MENTAL HEALTH CARE BILL, 2013

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This article was written by Akanksha, a student of Amity Law School, Delhi.

Mind and body are connected, one tends to remain mentally fit if they treat their body right, but such is not the case these days. With unhealthy lifestyle taking over people’s life, mind-body imbalance is caused. People get caught up with all kinds of destructive thoughts that have a negative effect on their perceptions and behaviors. This isn’t  unnatural but it’s just part of our brain chemistry and there are certainly many things that can be done to help get you back on track. Such mind body imbalance has a tendency of causing mental illness.

What is mental illness?

The medical dictionary defines mental illness as : “any of a broad range of medical conditions (such as major depression, schizophrenia, obsessive compulsive disorder, or panic disorder) that are primarily marked by sufficient disorganization of personality, mind, or emotions to impair normal psychological functioning and cause marked distress or disability and that are typically associated with a disruption in usual thinking, feeling, mood, behavior, interpersonal interactions, or daily functioning” [1] the above definition explains the concept in a broad way, including Depression, Schizophrenia, OCD; It also takes into account the malfunctioning of personality, mind and emotions and  includes them under the umbrella term of  Mental Illness.

In India, the need for a broader definition of mental illness was recognized some time after the implementation of The Mental Health Act of 1987 which defined Mental Illness as “any mental disorder other than mental retardation” which was been criticized as it failed to protect the interest, and to reduce the social stigma associated with mental illness. The country rejoiced on 8 August, 2016, when the Mental Health Care Bill, 2013 was passed in the Rajya Sabha, the much neglected aspect of mental health finally got some recognition under this act. The new bill, when passed in the Lok Sabha, will replace the rather outdated Mental Health Act of 1987, and when compared to the existing law, it is definitely reformist.

The new bill defines the term “mental illness” in a broader and inclusive way 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 standard 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 characterized by sub normality of intelligence.” The bill contains various provisions which will contribute to the development in the field of mental health.

First, Section 309 of the Indian penal code punishes anyone who attempts to commit suicide. It’s constitutionality has remained under question from a lot of time. In P Rathinam v. Union of India[2] a Division Bench of the Supreme Court supporting the decision of the High Court of Bombay in. Maruti Sripati Dubal case held that under Article 21 of the Constitution of India right to life also include right to die and laid down that section 309 of Indian Penal Court which deals with ‘ attempt to commit suicide is a penal offence’ unconstitutional. Supreme court in the case of Smt. Gian Kaur vs The State Of Punjab [3] overruled the P. Ratinam’s case and held that “Right to Life” under Article 21 of the Constitution does not include “Right to die” or “Right to be killed” and there is no valid ground to hold that the section 309, IPC is constitutionally invalid, thus continuing to punish the people who attempted to commit suicide. Thus to improve the situation there is a mention of decriminalization of attempted suicide. It is specifically stated that there is a presumption of severe stress in person who attempts suicide and such person shall not be tried and punished by the courts under the said code. Moreover, it is highlighted that the appropriate Government will be bound not only to provide care, treatment, and rehabilitation of such persons but also to take suitable measures to reduce its recurrence. This is an important and progressive step which will have positive implication throughout the country.[4]

Second, there is a detailed elucidation on “Rights of person with mental illness.” This is highly significant step to make the Bill as patient-centric. There is a mention of the right to access mental health care and treatment at affordable cost, good quality which is acceptable to person with mental illness, their family members, and caregivers. The onus will be on appropriate Government to make such provisions for range of services including outpatient and inpatient services, half-way homes, sheltered accommodation, supported accommodation, hospital- and community-based rehabilitation, free cost of medicines, specialized services of child and adolescent, and old age mental health. The appropriate Government will ensure necessary budgetary provisions for effective implementation along with integration of mental health services into general health care at all levels of health. Every person with mental health illness will have right to protection from cruel, inhuman, and wretched treatment.

Third, the key feature in this new Bill is the provision for medical insurance for treatment of mental illness at par with physical illness by all insurers. Mental health insurance has remained a neglected area for a long time. This new feature will have huge and significant impact for the persons with mental illness, families of mentally ill people, and caregivers.[5]

Fourth, the new Bill lays down the “Duties of appropriate Government.” This is a unique feature as the appropriate Government will have responsibility to plan, design, and execute programs for mental health such activities related to promotion, prevention, reduction of suicide, stigma. The important aspect will also to address the human resource needs which include training of medical officers and other persons.

CHALLENGES

The Bill instructs the central and state governments to ensure access to mental health services in each and every district. These health services will include outpatient and inpatient services, hospitals, and community-based rehabilitation establishments. However, the financial memorandum of the Bill does not provide an estimate of the required in meeting the obligations under the Bill nor does it provide details of the sharing of expenses between the central government and state government. Without the grant of adequate funds and other resources, the execution of the new Bill could be seriously affected. The Standing Committee examining the Bill had clearly noted that public health is a state subject. Since several states face financial constraints, the central government might have to step in to ensure adequate funds for the carrying out of the law. The Bill as passed by Rajya Sabha does not consider the issues pertaining to guardianship of mentally ill persons. The Act of 1987 contained detailed provisions relating to appointment and removal of a guardian, and his powers and duties. The provisions relating to guardianship of mentally ill persons are mentioned in the Rights of Persons with Disabilities (RPD) Bill, 2014, which is pending in the Parliament. If the Bill is passed by Parliament in its contemporary form, there will be a legal nihility with regard to provisions of guardianship of mentally ill persons.

[1] https://www.merriam-webster.com/medical/mental%20illness

[2] 1994 AIR 1844

[3] 1996 AIR 946

[4] Ranjan R, Kumar S, Pattanayak RD, Dhawan A, Sagar R. (De-) criminalization of attempted suicide in India: A review. Ind Psychiatry J 2014;23:4-9.

[5] Pattanayak RD, Sagar R. Health insurance for mental health in India: A welcome step toward parity and universal coverage. J Ment Health Hum Behav 2016;21:1-3.