REPORT NO. 74 PARLIAMENT OF INDIA RAJYA SABHA DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE SEVENTY-FOURTH REPORT On THE MENTAL HEALTH CARE BILL, 2013 (Ministry of Health and Family Welfare) (Presented to the C h a i r m a n , Rajya Sabha on the 20 t h November, 2013) ( F o r w a r d e d t o the Speaker, L o k Sabha on the 20 t h November , 2013) Rajya Sabha Secretariat, New Delhi NOVEMBER, 2013/ KARTIKA, 1935 (SAKA)
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REPORT NO.
74
PARLIAMENT OF INDIA RAJYA SABHA
DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE
SEVENTY-FOURTH REPORT
On
THE MENTAL HEALTH CARE BILL, 2013 (Ministry of Health and Family Welfare)
( P r e s e n t e d to t h e C h a i r m a n , Rajya Sabha on t h e 2 0 t h November, 2013) ( F o r w a r d e d to t h e Speaker, L o k Sabha on t h e 2 0 t h November , 2013)
Rajya Sabha Secretariat, New Delhi NOVEMBER, 2013/ KARTIKA, 1935 (SAKA)
PARLIAMENT OF INDIA RAJYA SABHA
DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE
SEVENTY-FOURTH REPORT On
THE MENTAL HEALTH CARE BILL, 2013 (Ministry of Health and Family Welfare)
( P r e s e n t e d to t h e C h a i r m a n , Rajya Sabha on t h e 20 t h November, 2013) ( F o r w a r d e d t o t h e Speaker, L o k Sabha o n t h e 2 0 t h November , 2013)
Rajya Sabha Secretariat, New Delhi NOVEMBER, 2013/ KARTIKA, 1935 (SAKA)
C O N T E N T S
P A G E S
1. COMPOSITION OF THE COMMITTEE (i)
2. PREFACE (ii)-(iii)
3. A C R O N Y M S (iv)
4. REPORT 1- 56
5*. OBSERVATIONS/RECOMMENDATIONS AT A G L A N C E
6*. MINUTES
7*. A N N E X U R E
* to be appended at printing stage
5
10
15.
20.
25
30
COMPOSITION OF THE COMMITTEE (2013-14)
RATYA SABHA 1. Shr i Brajesh Pathak - Chairman 2. Shr i Rajkumar Dhoot 3. Shrimat i B. Jayashree 4 . Shri M o h d . A l i K h a n . Dr . Prabhakar Kore
6. Dr . R. Lakshmanan * 7. Shr i Rasheed M a s o o d 8. Shri Jagat Prakash N a d d a 9 . Dr . Vi jay laxmi Sadho
. Shri A r v i n d K u m a r Singh
LOK SABHA 11. Shr i K i r t i A z a d 12. Shr i M o h d . A z h a r u d d i n 13. Shrimat i Sarika Devendra Singh Baghel 14. Shr i Kuvarj ibhai M . Baval ia
Shr imat i P r iya Dut t 16. Dr . Sucharu Ranjan Ha lda r 17. M o h d . A s r a r u l Haque 18. D r . M o n a z i r Hassan 19. Dr . Sanjay Jaiswal
Shr i C h o w d h u r y M o h a n Jatua 21. Dr . Tarun M a n d a l 22. Shr i Mahaba l M i s h r a 23. Shr i Zafar A l i N a q v i 24. Shr imat i Jayshreeben Patel
. Shr i H a r i n Pathak 26. Shr i R a m k i s h un 27. Dr . A n u p K u m a r Saha 28. D r . A r v i n d K u m a r Sharma 29. D r . Raghuvansh Prasad Singh
. Shr i P.T. Thomas 31. Vacant SECRETARIAT Shri P.P.K. Ramacharyulu Joint Secretary Shri R. B. Gupta Director Shrimati Arpana Mendiratta Joint Director Shri Dinesh Singh Deputy Director Shri Pratap Shenoy Committee Officer
* vacant vide disqualification as a member of the Council of States (Rajya Sabha) w.e.f. 19t h September, 2013.
(1)
PREFACE
I, the Chairman of the Department-related Parliamentary Standing Committee on Health and Family
Welfare, having been authorized by the Committee to present the Report on its behalf, present this
Seventy-fourth Report of the Committee on the Mental Health Care Bi l l , 2013*.
2. In pursuance of Rule 270 of the Rules of Procedure and Conduct of Business in the Council of
States relating to the Department-related Parliamentary Standing Committees, the Chairman, Rajya
Sabha, referred** the Mental Health Care Bi l l , 2013 ( Annexure I) to the Committee on the 20 t h August,
2013, as introduced in the Rajya Sabha on the 19t h August , 2013 for examination and report within
three months.
3. The Committee issued a Press Release inviting memoranda/views from individuals and other
stakeholders. (Annexure-II). In response thereto, 59 Memoranda from individuals and others relevant to
the Bi l l were received till the specified date. List of individuals from whom memoranda were received is
at Annexure-III.
