Mental Health Care Bill: A much-

needed reform that still has a long

way to go
Divya Srivastava Aug 13, 2016 11:38 IST
#BodyAndSoul #FWeekend #Lok Sabha #Mental health #Mental Health Care Bill #mental illness #parliament

143

On 8 August, 2016, the Mental Health Care Bill, 2013 was passed in the Rajya Sabha. Many people on social
media rejoiced and it is, indeed, a cause for celebration. The largely-neglected field of mental health finally
got some much-needed attention. The new bill, when passed in the Lok Sabha, will replace the rather
outdated Mental Health Act of 1987, and when compared to the existing law, it is definitely reformist.
The definition of mental illness is no more any mental disorder other than mental retardation. It is
broader and more inclusive. Mental illness is defined as a substantial disorder of thinking, mood,
perception, orientation or memory that grossly impairs judgment, behaviour, 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 mind of a person, specially characterised by sub normality of intelligence.

Representational image. Reuters.

One of the salient features of the new bill is that it decriminalises the attempt to suicide. This repeals
Section 309 of the Indian Penal Code which provided for a year-long imprisonment for a failed suicide bid.
This law had been criticised for a very long time. In 1971, the Law Commission had tried to do away with it.
The Janata Party had tried to implement the recommendation in 1978, but it fell before both Houses could
pass that Bill.
Proposing that attempted suicide will not be criminally prosecuted helps the world look at suicide in a more
kindly light. In order to understand why, picture this scenario: Saras a young girl who recently moved to a
new city to pursue further studies. Not being as well-off as the rest of her classmates, she had to spend most
of her time by herself because she could not afford to eat out and party as frequently as the rest of her peers.
Adjusting to the new environment had been tough. The long distance took a toll on her two-year long
relationship, and her boyfriend finally broke up with her over the phone. To make matters worse, the
semester results were announced, and Sara discovered that she had failed two papers. When her mother
called her in the evening, Sara was just not able to break the disappointing news to her parent.
Things cant get any worse, thought Sara. My life is not worth living. In a fit of impulse, she consumed a
bottle of phenyl. When she was discovered in her room, people immediately rushed her to the hospital. The
hospital authorities were reluctant to admit her, due to the legal complications that rose with a suicide
attempt, nevertheless, after some coaxing, they began treatment until the police arrived. If Sara made it out
alive, in the old scenario, the gift of being alive would be presented to her with a one year imprisonment for
attempting to end her life! This would just add to more trauma and stigma of having to deal with police and
courts. Criminalising suicide attempts actually stops many people from reporting, and this hinders people
in distress from receiving the help that they need.
The new law actually recognises suicide as a cry for help, and stresses on the immediate need to reach out
and help the person overcome their issues. It does not treat the person as a criminal.
The bill does not allow psychosurgery unless it is approved by the district medical board. The bill also bans
the use of shock therapy for treating children with mental illness. It is still permissible for adults provided
theyre given anaesthesia and necessary muscle relaxants.
However, the most remarkable feature of this bill is the introduction of advance directives this gives
people suffering from a mental illness the right to choose their mode of treatment, and by nominating
representatives who will ensure that their choices are carried out. Giving people diagnosed with a mental
illness the freedom to choose conveys a strong message to the masses that suffering from a mental disorder
does not rob an individual of decision-making capacities. It instils in the citizens that everyone, even those
diagnosed with a mental illness, are entitled to a life of dignity, and they must not have to live in isolation,
away from their families or the community, at large.
The bill identifies inhuman and degrading treatment of the mentally ill as a crime, and for the first time,
tackles the issue of mentally ill patients often admitted in institutionalised care forcibly, against their will.
However, no matter how progressive the new bill is, it is still just a baby-step in the direction of reform. The
bill only recognises the role of psychiatrists in the treatment of a mental illness. It still does not
acknowledge the roles of counsellors and psychologists who also work with patients suffering from mental
and emotional distress. Also, the bill largely addresses requirements of those people in mental healthcare
facilities, but not every person diagnosed with a mental illness needs institutionalisation. While the bill
mandates insurance companies to provide medical insurance or the mentally ill on the same grounds that
they would issue insurance for physical illnesses, counselling services would probably not be covered even
in the new insurance schemes.
Implementation of the Act will also pose to be a problem. There is a shortage of mental health professionals
in our country. For every four lakh Indians, there is only one psychiatrist, Dr Rajesh Sagar was quoted as
saying in DNA. With budget cuts in the health sector, how will state governments successfully implement
the dictates of this new law?
The new bill largely adopts a biomedical model to treat mental illness. It does not talk about newer
modalities like arts-based therapy, for instance, which helps people cope with stress, and speeds the
recovery process. The bill provides facilities to the mentally ill, but how far does it address the stigma and
discrimination a person with a diagnostic label is forced to endure? To what extent does it shape the nation
into adopting a healthier attitude towards the issue of mental health? Only time will tell.

