Mental Health Care Bill

Last week parliament passed GST bill amidst much hype and publicity. At the same time, Rajya Sabha passed Mental Health Care Bill as well, which hardly anyone noticed. This is major milestone for the bill which was formulated in 2013.

I am associated with Schizophrenia Awareness Association(SAA) which works in the area of mental health area. The president of SAA, Amrit Bakshey has been championing this bill and has keenly following its journey. He has written an articles on its journey which I am reproducing it below:

Stake holders’ wait for it become a law will end soon! Much to the joy of the mental health community, the Rajya Sabha passed the Mental Health Care Bill 2013 with a voice vote on Monday the 8th August 2016. As the news spread that the Bill is listed on the business of the day, thousands of stake holders left their other engagement and were glued to the TV channels, sending minute to minute reports to their groups. The Bill should have an easy passage in the Lok Sabha and President’s assent should come soon.

For those of us who have been following the passage of the Bill from day one, it was a great historic moment. Six years back, with a view to harmonize the Mental Health Act 1987 (MHA 1987) with the United Nations Convention on Rights of Persons with Disability (UNCRPD) which India had signed and ratified on 30th March 2007 and 1st October 2007 respectively, the Ministry of Health and Family Welfare (MHFW) decided in the National Consultation Meet held on 22nd January 2010 to amend or replace the MHA 1987. The work was assigned to a senior and a highly qualified psychiatrist with vast experience in drafting mental health laws of several nations on WHO assignments and a legal expert from a reputed law college of the country.

After a rigorous participative process stretching over 3 years, consisting of regional and national consultations with stake holders, including psychiatrists, family care-givers, user survivors and NGOs and consultations with states and various ministries and after 3 drafts ( the first two were amendments to Mental Health Act 1987), the 4th and final draft bill, repealing the MHA 1987, was cleared by the Cabinet on 13th June 2013 and was introduced in the Rajya Sabha on 19th August 2013 as Mental Health Care Bill 2013 (MHCB 2013). On 20th August 2013, the Chairman Rajya Sabha referred the Bill to the all-party Parliamentary Standing Committee on Health and Family Welfare. The Parliamentary Committee after due deliberations and consultations with experts signed its favourable report on 11th November 2013 and presented to the Chairman Rajya Sabha and Speaker Lok Sabha on the 20th November 2013. The Cabinet approved the recommendations of the Parliament Committee on 30th January 2014.

The Bill cleared by the all-party Parliament Committee fell in the category of consensus bills and not much debate as such was required to pass it. The Bill, a property of the House, however, awaited an agonizing 3 years for Parliament’s time to discuss and pass to become a law.

MHCB 2013 is a highly progressive and beneficial legislation in offing. Right to access mental health care facilities, community living, protection from cruelty, inhuman treatment and right to equality and non-discrimination in treatment are some of the most laudable features of the Bill.

This chapter V of the Bill provides far reaching rights and elaborate benefits to the persons with mental illness (PWMI). The benefits provided as rights are unparalleled in the history of Indian legislation. What is offered is comparable to the best in the World. Section 18 makes mental health care and treatment at affordable cost and nearer home as a right and free for those below poverty line. Section 19 gives PWMI the right to live in the community rather than languish in institutions. This will reduce stigma. Sections 20 to 28 protect the basic human rights of PWMI including the right to equality and non-discrimination, to know about their illness, the treatment being given, the confidentiality and free legal advice. It enables the PWMIs admitted in mental health establishments (MHE) to enjoy basic amenities as are available to patients in other hospitals. Section 21 (2) provides for medical insurance policies for PWMIs by insurance companies the same way as for physical illness.

