this Amendment (No. 130) is a very detailed amendment.
It is a welcome Amendment because what it lays out is what the Rules will
contain. Just now, the Minister has given an assurance that severe stress
will be defined in the Rules, but it is not a part of Amendment No. 130. The
Minister is taking the power to delegate and formulate the Rule. That is very
good. It is very detailed. But where does severe stress figure? He has
just now given an assurance that severe stress has figured in the Rules.
249
MR. DEPUTY CHAIRMAN: He said he would bring it in the Rules.
SHRI JAIRAM RAMESH: It is not there, Sir.
MR. DEPUTY CHAIRMAN: Even then he can do that. ...(Interruptions)...
AFFAIRS (SHRI MUKHTAR ABBAS NAQVI): Sir, it is not the Rule. It is an
Amendment to the Rule.
SHRI JAIRAM RAMESH: Sir, unless he gives an assurance
MR. DEPUTY CHAIRMAN: He has given an assurance.
...(Interruptions)... He gave an assurance.
SHRI JAGAT PRAKASH NADDA: Severe stress is a medical terminology
and accordingly it will be.. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: He is a doctor. He understands that.
...(Interruptions)... Dr. Nadda is a doctor. So, he knows it.
SHRI JAIRAM RAMESH: Sir, please read Amendment No. 130.
...(Interruptions)... You are going like a bullet train, faster than Mr. Suresh
Prabhus train. ...(Interruptions)... But please read Amendment No. 130.

250
Amendment No. 130 says that the rules will contain 1, 2, 3, 4 It does not
say anything about severe stress. That is my limited point.
...(Interruptions)... If you are happy to pass it, let us pass it, Sir.
MR. DEPUTY CHAIRMAN: No, no. No comments, please. Mr. Jairam
Ramesh, I am not passing it like a bullet train or any fast train. I am allowing
everybody who wants to object, in spite of the fact that there are so many
amendments. Everybody is tired, including myself. This is taking so much
time. Still, I am allowing everybody, and allowing you too.
DR. T. SUBBARAMI REDDY: Sir, he is complimenting you. Bullet train is a
fast train. ...(Interruptions)...
MR. DEPUTY CHAIRMAN: However, the Minister must fulfil the assurance
that was given.
SHRI JAGAT PRAKASH NADDA: Yes, Sir.
130, there are two Amendments (No. 130 and 131) by Shri Jagat Prakash
Nadda.
251
CLAUSE 130 POWER TO MAKE RULES
SHRI JAGAT PRAKASH NADDA: Sir, I move:-
namely:-
"130.(1) The Central Government may, by notification, make rules for

carrying out the provisions of this Act.
(2) Subject to the provisions of sub-section (1), the State

Government may with the previous approval of the Central Government, by
notification, make rules for carrying out the provisions of this Act:
Provided that the first rules shall be made by the Central Government,
by notification.
(3) In particular, and without prejudice to the generality of the

foregoing power, rules made under sub-section (1) may provide for all or
any of the following matters, namely:-
(a) qualifications relating to clinical psychologist under sub-clause (ii)

of clause (f) of sub-section (1) of section 2;
(b) qualifications relating to psychiatric social worker under clause

(w) of sub-section (1) of section 2;
(c) the manner of nomination of members of the Central Authority

under sub-section (2) of section 34;
(d) the salaries and allowances payable to, and the other terms and
252
conditions of service of, the chairperson and other members of the Central
Authority under sub-section (3) of section 35;
(e) the procedure for registration (including the fees to be levied for
such registration) of the mental health establishments under sub-section
(2) of section 43;
(f) the manner of nomination of members of the State Authority under

sub-section (2) of section 46;
(g) the salaries and allowances payable to, and the other terms and
conditions of service of, the chairperson and other members of the State
Authority under sub-section (3) of section 47;
(h) the procedure for registration (including the fees to be levied for
such registration) of the mental health establishments under sub-section
(2) of section 55;
(i) the form of accounts and other relevant records and annual
statement of accounts under sub-section (1) of section 59;
(j) the form in, and the time within which an annual report shall be
prepared under section 60;
(k) the form of accounts and other relevant records and annual
statement of accounts under sub-section (1) of section 63;
(l) the form in, and the time within which an annual report shall be
prepared under section 64;
(m) manner of constitution of the Boards by the State Authority for a

253
district or groups of districts in a State;
(n) other disqualifications of chairperson or members of the Board

under clause (e) of sub-section (2) of section 82;
(o) any other matter which is required to be, or may be, specified by
rules or in respect for which provision is to be made by rules.
(4) In particular, and without prejudice to the generality of the foregoing

power, rules made under sub-section (2) may provide for all or any of the
following matters, namely:-
(a) the manner of proof of mental health care and treatment under
sub-section (1) of section 4;
(b) provision of half-way homes, sheltered accommodation and

supported accommodation under clause (b) of sub-section (4) of section
18;
(c) hospitals and community based rehabilitation establishment and

services under clause (d) of sub-section (4) of section 18;
(d) basic medical records of which access is to be given to a person

with mental illness under sub-section (1) of section 25;
(e) custodial institutions under sub-section (2) of section 27;
(f) the form of application to be submitted by the mental health

establishment with the undertaking that the mental health establishment
fulfills the minimum standards, if any, specified by the Authority, under the
Explanation to sub-section (2) of section 65;
254
(g) the form of certificate of registration under sub-section (3) of

section 65;
(h) the form of application, the details, the fees to be accompanied

with it under sub-section (l) of section 66;
(i) the form of certificate of provisional registration containing

particulars and information under sub-section (4) of section 66;
(j) the fees for renewal of registration under sub-section (11) of

section 66;
(k) the person or persons (including representatives of the local

community) for the purpose of conducting an audit of the registered mental
health establishments under sub-section (1) and fees to be charged by the
Authority for conducting such audit under sub-section (2) of section 67;
(l) the person or persons for the purpose of conducting an inspection

or inquiry of the mental health establishments under sub-section (1) of
section 68;
(m) the manner to enter and search of a mental health establishment

operating without registration under sub-section (6) of section 68;
(n) the fees for issuing a duplicate certificate under sub-section (2) of
section 70;
(o) the form and manner in which the Authority shall maintain in
digital format a register of mental health establishments, the particulars of
the certificate of registration so granted in a separate register to be
maintained under section 71;
255
(p) constitution of the Boards under sub-section (3) of section 80;
(q) the honorarium and other allowances payable to, and the other
terms and conditions of service of, the Chairperson and members of the
Board under sub-section (3) of section 83;
(r) method, modalities and procedure for transfer of prisoners under

sub-section (1A) of section 112;
(s) the standard and procedure to which the Central or State Health
Authority shall confirm under sub-section (6) of section 112;
(t) the form for furnishing periodical information under section 119;
and
(u) any other matter which is required to be, or may be, specified by
rules or in respect for which provision is to be made by rules.".
131. That at page 52, lines 1 to 41 be deleted.
Clause130, as amended, was added to the Bill.
131, there is one Amendment (No. 132) by Shri Jagat Prakash Nadda.
256
CLAUSE 131 POWER OF CENTRAL AUTHORITY TO MAKE

REGULATIONS
namely:-
"(2) In particular, and without prejudice to the generality of the

foregoing power, such regulations may provide for all or any of the following
matters, namely:-
(a) manner of making an advance directive under section 6;
(b) additional regulations, regarding the procedure of advance

directive to protect the rights of persons with mental illness under sub-
section (3) of section 12;
(c) the salaries and allowances payable to, and the other terms and
conditions of service (including the qualifications, experience and manner of
appointment) of, the chief executive officer and other officers and
employees of the Central Authority under sub-section (3) of section 40;
(d) the times and places of meetings of the Central Authority and
rules of procedure in regard to the transaction of business at its meetings
(including quorum at such meetings) under sub-section (1) of section 44;
(e) the minimum standards of facilities and services under clause (a)
of sub-section (4) of section 65;
(f) the minimum qualifications for the personnel engaged in mental

257
health establishment under clause (b) of sup-section (4) of section 65;
(g) provisions for maintenance of records and reporting under clause

(c) of sub-section (4) of section 65;
(h) any other conditions under clause (d) of sub-section (4) of

section 65;
(i) categories of different mental health establishment under clause

(a) of sub-section (5) of section 65;
(j) the form of application to be made by the mental health

establishment and the fees to be accompanied with it under sub-section
(12) of section 66;
(k) manner of submitting evidence under sub-section (13) of section

66; (l) the manner of filing objections under sub-section (14) of section 66;
(m) the time and places and rules of procedure in regard to the
transaction of business at its meetings to be observed by the Central
Authority and the Board under section 87;
(n) regulations under sub-section (2) of section 105 and under sub-
section (8) of section 106;
(o) any other matter which is required to be, or may be, specified by
regulations or in respect of which provision is to be made by regulations.".
MR. DEPUTY CHAIRMAN: We shall now take up Clause 132. There is one
Amendments (No. 133) by Shri Jagat Prakash Nadda.

258
CLAUSE 132 POWER OF COMMISSION TO MAKE REGULATIONS
134, there is one Amendment (No. 134) by Shri Jagat Prakash Nadda.
CLAUSE 134 - LAYING OF RULES AND REGULATIONS
(134) That at page 54, line 12, the words "and the Commission" be
deleted.

259
CLAUSE 1 SHORT TITLE, EXTENT AND COMMENCEMENT
(3) That at page 1, line 5, for the words and figure "Mental Health
Care Act, 2013", the words and figure "Mental Healthcare Act,
2016" be substituted.
namely:-
"(3) It shall come into force on such date as the Central Government
may, by notification in the Official Gazette, appoint; or on the date of
completion of the period of nine months from the date on which the Mental
Healthcare Act, 2016 receives the assent of the President.".
(FOLLOWED BY KSK/4D)
skc/ds -- KSK/SC/6.10/4D
MR. DEPUTY CHAIRMAN: Now, we shall take up the Enacting Formula.
There is one Amendment (No.2) by Shri Jagat Prakash Nadda.

260
ENACTING FORMULA
(2) That at page 1, line 1, for the word Sixty-fourth, the word Sixty-
seventh be substituted.

The Enacting Formula, as amended, was added to the Bill.
The Preamble was added to the Bill.
MR. DEPUTY CHAIRMAN: Now, we shall take up the Long Title. There is
one Amendment (No.1) by Shri Jagat Prakash Nadda.
LONG TITLE
(1) That at page 1, in the Long Title, for the words health care wherever
it occurs, the word healthcare be substituted.

The Long Title, as amended, was added to the Bill.
That the Bill, as amended, be passed.
(Ends)
24.03.2017 jr-lh Uncorrected / Not for Publication 4
LOK SABHA DEBATES

PART II PROCEEDINGS OTHER THAN QUESTIONS AND ANSWERS
Friday, March, 24, 2017/ Chaitra 03, 1939 (Saka)
CONTENTS PAGES
RULING RE: NOTICES OF ADJOURNMENT MOTION 276
PAPERS LAID ON THE TABLE 277-83
MESSAGES FROM RAJYA SABHA 284-85

AND
BILL AS PASSED BY RAJYA SABHA LAID
COMMITTEE ON PUBLIC UNDERTAKINGS 286

18th Report
COMMITTEE ON PAPERS LAID ON THE TABLE 286

10th and 11th Reports
STANDING COMMITTEE ON PETROLEUM AND 286

NATURAL GAS
19th Report
STANDING COMMITTEE ON COAL AND STEEL 287

30th Report
BUSINESS OF THE HOUSE 288-95
SPECIAL MENTIONS 296-37
MENTAL HEALTHCARE BILL 338-73

(Inconclusive)
Motion for Consideration 338
Shri Jagat Prakash Nadda 338-43
Dr. Shashi Tharoor 344-64
Dr. Heena Vijaykumar Gavit 365-73
(Not Concluded)
BUSINESS OF THE HOUSE

1205 hours
THE MINISTER OF STATE IN THE MINISTRY OF
AGRICULTURE AND FARMERS WELFARE AND MINISTER OF
STATE IN THE MINISTRY OF PARLIAMENTARY AFFAIRS
(SHRI S.S. AHLUWALIA): Hon. Madam, I beg to lay the statement
regarding Government Business during the week commencing the 27th
March, 2017.
With your permission Madam, I rise to announce that
Government Business during the week commencing Monday, the 27th
of March, 2017 will consist of:-
1. Consideration of any items of Government Business carried over
from today's order paper: - [it contains consideration and passing of
the Mental Health Care Bill, 2016, as passed by Rajya Sabha.]
2. Consideration and passing of the following Bills: -
(a) The National Institutes of Technology, Science Education and
Research (Second Amendment) Bill, 2016.
(b) The Indian Institutes of Management Bill, 2017.
(c) The Constitution (Scheduled Castes and Scheduled Tribes) Order
(Amendment) Bill, 2016.
(d) The Footwear Design and Development Institute Bill, 2017.
(e) The Collection of Statistics (Amendment) Bill, 2017.
(f) The Repealing and Amending Bill, 2017.
Laid on the Table

(h2/1430/sr-rps)
1432 hours
The Lok Sabha re-assembled at thirty-two minutes past
Fourteen of the Clock.
(Hon. Deputy-Speaker in the Chair)

MENTAL HEALTHCARE BILL
1433 hours
HON. DEPUTY SPEAKER: The House shall now take up Item No. 13,
the Mental Healthcare Bill, 2016.
THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI
JAGAT PRAKASH NADDA): Sir, I rise to move:
That the Bill to provide for mental healthcare and services
for persons with mental illness and to protect, promote and
fulfil the rights of such persons during delivery of mental
healthcare and services and for matters connected therewith
or incidental thereto, as passed by Rajya Sabha, be taken
into consideration.
As we all know, we had come in 2014 with a Mental Health

Policy. After the Mental Health Policy, there was an active
consideration to change the laws related to mental health. Mental
healthcare has gone a long way. If we talk about 1912, we had the
Lunacy Act which was more giving seclusion and custodial treatment
to the patient. It was more about coercive measures that were
enunciated at that time. Later on, in 1987, we came up with the Mental
Health Act of 1987. In that, it was based on the institutional-based
mental health delivery. That was the basic framework on which it was
working. But in the course of time, it was also found that the mental
health services needed change. Broadly, because of that, we came out
with the Mental Health Policy in 2014.
(j2/1435/kmr/asa)
And now when we are coming with this Mental Health Bill
which has been passed in the Rajya Sabha in August 2016, we have
gone through a lot of consultations. First of all we had a consultation at
the regional level. Practically in the South, in the West, in the East and
in the Northern part of the country we arranged regional conferences
where the stakeholders and the people working in the mental health
sector were consulted. After that we had a national consultation and
after national consultation a Bill was drafted and brought before the
Committee of Secretaries, and after it went through the Cabinet, Group
of Ministers in the Cabinet, last year it was brought into the Rajya
Sabha and it was passed, and now it is here for consideration. So, this
Bill has come after due consideration on various forums and with due
consultations we are coming out with this Bill.
This Bill is progressive in nature and it is patient-centric. It
empowers the patient for mental healthcare. The focus is to give
treatment at the community level; not seclusion but inclusion. The
society should give a congenial environment in which we should see
that maximum mental healthcare is given in the community and that it
is community based. So, the focus is on community, and all the
stakeholders who participate in the community mental healthcare are
taken into consideration and that is how the focus is there. And it gives
the patient, empowers the patient for the rights so that he is not denied
or discriminated against because of his illness. So, it is a right-based,
patient-centric, progressive and community-focused Bill that we are
doing.
There is an international obligation also. We are the signatory to
the United Nations Convention of Rights of Persons with Disabilities
on October 1, 2007. So, that is also one of the obligations which we
have to fulfil and we are going in this direction.
The unique feature of this Bill is that it has got the provision of
advance directive. That means, a person who is sane, who is absolutely
alright but there are chances that at a given point of time in future he
may suffer some mental illness, so he can give the direction today that
if mental illness happens, which type of treatment be given to me, who
should take care of me, what type of facilities I would like to take,
whether I would like to go into the institution-based services or
community-based services, etc. This advance directive we can give.
This is the novel feature of this Act which I would like to point out.
It has got the provision of nominated representative. When a
person is sane, he can nominate his representative who is going to take
care of him and who is going to take care of all his personal rights and
his treatment part, his financial aspects. All that has to be taken into
consideration. So, he can nominate his representative.
The Bill also gives rights to the mentally ill persons. As I said, it
is a rights-based Bill. So, it gives right to access for mental health,
community living, equality and no discrimination and confidentiality.
He is also entitled for legal aid to make complaints about the

deficiencies. And it can be done by his representative also. And he has
a right to all medical records. So, the confidentiality is there and he also
has the right to have the medical records.
Here the role of caregivers has also been recognised. When we
say caregivers, caregivers are those who are community-based and
serving the people. The mental health authority or the State health
authority, or the District Board recognises the role of the caregivers
also. In this Bill we have taken care of that also.
Mental illness, mental healthcare and determination of mental
illness are defined. Previously the definition was very vague. We have
defined what we mean by mental illness and that provision has been
made in this.
(k2/1440/gm-asa)
There were many cases where people were put into the
institutions for other family reasons and they were left there only. To
safeguard their position, we have defined the mental illness for which
he has to be treated and in which conditions he can be admitted into the
institutions.
Any involuntary admission will need the consent of the authority
that is district level review board. If any surgeon or any mental
healthcare giver or any doctor has given a certificate that he should be
admitted, then it is the board to decide whether involuntary admission
has to be given to him or not.
Initially, when a person used to be mentally ill, the decision of

the sterilization of the person, whether man or woman, was considered
by the care giver or by the doctor. Now this sterilization part is
restricted. You cannot sterilize a patient just because he is mentally ill.
Supposing the mother is insane or mentally ill, we used to see to it that
the child is separated. Now, according to this Bill, we cannot separate
the child for three years. If we do it, we need the support of the mental
doctor or a certificate. That is how we will see to it that the child stays
with the mother.
We have seen that mentally ill persons are chained. After passing
of this Bill, you cannot chain a mentally ill person, whatever the
reasons may be. The electro-convulsive therapy can be given only after
giving anaesthesia and that too under medical supervision and consent.
For mental illness, no psychosurgery can be done without informed
consent.
One very important factor is that this Bill separates the attempt to
suicide from the Indian Penal Code. So, it does not now invite the
provisions of the Indian Penal Code, because it is said that a person
goes for suicide under great mental stress. So, it is mental illness in
which he is doing it. This is a very unique feature which has been
brought in this Bill.
In the Bill, there is a provision of penalty from Rs. 5,000 to
Rs. 50,000, penalty for imprisonment for those who do not obey these
laws; punishment to individuals is also there; fine is there and
imprisonment is also there. So, we have tried to see to it that the
patient who is mentally ill is protected. It is right based, whatever best

possible support can be given is given and no coercive method or
methodology is adopted on the patient. He has got the right for the
advanced directive to nominate his representative, to decide and choose
which type of treatment he wants; his property and other things are
protected. Accordingly, those who do not adhere to this are liable for
penalty and penalty is in terms of financial penalty and also in terms of
imprisonment.
I think this is a very progressive Bill. After due consideration for
a long time, we have come with this Bill. Hon. Members will throw
light on it and after the discussion, it may be passed.
(ends)
HON. DEPUTY SPEAKER: Motion moved:
persons with mental illness and to protect, promote and fulfill the
rights of such persons during delivery of mental healthcare and
services and for matters connected therewith or incidental
thereto, as passed by Rajya Sabha, be taken into consideration.
1444 hours
DR. SHASHI THAROOR (THIRUVANANTHAPURAM): Hon.
Deputy Speaker Sir, I thank you for allowing me to speak on the topic
which, frankly, has not been easy for us as a society to deal with. I
must say that mental illness has been an issue which by and large we in
India have preferred to brush under the carpet in the hope that it will go
away or it is really not something we have to deal with. But the fact is
that we do need to acknowledge, to understand and to take measures to
do something about it. The big elephant in the room is the fact that
every one of us actually knows somebody who has a mental health
problem.
(l2/1445/rsg-ind)
We do not realise it; we may not like it; we may not be aware of
it; they may not be aware of it; or they may not be conscious of it but I
can assure you that not one of us in this room has failed to come across
it.
HON. DEPUTY SPEAKER: All those who are in public life have all
problems!
DR. SHASHI THAROOR (THIRUVANANTHAPURAM): Hon.
Deputy Speaker Sir, you are right that the problems are there but we
have not been giving this issue the importance that it deserves. That is
why I think this debate is an important one. As our hon. Minister said
that we owe it to ourselves, to our loved ones, and to the future of our
society to find solutions in grappling with it. We must stop looking the
other way.
As a Congressman, hon. Deputy Speaker, I am proud that this

