Coming straight to the nub of the matter, let me begin first and foremost by penning down my extreme happiness and utmost satisfaction to note that the new Mental Health Care Bill decrimialising attempt to suicide is truly historic from all angles! It gives me more happiness to note that this new Mental Health Care Bill has been passed by both the Houses of Parliament. Thus we see that the Parliamentary approval has been secured which was mandatory for it to become a law.
While craving for the exclusive indulgence of my esteemed readers, let me inform them that the new Mental Health Care Bill the new Mental Health Care Bill which decriminalises attempt to suicide and bans use of electric shock therapy for treating children with mental illness was passed by the Lok Sabha on March 27, 2017. With the Lok Sabha’s assent to the legislation, the new Mental Health Care Bill secured parliamentary approval as it was earlier passed by the Rajya Sabha in August 2016. This is a very good news especially for those who require mental health care. Also, it has received the Presidential assent on April 7, 2017.
To put things in perspective, an important salient factor in the Bill is that it separates attempt to suicide from the Indian Penal Code. In effect, IPC provisions cannot be invoked in case of an attempt to suicide. Since the person undertakes the extreme step of killing oneself in extreme mental stress thus meaning that it is triggered by mental illness – the Bill does not criminalise it. This is what is so laudable and it has been lauded by human rights activists, lawyers, doctors and all right minded people. Those who attempt to commit suicide need treatment and not punishment. Many times even a good friend can do the job of a doctor and help his/her friend to come out of the mental illness and again lead a normal life much like any other ordinary person.
Be it noted, the new Mental Health Care Bill provides for a rights-based comprehensive health care to the mentally ill. It aims to provide for the right to better health care for mentally ill persons. Any mentally ill person shall have the right to –
· Access mental health care
· Community living
· Seek protection from cruel, inhuman and degrading treatment
· Equality and non-discrimination
· Access medical records
· Personal contacts and communication
· Legal aid
· Make complaints about deficiencies in provision of services
· Place restriction on release of information in respect of mental illness
Let me bring out here that the new Bill also allows a mentally ill person to have the right to restrict release of information with respect to the illness and make a complaint about deficiencies in provision of services. All this will surely benefit them and have therefore been very rightly incorporated in the Bill. Apart from this there are many other laudable features in this Bill. Some of them are as follows : –
1. The Mental Health Care Bill ensures that every person has the right to access mental health care and treatment from health services run or funded by government.
2. It assures free treatment for mentally ill persons if they are homeless or poor, even if they do not possess a Below Poverty Line card.
3. Health Minister JP Nadda himself said in Lok Sabha that, “This Bill compels the state to have a mental health programme and it empowers the individuals,” adding that the Bill has a “patient-centric” approach with the aim of increasing participation of service users.
4. It also goes forward to provide that a person with mental illness will have the right to make an advance directive in writing specifying the way the person wishes to be cared for and treated for a mental illness.
5. It also recognizes the role of caregivers as those who can be appointed as a nominated representative of a mentally ill person, members of the Central Mental Health Authority and State Mental Health Authorities, or members of Mental Health Review Boards.
6. On the clauses decriminalizing suicide, the Bill states that a person who attempts suicide should be presumed to have severe stress and shall not be punished. It shall benefit mainly those who are poor or have failed in an exam or have suffered any other major setback in their respective lives due to which they don’t feel like living further. JP Nadda who is our Health Minister also said that, “Suicide is a mental disease. It will not be a criminal act, it will be decriminalized. It recognizes that it is done under severe mental stress”. This is really most historic and will benefit not just poor farmers who attempt suicide due to poverty but all other persons who attempt suicide due to one reason or the other. No one has been left out and this is really good. Punishing further a person who is already tormented does not make any sense and this alone explains why most of the countries in the world are now doing away with the penal provisions which punishes persons who attempt to commit suicide but fail due to one reason or the other.
7. It is expressly provided in the Mental Health care Bill that, “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.” No sane person will ever recommend further punishing a person who is already under so much of stress and strain that he/she attempts to end his/her life. This is therefore most laudable and must be applauded by one and all.
8. It also provides mentally ill people a right to confidentiality in respect of mental health, mental healthcare, treatment and physical healthcare. Photographs or any other information pertaining to the person cannot be released to the media without the consent of the person with mental illness. This will ensure that no one is able to mock the mentally ill persons through media or in any other manner unless they consent to it.
9. The Bill empowers the government to set up a Central Mental Health Authority at the national level and a State Mental Health Authority in every state. Every mental health institute and mental health practitioners including clinical psychologists, mental health nurses and psychiatric social workers will have to be registered with this Authority.
10. A Mental Health Review Board will be constituted to protect the rights of persons with mental illness and manage advance directives.
11. Under Section 108 of this Mental Health Care Bill, the punishment for flouting of provisions will attract up to six months in prison or Rs 10,000 fine or both. Repeat offenders can face up to two years in jail or a fine of Rs 50,000 to Rs 5 lakh or both. This will make sure that the rights of mentally ill persons are protected under all circumstances. No one will dare transgress and still if someone transgresses then he/she will be awarded the appropriate punishment.
12. Section 18 stipulates that every person shall have a right to access mental health care and treatment from mental health services run or funded by the appropriate government.
13. Section 20 stipulates that every person with mental illness shall have a right to live with dignity and be protected from cruel, inhuman and degrading treatment in any mental health establishment.
14. Section 21 guarantees the right to equality and non-discrimination to every person with mental illness. No discrimination of any kind will be permitted under any circumstances against the mentally ill persons.