New Mental Health Bill provisions

and some challenges in
their implementation
Rajya Sabha has passed a Bill decriminalising attempt to suicide, and
giving individuals with mental illnesses new rights that include access to
health care and insurance.

401 FacebookTwitterGoogle+Email

SHARES

Written by Mandira Kala | Published:August 10, 2016 12:06 am

At the mental hospital in Thane. There are no reliable figures on the number of the mentally ill in India. (Express Photo
by Amol Shetge/Archive)

The Mental Health Care Bill, 2013 was passed by Rajya Sabha on Monday, and is expected to be discussed in Lok
Sabha soon. The Bill seeks to replace the Mental Health Act, 1987. In 2007, India ratified the United Nations
Convention on the Rights of Persons with Disabilities, which requires signatory countries to change their laws to give
effect to the rights of persons with mental illness. It was believed that the 1987 Act did not adequately protect these
rights, and a need was felt to provide them with better treatment and improve their access to health services.

So, what kinds of mental illness are covered under the Bill?

Mental illness was earlier defined as any mental disorder other than mental retardation. The Bill passed by Rajya
Sabha defines mental illness to mean a disorder of thinking, mood, perception, orientation or memory. Such a disorder
impairs a persons behaviour, judgement, capacity to recognise reality or ability to meet ordinary demands of life. This
definition also includes mental conditions associated with substance abuse, and does not include mental retardation.

What is the population of the mentally ill in India?

There are no official estimates currently. In 2005, it was estimated that 6-7% of the population suffered from mental
disorders, and about 1-2% suffered from severe mental disorders such as schizophrenia and bipolar disorder. Nearly
5% of the population suffered from common mental disorders such as depression and anxiety. However, real numbers
could be higher, as mental illness often goes underreported due to the associated stigma. The World Health
Organisation has recently estimated that 1 in 4 persons will be affected by some form of mental illness once in their
lifetime.
And what are key rights being guaranteed under the Bill?

Manner of treatment: The Bill states that every person would have the right to specify how he would like to be treated
for mental illness in the event of a mental health situation. An individual will also specify who will be the person
responsible for taking decisions with regard to the treatment, his admission into a hospital, etc.

Access to public health care: The Bill guarantees every person the right to access mental health care and treatment
from the government. This right includes affordable, good quality, easy access to services such as minimum mental
health services in every district. Persons with mental illness also have the right to equality of treatment and protection
from inhuman and degrading treatment.

Suicide decriminalised: Currently, attempting suicide is punishable with imprisonment for up to a year and/or a fine.
The Bill decriminalises suicide. It states that whoever attempts suicide will be presumed to be under severe stress, and
shall not punished for it.

Insurance: The Bill requires that every insurance company shall provide medical insurance for mentally ill persons on
the same basis as is available for physical illnesses.

Ads by ZINC

And are there any implementation challenges?

The Bill mandates the central and state governments to ensure access to mental health services in every district. These
will include outpatient and inpatient services, hospitals, and community-based rehabilitation establishments. However,
the financial memorandum of the Bill does not estimate the expenditure required to meet the obligations under the Bill
nor does it provide details of the sharing of expenses between the central and state governments. Without the
allocation of adequate funds, the implementation of the Bill could be affected. The Standing Committee examining the
Bill had noted that public health is a state subject. Since several states face financial constraints, the central
government might have to step in to ensure funds for the implementation of the law.

Watch Video: Whats making news

What about guardianship provisions for mentally ill persons?

The Bill as passed by Rajya Sabha does not address issues related to guardianship of mentally ill persons. The 1987
Act has detailed provisions related to appointment and removal of a guardian, and his powers and duties. The
provisions related to guardianship of mentally ill persons are in the Rights of Persons with Disabilities (RPD) Bill,
2014, which is pending in Parliament. If the Bill is passed by Parliament in its current form, there will be a legal
vacuum with regard to provisions of guardianship of mentally ill persons.

What happens when the provisions of the planned law are violated?
The Bill does not prescribe specific penalties for non-compliance with several of its provisions. A general punishment
of imprisonment up to 6 months or a penalty of up to Rs 10,000, or both, is provided. The absence of specific penal
provisions might create ambiguities with regard to the implementation of the Bill.

