India's New Mental Healthcare Law

On Monday the 27^th of March 2017 the Lok Sabha passed the Mental Healthcare Bill 2016. The bill was earlier passed by the Rajya Sabha in August 2016. It now awaits Presidential Assent after which it will be notified in the official gazette and rules will be framed.This bill replaces the Mental Health Act of 1987 which was found inadequate in protecting the rights of mentally ill patients. The bill takes a rights based approach to mental health which is a first in the country. It is a landmark bill because of the following reasons ^[1]:

·         Decriminalizes Suicide Attempts: The bill seeks to decriminalize Attempt to Suicide which was a crime under Section 309of the Indian Penal Code. Any person attempting suicide will be presumed to be under severe stress and not be tried under the IPC until proven otherwise. The onus of proof now lies with the law enforcement agencies and not the victim. This is the most progressive feature of the bill and is in consonance with the 42nd and 210^th report of the Law Commission of India.

·         Individual Rights and Agency: The Mental Health Act of 1987 did not recognize the agency and rights of the mentally ill. This bill adopts a new approach to empowering the individual in making decisions regarding treatment. The bill provides every mentally ill adult the right to make an advance directive which specifies the way the patient wishes to be treated and cared for. The patient can also appoint a nominated representative who is entrusted with the task of protecting the rights of the patient. It is mandatory for the medical officer to treat the patient as per the advance directive. The bill seeks to create a Mental Health Review Commission at the national level and a Mental Health Review Board at district level with State governments consent to manage and review advance directives. The Commission can recommend the government on steps to be taken to protect the rights of mentally ill patients.

·         Regulation of Mental Health Establishments: The bill creates central and state level mental health authorities who will register and supervise mental health establishments. The bodies will set standards and will penalize those who those who don’t comply with them. They will also register the mental health professionals and sensitize law enforcement agencies.

·         Privacy: The bill grants the mentally ill people a right to confidentiality in respect of mental health, mental healthcare, treatment and physical healthcare. Information pertaining to the person cannot be released to the media without the consent of the person with mental illness.

·         Insurance: So far mentally ill patients couldn’t be covered by insurance policies. This bill tries to redress it by making insurance companies to treat mental illness as any other physical illness^.[1]

However good a law may sound on paper its success can be measured by the way its implemented on the ground. This law needs the support of not just the government but society as a whole. It is a fact that India spends measly amount (0.06% of health budget) on mental health and there is a shortage of mental health professionals. Health Minister JP Nadda informed the Lok Sabha in May 2016 that roughly 5% of Indian suffer from common mental illnesses such as depression, anxiety and 1-2% of Indians suffer from severe mental disorders such as schizophrenia, bipolar disorder as per the 2005 report of National Commission on Macroeconomics. As per the available data (which is 12 years old), 6 crore Indians suffer from mental health issues and this is only the cases which have been reported. Mental health issues are underreported due to the stigma attached with it. In such cases the family or caregiver plays a vital in the recovery and rehabilitation of the patient. As per the reply given by Health Minister JP Nadda in Lok Sabha in December 2015, there are 3880 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1,500 psychiatric nurses nationwide. This boils down to 3 psychiatrists per million which is far below the 5.6 psychiatrists per million in CIS countries( Russia, Belarus and the Stan States).We are short of sixty thousand psychiatrists and over two lakh psychiatric nurses. The Health Ministry with the Medical Council of India needs to work to ensure the availability of trained mental health professionals. ^[2] Also the awareness campaigns must be held on a war footing by involving civil society and NGOs. India has seen successful awareness campaigns when it comes to diseases like HIV-AIDS, Breast Cancer and Heart diseases. The lessons learnt from such campaigns must be applied in delivering one for mental health issues.

All in all the law is welcome step in the delivery of mental health programs but one cannot leave the law to address every issue. Proper implementation, training, awareness and sensitization programs for all the stakeholders i.e. the doctors,nurses,law enforcement agencies, educational institutions and society is the need of the hour.

References:[1] Mental Healthcare Bill to strengthen systems that safeguard fundamental rights of the patients, Deya Bhattacharya, March 29, 2017, Firstpost.com

[2] Nearly 60 Million Indians Suffer From Mental Disorders, Prachi Salve, September 2, 2016, IndiaSpend.com