4. The Committee held seven sittings during the course of examination of the Bi l l , i.e., on
29t h August, 16t h September, 04t h October, 11 t h October, 21s t October, 1s t November and 11 t h November,
2013. The list of witnesses heard by the Committee is at Annexure-IV.
5. The Committee considered the draft Report and adopted the same on 11 t h November, 2013.
6. The Committee has relied on the following documents in finalizing the Report:-
(i) Mental Health Care Bi l l , 2013;
(ii) Background Notes on the Bi l l received from the Department of Health and Family Welfare;
(iii) Presentation, clarifications and Oral evidences of Secretary, Department of Health & Family Welfare;
(iv) Memoranda received on the Bi l l from various institutes/ bodies/associations/organizations/experts and replies of the Ministry on the memoranda selected by the Committee for examination.
(v) Oral evidences and written submissions by various stakeholders/experts on the Bi l l ; and
(vi) Replies to the questions/queries raised by Members in the meetings on the Bi l l , received from the Department of Health & Family Welfare
7. On behalf of the Committee, I would like to acknowledge with thanks the contributions made by those who deposed before the Committee and also those who gave their valuable suggestions to the Committee through written submissions.
(ii)
8. For facility of reference and convenience, the observations and recommendations of the Committee have been printed in bold letters in the body of the Report.
NEW DELHI; 1 1 t h N o v e m b e r , 2 0 1 3 Kartika 20 , 1935 (Saka)
BRAJESH PATHAK
C h a i r m a n , Department-related Parliamentary Standing
Committee on Health and Family Welfare
* Published in Gazette of India E x t r a o r d i n a r y Part I I S e c t i o n 2, dated 1 9 t h A u g u s t , 2 0 1 3 .
** Rajya Sabha P a r l i a m e n t a r y B u l l e t i n Part II, N o . 5 1 1 7 4 , dated 2 0 t h A u g u s t , 2 0 1 3 .
(iii)
5. C M H A - Central Men ta l Hea l th Author i ty
10. D M H P - District Men ta l Hea l th Programme
15. I R D A - Insurance Regulatory and Development Author i ty
20. M H R C - Men ta l Heal th Review C o m m i s s i o n
25. PG - Post-Graduate
30. S O R - Statement of Objects and Reasons
ACRONYMS
1. AD - Advance Directive 2. A I I M S - A l l India Institute of M e d i c a l Sciences 3. B O V - Board of Visi tors 4. C I P - Central Institute of Psychiatry
6 . C M H C - Central Men ta l Hea l th C o m m i s s i o n 7. C R P D - Convent ion on the Rights of Persons w i t h Disabili t ies 8. C r P C - Code of C r i m i n a l Procedure 9 . C R R - Central Rehabil i tat ion Register
11. E C T - Electro-convulsive Therapy 12. G H P U s - General Hea l th Psychiatric Uni ts 13. I H B A S - Institute of H u m a n Behaviour & A l l i e d Sciences 14. I P C - Indian Penal Code
16. IPS - Indian Psychiatry Society 17. L G B R I M H - L o k o p r i y a Gopina th Bordo lo i Regional Institute of Menta l Heal th ,
Tejpur 18. M H A - Men ta l Hea l th A c t 19. M H C B - Men ta l Hea l th Care B i l l
21. N I M H A N S - Na t iona l Institute of Men ta l Hea l th and Neuro-Sciences 22. N M H P - Na t iona l Men ta l Hea l th Programme 23. NR - Nomina ted Representative 24. P H C - Pr imary Heal th Centre
26. PwD Act, 1995- Persons w i t h Disabilit ies Act , 1995 27. R C I - Rehabili tation C o u n c i l of India 28. S M H A - State Men ta l Heal th Author i ty 29. S M H C - State Menta l Heal th C o m m i s s i o n
31. U N C R P D - Un i t ed Nat ions Conventions on the Rights of Persons w i t h Disabilit ies 32. UT - U n i o n Territory
(iv)
REPORT The Mental Health Care Bil l , 2013 (hereinafter referred to as the Bill) was
introduced in the Rajya Sabha on the 19th August,2013 and referred to the
Department related Parliamentary Standing Committee on Health and Family
Welfare on the 20t h August, 2013 for examination and report thereon.
2. As per the information furnished by the Ministry of Health and Family Welfare
the Mental Health Care Bil l , 2013 seeks to consolidate the legislations related to
mental illness and improve the conditions in mental health facilities existing in the
country while ensuring the process of appeal by a person admitted to a psychiatry
institution, rehabilitation, reintegration with families and community in non-
medical settings. The Bil l addresses the issues of mental illness and capacity to
make mental health care and treatment decisions; advance directive; nominated
representative; rights of persons with mental illness; duties of appropriate
government; central and state mental health authorities; mental health
establishments; mental health review commission; admission, treatment and
discharge. The Bil l also consolidates the law regarding the responsibilities of other
agencies, restriction to discharge functions by professionals not covered by
professional offences and penalties.
3. According to the Statement of Objects and Reasons (SOR) of the Bill , the
United Nations Convention on the Rights of Persons with Disabilities, which was
ratified by the Government of India in October, 2007, made it obligatory on the
Government to align the policies and laws of the country with the Convention. The
need for amendments to the Mental Health Act, 1987 was felt by the fact that the
related law, i.e., the Persons with Disabilities (Equal Opportunities, Protection of
Rights and Full Participation) Act, 1995 was also in the process of amendment.
The Mental Health Act, 1987 could not protect the rights of persons with mental
illness and promote their access to mental health care in the country. In the light of
above it was proposed to repeal the Mental Health Act (MHA), 1987 and bring in a
new legislation.