What was the scrutiny that the Bill received in Parliament?

The Bill was examined by a Parliamentary Standing Committee, which made a number of recommendations. Rajya
Sabha debated the Bill for approximately 4 hours, and 17 MPs participated in the debate. In a 136-clause Bill, the
government moved 134 amendments, giving MPs almost no time to reconcile the amendments with the
recommendations of the Standing Committee. The Bill will now be debated in Lok Sabha before it is passed.

The Mental Health Care Bill, 2016, passed by the Rajya Sabha is a watershed legislation that lays down clear
responsibilities for the state and has provisions that empower individuals and families. Crucially, it can expand access to
treatment, which is dismally poor today. According to a recent review in The Lancet, of gaps in mental health treatment,
although both India and China have renewed their commitment to address the problem through national programmes,
it is Beijing that has done better in terms of improving coverage. India allocates just over 1 per cent of the Centres
health budget to mental health, with States making comparable allocations. This situation should change if the
provisions of the bill are to be meaningful. The legislation, inter alia, gives everyone the right to access mental health
care as well as treatment from mental health services run or funded by the government; it also provides for supply of all
notified essential medicines free of cost to those with mental illness, through the government. The situation today is a
far cry from what is promised. While the bill says mental health services should be available at the district level, even
States with well-functioning district hospitals do not offer regular psychiatric outpatient services, leave alone in-patient
facilities. In government hospitals, medication to treat even the more common psychiatric disorders is not always
available. These and other deficiencies need not have waited for a law.

In a much-needed change, the Centre has adopted a medicalised approach to attempted suicide, treating it as the
outcome of severe stress. The bill rightly blocks the application of the Indian Penal Code section that criminalises it. A
duty is also cast on the authorities to care for and rehabilitate such individuals. What this means is that official policy
must strive to strengthen the social determinants of health, especially when it comes to universal welfare support
systems against catastrophic events in peoples lives. Reliable and free professional counselling must be widely offered.
For too long, mental health treatment in India has existed with the colonial legacy of large asylums and degrading
confinement. Many who are held in such places have nowhere else to go, as families facing stigma have abandoned
them. There is much to be said, therefore, in favour of the halfway home system that the bill provides for, where
supportive families, medical care and a better quality of life will help many recover. The success of this more progressive
law brought in to replace the Mental Health Act, 1987, will depend ultimately on the community keeping up the pressure
on the designated Central and State authorities to implement it in letter and spirit.

The Mental Health Care Bill, 2016, passed by the Rajya Sabha is a watershed legislation that lays down clear
responsibilities for the state and has provisions that empower individuals and families. Crucially, it can expand access to
treatment, which is dismally poor today. According to a recent review in The Lancet, of gaps in mental health treatment,
although both India and China have renewed their commitment to address the problem through national programmes,
it is Beijing that has done better in terms of improving coverage. India allocates just over 1 per cent of the Centres
health budget to mental health, with States making comparable allocations. This situation should change if the
provisions of the bill are to be meaningful. The legislation, inter alia, gives everyone the right to access mental health
care as well as treatment from mental health services run or funded by the government; it also provides for supply of all
notified essential medicines free of cost to those with mental illness, through the government. The situation today is a
far cry from what is promised. While the bill says mental health services should be available at the district level, even
States with well-functioning district hospitals do not offer regular psychiatric outpatient services, leave alone in-patient
facilities. In government hospitals, medication to treat even the more common psychiatric disorders is not always
available. These and other deficiencies need not have waited for a law.
In a much-needed change, the Centre has adopted a medicalised approach to attempted suicide, treating it as the
outcome of severe stress. The bill rightly blocks the application of the Indian Penal Code section that criminalises it. A
duty is also cast on the authorities to care for and rehabilitate such individuals. What this means is that official policy
must strive to strengthen the social determinants of health, especially when it comes to universal welfare support
systems against catastrophic events in peoples lives. Reliable and free professional counselling must be widely offered.
For too long, mental health treatment in India has existed with the colonial legacy of large asylums and degrading
confinement. Many who are held in such places have nowhere else to go, as families facing stigma have abandoned
them. There is much to be said, therefore, in favour of the halfway home system that the bill provides for, where
supportive families, medical care and a better quality of life will help many recover. The success of this more progressive
law brought in to replace the Mental Health Act, 1987, will depend ultimately on the community keeping up the pressure
on the designated Central and State authorities to implement it in letter and spirit.