Mental Health Care Bill does not undermine family

Nirmala Srinivasan

THIS is a  rejoinder to the article, “Why the new Mental Health Bill is retrograde,” by BS Chavan, (published on March 3 on the Oped page). The effort is to correct the misinterpretations of the Bill. This is a collective effort of families who are founder-members of Families Alliance on Mental Illness in India (FACEMI). It is a project under the NGO, Action for Mental Illness, or ACMI.

The Mental Health Care Bill (MHCB) 2013 is not an amendment of but a replacement of the Mental Health Act, 1987. The process to amend the 1987 Act started in 2009 and not in 2013, as the author says. It is still a Bill and will become an Act after it is passed by the Parliament and the President gives his assent.

Indian stakeholders
Concerns expressed by the author on behalf of other professional bodies  would have been appreciated had they participated in the process of  formulating UN CRPD or UN Convention for the Rights of Persons with Disabilities since 2004.  Barring ACMI , there was no participation from  family groups or mental health professional bodies, not even the Ministry of Health and Family Welfare in formulating UN CRPD.  The Australian Declaration that Australia signed much before ratifying the UN CRPD  spells out all the requirements of treating mental patients as a conditional requirement for ratification of CRPD. Indian stakeholders, including psychiatrists, were conspicuously absent in this entire UN exercise that spanned almost five decades.  Even today many are ignorant of the RPDA Bill 2014  from our Ministry of Social Justice and Empowerment  that  is likely to impact the treatment process.

It is wrong to assume  that the Bill is based on the western concepts of psychiatry. The Bill is drafted keeping in view the UNCRPD, to which India is a signatory and the concept of mental health and care and protection of human rights related thereto, is universal and not country or region specific. This is a Mental Health Care Bill to provide rights to mental health care to persons with mental illness.  The other stake holders are beyond its scope. It is pointless for anyone to present their objections now because it is not in the interest of patients. 

Patient care and property
Families will rejoice because  the MHC Bill facilitates emergency and crisis ambulance   services  at  the doorstep of  involuntary "patients". Contrary to the claim that families are marginalised, this Bill and the new District Mental Health Programme  provide for mandatory inclusion of families in all official bodies so that their voice is heard directly. It is incorrect to say that the nominated representative will take all the major decisions regarding patient's care and property. The nominated representative has no role in regard to property. His role is limited to providing support to the person with mental illness in making treatment decisions (Clause 17. c) and matters related thereto.

Nothing in the Bill would lead to segregation of the treatment of the mentally ill from the mainstream medical establishments or increase stigma. Merely registration of a medical establishment with psychiatric ward, where inpatient facilities are provided to persons with mental illness under clause 65 of the Bill read with Clause 2. (o) does not amount to segregation of the treatment of persons with mental illness. There is no requirement to keep them segregated from other patients.  Rehabilitation is technically out of its scope but Clause 107 of the Bill  provides  for discharge planning, continued care and lifelong care as rights — not favours or mercies.   Conceptually, continued care inheres rehab; this is  taken care of also  in DMHP  12th Plan brought under the purview of the Bill.

Access to mental health
Currently, the Indian Psychiatric Society (IPS) has 5,700 psychiatrist members and the total number of psychiatrists in the country is estimated to be slightly more than that, after including the non-members. Only 3,500 psychiatrists in the country are two-decade-old statistics. The percentage of persons having access to mental health care is much less than not more than 5 per cent. After the Bill becomes a law, the access to mental health facilities will substantially increase due to Rights of Persons with Mental Illness in regard to treatment (Chapter V of the Bill) and the Duties of appropriate government in respect of persons with mental illness (Chapter VI). No stake holders were kept outside the five national consultative process that were diligently conducted by the MoHFW. Consultative process at the regional level and also at national level was all-inclusive. Psychiatrists as well as caregivers’ representatives were invited for consultations. The Bill provides for nomination of a nominated representative from family members too. Modifications are possible through rules, especially state rules because health  is a state subject in India. Another error is that the Mental Health Review Commission is not a Court. Its role is only to protect the human rights of persons with mental illness, especially where there are admissions without consent. In the present-day world, it would be highly unacceptable to detain a person in a hospital against his will without a system of review by a higher authority. The Commission will also include psychiatrists. (Clause 73 of the Bill). The admission of a minor in a mental health establishment does not require permission of the concerned Board. Only the concerned Mental Health Review Board has to be informed about the admission within 72 hours, a necessary safeguard to protect a minor.

It is factually incorrect to state that the  Bill also proposes that patients suffering from major mental illness cannot be treated without their consent. Clause 98 of the Bill provides for supported admission of persons with mental illness with high-support needs to mental health establishments. If an establishment has a psychiatric ward and in-patient facilities for persons with mental illness, what is the problem in following the simple procedure of registration? The requirement is not for licensing but for a simple registration which is necessary for statistics purpose and also to prevent mushroom growth of commercial establishments without following the minimum standards. We do not agree that in the present form, MHCB will be worse than existing Mental Health Act, 1987 and will be rejected by the mental health professionals and the caregivers. Calling the Bill worse than the 1987 Act implies that the 1987 Act was bad which is wrong. The 1987 Act was good but it is now outdated.

Importance of the Bill
The  MHC Bill  2013 does not undermine the importance of family in any way. The Bill has passed through various stages of consultation and examinations in its four-year journey and now carries the seal of the Standing Departmental Committee of Parliament on Health and Family Welfare. As one of the caregivers, I deposed before it as well as before the  Lok Sabha Committee on Disability. I was nominated to the National Mental Health Policy Group 2011 set up by MHFW. The IPS and Indian Association of Social Psychiatry should strengthen their partnership with families and ensure that this Bill is passed in the current session of the Parliament.

The writer is the Trustee of the Bangalore-based NGO, Action for Mental Illness or ACMI