Bill was first brought to this House in 2013 by my esteemed colleague
now in the Rajya Sabha, then the Union Health Minister Shri Ghulam
Nabi Azad. He recognised early the necessity for India to take pro-
active steps to protect the well-being of our citizens. I am sorry that in
some ways it has taken so long, three years for the present Government
to bring it back but I want to congratulate Shri Nadda for his masterly
exposition of the provisions of the Bill; and to congratulate the
Government of today for having recognised the good work that was
being done on a number of issues by its predecessors.
It is striking that we have now seen so many Bills brought to the
House in the last two and a half years by this Government for which
preparatory work and very often the drafting were done by the UPA
Government and this is one such Bill. I think we all know there is
Aadhar, there is FDI, and there is insurance reform; so many other
things have come to this House thanks to the hard work done by the
predecessors of this Government. I hope, they will also have the grace
to acknowledge that this is the legacy of that hard work.
Let me come back to the substance of the Bill. Frankly hon.
Deputy Speaker, the numbers in our country really plead for urgent
measures. It is estimated that at least one in twenty people in India live
with mental illness; that is about five per cent. So, fifty million of our
citizens are dealing every day with a problem that we are only now
starting really to even acknowledge in all its gravity. The fact is that
experts think this may be an underestimate. By 2020 as much as 20 per
cent of our population might be affected by mental health issues. Yet as

I said, we have really ignored the problem; and very often when we
have considered mental health, we have done so with ignorance and
prejudice.
Let us just look for example at the past legislations on this
subject. We have for instance the Lunatics Removal Act of 1851, the
first legal provision on this subject; the Indian Lunatic Asylum Act of
1858; the Military Lunatics Act of 1877 perhaps we may think that
they have all gone to the other side of the border but still military
lunatics had an Act here and the Indian Lunacy Act of 1912. These
were all bequeathed to us by the colonial authorities. I think many of
you know what I think of many of the legal and penal provisions left
behind by the colonial authorities but the fact is that their only answer
to mental health problems was to brand individuals as lunatics, confine
them in so-called mad houses, physically in certain spaces and pretend
that that took care of the problem.
Even just before Independence in 1946 there was a Bhure
Committee, a Government Committee of Inquiry which concluded and
I quote:
The majority of mental hospitals in India are designed for
detention and safe custody without regard for curative
treatment.
But I am sorry to say that this has continued largely to be the

pattern even after Independence. It was easy for a foreign power
dominating a subject people to incarcerate individuals and continue
with the business of ruling as they saw fit but in independent India our
Government is there to serve Indians. We must look after the health and
well being of our own people. We owe it to our people to find answers,
not to just brand them as lunatics and look the other way instead of
giving assistance.
It has to be admitted that we are already late in rising to the
occasion. The 1987 Act which we are now here to amend was first
drafted actually in 1950. It took decades of protracted debate even to
get adopted 37 years later. By the time that Act was realised, it was
already out of date. It is no wonder that Human Rights Watch for
example has reported that inmates particularly women and children in
our mental health facilities are treated worse than animals; not only
have our laws been stuck in this colonial era mindset but our own
mindsets with regard to mental health have also been frozen in time and
frozen in history.
(m2/1450/rk-mm)
As India looks to a new future in the 21st century, it must
acknowledge the errors that we have made in the past. We must right
long standing wrongs even if we have to accept hard truths and reorient
our thinking.
It was only in 2007 that India ratified the United Nations
Convention on the Rights of Persons with Disabilities, following which
the UPA Government commenced the process of overhauling the
antiquated Mental Health Act of 1987. Even the basics have had to be
re-visited for the better. I note from Shri Naddas Bill that the term
mentally ill has been replaced with person with mental illness which
preserves the dignity of the individual seeking treatment. I am really
grateful that Shri Nadda has continued this kind of line of logic and
approach and continued the good work. On this, I want to assure you
and the Government that my Party and I are with him. We agree that
there is no justification for India to continue to rely on outdated and
patently unjust notions of so-called treatment which really is locking
people up.
The world has moved ahead. Other countries have discovered
better answers. The truth is that if we can focus on helping those
affected directly, helping their families, helping them within their
communities, then people afflicted with mental illness can re-build
their lives and move forward. It is for us as a society, if we want to be
a modern, progressive society, we must do this, Mr. Chairman.
Mental health remains an issue that is not only difficult for many
to comprehend but it comes as a colossal baggage of stigma. People
think c i {M c* This whole attitude that comes in, the way in
which people are disregarded, despised, one is shunned as a mad
person, a lunatic and worse if it is known that one has even been to a
psychiatrist one is looked upon by many people with fear or with
confusion. What is the matter with this person? He goes and sees a
psychiatrist. That is the attitude in our culture. The patient is painted
with a brush of ignorance and treated very often by distance. This
person is not well mentally let us keep distance from him. The real
truth is this person needs medical assistance, needs help and

understanding. It is an illness. It is not just a behaviour pattern.
The truth is, of course, that mental illness is a very complicated
disability to gaze. When you have another kind of disability, somebody
is sitting with a broken leg you can see he has a broken leg. Somebody
has a broken mind. It is extremely difficult to diagnose it. Sometimes,
people as far as their appearances go seem perfectly healthy. They are
happy. They come across as social beings while confronting painful
inner battles. I can tell you, Mr. Chairman, from personal experience
that there is nothing sadder than witnessing a close-one a loved-one
with mental illness at close quarters. I have lived with a victim of
mental illness. Like many in that condition, very often such people are
in a state of denial. They do not accept that they have a mental
problem. They do not even go to see a doctor. Nadda Sahib is talking
about how they can easily authorise somebody to help them but they do
not accept that they are mentally ill. One of the first symptoms of
mental illness is an inability to recognise it and to be in denial about it.
They are, therefore, unwilling to seek help even after their behaviour
may raise questions about their mental condition. Very often you can
see in public behaviour that somebody is really not normal or right and
when you say will you go and see a doctor as this is not a right
behaviour, they will say, nothing wrong with me. The truth is, it gets
ten times worse with its private behaviour. Even diagnose is a
challenge. There are many-many people, perhaps even in our own
profession, suffering from un-diagnosed mental illness.
I must say that we need more people to set an example of a

prominent film actress. I cannot take her name in the House but she
has courageously spoken out about her battle with depression and how
difficult it was for her to receive understanding let alone help for her
condition. And by doing so she has brought some people out to seek
help. But this is again a part of the challenge. I would urge the
Minister to think in terms of how to use role models to go and say, I
have had this problem, it can be treated. There is nothing wrong. She
is a big star in bollywood. Therefore, her message gets across to the
general public.
There are patterns, of course, that experts can notice but where
even seeking an expert assistance is sometimes treated with stigma,
many are reluctant to seek help.
(n2/1455/ps-mz)
The stigma and the lack of a support system mean that most of
them must fight these battles on their own. A frustrating and isolating
experience sometimes lead to such eventualities, that is, suicide, which
the hon. Minister has mentioned.
Sir, the National Crime Records Bureau has calculated in 2014
that at least 15 suicides take place in India every hour. That is too many
and the fact is these 15 instances in every 60 minutes is our collective
failure to recognise and solve the problem. This is what confronts us.
This Bill brings to the Table an opportunity for us as a society to do
better about it.
Mr. Chairman, I am very glad that the hon. Minister has flagged
the issue of suicide because our treatment of suicide or attempted
suicide has been appalling. The suicide is now a leading cause of deaths
amongst young and adults in India. On the one hand, we sing songs
about the demographic dividend and the potential of our youth, but, on
the other hand, do we realise how many of our young people are
depressed. The world around us is changing constantly. The pressures
are mounting. There are economic necessity and academic pressures.
There are jobs to be found as there are no jobs in our economy today
despite the assurances made by the hon. Prime Minister. We have only
created a lakh and a half jobs last year when we need to create a crore.
These are genuine problems. There are uprooted lives from villages to
cities and from joint families to individual units. There is the weight of
expectations and there is a fast pace at which familiar culture networks
are being replaced by new and unfamiliar systems. It is because the
people are lacking an anchor and a steady base and the nation is also in
a state of transformation, as a result, our young population is lapsing
into depression and disorientation and they are getting stigmatised.
In 2013, around 62,960 adolescents suicides were reported. Most
of the 3,594 suicides were committed by children aged between 10 and
14 years. So, these numbers obviously show that they had no one to
turn to or no one to rely on and no help available. Our education system
is one where we do not have counsellors. We do not have counsellors
who can serve the mental health needs of our youth. We expect them to
deal with the weight of expectations and performance pressures. {F
{ BE* This is the whole pressure coming from home and from their
peers and we expect them to do it single-handedly while we pursue
them relentlessly to do this. I hope the hon. Minister will not only take
note of this alarming phenomenon, but, I hope that you can persuade
your colleague Shri Javadekar to make it mandatory for educational
institutions to hire professionals who can attend to the mental health
needs of our students and the young. It is literally the need of the hour.
In order to try and persuade us to take cognisance of the issue,
some studies have even tried to estimate the effect it has on GDP
annually. I am not going to equate the human life to any monetary
equivalent. The children, who are our future, are falling prey to mental
illness. But, let me say, to brush this issue under the carpet means to
handicap the future of this nation just to satisfy the prejudices. I know
that there are many Members on the other side who represent the State
of Rajasthan. We have Kota where so many students go there every
year to study and to pass the IIT examinations and so on. Every month
there is a suicide of a student there. Can we realise what kind of an
intolerable pressure we are putting our children under.
So, I do welcome the decriminalisation of suicide and your
intention to look at the matter in a more comprehensive manner. But, I
would like to call upon you to have a wider look on the points that I
have raised and to ensure that the law enforcement agencies and those
who are the first responders in incidents of suicides or attempted
suicides are sensitized to the issue. In fact, we should also sensitize our
media to the issue. Sometimes, our media reports suicides in such a
way that encourages other depressed people to take copy cat actions
and commit suicides. We have to change not only our law today but
also our mindsets. That is a bigger and steeper challenge than just
changing the law. That is why, this Bill must be accompanied by
effective mechanisms for implementation. If we do not implement it,
this law will remain on paper. I have good intentions. I really hope that
you will be able to give implementation priority. We need a
Government to ensure that your officers are sensitive to the needs of
those who are in distress and depressed.
(o2/1500/rc/bks)
The police should be trained to understand that an attempted
suicide is a cry for help and it is not a crime. Who is going to tell this
to the police, Mr. Minister? I hope you will raise this in the Cabinet. It
is not only just here today in this law, it is other Ministries also that
have to be conscious. In fact, if we treat attempted suicides as a crime
to be punished, the police way is going to prevail over the human way
that your Bill is actually talking about. What we need to ensure is that
people get help. They get guidance and assurance that they would get
the helping hand that they are seeking from all of us. Then, they
would find their way back to happy and productive life. We owe it to
them to extend that hand to bring them back to a meaningful life and a
life full of meaning quite literally.
I am sorry to say that our educational system is so much at fault
in this particular problem. I am afraid the very institutions that we have
created to give our children a future are also putting them under so
much of pressure that their future is disappearing.
Sir, there was a recent study which I have here to ascertain the
presence of psychological mobility amongst medical under-graduates in
India. Just people who are going to be doctors and who are studying
medicine, half of medical students suffer from depression, anxiety and
stress as per a global study. This is 50 per cent. This is not a small
matter. We have both Dr. Harsh Vardhan and Dr. Nadda sitting there.
They are eminent doctors. This is the process which is producing our
doctors. They need trained professionals and I hope that the Bill will
deliver trained professionals.
I am concerned very seriously by the gap in our professional
capacities at the moment. The psychiatrists are telling us that in a
society where psychiatrists amount to 0.2 for every one lakh people,
there is one psychiatrist in our country for five lakh people. Not to
speak of shortage of nurses, psychologists, psychotherapists and even
NGOs working in the mental health space are few and far between.
How can we rise to this challenge? We have to put this issue higher on
the agenda. We are discussing it on a Friday afternoon in a half empty
House. The truth is that this is an issue that is a national challenge. I
certainly hope that you will also contribute, Mr. Minister, to building
networks to seriously rehabilitate mentally ill patients and persons who
require constant assistance even after their treatment.
Now there are a number of good things in this Bill but they leave
also a number of significant issues out. Even when you talk about
mental health professionals, clinical psychologists and even those

trained in homoeopathy, naturopathy, ayurveda and Unani have been
recognised in your Bill but psychoanalysts, psychotherapists
counselling psychologists and others have not been included in the Bill
amongst the professionals who can help us and our people on mental
health issues. I would request the Minister - when the Bill is adopted -
to bring in a small amendment and just add these categories. When you
have mentioned so many, you have failed to mention psychoanalyst,
psychotherapist and counselling psychologist, it is a genuine omission
and rather a serious omission. As you know, Mr. Minister, there would
be no technical difficulty in just amending the Bill at the moment of
adoption with one small change, especially since we are going to
continue this process on Monday, I understand.
All around the world, these are the people who are assisting
mental health victims and in various contexts, in the family, in the
schools and hospitals and so on. The whole principle is that we should
not only address mental health problems after they have emerged and
have been diagnosed but we should prevent individuals from going into
depression in the first place. If you have counsellors in the school
system and if you have them in the medical colleges, you may be
saving suicides, you may be benefiting India with future geniuses,
future good doctors and so on because you have prevented them from
committing suicides.
We have to help our children. We have to help our adolescents
and we have to help all our citizens who are at risk. Therefore, we need
a wide range of professionals with a wide range of skills. Mr. Minister,

I think we need to ensure that we create an infrastructure where mental
health issues even as they arise at the earliest of stages can be addressed
and resolved without having to wait for treatment at a later more
complicated stage.
I will give you one example from my home State of Kerala. I
have been informed there by the Indian Association of Clinical
Psychologists that every individual who seeks mental health services
whether it is a child who is learning these abilities or somebody with
serious psychiatric complications is expected to meet with a
psychiatrist.
(p2/1505/snb-gg)
As I said there are very psychiatrists available, but you have to
meet a psychiatrist, that too, only medical science professionals, those
qualified with a medical degree are deemed suitable. Those who
studied behavioural sciences are treated as subordinate or inferior,
whereas what we clearly need is a multi-disciplinary, multi-pronged
approach that takes advantage of all that is offered in different streams,
levels, layers and branches of mental health discourse and practice so
that more holistic answers and solutions can be found. We want to
address the issue and not to create another hierarchy of professionals
when we are dealing with this issue. We are already having a very
hierarchical society. Let us not reduce mental health again being stuck
in hierarchy of professional treatment.
Sir, the Bill is very broad in its defining terms and definitions.
Even individuals with, what could be deemed to be relatively minor
ailments such as memory orientation, or mood disorders are brought
within its purview. Now, I think, that is good. But if we are doing that
then we must also be able to provide wide range of assistance at all
levels; bring on board professionals with different kinds skills and
focus areas. In our society it is not just a question of people in the
drawing rooms or offices that we all frequent, there are displaced
persons whose lives have been devastated by natural calamities, by
riots, the people who have lost their homes, the Kashmiri Pundits who
have fled. What we need is psychological first aid provided by relevant
professionals. They cannot be herded into clinics of psychiatrists. They
would be overwhelmed by the sheer scale of the problem. What we
need, it seems to me, is different degrees of support for different kinds
of professionals.
The Military has been neglected. I tried to raise a question in
Parliament. It did not get asked, but I think a written answer is coming.
The Military has a crying need for a post-traumatic stress disorder and
it is not just after military engagement, obviously they have some real
issues there. But even during prolonged periods of service in high
tension environments, such as the LoC in Kashmir, sometimes in the
North-East and so on, they need psychological counselling. Tomorrow
we cannot afford a situation where one of our soldiers are manned with
a gun becomes mentally disturbed. The consequences could be very
serious for the morale of our Armed Forces. It is cheaper and wiser and
more far-seeing to just have mental health professionals available in the