4. The Statement of Objects and Reasons (SOR) of the Bil l further states that the
Bill proposes to repeal the Mental Health Act, 1987. Its objectives are to: (i)
protect and promote rights of the persons with mental illness during the delivery of
health care in institutions and in the community; (ii) ensure that health care,
treatment and rehabilitation of the persons with mental illness, is provided in the
least restrictive environment possible, and in a manner that does not intrude on
their rights and dignity; (iii) fulfil the obligations under the Constitution and the
obligations under various International Conventions ratified by India; (iv) regulate
public and private mental health sectors within a rights framework to achieve the
greatest public health good; (v) improve accessibility to mental health care by
mandating sufficient provision of quality public mental health services and non-
discrimination in health insurance; (vi) establish a mental health system integrated
into all levels of general health care; and (vii) promote principles of equity,
efficiency and active participation of all stakeholders in decision making.
5. Keeping in view the objectives behind the proposed legislation and its impact
on the people who are mentally i l l , the caregivers, the families and professionals
associated with this health sector, the Committee decided to have opinion of
different stakeholders on the Bil l , and issued a Press Release, inviting
views/suggestions from all the stakeholders. An overwhelming response to the
Press Release was received by the Committee. A considerable number of
containing their views. The Committee held extensive interactions with
representatives of associations/organizations/Councils/institutes as well as
renowned experts and professionals from the discipline of Psychiatry and care-
givers/family members and patients.
6. The Ministry of Health and Family Welfare in its background note made the following submissions. :-
"The M e n t a l H e a l t h A c t , 1 9 8 7 (MHA, 1987) was e n a c t e d to r e g u l a t e the a d m i s s i o n a n d t r e a t m e n t o f persons w i t h m e n t a l i l l n e s s t o p s y c h i a t r i c i n s t i t u t i o n s a n d f o r the management o f t h e i r p r o p e r t y a n d affairs. O v e r the y e a r s , the MHA, 1 9 8 7 has been c r i t i c i z e d by many s t a k e h o l d e r s i n c l u d i n g persons w i t h m e n t a l i l l n e s s , f a m i l i e s a n d c a r e g i v e r s , r i g h t s a n d d i s a b i l i t y a c t i v i s t s , u s e r - s u r v i v o r s o f p s y c h i a t r i c c a r e a n d a segment o f the p r o f e s s i o n a l p s y c h i a t r i c c o m m u n i t y . The g r o w i n g c o n c e r n t h a t the MHA , 1 9 8 7 needed to be amended g a i n e d u r g e n c y w i t h the ratification of the United N a t i o n s C o n v e n t i o n on the R i g h t s o f Persons w i t h D i s a b i l i t i e s (UNCRPD) by the G o v e r n m e n t o f I n d i a in O c t o b e r , 2 0 0 7 w h i c h r e q u i r e s I n d i a to a m e n d or replace l a w s n o t c o m p l i a n t w i t h the CRPD. The d e m a n d f o r amendments t o M e n t a l H e a l t h A c t , 1 9 8 7 was s t r e n g t h e n e d b y the f a c t t h a t the r e l a t e d A c t , The Persons w i t h D i s a b i l i t i e s (Equal O p p o r t u n i t i e s , P r o t e c t i o n o f R i g h t s a n d F u l l P a r t i c i p a t i o n ) A c t , 1 9 9 5 was a l s o in the process of amendment. The MHA, 1 9 8 7 c o u l d n o t p r o t e c t the r i g h t s o f persons w i t h m e n t a l i l l n e s s a n d p r o m o t e access t o m e n t a l h e a l t h c a r e in the c o u n t r y . Therefore it was p r o p o s e d to repeal the MHA, 1 9 8 7 a n d b r i n g in a new l e g i s l a t i o n . Essential Features of the Mental H e a l t h c a r e B i l l 2 0 1 3 :
• The C e n t r a l a n d S t a t e M e n t a l H e a l t h A u t h o r i t i e s w i l l c o n t i n u e a s
r e g u l a t o r y a g e n c i e s .
• A n y p e r s o n , w i t h o r w i t h o u t m e n t a l illness, can m a k e a n A d v a n c e
D i r e c t i v e (AD) s t a t i n g h o w h e / s h e wishes t o b e t r e a t e d f o r a f u t u r e
m e n t a l illness a n d a l s o h o w h e does n o t wish t o b e t r e a t e d . Such a n A D
can a l s o be c h a l l e n g e d by f a m i l i e s , p r o f e s s i o n a l s e t c . This p r o v i s i o n i s
i n c l u d e d t o m e e t t h e CRPD's r e q u i r e m e n t f o r p r o t e c t i n g l e g a l c a p a c i t y o f
p e r s o n s w i t h m e n t a l illness.
• A p e r s o n w i t h m e n t a l illness can a p p o i n t a N o m i n a t e d R e p r e s e n t a t i v e t o
t a k e d e c i s i o n s f o r him/her. This p r o v i s i o n t o o i s i n c l u d e d t o m e e t t h e
CRPD's r e q u i r e m e n t f o r p r o t e c t i n g l e g a l c a p a c i t y o f p e r s o n s w i t h m e n t a l
illness.
