The Mental Health Care Bill, 2013

Background: • It was introduced in the Rajya Sabha in August

2013 to repeal the Mental Health Act (MHA), 1987.
• The Mental Health Care Bill (MHCB) 2013 attempts The Bill was referred to the Parliamentary standing
to address issues in mental care, such as quality of committee, which submitted its report in November
service delivery, trained professionals and infrastruc- 2013.
ture.
• In the Indian scenario, mental health has often
• The MHCB came up after India ratified the United been given inadequate attention due to the stigma
Nations Convention on the Rights of Persons with and taboo attached to it.
Disabilities (UNCRPD), which came into force in
2008 during the UPA I regime. After signing the • At present the mentally ill accounts for nearly 6.5%
UNCRPD it became imperative for the government of the country’s population. By 2020 this number
to revise all the disabilities laws in the country to may go as high as 20%.
make it more compliant with the international conven-
tion. The Ministry of Health and Family Welfare under • The existing MHA is completely inadequate to keep
the UPA initiated the process of amendment of 1987 pace with the current needs in mental healthcare.
Act. After years of consultation of several drafts the Criticisms of the MHA have ranged from human
government came up with MHCB in 2013. rights issues to inadequate mental healthcare deliv-
ery system.

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Contact Office of Prof MV Rajeev Gowda: [email protected]
Key provisions of the Bill: the right to complain with the concerned authorities.
The bill also provides for free mental services to
• The Bill replaces the term “mentally ill” with “per- poor, destitute, and homeless (section 18 [7]).
son with mental illness”: While the former term sug-
gests a relatively permanent trait of the individual, • The role of Central and State Mental Authorities:
the latter term suggests a liberal approach and identi-
fies mental illness as a state or condition of the per- These are administrative bodies are required to--
son which is not necessarily permanent. In other (a) register, supervise and maintain a register of all
words, it is a more dignified way of looking at a prob- mental health establishments.
lem condition and protects the person from stigma (b) develop quality and service provision norms for
and social taboo. such establishments
(c) maintain a register of mental health professionals
• Rights of persons with mental illness: It is for the (d) train law enforcement officials and mental health
first time in India that a rights based approach to professionals
mental illness is being guaranteed. It emphasizes (e) receive complaints about deficiencies in provision
many rights for persons with mental illness from dif- of services
ferent aspects of life. Every person shall have the (f) advise the government on matters relating to men-
right to access mental health care and treatment tal health.
from services run or funded by the government. This
• Mental Health Review Commission Board: It pro-
also includes access to affordable and easy services
for the treatment of mental health without any dis- vides for the Mental Health Review Commission, a
crimination based on gender, caste, class, religion quasi-judicial body to foster reforms both within men-
and sex. tal hospitals and within the community. The Board
regulates admission, discharge and deals with viola-
• Decision on treatment: This new bill endorses the tion of rights. The Mental Health Review Commission
persons’ rights to take decisions regarding his/her will be a quasi-judicial body that will periodically re-
treatment. This means that the person with illness view the use of and the procedure for making ad-
and the nominated representative shall have the right vance directives and advise the government on pro-
of advance directive that states how he/she wants to tection of the rights of mentally ill persons.
be treated during the condition of mental illness. The
• De-criminalizing Suicides: Under IPC section 309,
advance directive can be made in writing with the
person’s thumb impression or signature and two wit- any attempt to commit suicide is a criminal offence
nesses. The nominated representative works as a in India. According to WHO data around 1,70,000
legal guardian and has the right to take all decisions deaths occur every year due to suicides. The govern-
in respect of the patient during whole process of the ment shall make special efforts to reduce suicides
treatment. and attempted suicides in the country. In the Bill, if a
person attempts to commit suicide, he/she will be
• Mental health care and services: Chapter V of the considered as mentally ill. Suicide will not be treated
Bill clearly highlights the different rights of people as a criminal offence. The bill clarifies that the act of
with mental illness for treatment from mental health suicide and mental health of a person are intimately
services run or funded by the appropriate govern- linked and cannot be looked at as separate issues.
ment. The bill not only focuses on quality mental
health services, but also other supportive provisions,
such as sheltered accommodation, home based re-
• Electro-convulsive Therapy and Psychosurgery:
habilitation, etc (Section 18 [4]). The bill also ensures
Section 104 of the Bill prohibits ECT without the use
that the patient gets complete information regarding
of muscle relaxants and anesthesia for the adults.
treatment records and the right to confidentiality re-
Psychosurgery would be performed only with the
garding all aspects of mental treatment. If there is
prior consent of the patient and approval from the
any lacuna, the nominated representative will have
concerned Board.

