Mental Health
What are the things that you should keep in mind if you or anyone close to you is living with a mental illness?

The Parliament passed the Mental Health Care Bill 2016 on Monday, and with this move, we now have a comprehensive legislation that provides for state health care facilities, spells out rules and protects the rights of persons with mental illnesses in India.

This Bill has now replaced the older Act which has been in place since 1987, which, experts say, stigmatised mental health and infantilized those suffering from mental illnesses.

The new bill, thankfully, is much better in terms of how it looks at persons with mental illnesses. "This Bill compels the state to have a mental health programme. It empowers the individual," Health Minister JP Nadda said in Lok Sabha.

In India, where 1 in 10 persons are reportedly receiving treatment for mental illnesses, and an  an estimated 150 million are in need of active medical intervention, this new law is a shot in the arm for the population.

But what exactly does the law entail? And what are the things that you should keep in mind if you or anyone close to you is living with a mental illness?

Rights of persons with mental illness

1. Access to affordable health care

"Every person shall have a right to access mental health care and treatment from mental health services run or funded by the appropriate Government,” the new law declares.

Basically, anyone living with a mental illness in India now has a right to good quality, affordable health care in a place near you. The doctors and staff at the facility should not discriminate against anyone on the basis of gender, sex, sexual orientation, religion, culture, caste, social or political beliefs, class, disability etc. If any of this is violated, you can in fact go to court to ensure that your rights are protected.

And if you can’t afford it, the government is mandated to provide you treatment free of cost.

Vandana Gopikumar, co-founder of Chennai-based Banyan, a mental health NGO for women, and who was also one of the members on the mental health policy group calls the bill pro-right and pro-poor. 

Pointing out some of the most positive features, she says, "This bill mandates that access to mental healthcare be a basic right of every Indian citizens, be it in remote, rural or urban areas."

Public Health Centres (PHCs), she says, will now have to gear up to identify and treat people with common mental disorders. "PHCs and all tertiary centres will have to revamp their approach to care and move from a exclusively bio-medical approach towards one that is much more psycho social. The Bill clearly indicates that access to care cannot only be restricted to pill popping but has to have support in terms of problem solving and access to welfare benefits." 

2. Informed consent and power to take decisions

People living with mental illness can now make decisions regarding their health and treatment as long as they can understand the information related to the treatment and its consequences, and are able to communicate it.

Which means no one else can forcefully admit anyone in a hospital if they are lucid and understand what is happening to them.

The new law also mandates that if you are living with a mental illness, you have the right to know not only the nature of your illness, but also the proposed treatment and possible side effects.

3. Right to live in a community

Persons with mental illnesses have the right to live in a community and cannot be segregated from society. For those whom this is not possible, the government must provide legal and other necessary forms of support to help them live a regular life.

Additionally, a woman in a mental health care institution cannot be separated from her child who is less than three years old, unless doctors feel that the child could be harmed.

4. Right to confidentiality

You do not have to divulge details of your illness or treatment to anyone. The right to confidentiality also applies to doctors treating you, and also prohibits the media from publishing any such information without the individual's consent.

5. Prohibited procedures

Electroconvulsive therapy (ECT), also known as ‘shock treatment’, cannot be performed on adults without the use of muscle relaxants and anesthesia. For children, the therapy is completely banned.

Hospitals are also barred from sterilising patients, chaining them or abusing them in any other cruel manner.  

Patients cannot be made to live in unsafe and unhygienic environments, and should have access to wholesome food, privacy and facilities for leisure, recreation, etc. and appropriate remuneration for the work they do in mental healthcare institutions.

6. Advance directive

A significant provision, the new law allows persons with mental illnesses to give an ‘advance directive’ for how they should be treated in case of a mental health situation. You can now appoint a person as a representative to take decisions on your behalf in case you’re not in a position to.

Although there are bureaucratic trappings - the directive has to be certified by a medical practitioner registered with the medical board. And in case the nominated caregiver does not want to follow the directive, they will have to petition the medical board to override them.

Vandana calls this shift from health-based to care-based rights the second most important feature of the Bill. "Accessing a nominated representative and being in a position to put out your own advanced directive and having control over how your care has to be planned in the event that you are not well at a particular stage, it is certainly a very important clause."

7. Decriminalisation of suicide

Suicide will not longer be treated as a criminal offence. Persons who do attempt suicide will be considered to be under severe stress by the law.

8. Punishment for those who violate law

For first time offenders, violating the law can result in imprisonment for a maximum period of six months, or a fine which may extend to Rs 10,000, or both. For subsequent violations, the person can be imprisoned for a maximum of two years or can be fined anywhere between Rs 50,000 and Rs 5 lakh, or both.

If you are stopped from exercising any of these rights, you can have free legal services to fight for your rights.

The Review Commission, Vandana says, will consists of a mixed group of people including everyone from judges to activists and even mental health survivors. "This group will ensure that power is in the hands of people seeking care besides being also greatly supportive to the needs of the caregivers. People who are affected are the ones to gain the most."

However, she adds that she is a little apprehensive about this "very aspirational, well-intentioned and very doable" bill. "Very often," she says, "bills that are really well-intentioned do not translate into immediate change or even mid term or long term change on the ground if the Bill if it is not executed thoroughly. I am hoping this Bill will go beyond being a great piece of legislation."

Anna Chandy, Chairperson– Board of Trustees, The Live Love Laugh Foundation, said that the passing of the Bill shows mental health is being taken seriously by our law makers. "The Bill also establishes the government’s role as a critical stakeholder by placing the onus on the government to ensure care, treatment and rehabilitation to those facing mental health issues. It is important that sufferers are adequately informed of their rights so that they can gain access to the support that they need. The clause decriminalising suicides is a move that’s been long awaited and its impact will be far reaching."