• A p e r s o n w i t h m e n t a l illness has t h e r i g h t t o l i v e i n , b e p a r t of, a n d n o t
s e g r e g a t e d f r o m s o c i e t y . G o v e r n m e n t has a n o b l i g a t i o n t o p r o v i d e f o r
h a l f w a y h o m e s , c o m m u n i t y c a r i n g c e n t r e s e t c .
• The M H C Bill, 2 0 1 3 m a k e s a c l e a r a s s e r t i o n t h a t a l l p e r s o n s h a v e a r i g h t
t o access m e n t a l h e a l t h c a r e a n d t r e a t m e n t f r o m m e n t a l h e a l t h services
r u n o r f u n d e d b y t h e G o v e r n m e n t . Such services s h o u l d b e a f f o r d a b l e , o f
g o o d q u a l i t y a n d a v a i l a b l e w i t h o u t d i s c r i m i n a t i o n .
• A p e r s o n w i t h m e n t a l illness h a s t h e r i g h t t o b e p r o t e c t e d f r o m c r u e l ,
i n h u m a n a n d d e g r a d i n g t r e a t m e n t . Some t r e a t m e n t s c u r r e n t l y b e i n g
used w i l l b e p r o h i b i t e d , m o s t i m p o r t a n t l y , E l e c t r o - c o n v u l s i v e Therapy
g i v e n w i t h o u t a n a e s t h e s i a a n d t h e p r a c t i c e o f c h a i n i n g p a t i e n t s t o t h e i r
beds.
• The B i l l r e c o g n i z e s t h a t t h e o v e r w h e l m i n g m a j o r i t y o f t h e m e n t a l l y i l l a r e
i n t h e i r h o m e s . Caring f o r a m e n t a l l y i l l p e r s o n i s f i n a n c i a l l y a n d
e m o t i o n a l l y d r a i n i n g f o r a n y family. A s i g n i f i c a n t p o r t i o n o f t h e
w a n d e r i n g h o m e l e s s h a v e m e n t a l illness. The Bill t h e r e f o r e addresses t h e
needs o f f a m i l i e s a n d c a r e g i v e r s a n d t h e needs o f t h e h o m e l e s s m e n t a l l y
ill.
• I n s o m e i n s t a n c e s o f a d v a n c e d illness, w h e n t h e p e r s o n i s n o t i n a
p o s i t i o n t o m a k e d e c i s i o n s f o r h i m s e l f / h e r s e l f i t m a y b e necessary i n t h e
b e s t i n t e r e s t o f t h e h e a l t h a n d w e l f a r e o f t h e p e r s o n w i t h m e n t a l illness
t o b e a d m i t t e d , t o a t r e a t m e n t f a c i l i t y w i t h t h e s u p p o r t o f t h e i r
n o m i n a t e d r e p r e s e n t a t i v e . The B i l l sets o u t i n s o m e d e t a i l t h e m e a s u r e s
e s t a b l i s h e d t o e n s u r e t h a t a l l cases o f s u p p o r t e d a d m i s s i o n a r e r e v i e w e d
w i t h o u t loss o f t i m e . This i s w e l l w i t h i n t h e p r o v i s i o n s o f A r t i c l e 1 2 o f t h e
UNCRPD.
• A l l cases o f such s u p p o r t e d a d m i s s i o n s w i l l be r e v i e w e d by a M e n t a l
H e a l t h Review C o m m i s s i o n w h i c h w i l l f u n c t i o n t h r o u g h D i s t r i c t Boards.
The e s s e n t i a l t a s k o f t h e C o m m i s s i o n / B o a r d s i s t o e n s u r e t h a t a d m i s s i o n
o f a n y p e r s o n t o a m e n t a l h e a l t h f a c i l i t y i s t h e l e a s t r e s t r i c t i v e c a r e o p t i o n
u n d e r t h e c i r c u m s t a n c e s .
• The M H C Bill has p r o v i s i o n s f o r C e n t r a l a n d S t a t e M e n t a l H e a l t h
A u t h o r i t i e s (CMHA & SMHA) a n d a M e n t a l H e a l t h Review C o m m i s s i o n
(MHRC). This i s t h e s t r u c t u r e f o l l o w e d i n a l l m o d e r n a n d p r o g r e s s i v e
l e g i s l a t i o n s . The CMHA a n d SMHA a r e l a r g e l y a d m i n i s t r a t i v e b o d i e s
c o n c e r n e d w i t h r e g u l a t i n g / s e t t i n g s t a n d a r d s f o r m e n t a l h e a l t h f a c i l i t i e s ,
m a i n t a i n i n g r e g i s t e r s o f such f a c i l i t i e s a n d o f m e n t a l h e a l t h p r o f e s s i o n a l s
a n d carry o u t t r a i n i n g f u n c t i o n s . The c o m p o s i t i o n o f t h e s e b o d i e s
r e f l e c t s t h e s e f u n c t i o n s .