Army to counsel people in high stress environments.
Sir, the Bill is finally with us after nearly five years of
consultation and it clears promises a potential. It is farsighted in
looking upon mental health as a right and the delivery of mental health
facilities as a responsibility of the Government. I hope the Government
now will allocate significant resources to this end. I do want to say now
that we have seen now three Budgets from this Government. Many
essential things, particularly in the health care area as a responsibility
of the Government. I hope the Government now will allocate
significant resources to this end. I do want to say now that we have
seen now three Budgets from this Government. Many essential things,
particularly in the health care area were cut in the first two years. This
year you have succeeded in getting some health care money restored,
but now that you are passing a Mental Health Bill, please speak to your
Finance Minister colleague to ensure that you will get the money you
need to make this Bill real and operational because we have seen such
schemes being really let down by the present Government. That debate
is for another day. The Government is setting up a Mental Health
Review Commission to regulate patient admission and so on. That is
fine. I do not talk only about resources for salaries for these people. I
am talking about resources for actually getting help to the victims.
Now, on the question of violation of rights, my colleagues were
mentioning and reacting when you were speaking Mr. Minister, you
must appreciate that in our country very often mental health hospitals,
especially womens hospitals are often packed with people who should
not be there. They have been actually forced unknowingly, sometimes
by their husbands, sometimes by their family members to be admitted
under some pretext or the other and we really must protect people
against this. The first resort is they live in their community; they live in
their home and they get help and only in extreme cases of danger to
themselves or others, if they are harming themselves, or harming
others, then they should be put in a mental asylum. This is, at the
moment, is a very worrying and disgraceful practice. We should ensure
that long-term hospitalisation is only in extreme cases.
Now, Mr. Minister, you have struck a good balance in the Bill
between involuntary treatment and the rights of the patient. But the fact
is that when you are talking, just as you did in your introductory
remarks, about them nominating a person to decide on their behalf, that
is a bit worrying.
(q2/1510/ru-cs)
Because the fact is, who decides whether one is at risk of
harming oneself or the other. Who decides that you are well enough to
nominate somebody else or when you are not well enough that you
need to nominate some one else? In practice, we are talking about the
condition that many people are in denial about. If the people who are
in denial and are then expected to nominate somebody else, they would
not do it because they are not ill in the first place. Then if the
nomination is coaxed under duress or if a signature is false or anything
else, you are suddenly subjecting a person to involuntary treatment. I
think, this is not going to be easy. I hope that you will be careful in
drafting the regulations of the Bill to ensure that it is not misused
because if we decide to disallow involuntary treatment, then we will be
leaving out mental patients who have lost their capacity to judge their
own mental state. But if we give people unsolicited powers to impose
involuntary treatment to lock up people, incarcerate people without
adequate medical evidence, then we are actually opening the door to
abuse and misuse. So, by instituting review procedures for
hospitalisation and leaving room for medical institutions and family
members to take action on behalf of a patient, I think, we should really
strike a balance, Mr. Minister, not just in the Bill but in the regulations
under which you will implement the Bill. You should strike the right
balance, the balance that we have lacked so far and I do want to
applaud you for the steps you have taken in this Bill in that direction.
I am glad that the drafting of this Bill was inclusive as Minister
has mentioned. A wide range of people have offered comments,
suggestions, and expertise which include the civil society and medical
professionals. Indeed, we should today appreciate the efforts of the
previous Government and Shri Ghulam Nabi Azad who offered a well
rounded Bill and of course, Shri J.P. Nadda for keeping up the
momentum and bringing it to us today.
The Bill will inevitably require refinement from time to time
because the world is moving on. The treatment of mental health
illnesses is getting more sophisticated each year. We have to be
prepared to keep amending our provisions. But I do want to say that
the issue of mental health, in our legislative process, needs to find an

important place and needs to accept the progress being made in todays
Bill but also newer methods and solutions may be found.
Some may raise questions like whether we are over-reaching and
whether our society is really prepared for a Bill of this nature. It might
well add to the stigma with which victims are seen. Legislation laws
sometimes have to take a leap and we have to move not only with the
times but we have to move ahead of the times also.
Just earlier today, somebody was pointing out that judiciary
keeps moving ahead of us. Let us for once not give our friendly judges
the opportunity to say that we are behind times or something like this
and some PIL may come up with new farther reaching things. Let us
pass this Bill soon and let us make sure that this landmark legislation
you have officered us today, Mr. Minister, is implemented quickly with
good regulations and is kept open for amendment as we need in the
future.
I believe, future generations will be grateful to us for having laid
down a much improved marker for treating mental health.
I have a couple of final points. I do want to make one more
request to the hon. Minister, not to amend the Bill but just requiring
your action. You need to review the existing case load of mental
patients admitted in our institutions because all those who are admitted
now are being admitted under the old law and that includes people who
are involuntarily locked up and so on. You should give us a date by
when you can review these cases.
As an MP, a case has been brought to my attention of a 46 year

old woman who was forcibly institutionalised. She was drugged
unconscious by health workers, brought by her doctor who said that
they were giving her a vaccination. Then she was taken; she was given
forced medication and electric shock therapy. Somehow her friends
and relatives went to the courts and the courts ruled that she was not
mentally ill and should be released. Thank God, your Bill does allow
for the consent of the patient as well as the approval from the
concerned Board before administering any electric shock therapy but
this is what had happened to this lady.
So, if our existing laws and our existing societal biases against
certain segments of people make it extremely easy to falsely
institutionalise a person, then those who suffer under the previous law
must not be left behind and forgotten when we pass todays law. That
is why, I request you to order an inspection and review of the existing
case load of those locked-up.
(r2/1515/rbn/rv)
I do want to say something else that is of concern to my party,
which is that in our country sadly whenever we do anything that is
good for society we are forced to bear in mind that the problems are
particularly for the poor, for the lower caste, for the marginalised
sections of the society, women, and homeless, and such people are the
first victims of abuse. I want to request you we must take monumental
steps to reduce our social biases, restore the right of life with dignity
that is fundamental to each person.
Just today we are talking about an MP misbehaving in an airline

and certainly action must be taken. But I can tell you about an airline
misbehaving with the mentally handicapped person. A person suffering
from cerebral palsy was forced to leave a flight. People with physical
deformities are facing humiliations. (Interruptions)
We must change our attitudes. We must change the attitudes of
society. All public servants must also have a constructive opportunity.
Let me conclude by welcoming this legislation. I congratulate the

Minister for rising to the occasion. Let us all, as a society, rise to ensure
that our citizens do not fight these battles of the mind alone. Let us tell
them that we as a people are here to support, to help, to hold their hand
until once again they are able to stand strong and lead a healthy, happy
and self-determined life. Thank you.
(ends)
1517 hours
DR. HEENA VIJAYKUMAR GAVIT (NANDURBAR): Mr. Deputy-
Speaker, Sir, thank you. I rise to support the most remarkable and
important Bill in the true sense which is going to do justice to the
people who have mental illness. Broadly we can say that time has come
in India where dignity and other human rights for persons with mental
illness now shall be ensured by allowing the passage of this Bill.
Mental and behavioural issues are increasing part of health
problems across the globe. Psychiatric disorders account for five to ten
leading disabilities in the world. Currently mental and behavioural
disorders account for around 12 per cent of global burden of diseases.
The WHO has estimated that globally over 450 million people are
suffering from mental disorder and this is likely to increase more by 15
per cent by 2020.
With the changing health patterns among Indians, mental,
behavioural and substance-used disorders are coming to fore in the
healthcare delivery system. In India nearly 150 million people are in
active need of intervention for their mental illness. In India around one
per cent of the population is reported with high suicidal risks. While
common mental disorders like depression, anxiety, substance-used
disorders are affecting nearly ten per cent of our population, very
severe mental illnesses like psychosis, bio-polar disorders are affecting
nearly one per cent of our population.
This Bill is very important in the sense that first of all it defines
what is mental illness. For categorising somebody as suffering from
mental illness or not, it is very important to define what is mental

illness. The Mental Health Act, 1987 has grossly said, any mental
disorder other than mental retardation will be a mental illness. But this
Bill defines mental illness as, a substantial disorder of thinking, mood
perception, orientation or memory that grossly impairs judgement,
behaviour, and capacity to recognise reality or ability to meet the
ordinary demands of life, mental conditions associated with the abuse
of alcohol and drugs, but does not include mental retardation which is a
condition of arrested or incomplete development of the mind of a
person, especially characterised by sub-normality of intelligence.
This Bill seeks to fulfil Indias international obligation pursuant
to the Convention of Rights of Persons with Disabilities and its
optional protocol. India signed and ratified the United Nations
Convention of Rights of Persons with Disabilities in October, 2007.
The Convention requires the laws of the country to align with the
Convention.
The Bill adopts a more understanding of mental illness than the
Act of 1987. This Bill also seeks to empower persons suffering from
mental illness marking a departure from the Act of 1987.
(s2/1520/ksp/my)
But the Act of 1987 did not recognise the agency and capacity of
a person suffering from mental illness, the Bill adopts a radically
different approach empowering the individuals to make decisions
concerning their mental healthcare or treatment. This is in line with the
objective of the Convention to uphold the inherent dignity of a person
with disabilities. The capacity to take decision is recognised. If an

individual is able to understand his situation, if he is able to understand
the foreseeable consequences of his decision and if he can
communicate it, then that person can take his own decision. As the hon.
Minister has rightly mentioned about advanced directive, this is a very
important provision made in this Bill. Earlier, when a person was
suffering from mental illness, he was not given an option whether he
would like to choose the kind of treatment he wants to undergo. People
were just treated like that these persons are mentally ill and they will be
put in some mental asylum. But today, this provision in this Bill gives
the rights to these people who are suffering from mental illness to
choose the kind of treatment they want to undergo and to choose the
kind of care they wish to take. So, I think, it is a very good and
welcome provision that has been brought in this Bill because this will
really make it mandatory for every medical officer and psychiatric
doctor to provide treatment to an individual as per Advance Directive.
If a person is not in a condition to decide as to what kind of treatment
he should take, then the doctors or medical officers can refer this case
to the Mental Health Review Board and they can take a decision
whether Advance Directive should be taken in consideration or should
not be taken in consideration. This is a very good provision that the
hon. Minister has brought in through this Bill.
The Bill also adopts a right based approach which has been done
for the first time in mental health law in India. This is a remarkable
difference that has been made from the Act of 1987. The Act of 1987
provided only general protection against cruel treatment. But Chapter V

of the Bill operates as a Charter of Rights for person with mental
illness, consolidating and safeguarding the basic human rights of these
individuals. The Bill guarantees every person the right to access mental
healthcare and treatment from mental health services. This right is
meant to ensure mental health services of affordable cost, of good
quality, of sufficient quantity are geographically accessible and are
provided without discrimination.
The Bill also recognises the right to community living, right to
live with dignity, protection from cruel, inhuman or degrading
treatment, treatment equal to person with physical illness, right to
relevant information concerning treatment, other rights and recourses,
right to confidentiality, right to access their basic medical record, right
to personal contacts and communication, right to legal aid, and recourse
against deficiencies in provision of care, treatment and services. A very
good provision that has been brought in through this Bill and a very
good decision taken by the hon. Minister is that insurance will be
provided to the patients who are having mental illness. Till date,
insurance was given only to people who have physical illnesses. But
now even with mental illness will get insurance.
Sir, the people, who are having mental illness, they do not have
short term treatment, they have long term treatment and because the
treatment is expensive, sometimes even the family is not ready to
support such patients and the treatment is left incomplete. So, this is a
very welcome and a very good provision that has been provided
through this Bill.
This Bill also seeks to decriminalise the attempt to commit
suicide. As I just mentioned, in India one per cent of the population is
at high risk of suicidal attempts. Till date, in India when a person
commits suicide, that was punishable under Indian Penal Code and so,
sometimes people who attempt to commit suicide never go to the
doctor because of the fear that they will be tried under Indian Penal
Code and they will be given punishment. So, many people who require
treatment never turn up to the doctor. But due to decriminalisation of
the attempt to suicide, because of this clause, even people who are
attempting suicide will come to a doctor and will get treatment because
this Bill says that the most important feature of the Bill is that a person
attempting suicide shall be presumed, through rebuttable, to be
suffering from severe stress and hence exempt from trial and
punishment. Therefore, this is a very good decision that has been taken
through this Bill.
(t2/1525/kkd/cp)
As my colleague, hon. MP, Dr. Shashi Tharoor-ji mentioned that
medical doctors have more stress; and, me myself being a medical
doctor, I have seen, yes there is so much of stress. But I think, this step
of exempting people, who are committing suicide, is a very good
decision that the hon. Minister has taken. I think that this Bill will
actually bring more stressful people to the doctors and they will get
adequate treatment. So, I think, this is again a very good step that has
been taken.
Electroconvulsive therapy (ECT), Sir, is a therapeutic treatment
given to patients, who are suffering from mental disorders. I would
like to highlight what is electroconvulsive therapy, which we know as
shock treatment. In this ECT, what happens is that the brain is
stimulated and the patient gets artificial seizures/convulsions, which
has to last for, at least, 20 seconds. In this case, when the patient is non-
manageable or when the patient is very violent, in such conditions,
ECT is given. But the contraindication to ECT is there when the patient
has any other disorders, say, the patient has brain tumour or the patient
has raised intracranial tension. There have been incidences where the
patients have been given ECT in emergency and they have died. When
the patient is brought to the hospital, he is behaving like a mentally ill
person and his condition underlying is not some mental illness but
some other pathological abnormality in the brain, and if he is given
ECT, he may die.
So, this decision that our hon. Minister has taken through this Bill
is very good that ECT will not be given in emergency. It is because in
emergency, nobody does brain scans; nobody checks for raised
intracranial tension; and nobody checks for bipolar oedema. So, other
conditions causing that kind of behaviour is not ruled out, and the
patient is very blindly given ECT. So, it is a very good step that ECT
will not be given in emergency.
Sir, another important provision in this Bill is that ECT will be

given only with anaesthesia and muscle relaxant. Some hospitals in our
country, who are treating mentally ill patients, are giving ECT without
giving anaesthesia to the patient. Let me tell you that when the patient
is conscious, he can see that his body is contracting, he can see that his
body is getting seizures. That entire incident is so traumatic to him that
he never wants to take ECT again in his life. So, this is very important
that when the patient is given ECT treatment, he should be under
anaesthesia and he should get muscle relaxant because his body
muscles contract and he might get injuries. So, this is again a very
good step.
Sir, that minors will not be given ECT, again is a very welcome
step. In this Bill, a very good provision that has been made is that
minors will be given ECT only after they get consent from their
guardians, and the Review Board decides the case that this minor
patient should get ECT treatment. So, it is again a very good decision
taken as far as ECT treatment is concerned. If the patient normally on
pharmacological treatment, will require a course of treatment for, say
two to three months, in the ECT treatment he will recover in one to
two weeks. So, in shorter duration, the patient recovers. Plus, it has got
very good benefits. So, again, it is a welcome step.
Sir, the Bill has also provisions for registration of institution and
regulation sector. This also provides for creation of Central and State
Mental Health Authorities. This is very important because when the
institution is registered and through this Authority, there will be
registration and supervision mental health establishment. To develop

the quality and service norms of these establishments, to ensure
registration of psychologists, mental health nurses, psychiatric social
workers, to train law enforcement officials and mental health
professionals about implementation of the Bill, and to advise the
Government on mental health related issues, the registration of mental
health establishment is made mandatory by providing for stringent
penalty for violation. The registration is contingent on the
establishment complying with regulation issued by relevant Authority.
Sir, again, another important decision in this Bill is the creation
of Mental Health Review Board. That has adjudicatory powers over the
various rights and protections guaranteed by the Bill. Further, an
appeal is allowed to the High Court against any Order that is being
given by the Authority or the Board, and there is a bar on jurisdiction of
Civil Court to entertain any suit or proceeding in respect of any matter,
which the Authority or the Board is empowered to decide.
(u2/1530/rp-nk)
Sir, this will not replicate cases. This will help us to come to a
conclusion or come to a decision faster because there is a bar on
jurisdiction on civil courts. Now, the cases which are decided or
reviewed by the Board will directly go to the High Court. So, again
this is a very welcome step.
The Bill also makes provision for responsibility of certain other
agencies. In our country, many a times we see patients with mental
illness roaming here and there on the streets. Nobody is there to take
care of such people. So, it is very important that such people should be
taken care of. That has been taken care of by provisions made in the
Bill like the Bill imposes a duty on the police officer in the charge of a
police station to take under protection any person found wandering at
large within the limits of the police station; such person will be subject
to examination by a medical officer and based on such examination will
be either admitted to a mental health establishment or be taken to her
residence or to an establishment for homeless persons.
HON. DEPUTY SPEAKER: Hon. Member, you can continue later on
when this Bill will again be taken up for discussion.
27.03.2017 Lh/Mkg Uncorrected / Not for Publication 121
1404 hours
MENTAL HEALTHCARE BILL contd.
xx {i: + vBE { SS cM* xx b. cx VBE Mi V c

l* b. cx VBE Mi V, +{ A*
1404 hours
DR. HEENA VIJAYKUMAR GAVIT (NANDURBAR): Thank you, Chairman, Sir. I

rise to support the Mental Health Care Bill, 2016.
In our country, we see that in most of the cities, people with mental
illness are wandering on the streets. Nobody is there to take care of them.
This Mental Health Care Bill, 2016, has made a special provision for all those
people who are suffering with mental illness and are wandering on the
streets. The Bill makes a provision that the police officer, who is the in-
charge of the police station, in whose area people are wandering at a large
scale, can take them under his protection and those people will be subject
to examination by a medical officer. If their residences are known, those
people will be taken to their residences. If their residences are not known,
those people will be taken to establishments for homeless persons. Further,
if a police officer, in-charge of a police station, thinks that such a person,
who is suffering from mental illness, is being ill-treated or is being neglected,
then he can report such cases to the magistrate. The magistrate can ask for
a report and pass an order to cause the person to be produced before him,
to be subsequently examined by a medical officer or a mental health
professional or be provisionally admitted to the mental health Comment: Cd by c2
establishment.
Comment: Dr. Heena Vijaykumar
Gavit contd.
(c2/1405/rcp/cp)
Sir, this Bill also provides that whenever, during a judicial process, a
proof of mental illness has been produced and the same is challenged in the
court of law, the court shall refer such cases to the Mental Health Board and
the Board will submit its opinion to the Court.
This Bill also guarantees the right of affordable, accessible and quality
mental health care and treatment for mental health services run or funded
by the Central and the State Government. The Bill also makes a provision
for a range of services to be provided by the appropriate Government.
When a person is suffering from mental illness, this comes with a stigma
that this person is mentally ill. But the Mental Healthcare Bill, 2016 has
addressed this issue by having a holistic approach of treating the people
with mental illness and empowering such mentally ill persons. This Bill seeks
to remove the stigma attached to mental illness. It makes efforts to secure
equal treatment for person with mental illness just like people with other
physical illnesses.
The Bill also allows a mentally ill person to have a nominated

representative. In some diseases, when a person is suffering from mental
illness, he might change the nominated representative every now and then,
sometimes may be two-three times even in a day. In such cases, the cases
will be given to the Mental Health Board and the Mental Health Board has
been given powers to decide whether the nominated representative that
has been nominated by the mentally ill person should be considered or
should be rejected. This needs to be done in a very short time as it will
enable the treatment.
This Bill makes a very good provision for people suffering with mental
illness. When a patient is treated in a hospital and the active management
part of the patient is completed in the hospital and he does not require any
longer stay in the hospital, such patients can be sent to half-way homes.
Half-way home is something where a patient is not completely well but he is
in a dischargeable position. He can be discharged but he is not fit to stay at
home or in the circumstances in the house; it might affect his illness. In such
cases, these half-way homes are established. In our country, not many
Government owned or Government aided half-way homes are there. There
are most of the NGO owned half-way homes. So, I would like to request the
hon. Minister, through you, that if Government establishes such half-way
homes or provides aid to the NGOs who are interested in making such half-
way homes, it will address the issue on a large scale.
Also, in our country, we see most of the mental hospitals. The Mental
Health Act of 1987 had allowed the mental hospitals to keep mentally ill
patients hospitalized for a maximum period of 180 days after second
reception order by hon. Magistrate in response to request made by the
superintendent of mental hospitals. The Mental Healthcare Bill, 2016 has a
similar provision in a staged manner and does not allow stay during
admission beyond 180 days. In such cases, practically in our country, many
such hospitals are there specially meant for the mentally ill patients where
the patients are dumped for more than 180 days. So, 180 days is the
prescribed time when a person has to be in the mental hospital but
sometimes relatives do not come to take the patients. In such cases, those
patients can be kept in the half-way homes. This is a welcome step that
half-way homes will be created under this Bill.
Also, another important provision that the Bill has is about the
rehabilitation. The prevalence of major psychosis is one to two per cent in
our country. It constitutes disorders like schizophrenia, mania and psychotic
depression. Schizophrenia poses a major problem in management as a
majority do not recover completely and show deficits and hence do not
return to pre-morbid level of functioning. The Bill mentions about
rehabilitation; the Bill mentions about providing support to the families of
people suffering from mental illness. Also, Chapter V of this Bill, Section
18(4), (c) and (d) provide for rehabilitation of people with mental illness in Comment: Contd. By e2
all the spheres of functioning.

Comment: Ms. Heena gavit continued
(d2/1410/smn/nsh)
But, Sir, through you, I would like to know from the hon. Minister if he
can throw some light on vocational rehabilitation because vocational
rehabilitation has not been mentioned in the Bill. In some cases like I said
about schizophrenia or in some burnt out cases where despite giving them
treatment, the mentally ill person does not return to his normal cognitive
ability. In such cases, it is very much required for that person to lead a
normal life and he should have vocational rehabilitation done. So, the hon.
Minister should throw some light on this aspect as well.
This Bill is very good in the sense it has covered almost all aspects of a
person suffering with mental illness. But while talking about providing care
to mentally ill persons, I think there are certain parameters that one should
look at. Psychiatric illness treatment is basically a team treatment. It is not
just one doctor giving medicine and the treatment is done. It requires
clinical psychologists; it requires social workers; it requires counsellors; it
requires psychiatric nurse other than the psychiatric doctors.
I would like to highlight some important numbers in our country.

