The right of mentally-ill patients to decide their mode of treatment, decriminalising suicide for them and a ban on electric shock treatment without anaesthesia are some of the progressive provisions of the new mental health bill proposed by the government.
“The bill was passed by the union cabinet last week,” Health Secretary K. Desiraju told IANS.
Once passed by parliament, the bill will repeal the Mental Health Act, 1987.
If passed, it will make access to mental healthcare a right for all. Also, such services would be affordable, of good quality and available without discrimination.
An estimated 10-12 million or one to two per cent of the population suffers from severe mental disorders such as schizophrenia and bipolar disorder and nearly 50 million or five percent from common mental disorders such as depression and anxiety, yielding an overall estimate of 6.5 percent of the population.
Keeping in mind the rising number of people suffering from mental ailments, the new bill aims at introducing progressive and far-sighted steps for patients, a senior health official told IANS.
“If a person has given an advance directive to the state that he or she should not be admitted to a facility without consent, it will be heeded to,” the official said.
This was proposed keeping in mind that a person can be branded mentally ill by family members in property or marital disputes.
The official said the 1987 Act had vested extraordinary powers in treating psychiatrists. The bill now states that an individual can himself or herself take a call on the treatment.
Psychiatrists, however, feel that by giving powers to a mentally-ill patient to decide on the course of treatment would put him at risk.
“A patient in a psychotic phase or a mentally-ill person doesn't have the judgemental capacity to decide what is good or bad for him or her. So trusting that person to make the correct choice in such circumstances might be risky,” Samir Malhotra, head of the Department of Psychiatry at the Max hospitals, told IANS.
He further said that the bill would significantly reduce the powers of the doctors in deciding the patients' well-being.
The bill also provides the right to confidentiality and protection from cruel, inhuman and degrading treatment, in addition to the right to live in a community. Legal aid will also be extended to them.
It bans the electric-convulsive therapy or the electric shock treatment without anaesthesia and restricts psychosurgery.
Under the provisions of the bill, the government has an obligation to provide half-way homes, community caring centres and other shelters for mentally-ill people. Half-way homes, common in the western world, are for those patients who have recovered but need 24-hour monitoring and rehabilitation.
It also envisages a mental health review commission, which will review all admissions in mental health institutions beyond 30 days.
The commission would be a quasi-judicial body to oversee the functioning of mental health facilities and protect the rights of persons with mental illness in these facilities.
The bill also proposes to provide free care to all homeless, destitute and poor people suffering from mental disorders.
Trying to address the needs of the families, caregivers and those of homeless mentally ill people, the new legislation provides for setting up central and state mental health authorities, which would act as administrative bodies.
The bill decriminalises suicide for mentally ill patients.
Reacting to this provision, Dr. Malhotra said: “In certain circumstances it can help, as police action is sometimes cumbersome, but it can also not be denied that criminalising suicide had acted as a deterrant in some cases.”
Under the Indian Penal Code, suicide is a criminal act and a person can be jailed for at least one to three years.
The government had launched the National Mental Health Programme (NMHP) in 1982, keeping in view the heavy burden of mental illness in the community, and the absolute inadequacy of mental health care infrastructure in the country to deal with it.
According to eminent psychologist Aruna Broota, many Indian mental facilities and institutions are in a pathetic state and need to show a sympathic attitude towards these people.
“The situation is slightly better in south India than in north India, but generally the condition of these facilities is very bad,” she told IANS.
“One can have as many fancy bills and laws you want. But ultimately, it is us the society that has to accept that mental disorder is like any disease and we need to accept this,” she added.