• The MHRC is a q u a s i - j u d i c i a l b o d y to p r o v i d e an i n d e p e n d e n t o v e r s i g h t to
t h e f u n c t i o n i n g o f m e n t a l h e a l t h f a c i l i t i e s a n d p r o t e c t t h e r i g h t s o f
p e r s o n s w i t h m e n t a l illness i n t h e s e f a c i l i t i e s . I t t h u s m e e t s t h e n e e d f o r
an i n d e p e n d e n t r e v i e w m e c h a n i s m as r e q u i r e d u n d e r t h e CRPD. The
c o m p o s i t i o n o f t h e MHRC r e f l e c t s i n q u a s i - j u d i c i a l f u n c t i o n ( h e a d e d b y a
r e t i r e d H i g h C o u r t J u d g e a n d s t a f f e d w i t h D i s t r i c t Judges).
• The d i r e c t i o n a n d t h r u s t o f t h e M H C Bill, 2 0 1 3 i s t h a t t h e S t a t e assumes
t h e r e s p o n s i b i l i t y f o r p r o v i d i n g a d e q u a t e h e a l t h c a r e , i n c l u d i n g s u p p o r t t o
c a r e g i v i n g f a c i l i t i e s . A t p r e s e n t t h e D i s t r i c t M e n t a l H e a l t h P r o g r a m m e
(DMHP) o p e r a t e s i n 1 2 3 d i s t r i c t s i n t h e c o u n t r y t h o u g h i t m u s t b e
r e c o g n i z e d t h a t d e l i v e r y o f h e a l t h c a r e services i s n o t o p t i m a l e s s e n t i a l l y
f o r t h e r e a s o n t h a t t h e D M H P r e q u i r e s every d i s t r i c t t o h a v e a f u l l
c o m p l e m e n t o f a p p r o p r i a t e l y t r a i n e d p r o f e s s i o n a l s . Though t h e N a t i o n a l
M e n t a l H e a l t h P r o g r a m m e ( N M H P ) offers f i n a n c i a l s u p p o r t t o s t a t e
g o v e r n m e n t s t o i n c r e a s e t h e n u m b e r o f s e a t s i n m e d i c a l c o l l e g e s a n d
n u r s i n g c o l l e g e s i n t h e a p p r o p r i a t e d i s c i p l i n e s , p r o g r e s s has n o t b e e n
fast. The 1 1 t h Plan o u t l a y f o r N M H P i n c l u d i n g DMHP was Rs.623 crores.
I n a p a r a l l e l exercise t o t h e d r a f t i n g o f t h e M H C B i l l 2 0 1 3 , t h e D M H P has
been s u b s t a n t i a l l y r e w o r k e d w i t h a f o c u s o n c o m m u n i t y a n d h o m e b a s e d
c a r e a s r e q u i r e d b y t h e M H C Bill, 2 0 1 3 . "
7. During the course of his oral evidence before the Committee on the 29th
August, 2013, the Secretary, Department of Health and Family Welfare
apprised the Committee of the salient features of the Bill . He pointed out that
unlike the existing Act, which mixes healthcare and social care issues, the present
Bil l seeks to isolate the purely healthcare-related aspects while not going into the
questions of guardianship and civic and political rights. He pointed out that the
number of psychiatrists in our country is very small; it is not more than 4,000.
Further, the number in public sector, amongst these 4,000, would be a small
number. Many are in private practice. So, this is one of the reasons that this Bill
insists on various levels of community-based care and half-way homes. It is
because every person with illness is not going to have access to a qualified
psychiatrist. There may be one level of consultation, but on-going care and
treatment will need to be provided in the districts, sometimes at the PHC level,
through care givers. Number of those people is not adequate, but clearly, the onus
is on the Department to create much larger number of health professionals in this
area who cannot all be psychiatrists.
8. Further elaborating on the present scenario on the mental health care
facilities in the country, the Secretary, submitted that the most exhaustive studies
have been done by the National Human Rights Commission, which after the
Erwadi tragedy of 2001, undertook a very detailed study. At that time, 36 mental
health facilities were there in the country which is 38 now. The study was very
detailed and that report brought out many of the instances of cruel treatment and
people being chained, people being beaten, people being denied any kind of
dignity. If there was one question that has driven this whole process, it was on the
voluntary versus involuntary admission. It was presumed that all the time, a
person with mental illness has the capacity to make a decision unless the situation
was so exceptionally otherwise that he could not take a decision. Even in those
situations, the quasi judicial process would come into play.
9. Apprising the Committee of the scenario of Post Graduation Education Dr.
P. Satishchandra, Director, NIMHANS, Bengaluru during the course of his
deposition before the Committee on 11th October, 2013 delineated on the brief
history of the Acts enacted in the field of mental health and the need for
introduction of the present Bill . He also made the following suggestions as regards
the Bi l l : (i) need to exclude general hospitals from the licensing procedure under
the definition of 'Mental Health Establishment' in the Bi l l ; (ii) need to exclude
people with alcohol and substance users ( who do not have substance induced
mental illness and mental retardation/intellectual disability) in the definition of
"Mental Ilness"; (iii) Electro Convulsive Therapy should be done under
Anaesthesia always; (iv) Need to have State Mental Health Commission(SHMC)
in each State and Union Territories and the said commission will be formed in
consultation with Central Mental Health Commission and the State. He further
stated that Mental Health Boards will be constituted by the SHMC after assessing
the needs, etc. He also delineated that the following rights need to be enlisted in
the B i l l : (a) Mental illness should not be a ground for divorce;(b) disability due to
mental illness is usually ignored or discriminated. Mental disability need to be
considered on par with physical disability for all disability benefits; (c) all general
hospitals(public and private) shall not refuse emergency psychiatry treatment.