Today, in our country, we have 25 per cent medical colleges in India which
do not have psychiatry department. Only 289 institutes provide under-
graduate teaching and 151 institutes provide post-graduate training facility.
There are totally 302 post-graduate seats of psychiatric illness out of which
MD seats are 159, diploma seats are 107, DNB seats are 36 but there is no
Ph.D seat in our country.
Sir, apart from this, the budget provision is less than one per cent as
compared to 18 to 20 per cent in the western world. I really appreciate the
hon. Ministers effort. He has announced the National Mental Health Policy
in 2014 which takes care of all these issues. But I think these numbers have
to be improved like I already said that this is teamwork.
Talking about human resources, the number of psychiatrists in the

country as of today is around 4,500. Today, in our country, we require
around 12,500 psychiatrists. That is what is required. The number of
psychiatric nurses today is 0.4 nurses per one lakh which is around 3,000.
The number of clinical psychologists is around 0.02 per one lakh which is
again around 2,000. The number of psychiatric social workers is around 0.02
per one lakh which is around 2,000. So, in total, other than doctors, these
are other para-medical personnel that we require in the treatment of
psychiatric illness are around 7,000. The number that we require today is
around 56,000 para-medical personnel. So, I urge upon the Government
that these numbers should also be taken into consideration for effective
implementation of this Mental Healthcare Bill.
In this Mental Healthcare Bill, 2016, the qualification criteria for

psychiatric nurses, psychiatric social workers and clinical psychologists are
made simpler so that the qualified staff will be easily made available. This is
a welcome step that has been taken.
We have the Medical Council of India for doctors which is a registering

body. For nurses, we have a Nursing Council as a registered body but for
other para-medical staff that is required in the treatment of psychiatric
illness, there is no designated council for these people. Now, we are talking
about mental illness patients. There can be legal issues coming up when the
treatment is going on because sometimes the patient is not able to
understand and, the person, who is giving treatment, or say, the para-
medical staff, is not registered under any Council. Then, there can be legal
issues coming up. So, I think we should consider about those councils as
well. For research, there has been a provision. Mental Healthcare Bill, 2016
allows persons to take part in clinical research. Research is the very
important part as far as mental healthcare is considered.
In this, the consent of the patient should be taken before doing any
kind of research on that person. In case the person is not able to give
consent for being included in the research study, then the concerned State
authority should give this permission for including that person into the
research. I think the person with mental illness cannot be used as
experimental animal. So, proper consent should be taken from the
concerned authority if the person is not in a position to give his own Comment: Ms. Gavit continued
consent.
Comment: Dr. Gavit cd..
(e2/1415/ak-nk)
Another very good provision in the Bill, which is very much

appreciable, is inclusion of AYUSH -- Ayurveda, Yoga and Naturopathy,
Unani, Siddha and Homoeopathy. It is a very welcome step. I am very happy
to share with this august House that this decision of including AYUSH into
the mental healthcare was first taken by the State of Maharashtra, the State
that I represent, and I am glad that this has been included in the Mental
Healthcare Bill as well.
This Bill also mentions about research methodology, namely, the

procedure of how to do research. Again, through you, I would like to request
the hon. Minister that we have to prioritise the areas in which we have to do
research. We have included AYUSH and Allopathy, and all these pathies
should have the best of research done in their respective areas. I think that
it will be for the benefit of the mental illness patients.
It is appreciable that the National Mental Health Policy has been

announced by hon. Minister, Shri Nadda, and also for keeping in mind that
there is shortage of doctors in the country he has provided funding for
almost 15 Centres of Excellence and 35 PG Training Departments, which is
again a very welcome step. The District Mental Health Programme has also
been extended to 118 Districts in the 12th Five-Year Plan in addition to 123
Districts, which was initially included in the 11th Five-Year Plan.
The funds have been increased from Rs. 56 lakh to around Rs. 83 lakh,
which is almost double. So, this is showing that the Government is really
interested in taking care of the mentally-ill patients and is thinking in terms
of improving the mental-illness patients condition. But what bothers me is
that the hon. Minister, in his speech, mentioned about mentally-ill mothers
who can keep their children with them. This is one of my concerns that in
some cases like bipolar diseases or schizophrenia it is not advisable that the
child should be kept with the mother. In such cases, since the Bill does not
speak anything on this, my request to you will be that such cases should be
referred to the Mental Health Board, which will take a call on whether the
child should be kept with the mentally-ill mothers or not.
Lastly, I would like to specially thank the hon. Minister for making a
provision in the Bill of punishing those people who are not following the Bill.
Unless and until a person has a fear of getting punished, he will not do
anything that is in the law. I am glad that there is a special provision of
imprisonment as well as fine to all these patients.
With this, I would like to say that this Mental Healthcare Bill is, in a
true sense, getting Achhe Din for the mentally-ill patients. Thank you very
much.
(ends)
1418 hours
DR. RATNA DE (NAG) (HOOGHLY): Thank you, Sir, for giving me the
opportunity to speak on the Mental Healthcare Bill, 2016. The Bill seeks to
protect, promote and improve the rights of patients in need of mental
healthcare.
The National Human Rights Commission conducted detailed studies of

the patients in mental institutions and the conditions they live in. They
found numerous instances of cruel treatment, people being beaten, people
being chained and people being denied dignity of any kind. Presently, we
have about 300 District Mental Health Programmes, but the effectiveness of
the Programme varies across the State because of the restricted funding,
lack of trained human mental healthcare provider and low motivation
among the healthcare provider at all stages.
The access to Mental Health Programme is going to be a big concern in

India as up to 40 per cent of the patients do not get access to the Mental
Health Programme because they have to travel more than 10 kms.
Depression is the leading cause of death in the world and it is the second Comment: cd.. by f2
leading cause of death in 15-29 years old.

Comment: Contd. By Dr. Ratna De
Nag
(f2/1420/ub-raj)
According to World Health Organisation, about 350 million people

suffer from depression worldwide. As per National Crime Records Bureau,
1,31,666 people committed suicide in India in 2014. People commit suicide
due to lack of funding, lack of human resources and social stigma associated
with mental illness.
There are about 4000 psychiatrists in India. Most of them are in

private practice. So, there is a massive shortage of psychiatrists in the public
sector. This will lead to a large number of people requiring treatment
remaining undiagnosed.
There are some good provisions in the Bill also. For example, Advance
Directive stating how he/she wishes to be treated for future mental illness
and also how he/she does not wish to be treated. Such an Advance Directive
can also be challenged by families and professionals etc. Decriminalisation
of suicide is a much needed reform. A person attempting suicide shall be
considered to be under severe stress and will not be liable to be prosecuted
under Section 309 of the Indian Penal Code. The Government shall provide
care, treatment and rehabilitation to all such persons. There is another good
provision. It also provides protection to patients from cruel, inhuman and
degrading treatment. Some treatments currently being used will be
prohibited, most importantly, Electro-convulsive Therapy (ECT) given
without anaesthesia and the practice of chaining the patients to their beds.
There are some points I would like to raise. The provision of

appointing a nominee and then subsequent decision being taken by him
may lead to damaging the goodwill and bonding between the families.
Furthermore, a mental patient can only be admitted to a mental institution
after being reviewed by the Mental Health Review Commission. This may
lead to undue delay in the treatment and make the entire process more
complicated. Furthermore, these reasons may discourage the families from
playing a proactive role.
Mental Health Review Commission has six members out of which one
is a psychiatrist and another is a mental healthcare professional. That means
this will lead to a crucial decision being taken in the field of mental health by
non-experts.
The Bill states about Electro-convulsive Therapy (ECT) in case of

mental illness on minors. Sir, as the Board advises it with the consent of the
parents and prior permission of the psychiatrists. Due to serious hazards of
Electro-convulsive Therapy on minors and its controversial practice in the
treatment of mental illness in minors, a blanket ban on ECT for minors
should be implemented as advised by the World Health Organisation.
The Bill states that medical records can be accessed by patients unless
it results in causing serious mental harm to the patient. There is no
definition of what would constitute as serious mental harm, it is left to the
psychiatrists decision. This could lead to cases of unscrupulous persons
taking advantage of this for their own benefit. The Bill must provide for
stringent punishment in cases of falsifying the medical records.
The Bill states that there shall be one District Board for the eight
north-eastern states of India, covering an area of 262,230 sq kms. This
would make it inaccessible for a large number of people who face difficulties
in connectivity and terrain.
Sir, the Bill states the community-based rehabilitation establishment

and services for patients has not been defined. There is a clear definition Comment: Contd. By Dr. Ratna De
Nag
needed.
Comment: Dr. Ratna De (Nag) - Cd
(g2/1425/sh-ind)
Sir, we request the hon. Minister to include dementia under Mental

Healthcare Bill, to incorporate one Neurologist in the Board, and the
admission and discharge of a mental patient in a mental health institution
should be done under the jurisdiction of a physician. Regular mental health
awareness camps should be arranged by the Government Organizations and
Non-Government Organizations, and to review and assess that programme
by an expert; and finally, assess, analyse the benefit of the programme and
the response of the people.
With these words, I would like to request the hon. Minister to look
into these issues so that our country gets a good Bill which will help in
raising the awareness and eradicating the social stigma associated with
mental illness. Thank you.
(ends)
1426 hours
SHRI BHARTRUHARI MAHTAB (CUTTACK): Mr. Chairman, Sir, I stand here to

deliberate on the Mental Healthcare Bill, 2016 that is before us for
deliberation. The provision of mental healthcare, at the primary level, in low
and middle income countries is awfully inadequate today. To a certain
extent, this Bill is going to address that.
I would remind this House the tragedy that struck in Erwadi in Tamil
Nadu in 2011 where people being treated at a religious facility died in an
accidental fire that brought the plight of those with mental illness into
national consciousness. The subsequent directive of the Supreme Court and
the National Human Rights Commission temporarily refocused the countrys
attention on the care of people with mental disorders. Yet today, I would
say that mental healthcare in the country, in the community and in primary
care, remains a distant dream.
Sir, when I talk about mental healthcare, we should also be aware that
the World Health Organization, in its Global Estimates on Depression for
2015, has said that over five crore Indians suffered from depression and
over three crore others suffered from anxiety disorder in that year. This was
the calculation or the figure of 2015 alone.
In this country, this social and medical challenge has always been
brushed aside under the carpet. Though things are changing, depression is
the leading cause of disability worldwide and is a major contributor to the
overall global burden of disease, WHO has said, ascertaining that more
women are affected by depression than men and at its worst depression can
lead to suicide.
Sir, reflecting this viewpoint, Bombay High Court, in 1987, in Maruti

Shripati Dubal Case, had termed Section 309 as unconstitutional. In the P.
Rathinam Case in 1994, the Supreme Court ruled that a person would not be
forced to live a distressed life and hence Section 309 violated Article 21.
However, in 1996, in Smt. Gian Kaur Case, a five-Judge Constitution Bench
overturned the Rathinam Case judgment saying that right to life could not
be construed ever as a right to die. In 2011, the Supreme Court
recommended to Parliament to consider decriminalizing the attempt to
suicide. The Mental Health Bill seeks to nullify the punishment that Section
309 imposes. Therefore, in a way, it is not only going to provide healthcare Comment: Cd bby h2
to the mentally ill persons, but also in a way is nullifying Section 309.
Comment: shri b. mehtab cd.
(h2/1430/sr-vb)
It actually criminalises a person who attempts suicide. To a great

extent, that is a good thing. I think, a number of Private Members Bills also
were moved relating to Section 309 and are still under consideration.
Is our country equipped to tackle such a burgeoning crisis? The answer

is no. There is no insurance coverage for a person with a mental disorder.
WHO says that the Governments expenditure on mental health is only 0.06
per cent of the total Health Budget. The Bill before us today is, no doubt,
progressive in many ways. The definition of mental illness is no more any

mental disorder other than mental retardation. It is a broader and more
inclusive, yet this Bill receives 124 amendments, perhaps the highest for any
law. Readily, the Government also has accepted those amendments. This
was deliberated in Rajya Sabha.
This new Bill I do not know whether in the course of our

parliamentary history any Bill has got that much of amendments to be done
and also been accepted by the Government will replace the Mental Health
Act, 1987. It prohibits electro-convulsive therapy in children and makes it
mandatory for medical experts to use electric shock only under anaesthesia
for adult patients. I am of the opinion that this is an important piece of
legislation to deal with a serious but grossly neglected public health issue. In
2007, India had ratified the UN Convention on the Rights of Persons with
Disabilities which requires the signatory countries to change their law to
give effect to the rights of persons with mental illness.
This Bill guarantees every person the right to access mental healthcare
and treatment from the Government. This right includes affordable good
quality, easy access to services such as minimum health services in every
district. Persons with mental illness also have the right to equality to
treatment and protection from inhuman and degrading treatment.
Decriminalisation of the attempt to suicide is one of the most outstanding
facets of this new Bill. It considers it as a sign of mental illness that requires
treatment unless otherwise proved. The 210th Report of the Law
Commission in 2008 called for decriminalisation and humanising attempt to

suicide. At present, it is punishable with a jail term or fine under Section 309
of the Indian Penal Code. This has been criticised far and wide. It is high time
this needed to be corrected.
This Bill provides introduction of advance directives to people with

mental health disorder. People with mental health disorder are empowered
to choose the mode of treatment to say no to institutionalisation and to
nominate representatives to ensure that their options are carried out. This is
a Western concept. In Western countries, this is prevalent. This was not
prevalent in our country. But, this Bill mandates provision of mental health
services in every district with all facilities. It provides for establishment of a
State Mental Health Authority and the Central Health Authority alone with
the Mental Health Review Commission to regulate the sector and register
institutions.
This Bill requires that every insurance company shall provide medical
insurance for the mental health on the same basis as it is available for
physical illness. Yet, I would draw the attention of the Minister towards
certain drawbacks. It is too Western a concept to think of people with high
illiteracy, it would give advance directives with regard to what type of
management should be given.
The Bill also ignores parents and families. I think, a little bit of
correction is necessary because here whoever brings in a mentally ill patient
to the hospital or a doctor is carried by his parents or by the family. The

persons may not be in a position to determine as to what is written in that Comment: cd. by j2
form that he has to sign.

Comment: Bhartruhari mahtab cd
(j2/1435/kmr/pc)
So, in that respect, recognize the family, recognize the parent so that
he will be in a position also to take decision on behalf of the patient there.
Since many mentally ill patients lack insight during acute phase of illness
they can be easily cheated by the so-called nominated representatives also.
The existing medical infrastructure is poor. Lack of specialists to treat

mental disorders is another problem. India has just 0.1 psychiatrists for one
lakh people compared to 1.7 for one lakh in China. Over 50 per cent of the
mentally ill in India have no access to healthcare. One of the challenges is
increasing the number of mental health professionals. The other day I had
written a book which was released by the hon. Speaker and hon. Health
Minister also was present. I was relating to the old-age diseases specially
related to dementia.
What type of healthcare is available today in our country and what

more needs to be done? There are a number of physicians or doctors
present today in this House. I would say that one of the major problems that
we have is shortage of nursing staff to take care of geriatric patients, to take
care of those who suffer from dementia, to take care of mentally ill patients.
Treatment is one thing and taking care of them continuously is another
thing. We do not have that curriculum yet so that they can be provided good
nursing and good care.
These are the challenges which need to be met. One of the challenges
is increasing the number of mental health professionals. The other is for
people to come forward and seek help, something they rarely do given the
taboo associated with this illness. Women particularly in rural areas are
subjected to great stress in carrying out daily chores and living in a
patriarchal, oppressive society. There are very few facilities where women
with mental illness can be treated, and even fewer which deal with their
rehabilitation in society. This Bill rightly speaks of not separating a mentally
ill mother from her child while she undergoes treatment.
While the intentions of the Bill are laudable, much of it will fall
through the cracks unless appropriate infrastructure is set up. In the 2017
Union Budget, growth in health and disability budget remains marginal.
Particularly disappointing is the negligible focus on mental health especially
considering Indias suicide rates rank among the highest globally. Allocations
primarily assigned towards upgradation of premium institutes leaves scarce
resources to address challenges in mental hospitals, what to speak of issues
around long-term care in inclusive society, spaces or constructing a robust
social care component within the District mental health programme.
Public health is no doubt a State subject and the Union Government

after consultations has brought this Bill. I do not know why but four States
did not fully support the Union Government to repeal Section 309. The
Union Government should give financial help to States to provide mental
healthcare services up to District level. Society needs to be educated that
mental distress, disorders and derangement are inevitable byproducts of a
stressful social order. As a society we need to move beyond stigma and
instead develop sympathy. Needless to say, Sir, the Government needs to
invest more money and health workers in tackling this challenge.
Thank you, Sir.
(ends)
1439 hours
DR. RAVINDRA BABU (AMALAPURAM): Namaskar, Sir.
On behalf of the Telugu Desam Party we wholeheartedly support this

Bill. I can say from my last three years experience that this is one of the
finest drafted Bills that I have ever come across. This finest drafted Bill takes
into account the actual suffering of the people and makes best efforts to
codify even the behavioural disorders also. Sir, I really congratulate the hon. Comment: Cd by k2
Minister of Health for the excellent effort he has made.