15. Section 19 guarantees to every person with mental illness to have a right to community living and not to be segregated from society.
16. The Bill defines “mental illness” as a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behavior, 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 subnormality of intelligence.
17. A person with mental illness shall have the right to make an advance directive that states how he/she wants to be treated for the illness and who his/her nominated representative shall be. It includes the right not to be treated and say no to institutionalization. The advance directive should be certified by a medical practitioner registered with the Mental Health Board. If a mental health professional/relative/care-giver does not wish to follow the directive while treating the person, he can make an application to the Mental Health Board to review/alter/cancel the advance directive.
18. A person with mental illness shall not be subjected to electro-convulsive therapy without the use of muscle relaxants and anaesthesia. Also, electro-convulsive therapy will not be performed for minors. Sterilisation will not be performed on such persons. They shall not be chained in any manner or form whatsoever under any circumstances.
19. The Bill clearly emphasizes on ensuring no intrusion of rights and dignity of people with mental illness.
20. The Bill provides for ensuring healthcare, treatment and rehabilitation of persons with mental illness “in a manner that does not intrude on their rights and dignity”.
21. The Bill also stipulates administrative bodies at central, state levels to register, supervise, maintain list of mental health establishments; develop quality and service provision norms; keep register of mental health professionals; train officials; receive complaints and advise the government on matters of mental health.
This Bill has undergone wide ranging public consultations, debates and discussions from 2010 onwards. These include regional consultations and a national consultation that was attended by nearly 300 stakeholders. In a first, Parliament devoted six hours exclusively debating and discussing mental health issues. Also, it merits mention here that a record number of 29 MPs had participated in the debate, without the usual acrimony, ruckus, cacophony or disruptions and most important of all they all expressed their unstinted support to it.
The Bill lays down that “Every person shall have a right to access mental health care and treatment from mental health services run or funded by the appropriate government. The right to access mental health care and treatment shall mean mental health services of affordable cost, of good quality, available in sufficient quantity, accessible geographically, without discrimination on the basis of gender, sex, sexual orientation, religion, culture, caste, social or political beliefs, class, disability or any other basis and provided in a manner that is acceptable to a person with mental illness and their families and care-givers.”
It would be pertinent to mention here that the range of services specified in it includes outpatient and impatient services, half-way homes, sheltered accommodation, supported accommodation and provisions for child and old-age mental health services. It also contains a provision for the notification of a list of essential medicines, providing which will be the obligation of the relevant government.
It must be highlighted here that Pune-based psychiatrist Dr Saumitra Pathare who had drafted the Bill along with Professor Jaya Sagade said the Bill will turn good lot of aspects in the mental health care. Dr Pathare said that, “For the first time, there is an emphasis on rehabilitation within the community. The Bill talks about the patients right to live within the community and not in seclusion. This changes the perspective with which we look at mentally ill patients,” adding that the Bill has a clause that mandates the government to increase the number of mental health workers.
It is no ordinary thing that 150 million Indians require treatment for mental illness but nearly 80-90% receive just no treatment. Also, we spend less than 1% of the public health budget on mental health even though it is true that mental health problems constitute nearly 13% of the health burden. An estimated 6-7% of India’s population suffer from some kind of mental illness, while 1-2% have an acute condition.
As things stand, the nation’s grossly inadequate base of professional resources is evident from its ratio of 0.3 psychiatrists for 100,000 people with marginally higher numbers taking independent private practitioners into account as compared to China’s 1.7. There are also massive deficiencies in the availability of trained clinical psychologists and psychiatric social workers. All this must be set right which is a herculean task but definitely not impossible!
It must be noted here that India which has 17.5% of the world’s population alone accounts for 17% of the world’s suicides. As per government data, 1,31,666 Indians committed suicide in 2014. This grew to 1,33,623 suicides in 2015. 150 million Indians need treatment for mental illness but nearly 80-90% receive no treatment. We spend less than 1% of the public health budget on mental health even though mental health problems constitute nearly 13% of the health burden. This alone explains what necessitated the urgent bringing of this Bill and passing it as soon as possible so that it comes into effect at the earliest!
All said and done, this new Mental Health Care Bill which decriminalizes attempt to suicide is truly historic from all angles. This alone explains why it has been hailed by a lot of eminent jurists, intellectuals and lawyers. Even the 210th report of Law Commission had recommended to decriminalize the attempt to suicide. To punish a person who is already not mentally well can never be justified under any circumstances! So it is really great to see that finally humanity has won and this is clear from the passage of this historic Bill and has even received the assent of the President now.
No looking back! A change in people’s perception is also required towards those suffering from mental illness as this alone can remove the stigma and discrimination that stands in the way of finding cures and enabling them to live a complete life which they actually deserve also! Let’s hope so! In fact hoping alone will not suffice! We all have to collectively work together to ensure that this new Bill once it comes into effect is effectively implemented instead of just leaving everything on the Government alone! It is certainly not easy but definitely it is eminently possible provided we are all committed to it! The present NDA government must be lauded for bringing forward such a historic Bill and in fact all those MPs who ensured its passage in Parliament must also be lauded unequivocally no matter from which party they hail! This ostensibly shows that all MPs who have ensured the passage of this historic Bill in Parliament are all concerned equally about the deplorable plight of the mentally ill persons and have done their level best to ensure that they are adequately protected and cared for!
Sanjeev Sirohi, Advocate,
s/o Col BPS Sirohi,
A 82, Defence Enclave,
Sardhana Road, Kankerkhera,
Meerut – 250001, Uttar Pradesh.