10. He further submitted that Post Graduate Education in Psychiatry in the country
is growing very well now as compared to few years back. In the last five years, the
number of seats have been doubled. In all medical colleges now, the Psychiatry
Department has been started. There are many psychiatric departments running
these courses. The Central Institutes like the National Institute of Mental Health
and Neurosciences, Bengaluru, the CIP (Ranchi) and Tejpur have doubled the
intake of the seats. However, the number of psychiatrists in this country still does
not exceed 4,000, and that is why, there is a great need to add on the number of
psychiatrists. He felt that the only way of addition was to increase the Institutes as
well as the courses at the level of post-graduation in the medical colleges.
According to him a serious attempt has been made by the Government and it was
expected that within the next two to three years' time, there would be a significant
increase in the number of the post-graduates coming out of these institutions. But,
compared to the western world, the number of psychiatrists in this country was
definitely very low. The way to progress was to use the other mental health
professionals in the form of psychologists. The psychiatrist social workers as well
as the psychiatrist nurses are also needed. Their number is also significantly less.
Thus , there is a dire need to increase the number of seats in all these colleges.
Apart from this, the post-graduates in medicine are being trained in psychiatry
now, and, a short-term training course has been given to many of the District
Medical Officers. They have all been provided with a short-term training in the
institutions like Central Institutes of Bangalore, Tejpur and Ranchi. He also stated
that the physicians, general practitioners and the doctors in the District Mental
Hospitals are being trained under the National Mental Health Programme as well
as District Mental Health Programme, and, this short-term training helps them to
deal with the acute emergencies at the peripheral centers. Regarding the
Electroconvulsive Therapy with a modified variety, Dr. Satishchandra stated that
the number of anaesthetists in the country is 16,000 and the number of
psychiatrists is 4,000. So, at every place, where the psychiatrists were available,
there were anaesthetists and that the Government has been requested to provide
these facilities of anaesthetists . Further this law will ensure that the facilities are
provided at all these places where ECT has to be given.
Views of the State Governments 11. To acquaint itself with the views of the State Governments, the Committee
sought the written comments of all the State/UT governments. However, only
Delhi government responded. In a written submission, the Government of Delhi
furnished the following comments based on the experience of Institute of Human
Behabiour &Allied Sciences (IHBAS), Delhi and technical office of State Mental
Health Authority (SMHA), Delhi:
(i) Differentiation of "treatment order" versus "admission order" in the Bil l as mandatory admission for involuntary treatment is difficult to apply in the community setting and is also not in the spirit of the government policy of promoting and providing community based mental health services including rehabilitation. (ii) Confidentiality of Psychiatric Case Records Related to Right to Information Act must be ensured. Thus the clause related to right to access to medical records must be finetuned accordingly. (iii) Provision of Mobile Mental Health Service needs to be introduced in the Bil l and specially the provision of legal authorization for emergency medication in the field by Mobile Mental Health Unit team should be mentioned in the draft Bill . (iv) There should be separate provision in the draft Bil l regarding foreign nationals with clear clauses as problems in terms of admission/initiation of treatment/forced treatment/discharge are faced when foreign national is being brought by Police/Magistrate/Embassy. (v) A provision for district wise Board of Visitors should be made in the Bil l and Board of Visitors should be sectorised by making provision for district wise BOV. (vi) Make it mandatory for all lincensed psychiatric hospitals/ nursing homes to provide emergency psychiatric services. (vii) The provision of retired judge to be the Chairman of the proposed Mental Health Review Commission may be reviewed as it would be better if some person from user/carer/advocacy group can be given the charge of the Chairman of Mental Health Review Commission. (viii) Government Hospital Psychiatry Units should be brought under ambit of SMHA in the Bill . Views of Other Stakeholders/Experts Some important issues raised by some of the other experts/stakeholders are discussed briefly hereunder-: 12. During her presentation on 21s t October, 2013 before the Committee,
Ms. Amita Dhanda, Professor and Head, Centre for Disabilities Studies, N A L S A R
University of Law, Hyderabad submitted that she was of the view that the said
Bil l was not in harmony with the United Nations Convention on Rights of Persons
with Disabilities (UNCRPD) in letter and spirit and was in infringement of Part III
of the Constitution. The said Bil l gives no power to the affected person to seek exit
from the institution if he was not satisfied with the treatment. The Bil l is also silent
on the right of the affected person to live independently and there was a need to
bring an amendment to the proposed legislation in this regard. Further there was a
need to relook at clause 124 which says that all persons who attempt to commit
suicide are presumed to be suffering from mental illness unless proved otherwise.
Further there was a need to relook at clause 114(2) of the Bil l in which "proof of
Mental Illness" obtained from a Board would suffice for obtaining 'divorce' which
was not fair to convert a legal dispute into a medical dispute. Therefore, there was
a need to delete this provision.