Comment: Ravindrababu cd.
(k2/1440/gm-mz)
I am really proud to be a Member of Lok Sabha at least for now. I

have a small suggestion. My friends have already criticized me. I never get
any bouquets but only brickbats. This time, I deserve bouquets and not
brickbats. I was referring to the Maternity Benefit Bill on which I was
thoroughly misunderstood. I was actually pleading for one and a half years
leave and they thought I was being derisive. I was only exhibiting my
medical knowledge.
Mental illness has been defined as a disorder of thinking, mood,

perception, orientation, memory or aggression that grossly impairs
judgement, behaviour, capacity to recognize reality and ability to meet the
ordinary demands of life. I am afraid these are the qualities with which
everyone of us would have suffered. The mood perceptions, behavioural
changes, ups or downs, depression, sorrows everybody undergoes all
these things and everybodys judgement gets impaired because of certain

other extraneous reasons or reasons which are beyond our control. If I lose
my mother, if I lose my father or if I lose my close kith and kin, my
impairment will be very clearly visible. Those things have also been labelled
as mental illness. This should have been called as a behavioural disorder
instead of calling them neurotic things or psychotic things. Things like mood
perception, behavioural disorder which impairs judgement, things which are
functional in nature should have been categorized as behavioural disorder
and not as mental illness.
When we go through all the provisions of the Bill, it looks as though

we are talking about only one disorder, though there are five or six disorders
as per the Psychiatry Association. Only one disorder has been spelt out and
that is schizophrenia. This is the one we are talking about. In schizophrenia
also, there are four or five stages- one is hebephrenic, another is mood
depression. Schizo means mind and phrenia means split. Whenever
there is a split in communication, thoughts or perceptions and it results in
gross neglect of personal hygiene, posing threat to the person himself as
well as the society, that is the time when we say that one is suffering from
schizophrenia. When there is a thorough break-down of the personality
system, it is time when we usually interfered and went for a treatment in
mental asylum. But, throughout, we have been over-enthusiastically trying
to classify even the maniac psychosis which is called bipolar disorder as a
psychiatry illness. Even anxiety neurosis or sleeping disorder which can be
easily attended and which is superficial in nature not affecting or not

fragmenting the personality should have been kept out of the purview of
this Bill. It reminds me of the movie A Beautiful Mind where actor Russel
Crowe played the role of the scientist John Nash who founded the Game
Theory. A person like John Nash who founded the Game Theory suffered
with schizophrenia; an ECT was given to him three times. My colleague from Comment: cd. by l2
BJP Dr. Gavit has already spoken about how ECT functions.
(l2/1445/rsg-bks)
Comment: DR. RAVINDRA BABU
It will turn a functional man into a total vegetable. Such is the power CONTINUED
of ECT. It leads to convulsions, seizures, contractions, and later on to a

flaccid body which becomes a total vegetable. Even after turning a man into
a vegetable three times, the human brain, human energy, human ingenuity,
and human intellect are so great that these two persons even after
undergoing ECG therapy thrice have made huge discoveries. But ECT may
not give a treatment; it might still have those symptoms. Without ECT also,
there are other drugs.
Of late, in psychiatry also many medicines are invented and

discovered. In psychiatry, the disorder most frequently seen is the bipolar
disorder and the manic depressive psychosis. During mania, most of the
emperors, kings, and achievers would have suffered manic depression
psychosis. The depression is one during which he may withdraw without
threatening anybody. He would be simply engrossed, he would become
introverted, and he would not do any harm. Even those things also must
have been connected to this Bill. The intention of the Government seems
only to treat a disorder where a person would only threaten himself and the
society. It is fine. But they should be covering MDP, personality disorder,
and faulty coping mechanisms because the definition of mental illness is a
little confusing. Therefore, through you, I request the hon. Minister who has
made an excellent draft of this Bill except the definition of mental illness to
include mood disorders, behavioural disorders, perception disorders, and
those disorders which impair the ability of judgement. These things should
have been included; otherwise those who go for counselling will find it very
difficult.
We go to a psychiatrist for treatment; we go to a counsellor only to

examine disorders or detect particular problems. Those counsellors also may
have a tendency to label anybody as per the Act as suffering from mental
illness. If mental illness is diagnosed by psychological counsellors in schools
and colleges, there will be stigma. There is a great stigma attached to this
even now in India.
I want to add one more point though not related to the Bill.
Psychological disorders are very uncommon in India because we used to
have the joint family system. We do not suffer from any emotional problems
or psychological or behavioural disorders because we have a joint family to
take care of our mental disorders, anxiety, neurosis, behavioural disorders,
sleep pattern disorders, personality disorders through father, mother,
fathers father, mothers mother and so on; all whereas in a capitalist

society, because of break-down of the joint family, the emergence of a
nuclear family will lead to break-down of personality. Therefore, I hail our
Hindu system and I hail our joint family system.
(ends)
1449 hours
SHRI KONDA VISHWESHWAR REDDY (CHEVELLA): Hon. Chairman, there is a

beautiful song by Don McLean, Starry, Starry Night. It is actually a eulogy
for Vincent Van Gogh, one of the greatest artists, a brilliant impressionist
painter, probably one of the most influential figures in the history of
Western art and yet a very sensitive human being.
His paintings sold for millions and millions of dollars but he died in
abject poverty. He painted ordinary people, beautiful flowers, cypress trees,
landscapes, gardens and Starry Night. He suffered from depression, Comment: CONTINUED BY M2
psychotic episodes, and delusions.

Comment: Vishveshwara reddy cd
(m2/1450/rk-gg)
He once said, There is nothing more artistic than to love people. He

loved everything around him but he was scared of loneliness. In a bout of
depression and loneliness he cut off his ear and later committed suicide.
When he was alive, nobody cared for him.
The song ends, The world was never meant for one as beautiful as
you. On the other hand, the movie Beautiful Mind is about John Nash, the
most brilliant mathematician. John Nash also suffered from depression and
mental illness but the difference is he had support of his wife and family and
he got good treatment and care. He went on to get the Nobel Prize in
Mathematics.
PROF. SAUGATA ROY (DUM DUM): He suffered from Schizophrenia.
SHRI KONDA VISHWESHWAR REDDY (CHEVELLA): Yes. These people had

severe disabilities but they also had phenomenal abilities, more than most
of us. Sir, we as a country need to recognise and support these beautiful
minds.
The Mental Health Care Bill, 2016 repeals the Mental Health Care Act,
1987. It is very-very comprehensive. I appreciate the hon. Minister for
taking views of all the stakeholders in drafting the Bill; the political parties,
the medical fraternity, the civil societies, the Standing Committees and the
judiciary. Congratulations, Sir. Earlier, the laws governing the mental
illness, the Indian Lunatic Asylum Act, 1858 and the Indian Lunacy Act, 1912
ignored the human rights aspect.
After 40 years of Independence, we did enact the Mental Health Care

Act of 1987 but it was really not implemented. The present Bill is
comprehensive and includes access to health care, treatment, rehabilitation,
insurance, right to choice of treatment but most importantly decriminalises
attempt to suicide and regulates mental establishments. The hon. Minister
had earlier said that the earlier Bill was regulation centric whereas this Bill
is patient centric. I congratulate him for that.
But how do you provide support and care for these vulnerable
individuals. Firstly, by creating awareness and acceptance. Mental patients
face social stigma. Public need to be aware of it. They need to be accepted
in society and they should not be confined. So, there need to be a Budget
for creating awareness through TV and media messages, etc.
Secondly, they need access to care. Many hon. Members have raised
this point. Presently, about 2 per cent of the population suffer from mental
illness. The other day Shri Shashi Tharoor and Shri Mahtab were mentioning
that it is five per cent. NIMHANS says that 10.6 per cent of the population
has some form of mental illness. There are only about 3,500 psychiatrists.
We need more institutions like NIMHANS. But, the more important point is
about psychology. There has been a great emphasis on psychiatrists.
Psychiatrists are doctors who give chemicals and medicines. We need
psychologists and they are even scarcer. There are only 1000 or so
registered psychologists in the country. There are so many branches of
psychology including health psychology. We need to really look at how we
can increase the number of psychologists in our country. Most hospitals and
institutions do not have psychologists, Sir.
We are very glad that the Bill has a provision for insurance cover of
mental illness. But many cases of mental illness are co-morbid, because of
mental illness other diseases like heart attack and gastroenterological
diseases exist and sometimes it is opposite. Because of other diseases
mental illness exists. Even if you provide insurance coverage, insurances are
done by private companies and they are independent entities, even PSUs.
So, you cannot force them. We can enact a Bill in the Parliament but what if
they do not provide the coverage. It is a business issue, we cannot force

them.
Today the psychological consultations are not covered under

insurance policy and it is very likely that tomorrow also, after passage of this
Bill, they may not be covered.
The most important question regarding insurance is, a lot of mentally

challenged children are born mentally challenged so, whose insurance
covers them; the mother or the child? So, there needs to be a public health
support system for that.
The urban life has become very stressful. The hon. Member has
extolled the virtues of joint family. Yes, Sir, the joint family acts like a shock
absorber but in todays world I do not think that shock absorber exists in
urban life. We need urban counselling centers. But it is not just urban
problem, Sir. We talk so many times about farmers suicide and a lot of
times it is not because of lack of fertilizers or lack of rainfall. As the lifestyle
is changing and the youth are fleeing, elderly and the middle class farmers Comment: cd
are living without support in the villages.

Comment: Sh. Konda Vishweshwar
Reddy ctd.
(n2/1455/ps-cs)
We need psychological counselling there. Nimhans has a rural

outreach programme, but it is very tiny and is probably only one in the
country. We need more programmes like this.
Now, I come to property management. We have seen in so many

movies that criminally-minded relatives declare somebody lunatic and usurp
their property. We need protection in the Bill. There is a lacuna in the Bill
and it does not protect the property of the mentally-challenged people. But,
most importantly, Sir, the Budget puts the entire thing in perspective.
Currently, the mental health accounts for 0.16 per cent of the total Union
Health Budget. The Union Health Budget itself is a little small of 2.2 per cent
of the overall Budget. So, if you translate it, the Budget for mental health
will be 0.0036 per cent. The hon. Minister can correct me on this. But, if it is
so low, how can we really implement this Bill?
The Bill decriminalises attempts to suicide. That is very welcome. But,

also we have seen in many cases that criminals commit crime and then they
go to the court and take shelter saying that at the time of crime, they were
mentally unstable. Again, it is a very important point of distinguishing and
codifying behavioural disorder from mental disorder. Shri Ravindra Babu Ji
has pointed out this. It is very important. Otherwise, criminals will take
shelter on this.
Lastly, I am very glad that we are passing this Bill today. Let us make
sure that the Bill is implemented immediately.
But, Sir, in the end we should make sure that no one will ever say our
country, India, is not meant for one as beautiful as these people. On Behalf
of the TRS Rashtriya Samithi, I support the Bill and its speedy
implementation. Thank you, Sir.
(ends)
1457 hours
SHRIMATI SUPRIYA SULE (BARAMATI): Thank you, Sir. I would like to take
this opportunity to congratulate the entire Ministry of Health and Family
Welfare for coming up with one of their finest legislations they have come in
the last few years. I take this opportunity to congratulate the hon. Minister
of Health and Family Welfare. Sir, since he has come, he has added a
glamour quotient to the Health Ministry by a lot of advertising. It is because
advertising really makes a difference. Right from the T.V. advertisement of
Shri Amitabh Bachchan, definitely I think Polio was one of the few success
stories that our Health Ministry has had purely by the right advertising and it
has reached the last home whether it is a home shelter or village.
So, whenever, the Health Ministry in India decides to make a

difference, whether it is a village or Parliament or any corner, you have
always had an extremely efficient and successful job done, especially since
Nadda Ji took over, be it the AYUSH or the immunization programme. I
would like to take this opportunity to thank him for even the tobacco
control programme. He has been exceptionally supportive for all these
changes that we are trying to do in the society. He has been very patient.
Even Dr. Sanjay Jaiswal is here. I think the entire House should thank
them and the entire Standing Committee which has been exceptionally
patient by drafting this Bill. They heard every small or big person who had
applied or wrote to them about the Bill, whether it was technical or non-
technical or whether it was an NGO or psychiatric society. The Ministry and

the Standing Committee have walked an extra mile. So, I think the entire
House must congratulate them and I hope all other Ministries follow what
this Ministry has done because they have really done it with the right
intention rising above politics.
This Bill has come at a very difficult time especially in my State. We

had an unfortunate incident in Dhule district where an Orthopaedic Doctor
was at a Civil Hospital and there a person needed a doctor for a different
reason. But, the said doctor could not help the patient and unfortunately,
the patient died. The entire family attacked the doctor. The doctors skull
was broken, has lost one eye and is in ICU. So, I think the time has come,
even for all of us while we are coming up with all these good legislation, the
doctors security, I think is a very crucial issue. I do understand and respect
the emotions of the family whose member has passed away. Like there is a
good and bad politician and good and bad lawyer, there are good and bad Comment: Ctd.
doctors.
Comment: Smt. Supriya Sule cd
(o2/1500/rc/rv)
So, it does not mean every doctor is bad. That particular orthopaedic
doctor in Dhule is very unfortunate that he has to pay a price and is literally
fighting for his life today in Dhule. But let us all hope and pray that he
recovers and gets over this.
So, I would appeal to the hon. Minister of Health that he should talk to
all the Chief Ministers and see how we can make sure that all our doctors
are safe at all times. I am sure there will be still freak accidents but I am
sure we can all put our minds together and see how we can really protect all
these people who are trying to save lives.
This Bill is almost a flawless Bill but there are just a few quick
questions if the hon. Minister could answer. It would be much easier for all
of us to have more clarity on the doubts we have in our mind. As we all
know, access is a huge challenge and there is a gap. If the National Mental
Health Policy and the Mental Healthcare Bill are implemented completely, I
think it would be a complete win-win situation for all of us.
I have one suggestion which is a programme which the Maharashtra

Government has tried in Nasik. They used a small group of 60 Self-Help
Group women who worked in villages. They were called the leaders who
could help and they addressed a lot of mental health care issues which need
not be schizophrenia or severe depression but maybe post care depression
or small issues which would make people vulnerable. So, before we reach a
level of getting the number of psychiatrists done, could we take help of our
health workers or empower the Ashas and train them a little bit till we finish
off with this gap? So, could that be an option?
I remember, Dr. Tharoor talking about psychotherapists. Sir, I am not

sure what your view of psychotherapists is but today, unfortunately, in India
it has become almost cocktail conversation that I am depressed and I need a

Prozac. I think, we really need to get out of this. There are so many
counsellors. It is very good to have counsellors but how many qualified
counsellors do we have. For the mental health issue, the counsellors could
be at a very abysmally lower level. Are you going to allow these
counsellors? If you are going to allow them, how far can they go in helping
such persons? So, kindly clarify on psychotherapists, what you expect out of
them and how far they can go in treating them. It is because today anybody
can open a little shop and can start as a counsellor who is not even qualified.
I think we need to have that clarity.
As regards allied health professions, I think Ms. Heena Gavit also

mentioned it in her speech that what are we looking at because most
practitioners have guidelines. So, I think we need to have very stringent
guidelines because these issues are all chemical imbalances. This is just not
a freak accident where suppose there is an examination and you are
stressed. I do not think this Bill is just for stress and for competitive
examination stress. This is far deeper chemical imbalances that people have
which are beyond their control. We do not even know how this mental
health comes from. There is no science where we have been able to prove
how mental health occurs. It is provided through genes or what. So, I think
we really need to have clarity on psychotherapists. So, if you could kindly
clear that.
As regards rules and regulations, there are a very few States who had
the right rules and regulations after the Mental Health Act of 1987. I think
Karnataka is one of the States which has come out with the best regulations.
Maharashtra also has come up with it but in Maharashtra we have run into
an issue where we requested them to put alcohol and drugs also as mental
issues. Excessive alcohol and drug consumption is a disease which is not
even in this Bill. We got held up in Maharashtra while framing the rules and
regulations because we realised that that comes under the Ministry of
Home Affairs and it does not come under the Ministry of Health. So, if you
could kindly throw light and I would request you that if alcoholism and drugs
could be put into this Bill as a mental illness or at least consider it because I
do understand legislations have their limitations. But we can keep changing
them and strengthening them as we implement them.
Third point is the budget. Sir, we definitely have an issue with the
budget. A lot of earlier speakers have talked about it. So, I would not
repeat those points but please clarify the mother and baby clause at what
level and what access is there. I am a mother and I do understand that
however, ill the mother is, to take the child away from the mother may not
be the right decision. You have said that for three years, you will allow the
child. Please clarify what could be in the fourth and fifth year or what plan
do you have. How will we subsidize the child? You will look after the
mother but what happens to the care of the child if the child stays with the
mother.
In section 65, you have talked about registration which is a very good
step. But there is one little line which has come after clause 2, it talks about
the registration. It says:
Provided that the Central Government, may, by notification,

exempt any category or class of existing mental health
establishments ...
Comment: cd. by p2
Who is to decide about this exemption? How will you exempt?

Comment: supriya sule contd.
(p2/1505/snb-my)
At this rate, anybody can ask for an exemption. Who will have the
authority to exempt? The first clause is correct, but the by-line which has
just come needs a clarification.
The other point is about the District level Mental Health Boards. Who
is going to budget them? Who are all going to be on these Boards? I see that
in my district itself. People who have to come to Pune, Sasun hospital which
has one of the finest psychiatrist departments have to travel for hours
together. They spent sometimes Rs. 3 to Rs. 5 thousand rupees just to get to
the hospital. The Government is subsidising the help they are getting, but
what about their travel? Unless this infrastructure is there all over it is
difficult. So, these Boards need to be far more active and the Budgetary
allowance for the Board, it may not always be in Pune, it can go around in
the other Tehsils or the blocks. If the Government could come up with
something like that, then it would be of great help.
Sir, I would just like to make two more points. All the drugs that are
required for mental health are always for long-lasting treatments. So, could
we put all these in the Essential Drug List in the Drug Control Price? Would
the Government consider this?
Sir, the last point is that most of these issues that we face are more
women-centric. I do not want to make it men versus women debate, but
definitely a lot of depression issues are more in men. Men are more
schizophrenic in data base. Even in Sasun when we go, if you follow data, no
women are brought there. It is because the man is the earning member and
therefore, he needs the treatment. So, the entire family spends a lot of
money on the man coming there. But women do not get help. Can we have
a gender sensitive Bill where women can get the treatment? Even in
marriages we notice that if it is not an amicable divorce, we have data base
evidence, and in divorces and separation people have used mental health as
a huge category where women suffer because of that. So, I would take this
opportunity to ask the hon. Minister to kindly clarify some of these doubts
because it is a very strong Bill. I do understand that the Government has put
its best foot forward and the Government has asked the Psychiatrist Society
and all NGOs working on it before drafting the Bill. It is a good Bill but if the
hon. Minister could walk another extra mile and just give clarifications, I
think, the implementation would be better and the whole intent of the Bill
for which you have put this whole energy and time together would be
fruitful and the nation will thank you.
(ends)
1507 hours (Shri Hukum Singh in the Chair)
*SMT. P.K.SREEMATHI TEACHER (KANNUR) : Those afflicted with various mental

problems, are among the most neglected, insulted people who are also subjected
to the most inhuman treatment. As this bill, intends to protected them and
redress their suffering, I support the Mental Health Care Bill, 2017, introduced by
the Health Minister in this House.
But having said that, let me remind that the care and protection of the
mentally disturbed is the responsibility of our Government, and therefore
adequate financial provisions should also be included in the bill.
Sir, physical health and mental health are both equally important. When
we can maintain good mental health it is believe that we can also maintain good
physical health. But then even when physical health exists, due to various
reasons- social, economic, domestic or employment related reasons, or even
adverse behaviour of colleagues, can all lead to mental disturbances. In recent
times there is an increasing trend of mental illness among our children and youth.
So we are passing through a phase, when, mental illness is becoming more
widespread in our society. So it is appropriate, that the Parliament is now
accepting and upholding, the rights of the mentally ill by passing this bill. Let us
also not forget that the United Nations has already held a convention, to uphold
the rights of the mentally ill. So we are already late, in introducing this bill. But,
though late let us make up for the delay, by making this bill all inclusive.
Various states of our country have their own mental health authorities.
But what are the facilities that we provide for the mentally ill, in various
*Original in Malayalam.
states? The only national institute, which we can be proud of, is the NIMHANS
institute, at Bangalore. The other State Government hospitals have very limited
facilities. The mentally ill are the most marginalized. All the facilities for their
treatment, and rehabilitating the mentally ill once they are cured, are equally
important.
Sir, the patients are often rejected by their families, laughed upon by those
in the hospitals and often even doctors are not sensitive enough. The poor are
denied all facilities, and subjected to refection from all fronts.
Government hospitals are overcrowded. They are like jails. I would say
that the poor mental patients are subjected to worser tortures than are even
meted out to prisoners. We have to see their plight; to know what it . I am
talking from personel experience. They have a right to live with their family, and
engage in suitable employment. Are we ready to ensure and protect their rights?
Even when a patient is certified as fully cured by a competent doctor, the

family members of that patient are not ready to take him or her back home. If it
was a physical ailment the family is ready to accept the patient. Their parents,
children, husbands or wives refuse to accept them. Even after being cured, they
are compelled to live with other patients in a mental asylum. My suggestion,
therefore, is that all the states have separate mental health authorittes, who
should identify the cured patients from time to time and help them to rehabitate
and if possible find employment. A pension amount, to support them is also
essential. Since the physically disabled have pensions and financial assistance
from the state and central, why cant the mentally ill get the same support? Unit
they became capable of earning and being self sufficient, why cant the
Government give them a pension? This is our responsibility, sir.
I am speaking from personal experience. In my neighbour-hood there was

