The Mental Health Care Bill, 2013 passed by Rajya Sabha recently has triggered an avalanche of reactions and opinions. While some have hailed it as a ‘landmark’ Bill with many progressive clauses, others have lambasted it fiercely and dubbed it ‘Politics of Health’ that has nothing to do with care. We bring you four key perspectives of Government, Caregiver, Medical profession and Patient to help you deduce fair evaluation and assessment.
1) Government
The Mental Health Care Bill, 2013 was introduced in the Rajya Sabha on August 8, 2013. The Bill repeals the Mental Health Act, 1987.
The Statements of Objects and Reasons to the Bill, state the government ratified the United Nations Convention on the Rights of Persons with Disabilities in 2007. The Convention requires the laws of the country to align with the Convention. The new Bill was introduced as the existing Act does not adequately protect the rights of persons with mental illness nor promote their access to mental health care. The key features of the Bill are:
Rights of persons with mental illness: Every person shall have the right to access mental health care and treatment from services run or funded by the government. The right to access mental health care includes affordable, good quality of and easy access to services.
Advance Directive: A mentally-ill person shall have the right to make an advance directive that states how he wants to be treated for the illness during a mental health situation and who his nominated representative shall be. The advance directive has to be certified by a medical practitioner or registered with the Mental Health Board.
Central and State Mental Health Authority: These are administrative bodies are required to (a) register, supervise and maintain a register of all mental health establishments, (b) develop quality and service provision norms for such establishments, (c) maintain a register of mental health professionals, (d) train law enforcement officials and mental health professionals on the provisions of the Act.
Mental Health Establishments: Every mental health establishment has to be registered with the relevant Central or State Mental Health Authority. In order to be registered, the establishment has to fulfill various criteria prescribed in the Bill.
Decriminalising suicide and prohibiting electro-convulsive therapy: A person who attempts suicide shall be presumed to be suffering from mental illness at that time and will not be punished under the Indian Penal Code. Electro-convulsive therapy is allowed only with the use of muscle relaxants and anaesthesia. The therapy is prohibited for minors
Insurance: Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.
2) Caregiver
Amrit Bakshy, President, Schizophrenia Awareness Association and father of a person with schizophrenia
Mental Health Care Bill 2013 is a highly progressive and beneficial legislation that has been in offing for a while. 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.
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.
The Bill also casts 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.
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 2013 which should soon become a reality and which is in the interest of the entire mental health community.
3) Medical profession
Dr Anshu Kulkarni, Psychiatrist, S L Raheja Fortis Hospital
This is a long awaited Bill. It is a landmark judgement.
- The best part about it is that it is patient centric and focuses on how more facilities and support should be provided to the mentally ill. It will protect and promote the rights of the mentally ill and will provide better healthcare to people suffering from various kinds of mental illnesses. With the enactment of the Mental Health Care Bill 2013, mentally ill people can rightfully take treatment with dignity.
- The second positive feature about the Bill is that it allows an individual to make an advance directive on how they wish to be treated if they suffer from mental illness in future. A person can also chose a nominative representative who would take care of him or her.
- Another crucial aspect of the Bill is that it will decriminalize suicides. According to the Bill any person who attempts to commit suicide shall be presumed, unless proven otherwise, to be suffering from mental illness at the time of attempting suicide and shall not be liable to punishment. As of now, a person who commits suicide is charged under section 309 of IPC as it is considered an offence and could involve imprisonment.
On the whole it is a very reformative Bill and has been welcomed across the community.
4) Patient
Since every stakeholder felt it was a patient centric bill, we left the patient view to the end of the piece - to leave you with something to think about.
Reshma Valliappan, Artist-activist living with Schizophrenia without medicines
My opinion is I am not allowed to have one. It should be obvious by the very bill itself. It's about psychiatrist and caregivers. Not about me. It's about decisions they would be making.
It's all about power control and not care.
The schizophrenic is feared and one of the most dangerous person on earth according to majority in the profession anyway.
In fact just day before someone tried correcting me that crazy is not the same as
schizophrenia. That schizophrenia is a disease and crazy is something everyone experiences.
This disease reducing comments are uncalled for and it's the medical community that is responsible for coining our existence into some diseased creatures who can affect the global economy if we are left untreated.
Everyone will wake up and speak of mental health when some political upheaval arises. After that they go back doing what they do. Living their full lives with all their rights while the few of us still need to think twice when we tell another about the label we carry. One label enough to force treat me and throw me inside for life (as they've done with many friends) because everyone else including caregivers in the sector have undermined the schizophrenic to agree with professionals that we are incapable of making choices. Clearly they have no sense of loyalty to their own family members when they choose to buy into opinions of white coated professionals.
Throughout Mental Health advocacy there is one thing I've learnt and that is - it has nothing to do with care. It's ALL ABOUT POLITICS.
It's got nothing to do with care. It's the politics of health. A few days will pass and everyone will forget about it...
The day doctors spend time sitting in the cabins where they belong and not over legal drafts of when care comes in. And the day caregivers learn to be better parents and not fight over legal matters to control their own kin - is when both begin to heal.
Reshma advocates for better, humane doctors and professionals who can see beyond the label and does not feel that is a far fetched dream as they do exist but are side-lined themselves.
Having read the various perspectives, what do you think? Do you think enough has been done in this bill? Is this a step forward? Please share your views below.