13. Dr. Vikram Patel from the Public Health Foundation of India (PHFI) during his
deposition before the Commitee on 11th October, 2013 supported the Bill and
stated that the proposed Bill is a vast improvement over the last enactment in
1987. He made the following points in support of the Bill: (i) Constitution of
Mental Health Review Board in the districts under Section 80 of Chapter XI is a
key step to safeguard the rights of persons with mental health conditions;(ii) the
Bill contains sufficient safeguards in regard to the provisions for 'Advance
Directive' and 'Nominated Representative' (iii) unlike previous legislation where
the entire onus to protect the rights of the individual with mental condition was
on the magistrate, the new Bill places this responsibility on a five member district
board on which it would be mandatory to have a psychiatrist on board to review
the clinical status of patient and the psychiatrist has major decision making
powers in the functioning of the Board.
14. He further stated that for the majority of Indians who suffer from a mental
illness, and in particular those who live in poor and rural circumstances, the
unavailability of appropriate, evidence based mental health care was a major
impediment to their recovery. The quality of life of such persons and their
caregivers was abysmal, often initiating a downward spiral into further poverty,
hopelessness and even homelessness. Social exclusion, violent victimization and
human rights abuse were more prevalent in people with mental illness. The lack of
access to evidence based treatment and care for mental illness has reached a critical
point and a concerted national effort was needed to address this public health
crisis.
15. He also stated that the MHCB enshrines access to health care as a right
and holds the Government accountable for service delivery. The Bill proposes to
foster a climate of reforms both within Mental Hospitals and in the community by
setting up a Mental Health Review Commission that would regulate admission,
discharge and deal with violation of rights.
16. The Committee heard the views of Dr. S.K. Deuri, Director, Lokopriya
Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tejpur,
Assam on the Bill on the 16t h December, 2013. Dr. Deuri submitted that entry
point for treatment was given in the Bill but the Bill was silent on the procedure
for exit of patients after availing treatment. The Bill was also silent on
rehabilitation of the treated and recovered patients. He also raised the issues like
criminals being sent to Mental Institutions without availability or otherwise of
beds in such institutions; no proper definition of psychiatric nurse/psychiatric
social worker; regressive provision for transportation of patient from one State to
another which would not be in the interest of the patient. In a written
submission, the Department of Psychiatric Social Work, LGBRIMH, Tezpur Assam
made the following submissions:
(i) The Mental Health Care Bill 2013 has changed its outlook from a medical model
to a social model by incorporating the rights based provisions of UNCRPD. Unlike
the earlier Mental Health Act 1987(Chapter VIII, Section 81), the current one has
made provision for detailed rights of the person with mental illness in the Chapter
5.
(ii) Chapter I, Clause 2 defines Mental Health Professionals and but the definitions
put forth are wrongly inserted. It has been put forth that due to absence of
adequate number of professional social workers with M Phil degree, a lower PG
degree has been proposed as the required qualification for Psychiatric Social
Workers. This similar justification should have also been applied for all the mental
health professionals (Psychiatrist, Clinical Psychologists and Psychiatric Nurse) as
all are in the similar status in terms of quantity.
(iii) Rules could be specified that in places where there are shortages of
manpower with M Phil degree, personnel with PG in Social Work could be trained
under the NMHP to augment the services as Psychiatric Social Worker Assistant,
just as Medical Officers with training and experience in Psychiatry were
designated to take on the role of Psychiatrists by the State authority. (Chapter 1,
Clause 2 , Section x)
(iv) In regard to Mental Health Review Commission (MHRC), the number of
members should be increased. A representative from the allied professions like
psychiatric social work, clinical psychology and psychiatric nursing should be
considered to be a part of the Commission. Sections 80 and 81 which deals with
the Review Board at district levels, should consider increasing the number of
members. A representative from the allied professions like psychiatric social work,
clinical psychology and psychiatric nursing should be considered to be a part of the
commission.
(v) The proposed Bil l still continues its link with the correctional system. The
clause 101, chapter XII, on ' leave from the hospital' requires a police officer to
accost the person with mental illness to return to treatment facility. This further
serves to stigmatise the person with mental illness. The section dealing with 'leave'
should be repealed. It also contradicts with person's right to get discharged without
any consent from officer in charge/psychiatrist.
(vi) The Bil l vests the right to transfer the person with mental illness from one
mental health establishment to another, within and outside a state to the State
Authority and this could go against the interest of the person and his right . This
has the danger of abandonment and alienation of the person. Treating personnel in
Mental Health need to move to Prisons as part of integration of services and
community extension initiatives . A prison set-up coming to a hospital is not a very
practical move.
(vii) In Clause 109 under Chapter XIII , section 7 requires an FIR to be lodged for
any mentally i l l homeless person. The matter of using the police measures like
lodging FIR further increases the stigma and the person could get lost in the
system.
(viii) Clause 128 of protection for acts done in good faith does not include the
mental health professionals. Non- inclusion of mental health professional in this
provision is discriminatory.
(ix) The Bil l is silent on issues of rehabilitation aspects for chronic mental illness.
There is no provision for protecting the rights of persons with mental illness who
are abandoned/disowned by their family members/who refuse to accept the person
back into the family. The Bil l also could make a provision for addressing
stigmatizing behaviors in family, community and workplace. A provision should
be inserted as a penalty for indulgence in stigmatizing behavior and act as
deterrence in the society.