a family.The entire family was affected by mental diseases. Sometimes, I feel it is
a genetically transmitted problem. I have seen a brother, sister, mother ,father
the entire family members becoming mentally ill. The entire family members had
an untimely death.
Then, there are social problems, highlighted by my sister, Smt. Supriya Sule.
All kinds of drugs are within the reach of our children. Sir, five more minutes. So
there are factors that disturb the very mental health of our children. Why do
children of eight or ten or twelve years commit suicide. Lot many children suffer
from depression. Who is responsible for depression? Children do not commit
suicide just like that. It is the society, that has created this Situation.
So our society itself is responsible for driving our youngsters to this

situation. We have to help them out.
Why cant all states have NIMHANS like model institutions for health care?
Sir West Bengal has a national institute for rehabilitation of disabilities for
orthopedic patients.The centre has enough space sir. Why cant a NIMHANS like
mental care centre open in West Bengal National institute of orthopedic and
disabilities rehabilitation centre.
We have to insure that all states, have, qualified psychiatrists and

psychologists. For this, we have to increase the number of psychiatry seats in the
PG courses of all medical colleges. Let me conclude, by saying once again that I
support this bill.
(ends).
(r2/1515/spr-nsh)
1517 hours
SHRIMATI BUTTA RENUKA (KURNOOL): Thank you, Sir, for giving me this
opportunity.
It is with a lot of agony and hope, I take this opportunity to speak on

this subject. This subject has been a matter of serious concern for the society
and the nation. Mental illnesses are more common than cancer, diabetes, or
heart diseases. The World Health Organisation indicates that nearly 25 per
cent of the world's population are affected by mental illness. The figures for
our country may be much less. Many of the mental illness cases are under
reported or not reported at all especially in rural areas. Mental illness is
having significant impact on the society. Mental health and stability are very
important factors in a person's everyday life. It is pathetic to see a number of
children afflicted with mental illness. The most common mental illnesses in
children include autism, anxiety disorder, and depression especially in older
children and those in teens
Mental illness affects not only the person themselves, but the people
around them. Friends and family also play an important role in the child's
mental health stability and treatment. Social stigma is another factor which is
aggravating the issue. Movies and TV shows showing characters with mental
illness is in fact adding to the stigma and those with the illness are looked
down upon.
Unemployment is another important factor that is impacting emotional
stability sometimes leading to depression. I welcome this Bill whole
heartedly because it tries to address many issues relating to mental health
care. The most welcoming feature of this Bill is that it provides to the
individual affected with mental illness on how he would like to be treated and
also to specify who will be the person responsible for taking decisions with
regard to treatment, his admission into a hospital, etc. The Bill guarantees
every person the right to access mental healthcare and treatment from mental
health services run by the Government. This will ensure good quality mental
Comment: Cd by s2
health services at affordable cost. Comment: (Shrimati Butta Renuka -
Cd.)
(s2/1520/ksp/nk)
The most significant aspect of this Bill is decriminalisation of suicide. It

is unfortunate that suicides are on the increase due to depression on
account of unemployment, marital disputes, financial problems etc. It is
necessary to show sympathy and be compassionate rather than prosecute
such a person. When this Bill becomes law, whoever attempts suicide will be
presumed to be under severe stress and shall not be punished. We must put
in systems to counsel and rehabilitate such weak minded persons.
I also welcome coverage of medical insurance for mentally ill persons

on the same basis as is available for physical illnesses.
I request the hon. Minister of Health and Family Welfare to educate

the people on mental health so that the stigma attached to it in the society
can be got rid of. In many cases medical help is sought only for serious
mental conditions. But even milder forms of mental disorder like
depression, anxiety, post-traumatic stress etc. shall be treated in the initial
stages. Road rage and the incidence of rape attempts are a reflection of
delinquent behaviour which requires treatment at the initial stages. For this,
publicity and education on a large scale arerequired.
Madam, though the objectives of this Bill are laudable, the success lies
in the quick implementation of the provisions and setting up of necessary
medical infrastructure at the district level. I request the hon. Minister to
ensure that all district level hospitals are equipped to handle the patients
suffering from mental illness. Adequate training is to be imparted to the
medical and para medical staff for handling the patients with sensitivity and
care.
I welcome this Bill whole heartedly as this is a radical step providing

certain rights to the persons suffering from mental illness and aims to build
a healthy and orderly society.
(ends)
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1528 V
*SHRI SHER SINGH GHUBAYA (FEROZEPUR): I thank you Hon. Deputy

Speaker, Sir, for giving me the opportunity to speak on an important bill, the
Mental Health Care Bill,2016.
Sir, what are the reasons for the mental ailments? I think, some
children suffer congenitally from mental diseases. But, a large number of
people suffer from stress-related mental illness like depression etc.. When
educated young people dont get jobs and unemployment increases by leaps
and bounds, there is a spurt in mental diseases in the society.
The Government must provide employment avenues to our educated

youth. All facilities must be provided to drug-addicts and those suffering
from mental diseases. The agony of mental diseases is worse than the
agony of cancer. Those suffering from mental diseases have to bear the
stigma of society. Moreover, nobody takes care of them. Many such mad
people can be found roaming in the markets. People do not want to have
anything to do with them.
Sir, the Government must come to the relief and succor of such
people. A mechanism should be in place to take care of the mentally ill
persons so that they can lead a normal life.
Sir, this bill deals with a very sensitive issue. A system should be
evolved that is beneficial for the poor and needy mental patients. This bill
should be further refined whereby mentally ill people are traced and
*Original in Punjabi.
provided with all facilities to lead a normal life.
I thank the Central Government for bringing this bill in this august
House. It is a step in the right direction. I whole-heartedly support this bill.
Funds should be provided to the State Governments to work for the welfare
of mentally-ill people. Thank you.
(ends).
Comment: Sh Sher singh Ghbaya cd.
(u2/1530/ind-rp)
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(x2/1540/smn/pc)
1540 hours
SHRI IDRIS ALI (BASIRHAT): Thank you hon. Chairman Sir for giving me an
opportunity to share something in this Bill.
While participating in the Mental Healthcare Bill, 2016, passed by the

Rajya Sabha and now, as amended, as the Mental Healthcare Bill 2017, I
would like to say though public health is a State subject but with financial
constraints, it is next to impossible for the States of the country to
implement the provisions of this Bill.
India is the worst affected country in the world having more than six
crore people suffering from depression. The data of the UN agency shows
that the number of people living with depression across the world has
increased by 18.4 per cent between 2005 and 2015. India prevails
depression and mental anxiety disorders over by five per cent in women and
four per cent in men.
Apart from about four crore people in India suffered from anxiety
disorders in 2015, with a prevalence rate of three per cent, it is a fact that 78
per cent of global suicides are occurred due to mental instability and one
per cent commits suicide in every 40 seconds.
The most alarming thing is that a study indicated an average of 20.5

per cent mental health morbidity in older adults wherein 17.3 per cent are
from urban and 23.6 per cent from rural areas. Accordingly, it is found that,
at present, 18 million older adults of total population of 83.58 millions are
suffering from mental health problems in India.
In 1982, the Government launched the National Mental Health

Programme and in 2014, the Health Ministry has come up with revised
National Mental Health Policy to treat the elderly, affected by Alzheimers
and other dementias, parkinsons disease, depression and psychogeriatric
disorders.
The population of older adults in India is growing. In 1951, it was 5.3

per cent. In 1981, it was six per cent. In 1991, it was 6.8 per cent. In 2001, it
was 7.4 per cent.
HON. CHAIRPERSON (SHRI HUKUM SINGH): Now, please conclude.
SHRI IDRIS ALI (BASIRHAT): I will not take much time of the House.
Keeping in view making fruitful the object of the Bill, we immediately

require community based mental health care by using the public health
infrastructure and other resources of the primary health centres in
administrative structure to develop and monitor the progress of the
programme in a centralized manner. And to make it a success project
immediately, we have to set up psychiatry and psycho-orientation Comment: Idhris ali continued
department in all the levels of health centres and hospitals in the country.
Comment: Sh. Ali cd..
(y2/1545/ak-mz)
Lastly, I would like to request the Central Government to ensure funds

to the State Governments for due implementation of this Bill. It may kindly
be included with the schemes of the Department of Health and Family
Welfare under 100 per cent Central Government funding before the
situation gets out of hand of the Government.
Thank you, Sir. Jai Hind!
(ends)
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PLEASE SEND A COPY TO SHRI
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population. India requires at least 66,200 more physiotherapists
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Our
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population.
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only one mental Hospital at Tezpur and three medical colleges
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population in Assam, our State scenario is worse than other parts

of India. Indias annual Budget is less than that of Bangladesh as
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Healthcare

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1614 hours
SHRI N.K. PREMACHANDRAN (KOLLAM): Hon. Chairman Sir, I thank you for
giving an opportunity to speak on a very important and beautiful legislation
which our Parliament is going to pass. I fully support this Bill and take this
opportunity to congratulate both the Governments- the UPA Government
and the NDA Government for bringing such a comprehensive Bill to protect Comment: cd. by e3
and promote the interests of persons having mental disorder.
(e3/1615/rsg-cp)
This is a model legislation as far as this Parliament is concerned. I am

saying so because we have seen how the Finance Bill has been approved by
this House. As far as this Bill is concerned, it had the scrupulous scrutiny of
its entire provisions. The matter had also gone for the scrutiny of the
Standing Committee. The Standing Committee had a very detailed
discussion and submitted several recommendations. Most of the
recommendations of the Standing Committee have been approved by the
Government. All the stakeholders have been taken into confidence; the
States were consulted. Detailed discussions took place in Rajya Sabha. Now,
it has come for consideration before the Lok Sabha. So, this will establish the
fact that in order to have a fruitful and effective legislation definitely
scrupulous and micro level scrutiny of each and every provision of the Bill is
highly essential. That is why we are able to have a good and beautiful
legislation. This is a perfect legislation. Hence, I fully support the Bill and also
take this opportunity to congratulate the Minister for bringing such a

comprehensive Bill for the consideration of this House.
1616 hours (Dr. Ratna De (Nag) in the Chair)
One of the major reasons for mental illness or mental disorder is the
lifestyle factors such as lack of physical exercise, unhealthy eating,
inappropriate use of technology, night shift duties increasing the rate of
depressing, anxiety disorders, and substance abuse. It is surprising to know
that in India six to seven per cent of the population is suffering from mental
illness. Further one to two per cent suffer from severe mental disorders such
as schizophrenia, bipolar disorder, and alcohol and drug abuse. When we
consider the number of persons affected or suffering from mental illness,
the medical infrastructure available to address mental illness is very poor.
India has got just 0.3 psychiatrists for one lakh people when compared to
1.7 psychiatrists per one lakh people in China. This means, over 50 per cent
of the mentally ill persons in India do not have access to mental healthcare.
That is the real, factual situation prevailing in our country.
In this background, how can we address the issue of mental healthcare

and how are we to address it? A holistic approach is highly essential so as to
address the issue of mental healthcare for which we have announced the
National Mental Health Policy in the year 2014. It also gives a direction that
the mentally ill person should be given a life of dignity and access to sound
medical and psychiatric care. Persons with mental illness constitute a
vulnerable section of our society and are subject to social stigma and
discrimination. This has to be dealt with. So, mental healthcare, social
stigma and discrimination, and also rehabilitation are aspects which are well
addressed in the Mental Healthcare Bill, 2016.
I am now coming to the provisions of the Bill. India has ratified the
United Nations Convention on the Rights of Persons with Disabilities in the
year 2007. This Bill is to comply with the commitment which we have made
in the UN Convention. The Mental Health Act, 1987 which is an existing
legislation unfortunately is not sufficient to meet the purpose which is being
enunciated in the UN Convention on the Rights of Persons with Disabilities.
Hence, we have to repeal that Act also.
Coming to the provisions of the various clauses and the provisions of

the Bill, the long title of the Bill is itself very comprehensive. The entire
scope and ambit of the Bill is well embedded in the long title itself. That is
why I say that this is a very good drafting of the legislation. Each and every
provision of the Bill has been well scrutinized and it is a pucca and perfect
Bill. Even the long title as well as each and every clause of the Bill is very
perfect and pucca because it has had a detailed scrutiny done by Parliament
and outside the Parliament also.
The very ambit and the main object and aim of this Bill guarantees
that every person shall have the right to access to mental healthcare. The
definition of mental healthcare has wider scope. The definition of mental
healthcare in clause 2 (1) (o) says that it involves the analysis and diagnoses
of a persons mental condition; mental treatment and care; and Comment: CONTINUED BY F3
rehabilitation.
Comment: n.k. premachandran cd
(f3/1620/rk-nsh)
I would like to draw the attention of the hon. Minister to these three
areas by which the mental healthcare is being defined. Please refer to
clause 2(1)(o). I would like to seek a clarification from the hon. Minister on
this. How are we able to rehabilitate these mentally ill persons? This is a
very big task because we know even in the hospital we are not able to
rehabilitate them. In order to rehabilitate this number of population, that is
five to six per cent of the mentally ill population of India in addition to one
to two per cent of the population having acute mental disorder like bipolar
disorder, whether we will be able to implement the mental health care as
stipulated in clause 2(1)(o) of the Bill.
Clause 2(1)(s) well illustrates the term mental illness. The definition
of mental illness has a wider scope because it includes substantial disorder
of thinking, mood, perception, orientation, memory that impairs the
judgement and capacity to recognise. All these things coming within the
purview of mental illness means the ambit and the scope of mental illness is
wider. I fully support and agree to it. The only question is, if this be the
definition of mental illness and mental healthcare, will the Government with
the limited existing infrastructure be able to implement these provisions in
practice? This is the only apprehension which I would like to raise and seek
clarification from the hon. Minister.
Clause 4, which is a very important provision of the Bill, deals with the
capacity to make a decision. A person with mental illness shall be deemed to
have the capacity to make decisions regarding his mental healthcare if he
understands the information relevant to take decision, appreciate
reasonable consequences of the decision or lack of decision and
communicate the decision to the appropriate forum. My only genuine
doubt is whether such a person can be described as a person of mental
illness. I presume, if these three conditions are fully satisfied it definitely
means that he is a person without having any mental disorder.
I would appreciate the hon. Minister as well as the Government

regarding Section 309 of the Indian Penal Code that is decriminalisation of
the attempt to commit suicide which is provided in clause 115 of the Bill. It
is a very progressive and a logical provision. We know that till this date an
attempt to commit suicide is a crime punishable under the Indian Penal
Code. It is a criminal offence which will be tried by the court. By the
proposed amendment to clause 115, a person who attempts to commit
suicide shall be presumed as having severe stress and shall not be tried and
punished. A person who attempts to commit suicide means he is having a
severe stress. I would like to know from the hon. Minister as to what is Comment: cd
severe stress.
Comment: Shri N.K. Premachandran
ctd.
(g3/1625/ps-nk)
Severe stress is not defined in Chapter-II. So, we have to make out

definition for this also. I fully agree that for severe stress, he need not be
sent to jail. For severe stress, he has to be treated, has to be counselled and
has to be given proper medical care. The counselling is the best course of
action.
Regarding suicide, it is very interesting to note that in India suicide is

one among the top ten causes of death. Madam, kindly see that from 2004
to 2014, that is one decade, around 1,31,666 suicides have taken place in
our country. That means 15.8 per cent increase from 2004 to 2014. Kindly
see the population growth. During the same period, that is, from 2004 to
2014, the population growth was 14.6 per cent. So, population growth was
14.6 per cent from 2004 to 2014 and the suicide growth is 15.8 per cent.
That is why, the Law Commission in its 210th Report had recommended and
suggested for decriminalisation of attempt to commit suicide, providing
proper and clinical treatment as well as the medical, counselling and
psychological treatment has to be provided to those people who are having
a tendency to commit suicide. That is the best course of action to be done.
Severe stress has to be defined. That is the suggestion which I would like to
make.
I have moved 13 amendments. I have given notice of 13 amendments.

I request the hon. Minister to kindly go through the amendments. Out of
these 13 amendments, six amendments will help the Government and make
the provisions more clear. I urge upon the Government to kindly consider
these amendments in a positive manner.
With these words, Madam, once again I fully and wholeheartedly

support this Bill for having such a beautiful and comprehensive legislation
which the 16th Lok Sabha is going to pass. With these words, I conclude.
Thank you very much Madam, for giving me this much of time.
(ends)
1627 hours
SHRI ASADUDDIN OWAISI (HYDERABAD): At the outset, let me say that I

support this Bill. My points which I want the hon. Minister to consider is that
in this particular Bill there is no clear mention about the drug rehabilitation
centre. There is no mention as to how they should be managed and whether
they should be registered under the Bill. My suggestion is that the
management should have a psychiatrist or an addiction psychiatrist
specialist on board. They should be responsible for the therapies a patient
undergoes at these centres.
Secondly, the term for admission, detention, treatment and discharge

should be as in any psychiatric unit. However, many times a patient though
capable of making an independent decision, has an intense desire to
consume the substance in a substance abuse. So, the decision should be in
consultation with nominated authority of patient or family.
Thirdly, there is no mention about how we should go about in this care

of persons with mental illness in the community. This Bill is completely silent
on care of persons with mental illness in the community. My suggestion is
that a provision of psychiatrist or a clinical psychologist, at all primary
healthcare centres, should be made. They should visit PHC centres at least
once a week on a rotational basis. This one year mandatory service for fresh
PG of psychiatry should be implemented rigorously and this particular

provision of PG of psychiatry should be made in this Bill.
The fourth point is the process of licence. The National Mental Health
Policy advocates the integration of mental health into general and primary
care. Now, this particular Bill mandates that all establishments to take
licence from treating patients. So, by asking for licence under Section 65,
many private hospitals, nursing homes and general hospitals will refuse to
treat patients with mental illness. So, can the Government consider or have
a re-look at this whole insistence on having a licence?
Madam, my next point is advanced directives. The problem with this

step is that this is too hasty and ill-conceived in our country. Let me remind
the hon. Minister that these advanced directives will be counter-productive Comment: Ctd.
and this will lead to many issues.

Comment: Shri owaisi cd
(h3/1630/rc/rjs)
It is because the Cochrane Database of Systematic Review on Advance

Treatment Directives for People with Mental Illness has reported that there
are a few data available to make definitive recommendations to introduce it.
Even in the western world, this has certainly not had its intended affect.
Coming to the nominative representative, the insistence on

nominative representative breaks the very backbone and fabric of the
family. So, the Bill needs to make provision that at least one member needs
to be present with the patient during the in-patient treatment because
family members around the patient would, in a way, lead to a lot of psycho-
education, supervised medication and the rehabilitation process would be
much faster.
Another issue is about Mental Health Review Board. Why should the
judiciary be involved in this? The judiciary itself is incapable of clearing their
backlog. Again you are insisting the involvement of the judiciary. I do not
think this is required that the judiciary should be part of this Mental Health
Review Board.
My suggestion would be that this Board should comprise independent

psychiatrists, family care givers and recovered patients. It is because this
will go a long way in getting to know the real facts. Another alternative I
propose is to create a Board of Visitors at each hospital.
Lastly, as regards right to confidentiality under Chapter V of this Bill.