Sections 29 to 32 of Chapter VI cast responsibilities on State to promote mental health, launch preventive programmes, create awareness, reduce stigma and develop human resource. Sections 94 to 108 of Chapter XII regarding admission to, treatment  in and discharge from mental health establishments protect human rights fully without diluting the need for appropriate treatment. Sub Sections (4), (5) and (6) of Section 96 take adequate care to prevent molestation of minors in a MHE especially of minor girls. Section 103 on Emergency Treatment is a highly practical and helpful provision. Section 104 prohibiting certain treatments, such as unmodified ECT and sterilization and restrain on chaining are highly desirable pro human right provisions. Section 105 provides safeguards in regard to psychosurgery. Section 106 is a human right provision curbing physical restraint and seclusion, to be used only to prevent harm to self or others.

The Bill in its 4 year journey was debated and discussed and changes made after due process of consultation with all stake holders. Consultative process at the regional and at national level was all inclusive. Psychiatrists as well as other stake holders were invited and they participated. IPS Representatives also sought and got exclusive meetings with the Ministry Officials.

During this period of 4 years, there were several controversies and acrimonies. Some Human Right Activists criticized the Bill vehemently as in their view the Bill did not protect the human rights of persons with mental illness adequately. Some families felt that the provisions in regard to nominative representatives and advance directives would pose practical problems in caregiving. The Indian Psychiatrists Society (IPS) seemed unhappy that they were denied their due role in the drafting of the MHCB 2013. The MHA 1987 was drafted by IPS.

Their demurrals were banning of unmodified ECT which was for the attending psychiatrist to decide, the high cost of modified ECT, risk due to anesthesia and also non-availability of anesthetists for modified ECT. The IPS was also opposed to the registration of general hospitals with psychiatric beds.

The counter view of the framers and the supporters of the Bill was that ECT without anesthesia and muscle relaxant caused suffering and could cause injuries and therefore it was violative of human rights. It had been shunned by lot many nations. The country had over 16000 anesthetists against some 4500 psychiatrists. As a surgeon would not perform a surgery without an anesthetist, a psychiatrist should not administer ECT without an anesthetist. One time simple registration of mental health care establishments (where PWMI were kept overnight) including General Hospitals with psychiatric beds was required for statistical purposes and also to ensure that minimum standards were maintained and incidents like Erawadi, (28 chained inmates with mental illness died in a fire) did not occur again and patients were not exposed to abuse and neglect in ill-equipped mental health facilities both in the private and public sector. If a mental health establishment was registered under Clinical Establishments Act, (which was to be the case with general hospitals), registration under the proposed MHCA would have been waived.

Some IPS members also took cudgels on behalf of caregivers and said that the Bill was modelled after the western concept of institutional psychiatric care and would marginalize the families. It was also said that the nominated representatives would dupe the patients, taking major decisions on their behalf in regard to care and property.

Those associated with the drafting of the Bill quoted clause 17.c of the Bill and stated that a nominated representative had no role in regard to the property. His/Her role was limited to providing support to PWMI in making treatment decisions only. The Bill complied with the UNCRPD. The concept of mental health care and protection of human rights related thereto, was universal and not a country or region specific. It was a Mental Health Care Bill to provide mental health care to PWMIs. What was good for the PWMIs was also good for their families.

MHA 1987 which was a robust act when it was enacted had outlived its utility and needed to be replaced with a new law which inter alia protected human rights of PWMI. Its provisions had become outdated and were prone to struck down if challenged in a court of law leading to a vacuum which would have been dangerous.

The Caregivers and the PWMI are thrilled at the prospect of getting a beneficial law for them in a few months’ time and look forward to the passing of the sister Bill ‘’Rights of Persons with Disability Bill’’.  One hopes that all stake holders including senior and well respected members of psychiatric community and human right activists will also welcome the Mental Health Care Act 2016 which should soon become a reality and which is in the interest of the entire mental health community. The battle is half won as an equally important part would be the implementation of the new act. Many salutary provisions remain on paper only for want of proper implementation. State authorities, judiciary and mental health activists will have to be on their toes.

Indian Express also had article on this explaining various topics in this bill. Please find the link here. Hope this bill, once passed in Lok Sabha, with proper implementation, will change the lives and plight of persons with mental illness.

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