Monday, August 08,2016
The Mental Health Care Bill, which was first introduced in the Rajya Sabha in August 2013, was finally debated and passed by the Upper House of Parliament yesterday. The Bill repeals the Mental Health Act, 1987 and consists of 134 amendments, which many MPs in the Rajya Sabha hailed as historic, while also warning the Speaker that he must not rush through it given the importance of this amendment.
The first legislation addressing issues of Mental Health/ Illness in India was during the colonial era known as the Indian Lunacy Act, 1912; later it was amended and enforced in the form of the Mental Health Act, 1987. The focus of the Indian Lunacy Act and the Mental Health Act were primarily on treatment, regarding admission and discharge of diagnosed individuals and regulations for psychiatric institution among several others; however, both these legislations hugely lacked in making any provisions against the discrimination and upholding of the rights of persons with mental illness.
Mental Health/ Illness in India has always lacked awareness, understanding and nuanced perspective and the discourse on it has mostly been driven by Psychiatrists and other medical practitioners. Persons diagnosed with mental illness have a history of being discriminated, marginalised, and excluded and being denied basic fundamental rights. The Mental Health Care Bill was introduced in the light of the provisions made under the United Nations Convention on the Rights of Persons with Disability (UNCRPD), which was ratified by India in 2007. The Bill is an attempt towards aligning with the UNCRPD and addressing mental health issues from a right based perspective; while some amendments such as the decriminalisation of suicide are progressive, the Bill fails to holistically address the issues of Mental Health/ Illness.
Some of the salient features of the Bill are:
- The primary objective of the Bill is to ensure the right of every individual without discrimination to access affordable and good quality mental health services; which as per the provisions are to be made available by the Government in sufficient quantity and easily accessible geographically. It also states that persons with mental illness have the right to equality of treatment, protection from inhuman and degrading treatment, free legal services, access to their medical records, and complain regarding deficiencies in provision of mental health care.
- The new Bill defines mental illness 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 subnormality of intelligence’
- It decriminalises suicide and allows for Electroconvulsive Therapy (ECT) only with muscle relaxants and anaesthesia, prohibiting the use of ECT on minors
Makes provisions for ensuring ‘informed consent’ and for treatment procedures which maybe least restrictive in nature.
- The Bill also makes provisions with regard to individual capacity, it states that every individual shall be deemed to have the capacity to make decision unless it is proved that the individual is (i) unable to understand and (ii) unable to appreciate the foreseeable consequences of his decision
- The Bill makes provisions for the setting up of a Mental Health Review Commission; Central and State Mental Health authority and establishment of more treatment centres/ hospitals for mental illness.
- The Bill provides that each individual has the right to make an Advanced Directive specifying whether or not they want to be treat for a mental illness; the nature of treatment and who the care – giver might be. However, if the doctor or care – giver do not wish to follow the directive they can apply to the Mental Health Review Board.
- While certain provisions of the Bill are progressive in nature; the Bill in its entirety is not as progressive and does not reflect a nuanced understanding of mental illness. From the definition of mental illness to the various provisions in it, it is evident that the Bill does not take into account factors such as poverty, the immediate environment of the individuals and other socio – cultural factors which affect an individual’s mental health. Kanimozhi (DMK) and Viplove Thakur (INC) in their respective speeches emphasised on the need to look at and address environmental factors affecting mental health instead of only focusing on treatment; Husain Dalwai (INC) also pointed out that the Bill focuses only on illness and does not make provisions for prevention.
The Bill lays great emphasis on setting up several commission and boards for monitoring and regulation of Mental Health Care facilities; however, it fails to address issues of creating awareness, lack of human resource, absence of data regarding how many individuals in India suffer from mental illness, social integration of persons with mental illness and support systems for care – givers and family members. Madhusudan Mistry (INC), in a passionate speech raised several relevant issues pointing out that the Bill fails to lay down any provisions for creating awareness and addressing the stigma associated with mental illness. He also spoke of the need to entirely prohibit the use of ECT – a view held by several civil society/ user/ survivor groups; pointing out that internationally too there is a movement opposing ECT as a method of treatment. He also pointed out that the Bill is ‘individualistic in nature’ and does not make sufficient provisions for family members and care – givers who also face a lot of challenges – a view echoed by Rajeev Gowda (INC) in his speech demanding that counselling support also be provided to family members and caregivers.
Several other parliamentarians such as A. K. Selvaraj (AIDMK), Madhusudan Mistry (INC) and Vikas Mahante (BJP) also raised the need for a thorough survey and data base of the number of persons with mental illness. While several speeches made in parliament yesterday were backed by facts and ground realities, several points raised reflected the lack of understanding regarding mental health. Towards the end of the debate, while the voting was being carried out the Deputy Chairman of the House P. J. Kurien referred to persons with mental illness as ‘mentally challenged’; several other parliamentarians in their speeches too seemed to confuse mental retardation with mental illness – which reflects the poor understanding of the very basic difference between mental illness and intellectual disabilities.
From several studies conducted in the country it has been found that 9 out 10 cases of mental illness go untreated – in the light of these appalling statistics the Bill does little to address mental illness and mental health keeping by taking into consideration the various socio – economic, political and cultural factors. It is also worth noting the poor turnout in the Rajya Sabha for the debate. While the Bill is a welcome move towards the inclusion and better treatment of persons with mental illness, there is a lot more which need to be addressed and taken into account to ensure that the rights of persons with mental illness are protected.
(The writer holds a M.A. in Social Work in Disability Studies and Action; She is a Social Activist (Disability, Mental Health, Gender and Sexuality, Women and Child Rights); Poet and Writer.)