This is a fundamental right. My suggestion to the hon. Minister is that this
information should only be given to the family members and that too in
verbal form. Written documents or medical records should be shared with
only legal authorities on obtaining a written request.
As regards permission for research, it says that the State authority

should give permission. You please delete it and incorporate ICMR
guidelines because too many regulations can undermine the whole
research.
The final point is about what my hon. friends have said regarding
mental health. My opinion is that the definition of mental health is very
broadly covered under the National Mental Health Policy. The
WHO definition is also quite clear. Can the Government incorporate the
definition of mental health as has been given by the National Mental Health
Policy and WHO? As has rightly been pointed out by other colleagues, it
leaves out obsessive compulsive disorders, depressions and other disorders.
So I hope that the hon. Minister will take note of these few points
which I have mentioned over here. I support the Bill.
(ends)
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(k3/1640/raj-rbn)
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(l3/1645/ind-spr)g
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l{x BE VA* (<i)
1648 hours
SHRIMATI V. SATHYABAMA (TIRUPPUR): Madam, I express my sincere

reverence to our immortal leader, Puratchi Thalaivi Amma and once
again I thank you for allowing me to speak on the
Mental Healthcare Bill, 2016.
Tamil Nadu is one the best States in the country in providing

medical care for mentally ill people. The State Mental Health
Authority Tamil Nadu (SMHA-TN) was formed in 1994 when
Puratchi Thalaivi Amma was the Chief Minister. The authority is
mandated with the responsibility of developing regulating and
coordinating mental health services in the state of Tamil Nadu.
The multi stakeholders in this arena include the Government
Mental Health Hospitals/units besides the private organisations
including NGOs, Rehabilitation Homes and De-addiction Centres,
etc. The Institute of Mental Health at Chennai is the major
hospital under the Government sector offering all mental health-
related services. Further, the Departments of Psychiatry headed
by a senior Psychiatrist are functioning in all the Government-run
Medical College hospitals in Tamil Nadu taking care teaching
psychiatry to the medical students and providing treatment to
mentally ill patients. These apart, Psychiatry units are being run in
the entire District headquarters hospitals in Tamil Nadu. Therefore
I urge the Union Government to allocate more funds and support
for Tamil Nadu.
In so far as private sector is concerned there are a number of

Private Mental Health Nursing Homes/Hospitals for which
Comment: Cd by m3
licences are granted by the Director, Institute of Mental Health. Comment: (Shrimati B. Satyabama -
Cd.)
(m3/1650/ksp/vb)
In short, the SMHA is striving to enhance the level of participatory

role of Government Mental Health Hospitals, units, private organisations
and society at large in taking care of the mentally ill patients. In addition,
this Authority strives to integrate the various agencies involved in mental
healthcare and adopt a bottom-up approach in resolving the issues
involving mental disorders. SMHA aims to increase the level of
awareness and acceptance of the people towards the mentally ill patients
and to provide a platform for harnessing their potential in order to bring
them into the mainstream of society.
Mental health first aid has been defined as the help provided to a
person developing a mental health problem or in a mental health crisis.
The first aid is given until appropriate professional treatment is received
or until the crisis is resolved. Mental illnesses are psycho-socio
biologically based disorders which interfere with an individuals ability to
think, feel, act, and relate within the standard norms of society.
Severe mental illnesses are more common than cancer, diabetes or
hearth disease. Mental illness can strike any person at any time. The
World Health Organisation (WHO) defines health as physical,
psychological and social well being. According to WHO, throughout the
world, one per cent of the population suffers from severe mental
disorders, 15 per cent suffer from common mental disorders and alcohol
and substance misuse constitute 3 to 5 per cent of the population. Nearly
four per cent of the geriatric population, above the age of 60, suffers from
dementia and other psychiatric illnesses. Among children and
adolescents, one per cent suffers from some degree of general intellectual
functioning or learning disorders. About five per cent of children suffer
from emotional and behaviour disorders.
While applying above statistics, considering the population of India,
approximately 1.2 crore people suffer from severe mental illnesses, 20
crore persons suffer from common mental disorders, 50 lakh persons,
above the age of 60, suffer from geriatric psychiatric disorders like
dementia, depression, 2 lakh children suffer from subnormal intelligence
and learning disorders, 6 crore children suffer from other childhood
psychiatric problems and 6 crore people suffer from alcohol abuse and
substance misuse related problems.
While looking into the present scenario of human life, it has become
more and more complex and competitive. The number of stressors is on
the increase and the ability to cope with the stressors and tolerance is on
decline. This, in turn, leads to increase in proneness and precipitation of
psychiatric problems in vulnerable individuals.
Social stigma, in common, pertaining to mental illnesses is highly

prevalent especially in rural areas. In addition, ignorance, fear,
misconception and faulty attitudes regarding mental illnesses are highly
prevalent in rural and semi-rural areas.
While the magnitude of the problem in relation to psychiatric illness

is enormous, the mental health care facility in Tamil Nadu is not adequate
and is not evenly distributed, with more facilities available in urban areas
than in rural areas. So, to resolve the above issue, a Mental Health Policy
for Tamil Nadu has been evolved under the visionary leadership of hon.
former Chief Minister Puratchi Thalavi Amma.
Mental healthcare facilities have to be made available in all parts of
the country, even in remote rural areas and are to be distributed evenly
both in rural and urban areas. Mental healthcare professionals have to be
increased in number. Psychiatrists, psychiatric social workers, clinical
psychologists and psychiatric nurses have to be made available in all
parts of the country. Mental healthcare has to be integrated into all levels
Comment: (Cd. by n3)
of general healthcare. Comment: Shrimati satyabhama ctd
(n3/1655/kkd/pc)
Rehabilitation services for persons with chronic mental illness have to

be expanded so that their maximum potential can be developed and their
integration into community life can be facilitated.
Madam, the District Mental Health Programme is being implemented

in 123 Districts across the country with the aim of creating awareness about
mental health, its early detection and treatment, and removing the stigma
associated with it.
Madurai District of Tamil Nadu has the distinction of providing the

highest quality mental healthcare services, says an evaluation of the Distract
Mental Health Programme. The outstanding performance is primarily

attributed to regular inflow and availability of medicines at health centres.
While satisfaction with the quality of services is an average of 7.3 on a

scale of up to 10, Madurai attained a score of 9.6.
Madam, evolution of further expansion was done by ICMR, a Division

of Planman Consulting (India) Private Limited. It visited 20 Districts where
DMHP was being implemented and it also visited five non-DMHP District.
The results showed that the expenditure on training and IEC components
that require a lot of groundwork, coordination and network in the
community, is below par in most of the Districts. The results also showed
that only one-third of the Districts utilised the funds made available under
the programme, while the remaining used only 37 per cent to 47 per cent of
the money owning to administrative delay, difficulty in recruiting and
retaining qualified and mental health professionals.
Madam, I would urge upon the Union Government to enhance the

medical care facilities for mental health care programmes throughout the
country.
With these words, I conclude. Thank you.
(ends)
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V +{x { BE l Vx-{x c x BE l BE BEM*

Comment: Cd. Neelam Sonkar
(o3/1700/mz-rp)
xx j V x ci c cx BEn =~ c BE V c{] c + =x
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+{x Z c x BE A + n* vxn*
(<i)
1701 hours
DR. MAMTAZ SANGHAMITA (BARDHMAN DURGAPUR): Thank you Madam

for allowing me to speak on this Bill.
First of all, I would like to congratulate the hon. Minister through you
Madam. We are discussing such an important Bill at the time when the
World Health Day is going to be celebrated on April 7th and this years theme
is Depression. Let's talk. It is showing the global importance about the
psychological situations of PMI. We are the pioneers in this field. This year,
we can say about the mental health issues. This Bill is a revolutionary
approach towards the mental healthcare. It is a unique Bill. It seems to be
idealistic but not totally realistic. It is not foolproof.
1702 hours (Shri Anandrao Adsul in the Chair)
The Act of 1987 has provided only the general protection of PMI
against indignant and cruel treatment. This Bill of 2016 is talking about the
mental care in a broader sense. It is mostly dealing with the human right
aspect and focusing on admissible patients.
According to WHO, International Classification of Diseases, PMI has

been defines as disorder of thinking, mood, perception, orientation of
memory excluding mental retardation and including drug abuse. We have
also incorporated this definition in this Bill. That is good. Taking this in
account, when this Bill will become an Act1, it will be of great help to change
the general public attitude toward PMI persons. It will prevent public to call
them lunatic. It will change the attitude of those who abuse them, hesitate
to be associated with them and it would remove the sigma of avoiding the
medical help. Instead of calling mental asylum or in Bengali, we used to call
it pagla garad, which means jail for mentally retarded, it is a very bad
thing now, I suppose, it will have a new dignified name. It is highly
appreciable that the Bill guarantees certain human and social rights to PMI
persons. Most of them are the concepts of western developed countries.
They may not be feasible or suitable for implementation in our country
because of budgetary constraints and social lifestyle.
The Bill guarantees every person the right to easily access affordable,
good quality, minimum healthcare upto the district level. This right is
already given in our Constitution for a patient to have healthcare facility. It is
a fundamental right. I do not know the necessity to emphasize this. In
NHM, we have already got such programmes for PMI and propose of Comment: Cd by p3
establishment of special units for them upto, at least, district level.

Comment: Dr. Mamtaz Sanghamita
contd.
(p3/1705/rcp/bks)
In West Bengal, we already have 61 such centres including seven

medical colleges and many district hospitals. Some of them are even
upgraded to medical colleges. Irony of the thing is that the budgetary
allocation for health would be quite insufficient for these new health
programmes ventured by the Central Government.
The most bold, acceptable, scientific issue in the Bill is suicide

decriminalisation and unless otherwise proved, they should be taken as a
case of PMI. Well, it is a very bold attitude but the Bill does not give any
directive about what is the next thing to be done when the person is
recovered from the attempt of suicide. How will we council them? What
will be the directive regarding those people? Another good thing is about
insurance coverage. It is an appreciable gesture and a very important issue
regarding the persons life. But the problem is, there are no proper
guidelines about the coverage of the insurance. For example, in all other
diseases, we take it as a cost of operation, hospital admission, medical
facilities etc. But here, proper guidelines are not there. The basic thing may
be counselling. That is not taken into account as well.
The executive body of the Indian Psychology Society, the largest

professional organisation representing psychologists all over India, have
some reservations and resentments regarding the Bill though they also have
quite appreciated some parts of the Bill. They have already expressed their
feelings and have given representation to the hon. Minister. My opinion
regarding those lacunae is more or less similar.
As has been said by many Members, five to seven per cent Indians are
mentally imbalanced comprising of millions of population and are adding to
12 per cent of global burden. They are likely to increase. About five to six
per cent of them are of severe nature which needs admission or special care
or indoor care. But the rest of the 95 per cent is looked after by OPD or at
home or similar care. The care of those majority people has not been
addressed in this Bill properly.
There should be proper guidance regarding running of general

hospitals and the indoor beds in medical colleges in district hospitals which
are meagre. They can usually be used only for emergency admissions. Why
can we not think about increasing those and taking special care? It is
because, when we are trying to streamline mental illness along with other
illnesses, why should we give a special name, have another category and
have a Board etc.?
There is a clause regarding ECT. So far as ECT is concerned, this

modified ECT with muscle relaxant and anaesthesia in our set up is only
possible on tertiary care centres in the medical colleges and the clinics with
this special facility in most cases. It also needs at least half-a-day admission.
Moreover, it may be good in aesthetic sense but scientifically it is neither
mandatory nor it is evident based to prove to be better than conventional
ECT without muscle relaxant and anaesthesia. Moreover, it requires extra
cost, manpower and set up. Neither it is contraindicated for adolescents Comment: Contd. By q3
also, that is for persons over nine years of age and less than 19 years of age.
Comment: Smt mamtaz continued
(q3/1710/smn/gg)
Most of the sections are dealing with the establishment of the Central
and State Level Boards. This Bill gives right to the patient about a persons
own consent regarding admission, place and type of treatment and advance
directive and to choose the representative. It is very funny because it is

about something I apprehend. Maybe, I am not a mental patient but WHO
says one in four persons globally is or will be mentally upset. So, it shows
that his aim of apprehending that I may be admitted with a severe mental
disorder. At that time what will I do? I am consenting. If at all for the
mentally ill patients, who is going to decide he or she is in solid mental
condition to give consent? That directive is not given in the Bill. That is a
real fallacy in this Bill. The Board has the power to decide, register or prove
the authority of the directive and in need, can appoint patients
representative. It is funny enough. When the diseased itself defines
alteration of mood, loss of power of decision making, etc. the Bill does not
mention about who is going to certify the mental status of person in that
moment. It is said that the persons apprehended beforehand, any time he
or she may go into this dimaag ka daura padega.
Professional bodies are very meagre in the Board as well. About the
Board formation, I do not know the need for having a special board and
where mostly executives from the Government are there and highly
professional people are not there. Very meagre people are there.
Moreover, there is a dearth of psychologists and the mental health nurses
all over the country. It is apparent from the Bill that such institutions and
professionals should be registered under the Board and this Bill isolates the
institutions and psychologists from other general medical field and thus,
frustrated the idea of streamlining, psychiatric treatment along with others.
Thus, the very spirit of the thing is lost. Moreover, it should deal with
medical education which is badly lacking in psychiatric field. When we
qualified, we only had 15 days class and 15 days work for the psychology
learning. So, what will happen? We should look into it. It needs research. It
should increase research on the psychological situation for rapists and other
criminals, whoever in the jail. There may be one of the conditions where a
person is suffering from mental health related illness. The Bill does not
address the old people regarding property management of the PMI persons.
If and when, he or she is not in a position to do it himself or herself, it does
not give any direction regarding property custody of those patients. This is
the Bill which invited 124 amendments in Rajya Sabha, thus, it implies that it
should be reconsidered later on and with a special facility for child
psychologists and women.
Thank you very much.
(ends)
1714 hours
SHRI ABHIJIT MUKHERJEE (JANGIPUR): Thank you very much for giving me
the chance. Many points have already been raised and some counter points
have also been raised.
To make it precise, I will request the hon. Minister, through you, to

consider the following: (1) check up by psychiatrist for each and every child
in our country at the school level starting from first standard. With respect
to checking, make it compulsory whether they are mentally sound children
or not. Just like health card, mental health card should also be maintained.
It will help to detect any mental disorder of any child at the early age so that
required treatment can also be given to them.
At the same time, people in India think that mental illness or disorder
is a stigma. To come out from that, the parents of the child and their
relatives should also be given counseling and training so that they can Comment: Shri abhijit mukherjee
continued
handle their special child.
Comment: Shri Abhijit Mukherjee ctd.
(r3/1715/mmn-cs)
This point has also been mentioned earlier. I will also emphasize on
that that dementia must be included in this Bill while framing rules so that
the person suffering from itmost of the elderly people suffer from it
should be given proper required treatment.
My third point is that there must be some authority of mental health

which will oversee all the relevant issues with respect to mental health
problems and will provide guidelines and benchmarks to the persons who
are treating or attached with the mental persons for providing mental
treatment. The authority should be accountable to the Ministry and they
will also take into account those people who are responsible for the
treatment.
My next point is that one mental hospital in each State should be

identified by the Central Government or the Ministry of Health and Family
Welfare and it should be attached with an AIIMS or with the Delhi AIIMS for
better treatment or for giving counselling or rather controlling.
With these words, I will conclude. Thank you very much for giving me
this chance.
(ends)
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nx BE BE BE c* { i +i c, { i + {k i V Eb
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<BE i c c l*
Comment: SHRI MOHAMMAD
SALIM Cd.
(s3/1720/rv-san)
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xl M , JBE MV , xi c* +M <BE A Wx BE {x ci c i i
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V M +l{bBE cbBE{b ci c, +V =xc x v c c c, <A
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Mi c, V i BE BE Wx c, i Zi c BE = {k i BE
cM*
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1721 V
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2016 { x BE A J c+ c*
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M BE |i xBEiBE l, {xi c BE + c |vx j V x A M BE
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c* l M~x BE +BE { M BE i nx +V 45 BE Vn M
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nx < |BE BE VS BE Vx ScA BE {hi l c xc + < VS BE
n BE c +BE BE n Vx ScA, V BE +x BE l BE
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M BE ABE x n x M c* c { c cx BEi BEi c* x +{x
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vxn*
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vBE, 2016 { x BE BE n, <BE A +{BE ci-ci vxn*
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M BE nJx BE i c* l xi BE V xx j V x BE BE c,
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vn ni c*
Comment: g V V V
(t3/1725/my/ak)
{i cn, c V ] <x c, c ci c BE] SV c* <BE

substantial disorder of thinking, mood, perception, orientation or memory
that grossly impairs judgement, behaviour, capacity to recognise reality or
ability to meet the ordinary demands of life c, BEx c <ix BE] c BE
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x BE { Fi ci c*
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BE BE n c c SBE c, V c c SBE c* bBD] x BEc BE ~BE c +
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BE Mi i c* V c ~BE {EW ci c i BE c {E BEi c, c
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BEn c* <BE ci i{E BEi c*
< b.AS.+ u b|x BE xnx BE Pi BE M c* BE u

xBE l x ci c +SU BEn c* <BE + i V Px M c,
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BDxBE <BEV <ix +SU VBD] c M c + <ix M <BE {f c c BE +V
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ci c EiBE c + l + ci |O ]{ c VBE A j V
BE ci-ci v< ni c*
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{ lx BEi c*
(<i)
1729 V
b. i{ c (M{i) : {i cn, ci-ci vxn*
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xc Vx Sci c + BE< i {] xc BEx Sci c*

Comment: b. i{ c V
(u3/1730/cp/ub)
xx {i V, ABE { +vBE c + M BE ABE i ix

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BE +n < i BE VE BE* =xcx BEc BE V BBDi x <bx xx BEO BE
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Vn {n cM*
Comment: Dr. Satya P Singh cd
(w3/1735/nsh-sh)
c < { ci M { Sxi BEx BE Vi c BE c < |BE BE

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(<i)
1736 hours
SHRI S.P. MUDDAHANUME GOWDA (TUMKUR): Sir, I thank you for the
opportunity given to me. I am not going to speak much about the Bill. At the
first instance, we welcome this Bill, which was our creation.
Since the hon. Health Minister is very much present here, I would just
like to make a request to him. Earlier, NIMHANS used to be called as Mental
Hospital in Bengaluru. Now, it is known as National Institute of Mental
Health and Neuro Sciences. It is our pride and it is really doing a wonderful
service to the nation and particularly to the people of this country. A
common man without any financial help can go to that hospital and get
treatment. That is the specialty of that hospital. We are happy about its
performance and also the progress of that hospital.
By giving one example, I will conclude so that the hon. Minister can
take some initiative to improve and create more facilities in the hospital.
About three days back, one young boy from my constituency met with
an accident and sustained some head injuries. He was shifted to NIMHANS
in Bengaluru. Unfortunately, since there was no ventilator facility, he could
not be admitted into that hospital and he was advised to go to a private
hospital. He is a very poor boy and he is not capable or he cannot afford to
pay any bills in a private hospital. In spite of that, he was forced to get
himself admitted in a private hospital. Unfortunately, for the last three days,
he has incurred a very high expenditure over there. In fact, the family of that
boy is feeling that they cannot withstand that kind of a burden.
So, they once again went to NIMHANS and I also personally spoke to
the Director of that hospital, Dr. B.N. Gangadhar. Unfortunately, he told me
one thing, Sir, at the cost other patients, I have to accommodate your
patient. That is what he has told me.
Since that hospital is doing a wonderful service, I request the Central

Government to take a little more initiative and establish more ICUs, more
ventilator facilities in this hospital so that a common man who is in dire
need of assistance from the hospital could be provide with the necessary
help.
That is why, under the guise of speaking on this Bill, I urge upon the
Union Government to provide more facilities at NIMHANS in Bengaluru and
thus help the poor patients. Thank you.
(ends)
1739 V
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<b BEx]x BE M< c*

