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.
· 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-giv
er 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.
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!
Sanjeev Sirohi, Advocate,
s/o Col BPS Sirohi,
A 82, Defence Enclave,
Sardhana Road, Kankerkhera,
Meerut – 250001, Uttar Pradesh.