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Contact Office of Prof MV Rajeev Gowda: [email protected]
• Measure for Minors: This Bill gives special atten- First, the definition of mental illness in the bill is over-
tion to minors. Minors are to be accommodated inclusive. The bill definition is so broad that even
separately from the adult cabin. The legal guardians with people with minor ailments can be said to have
shall be their nominated representative. In case no mental illness.
suitable NR is available the Director of the Depart-
ment of Social Welfare (DSW) works as a NR. For mi- Second, the over-inclusive definition does not in-
nor girls, it is the duty of the NR to appoint female clude mental retardation. People with developmental
attendant. disabilities should also be treated at par with mental
illness as they too suffer from the disorder of mood,
• Penalties: The Bill provides for a stringent punish- thought, perception, and memory.
ment for those who are found to be running unregis-
tered mental healthcare establishments. This would • Is the Bill increasing stigma?
be fined between Rs. 50,000 and Rs. 5 lakhs depend-
The Bill seeks to segregate the treatment of the men-
ing on the frequency of the offence.
tally ill from the mainstream medical establishments
Shortcomings: and is likely to increase stigma. The inclusion of psy-
chiatry unit in general hospitals and medical colleges
• Is the Bill too ambitious? brought mental illness closer to medical illness.
There was reduction in stigma as the families were
Critics argue that the Bill is too unrealistic in its ap- feeling more comfortable in seeking treatment. How-
proach given the lack of infrastructure and resources ever, all General Hospitals Psychiatry Units (GHPUs)
in the country for the treatment of mental illness. The are required to be registered as MHE. These facilities
average number of psychiatrists in the country is are now proposed to be brought under and regis-
only 0.2 per 100,000 population compared with the tered as Medical Health Establishments (MHE),
global average of 1.2 per 100,000. Similarly, there is which could make the treatment stigmatising.
a shortage of nurses, psychologists, and social work-
ers in India compared to the global standards. • Marginalization of families:

Under the Bill all ‘involuntary admissions’ even for a Families bear the major burden of care of the men-
day, whenever challenged by the patient, will un- tally ill. Joint and extended family are vastly preva-
dergo a review by the Mental Health Review Commis- lent in India. The MHCB ignores the families and pro-
sion Board. This provision is undoubtedly progres- poses for nominated representatives. Mentally ill pa-
sive considering the basic rights of the patient. How- tients can easily be cheated by the NRs leaving the
ever, are we ready for this countrywide post admis- parents and relatives helpless.
sion review considering that most admissions in men-
tal health hospitals are admittedly involuntary? • No provisions for rehabilitation:

• Objections raised by psychiatrists: One of the major drawbacks of the Bill is that it is
completely silent on the issue of rehabilitation after
The six-member board consists of only one psychia- discharge from long-stay facilities. The biggest chal-
trist who is vested with vast powers to review and lenge in treatment of mental patients is rehabilitation.
regulate the professional conduct of psychiatrists These patients require constant care and support
and the plea of the patient. The Board may not have while staying within the community.
the knowledge and expertise to understand the pre-
dicament of the patient and “uphold” the rights of Congress’s stand on the Bill
the patient in case there is no NR.
In 2005 the National Commission on Macroeconom-
• Why exclude mental retardation in an over- ics and Health reported that 10-12 million people suf-
inclusive bill? fered from mental disorders like Schizophrenia and
bipolar disorder.

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Contact Office of Prof MV Rajeev Gowda: [email protected]
The then Union Health Minister Ghulam Nabi Azad References:
said that the prevalence of disorders was high http://www.livemint.com/Opinion/VLnBO3x30yi5ZyoMNirmYK
among women, poor, homeless and those who lived /A-muchneeded-mental-care-Bill.html
http://www.huffingtonpost.in/2015/10/09/5-things-you-need-t
in urban areas. Mr. Azad said that the bill tries to ad- o-know-about-indias-proposed-mental-health-b/
dress the needs of the families and caregivers and https://www.researchgate.net/publication/275954469_Mental_
the needs of the homeless mentally ill. Health_Care_Services_in_India_An_Analysis_of_the_Mental_H
ealth_Care_Bill_2013
In India, although the National Mental Health Pro-
http://www.firstpost.com/india/new-mental-health-bill-decrimi
gramme in 1985-90 was only 10 million rupees, the nalising-suicide-introduced-in-rajya-sabha-1050227.html
programme enjoyed a substantial increase in fund in http://www.thehindu.com/news/national/new-mental-health-bi
the subsequent two five year plans, especially during ll-decriminalises-suicide/article5045156.ece
the Congress government. http://www.tribuneindia.com/news/comment/why-the-new-me
ntal-health-bill-is-retrograde/48889.html
http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;y
The UPA II had undertaken many key health policy ear=2014;volume=56;issue=4;spage=321;epage=324;aulast=
initiatives in its tenure and the BJP seems to be tak- Narayan
ing credit of the already drafted bills with no further https://kractivist.wordpress.com/2013/06/19/india-mental-heal
enhancements. th-care-bill-cleared-by-cabinet/
http://www.prsindia.org/uploads/media/Mental%20Health/Bill
%20Summary-Mental%20Health%20care%20bill.pdf
http://www.nhp.gov.in/sites/default/files/pdf/national%20ment
al%20health%20policy%20of%20india%202014.pdf
http://indianexpress.com/article/india/india-news-india/mental
-illness-indias-ticking-bomb-only-1-in-10-treated-lancet-study
-2807987/
http://www.prsindia.org/uploads/media/Mental%20Health/Bill
%20Summary-Mental%20Health%20care%20bill.pdf

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Contact Office of Prof MV Rajeev Gowda: [email protected]