Comment: Cd J.P. Nadda
(x3/1740/nk-sr)
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c*
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x ABD{] BE* ]xbM BE] BE {E BE c M x ABD{] BE c, =BE
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c M x BE BE l BE <V BE <]]x BE +n M] lb n BE,
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ABE ci i, V { n xx n BE vx xc M c, BDBE = {
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(y3/1745/rjs-kmr)
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M c* =BE {F c M c + < + +SU BE BE V BEi c, < ic BE
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< Vx BE M*
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BEM* < BE] BE V +M, = c vx JM*
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c*
Comment: Shri JP Nadda cd.
(z3/1750/rps-gm)
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v V ABD] ]V S c c, +, AAxA +n BE ]<Vx BE |O
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xcx BE gi ]S A c BE i{E c Z + BE c
=BE S* We are working on it. We want to see to it that the
institution should grow. =BE O BEx BE A xcx BE c ] xBE, we are
working on it. +BEi fi V c c + +M ] cl BE c A f c c
i xcx V <]]x BE {BE] BEx BE +BEi cM* We are working

on it. < ic ]xM + {EhbM BE M x BEc c* < +{
BE +i BEx Sci c* l M BE c {n c M l BE {Ehb BE
BE c* x {U n < BE ix BE | BE c + +{ nJM BE c
V] A]] c ABD{bS f c + =BE {b BEx BE BE{] f
c* < c V] f c* < cx c {Ehb <xBDb xc BE c, V 900
BE { |vxj V x {A M BE {Di b BE A |vxj b
Vx BE c* +{BE +i BEx Sci c cl BE A {Ehb BE BE xc cM*
V c c BE +A c + c ABD] xM i < ABD] BE ici Vix ]BDS
xM, =xBE {EhbM BE VAM + {EhbM BE l c ] xM BE Bl BE VAM*
ci V u BEc M l BE c V M BE xx] BEi c, =x {] BE
BE VA* c b{Exx <xBDbb c* V xxx c BEM, =x {]
<xBDbb c* =xBE < {<] BE cx vx J c* c + l BE Vb BE
b]BD] b BD J M c, ix ScM BE c Vb BE +BEi ci c,
BDBE < AbVbBE] BEx ci c, <BE <{] BEx c, <BE M +{BD] c,
Vxc c vx Jx c* cx BE-M BE J c, <BEl{] BE J c,
<BE-Ax] BE J c, bBE |BD]x BE J c* <BE l c
Vb AM ci c, = Jx BE Vi c, <A Vb BE < J M c*
c +SU |vx c, <BE +BEi c* V c {x] ABDx M, V c {x]
MAM + V M < <{] xc BEM, =BE M- Vb AM xi c,
= nJx BE A Vb BE Vi cM* ABE BEx{DVx n BEx Sci c BE c
c V BE< BBDi ] < c Vi l + V c = <]]x bi l i BEc
x BEc =BE ]<Vx c Vi l* + < |vx BE ici =BE ]<Vx xc
cM, BDBE c ABE <xx ABD] c* n i c c BE + c <]]x =BE cl

+ c<Vx BE Sxi BEM* < i BE = <]]x BE vx Jx cM*
V n Ab S<b BE c, < c |vx BE M c BE +M S<b BE

n {] BEx c i =BE A Vx cx ScA* +M Vx xc c i the first
right of the child will be to be with his mother, BDBE c n-]BE c, c
x-] BE c* BE n BE { =BE SS BE c]x =BE xBE +l +SU
xc ci c, BE Vn J ci c* {c < ic BE |vx BEi l BE c + J Comment: cd. by a4.h
c VA*
Comment: Cd
(a4/1740/raj-rsg)
+ c M x = SV BE c BE essentially the child will stay with the

mother until and unless there is a reason given for it V c SS BE c J{E
c M< c, SS { c A BE< ABDx BEi c i {E c = {] BEM* {E <]
ABD ] n S<b c x cM* Whenever the mother wants the child, that
child has to be produced before the mother. c x AM c* c
xiBE c, VBE vx J BE c M x BE BE c* <BE BD] c VA,
A Sci c*
ABEc + bM BE + l BE <xc ] <x BE {] x V* c

b{ Exx x c+ c* Abuse of alcohol and drugs is a mental illness that has
been included in the definition. That has been done.
b V x c]x BE i BEc l* Since rehabilitation is with the

Ministry of Social Justice and Empowerment, we will be working in
collaboration with them and going in that direction.
+{x ]xb x { BE i BEc c, =BE A c BE-+=] BE c c c* We are

planning in a way where we are going to involve ASHAs and ANMs. Vix BE
c ]x M n BE, ]<V BE BE, =ix +SU cM, BDBE + c BEx] b ]]]
nx c i in a way, we have to sensitise the community. When we have to
sensitise the community, we need communicators between the society and
the health experts. c =BE +M fM* < b]BD] ] cl |O, +{Obx
+{E BEVV, x] +{E ABD, <x BE v c ] cl <|E]BDS BE
<EV BE c c* c <BE |vx BEx BE | BE c c*
Since mental health is separately taken care of, +{ M x V +SU Z

nA c, c x = + = J c c* V +b] +M i c = SS
BE M* < +b] x nJ c BE BE< A +b] xc c, V c {]
{i V c c* = {] BE Vn +SU iBE Jx BE A = A
Sci c BE c cM xc cM*...(Bvx)
What I am saying is that, = ] <{b c* The definition implies

them. It has to be taken care of. There are some more which we would be
taking into the rules and regulations. We would be covering them in rules
and regulations.
Z Mi c BE c= BE n < ] BE {F c* c ABE ci c
AicBE nx cM, BDBE <BE n ] cl BE V c ci {ix BE BEM*
BE l c c + i < BE BE li iBE c {cS c* < ] clBE {

l nx BE A BE vxn ni c* ScM BE +{ l-l +V < { BE
n* ...(Bvx)
g BEVx JM (MM) : BE ] BE c BEi c*...(Bvx)
g VMi |BE xbb : BE l M, +M ] cl BE V BE BE ~BE

c BEM* vxn*
(<i)
HON. CHAIRPERSON (SHRI ANANDRAO ADSUL): Now, the question is:
persons with mental illness and to protect, promote and fulfil
the rights of such persons during delivery of mental healthcare
and services and for matters connected therewith or incidental
thereto, as passed by Rajya Sabha, be taken into consideration.
----
Clause 2
HON. CHAIRPERSON: The House will now take up clause-by-clause

consideration of the Bill.
Shri N.K. Premachandran, are you moving your Amendments Nos. 8 to

10?
SHRI N.K. PREMACHANDRAN (KOLLAM): I beg to move:
Page 2, lines 5 and 6, --
for made by a person under section 5.
substitute made by a person in writing specifying the way
the person wishes to be cared for and treated
for mental illness under section 5 in the manner
as specified in section 6. (8)
Page 2, line 23, --
after performs this function
insert or is dutybound to perform such function. (9)
Page 2, line 40, --
after undue influence
insert coercion. (10)
I move amendment Nos. 8, 9, and 10 in which I am urging upon the

Minister that along with fraud, misrepresentation, undue influence, threat,
or mistake, all of which come under informed consent, where consent has
been obtained by means of coercion will also have to come. So, my
amendments may be accepted. That is my request to the hon. Minister.
HON. CHAIRPERSON: Mr. Minister, are you willing to give any clarification?
THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT PRAKASH

NADDA): As I said, he wants to substitute it with, made by a person in
writing specifying the way the person wishes to be cared for and treated for
mental illness under section 5 in the manner specified in section 6. This will
be taken care when we would be framing the rules. That is the assurance I Comment: CONTINUED BY B4
would like to give.
Comment: Shri Nadda cd
(b4/1800/rc/ind)
Then he wants to insert words dutybound to perform such function

and coercion. These are already implied in this. So, I would say that he
should withdraw his amendments. I would give him the assurance that it
will be included in the rules and regulations.
HON. CHAIRPERSON (SHRI ANANDRAO ADSUL): I shall put Amendment

Nos.8 to 10 moved by Shri N.K. Premachandran to the vote of the House.
The amendments were put and negatived.
HON. CHAIRPERSON: Now, Shri Rajeeev Satav to move amendment No.21.
SHRI RAJEEV SATAV (HINGOLI): Sir, I beg to move:

I have moved Amendment No.21 through which I am requesting to

expand the definition of mental healthcare professionals. I would request
the Government to accept this amendment because professionals having a
post-graduate degree or post masters degree in psychotherapy, counseling,
counseling psychology, etc. have been added.
HON. CHAIRPERSON: I shall now put Amendment No.21 moved by Shri

Rajeev Satav to the vote of the House.
The amendment was put and negatived.
HON. CHAIRPERSON: The question is:
That clause 2 stand part of the Bill.
HON. CHAIRPERSON: Hon. Members, the time of the House may be

extended till the Bill is passed.
SEVERAL HON. MEMBERS: Yes.
Clause 3
HON. CHAIRPERSON: Now, Mr. Premachandran to move Amendment Nos.

11 and 12.
SHRI N.K. PREMACHANDRAN (KOLLAM): Sir, since the Minister is giving

specific assurance and responding to the questions which we are raising, I
am not moving Amendment Nos. 11 and 12.
Clause 4
HON. CHAIRPERSON: Now, Mr. Premachandran to move Amendment Nos.

13 and 14.
SHRI N.K. PREMACHANDRAN (KOLLAM): I am not moving Amendment Nos.

13 and 14 also.
Clause 5
HON. CHAIRPERSON: Now, Shri N.K. Premachandran to move Amendment

No 15.
Page 5, omit line 43. (15)
HON. CHAIRPERSON: I shall now put Amendment No. 15 moved by Shri N.K.
Premachandran to the vote of the House.
Clause 6
HON. CHAIRPERSON: Shri Rajeev Satav to move Amendment No.22.

I have moved Amendment No.22 in which advance directive has been

specifically written.

Clause 8
HON. CHAIRPERSON: Now, Shri N.K. Premachandran to move Amendment

No 16.
Page 6, for line 23,-
substitute in the manner as may be specified by regulations

made by the Central Authority.. (16)
HON. CHAIRPERSON: I shall now put Amendment No 16 moved by Shri N.K.

Premachandran to the vote of the House.
Clause 10
HON. CHAIRPERSON: Shri Rajeev Satav to move Amendment No.23.
SHRI RAJEEV SATAV (HINGOLI): I beg to move:
Page 6, line 29, -
for section 11
substitute sections 7 and 11 (23)



Comment: Fd. By c4
(c4/1805/snb-vb)
Clause 11
HON. CHAIRPERSON (ANANDRAO ADSUL): Shri N. K. Premachandran

Amendment No. 17.
SHRI N.K. PREMACHANDRAN (KOLLAM): Sir, I am not moving.
HON. CHAIRPERSON: Shri Rajeev Satav Amendment No. 24.
SHRI RAJEEV SATAV (HINGOLI): Sir, I am not moving.
Clause 11 stand part of the Bill.
Clause 11was added to the Bill.

Clause 13
SHRI N.K. PREMACHANDRAN (KOLLAM): Sir, I beg to move:
Page 7, line19,--
after advance directive
insert as per the approved medical protocol for treatment of

person with mental illness. (18)
Page 7, line 21,--
for valid advance directive, if he has not been given
substitute valid advance directive, if he has no access to, or he

has not been given. (19)
HON. CHAIRPERSON: I shall now put amendment nos. 18 and 19 to Clause

13 moved by Shri N.K. Premachandran to the vote of the House.

Clause 18
HON. CHAIRPERSON: Shri Adhir Ranjan Chowdhury Not present.
Shri N. K. Premachandran to move amendment no. 20.
SHRI N.K. PREMACHANDRAN (KOLLAM): Sir, I beg to move:
Page 9, line 24,--
for funded by the appropriate Government.
substitute funded or controlled or recognized or approved by

the appropriate Government. (20)
Sir, my proposed amendment is `funded or controlled or recognized or

approved by the appropriate Government. This is an important
amendment. If the Government assures this, then I will withdraw my
proposal of amendment because it is very important. Now, as per the
existing provision, only on Government hospitals this right is being
conferred. Suppose it is controlled or recognized or approved by the
appropriate Government, then the definition, ambit and scope will be wider.
DR. MAMTAZ SANGHAMITA (BARDHMAN DURGAPUR): Sir, I beg to move:
Page 9, line 23,--
after Every person
insert with mental illness (25)

Page 9, line 24,--
after appropriate Government
insert or by private or trust run specialized

clinics/institutions. (26)
HON. CHAIRPERSON: I shall now put amendment no. 20 moved by Shri N. K.

Premachandran and amendment nos. 25 and 26 moved by Prof. (Dr.)
Mamtaz Sanghamita to clause 18 to the vote of the House.
Clause 65
HON. CHAIRPERSON: Prof. (Dr.) Mamtaz Sanghamita to move amendment

no. 27.
DR. MAMTAZ SANGHAMITA (BARDHMAN DURGAPUR): Sir, I am not moving.

Clause 75

nos. 28 and 29.
Page 30, lines 1 and 2,--
for five years.
substitute three years. (28)
Page 30, line 3,--
for five years.
substitute three years (29)

HON. CHAIRPERSON: I shall now put amendment nos. 28 and 29 moved by

Prof. (Dr.) Mamtaz Sanghamita to clause 75 to the vote of the House.
Clause 87

no. 30.
Page 33, line 33 and 34,--
for two psychiatricts, or one psychiatrist and one mental

health professional or one psychiatrist and one medical
practitioner.
substitute two psychiatrists of which one preferably would be

from tertiary Government set up. (30)
HON. CHAIRPERSON: I shall now put amendment no. 30 moved by Prof. Dr.
Clause 87 stand part of the Bill.
Clause 89

no. 31.
Page 34, lines 52 and 53,--
for One psychiatrist and the other being a mental health professional
or a medical practitioner.
substitute two psychiatrists of which one preferably would be from

tertiary Government set up unit. (31)
HON. CHAIRPERSON: I shall now put amendment no. 31 moved by Prof. (Dr.)

Comment: fld by d4
(d4/1810/rbn/pc)
Clause 95
HON. CHAIRPERSON (SHRI ANANDRAO ADSUL): Dr. Mamtaz Sanghamita, do

you want to move amendment No. 32 to clause 95?
DR. MAMTAZ SANGHAMITA (BARDHMAN DURGAPUR): I beg to move:
Page 39, after line 19, --

insert (IA) Notwithstanding anything in clause (a) of sub-

section (1), in case of non-availability of muscle
relaxants and anaesthetist, electro-convulsion
therapy may be performed on the recommendation
of senior most psychiatrist available in that set up.
(IB) Notwithstanding anything in clause of sub-

section (1), sterilisation of men or women shall be
performed only with their express consent taken at
the time when the person was certified by
psychiatrist to be in fit mental condition to give
consent and the consent has also been
countersigned by that psychiatrist..
(32)
HON. CHAIRPERSON: I shall now put amendment No. 32 moved by Dr.

That clause 95 was added to the Bill.
Clause 98
HON. CHAIRPERSON: Dr. Mamtaz Sanghamita, do you want to move

amendment No. 33 to clause 98?
DR. MAMTAZ SANGHAMITA (BARDHMAN DURGAPUR): I beg to move:
Page 40, after line 24, insert, --
Provided that before discharge, an undertaking, duly signed in

the presence of mental health worker, shall be taken from the
family member or care-giver to the effect that they will take
proper care of the person and give him shelter after discharge
from mental healthcare establishment. (33)
HON. CHAIRPERSON: I shall now put amendment No. 33 moved by Dr.


Clause 1
Amendments made:
Page 1, line 5, --
for 2016, substitute 2017 (2)
Page 2, line 3, --
for 2016, substitute 2017. (3)
(Shri Jagat Prakash Nadda)
That clause 1, as amended, stand part of the Bill.
Enacting Formula
Amendment made:
Page 1, line 1,---

for sixty-seventh, substitute Sixty-eighth. (1)
(Shri Jagat Prakash Nadda)
That Enacting Formula, as amended, stand part of the Bill.
The Enacting Formula, as amended, was added to the Bill.
The Preamble was added to the Bill.
Title
HON. CHAIRPERSON: Shri Adhir Ranjan Chowdhury not present.
The question is:
That the Title stand part of the Bill.
The Title was added to the Bill.
-----
HON. CHAIRPERSON: The Minister may now move that the Bill, as amended,
be passed.
SHRI JAGAT PRAKASH NADDA: I beg to move:

-----
HON. CHAIRPERSON: The House stands adjourned to meet on Tuesday, the

28th March, 2017 at 11.00 a.m.
1814 hours
The Lok Sabha then adjourned till Eleven of the Clock
on Tuesday, March 28, 2017/Chaitra 7, 1939 (Saka).

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81

Uncorrected/ Not for Publication-08.08.2016

SHRI BHUBANESWAR KALITA: What about migrant illegal workers?

MR. DEPUTY CHAIRMAN: It is okay. Now, Shri Jagat Prakash Nadda to

move the Mental Healthcare Bill, 2013.

THE MENTAL HEALTHCARE BILL, 2013

THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT

PRAKASH NADDA): Sir, I move:

The question was proposed.

DR. T. SUBBARAMI REDDY: I am on a point of order.

MR. DEPUTY CHAIRMAN: What is your point of order?

DR. T. SUBBARAMI REDDY: Sir, 134 amendments have been proposed by

In 50 years no Bill had so many amendments. It is happening for the first

SHRI D. RAJA: Sir, he has a point.

MR. DEPUTY CHAIRMAN: Do you want to say something?

SHRI JAGAT PRAKASH NADDA: Not now. Later, Sir. ...(Interruptions)...

MR. DEPUTY CHAIRMAN: Shri Madhusudan Mistry. You have 15 minutes.

Your Party has given 15 minutes.

, Health Minister , 7 , 2013

Rights of Persons with Disabilities,

recognise , 2007 ratify

. This Bill was long overdue,

recognizes that: (i) Persons with mental illness constitute a vulnerable

section of society and are subject to discrimination in our society; (ii)

Families bear financial hardship, emotional and social burden of providing

the environment around them should be made conducive to facilitate

recovery, rehabilitation and full participation in society.

, - , one per cent

population of this country is suffering from mental illness. -

inward and outward violence ,

full confidence , hygiene, -,

mentality young generation

, social workers , qualified psychiatrists ,

private rehabilitation centres treatment centres

, qualified social workers ,

treatments , treatments disciplines ,

curative discipline , community,

counselling , Curative treatment

shock therapy , which is

completely inhuman. ban

therapy , shock , patients

social workers , counselling

recognized scientist , garbage

accident mathematics game theory

, population , creative , intelligent ,

, social workers sensitivity , patients

counselling , intelligence match ,

patient treat , extreme violence

disease cure , diabetes control

, upper middle class even lower middle class ,

second ratification , families bear

financial hardship, emotional and social burden of providing treatment and

care for their relatives with mental illness, ,

rehabilitation centre sponsor

treat manpower social workers

, Medical Association Medical Council of India

MR. DEPUTY CHAIRMAN: Please conclude.

MR. DEPUTY CHAIRMAN: Please conclude. ...(Interruptions)... Please sit

...(Interruptions)... Let me complete. So, 15 minutes have been allotted by

MR. DEPUTY CHAIRMAN: Yes; I never said it is unimportant.

amendments are procedural, I understand. But some of the amendments

MR. DEPUTY CHAIRMAN: How do you think that?

Now, you don't speak.

Jairam Rameshji, why do you go on pre-conceived notions? Nobody