17. Dr. Sudhir K Khandelwal, Professor of Psychiatry, AIIMS, New Delhi
during the course of his deposition before the Committee on the 4th, October,
2013 stated that though the Bil l had addressed certain other concerns, there were
certain concerns which needed to be addressed viz. high level of qualification
needed to qualify as a clinical psychiatrist would act as a dampener as manpower
needed to qualify for the post of clinical psychiatrists would be difficult to find
in practice; definition of mental illness is ill-conceived and is over inclusive;
features like 'causing distress or impairment' would make practically whole of
Indian population mentally i l l at some point of time; number of clauses in the
'advance directive' would make it a difficult and lengthy process to actually
implement the said directive in practice; it is not clear if the person with the power
of advance directive has power for making the treatment decisions of the patient
only, or if he could also make civil and property related decisions also; it had not
been specified or defined ' serious mental harm' or likelihood of harm, thus the
provision regarding access to medical records might be misused; it is not clear
whether the Mental Health Review Commission (MHRC) will function as an
Authority or a Tribunal; fuctions of MHRC not clearly defined; the issues of
purview of State Mental Health Authority (SMHA), co-ordination among various
SMHAs had not been addressed; need for exemption in the provisions of the said
Bil l for the purpose of admission and discharge of mentally ill persons in General
Psychiatric care unit of the General Hospital; the Bil l is silent on provisions of
care and services for mentally ill homeless people; civil rights and property rights
have been ignored in the Bil l ; process of drafting MHRC is neither clear , nor
transparent.. He further stated that the Bil l should focus on governance and not the
treatment aspect and unmodified ECT treatment should be exempted from ban
under this Bill .
18. At the meeting held on 4th, October, 2013, Ms. Vandana Gopikumar,
Founder Trustee, The Banyan Centre, Chennai submitted before the Committee
that she was in favour of the Bil l in the present form. However, she suggested for
need to reframe clause 124 of the Bil l ; and need to include Primary Health Centres
(PHCs) under the ambit of the said Bil l .
19. During the course of the meeting held on 16th September, 2013, the
Committee heard the views of Dr. Indira Sharma, President, Indian Psychiatry
Society (IPS) along with fellows of Indian Psychiatry. Dr. Sharma submitted before
the Committee that as the Head of Indian Psychiatry Society she was against the
enactment of the said Bill in its present form. Delineating the reasons for the
same, she stated that the said Bill had been drafted without taking into
consideration the viewpoint of Indian Psychiatry Society (IPS). She stated that
though the society was a conglomeration of 5000 Members, it had been ignored
while drafting the Bill. She was of the view that the concepts incorporated in the
Bill like use of terms Advance Directive, nominated representatives; making
willingness of the patient mandatory for availing treatment were alien to Indian
culture, which would be dangerous for the patient as well as his near and dear
ones. She emphasized focusing on the family model treatment in which the
family members would be in a position to give consent on the need for
subjecting a patient to psychiatric treatment.
20. Dr. B.S Chavan, Chairman, IPS submitted that the concept of parents of
child having to take permission of Mental Health Review Commission for
treatment of mental illness was dehumanizing for the parents and the child in
question. Dr. T.V. Asokan, President-Elect, IPS was of the view that the concept
of nominated representative would lead to a tussle between the family of the
person suffering from mental illness and the nominated representative who may
not be a blood relation of the person suffering from mental illness and such
nominated representative could misuse the said provision for usurping the
property or deriving other benefits which would devolve upon the person
suffering from mental illness. Dr. T.S.S. Rao, Editor in Chief, Indian Journal of
Psychiatry, IPS was of the view that the said Bill treats Psychiatric diseases as a
stigma which was not good from the patients' as well as from doctor's point of
view. Dr. Dinesh Kataria, Convenor, IPS was of the view that the provisions of
the said Bill would lead to the exodus of doctors studying Psychiatry in India to
foreign shores.
21. Dr. Nirmala Srinivasan, Director, Action for Mental Illness, Bengaluru
during her deposition before the Committee on 4 t h October, 2013 stated that
while supporting the Bill she opined that the Bill needed to be nuanced in certain
terms viz. proper definition of family care giver needed to be included in the Bill;
need to make family of the affected person inclusive in the said Bill. She insisted
on the need for more broader role for nominated representative in the said Bill
and need to include safeguards in the Right to manage property of the affected
Association, Maharashtra; during his deposition on 4th, October, 2013
submitted the following that there was a need for a complete ban on modified
ECT. Further it was important to provide definitions of family care giver and paid
care giver separately in the said Bill. He submitted that nominated representative
appointed under section 14 should be deemed to be nominated representative
to give effect to advance directive when the need arises to avoid confusion and
conflict; a hierarchy among relatives may be given in the Advance Directive
clause; "shall" in place of "shall endeavour "in Section 21 (2) regarding medical
insurance to make it more effective; "who has reason to believe...." In sub
sections (1) and (2) of Sections 110 may be substituted with "who has some
evidence to the effect...." to protect the family caregivers from harassment.
23. Shri Akhileshwar Sahay, Whole Mind India Foundation, Pune; during his
deposition on 4th, October, 2013 submitted that he was a bipolar patient and
undergoing psychiatric treatment for the same in AIIMS and was completely in
favour of the present Bill. He felt that the present Bill should be passed by the
Parliament into an Act and whatever infirmities which are presently in the said
Bill could always be taken care of in the future by way of an amendment to the
present Bill after it was passed. He was also thankful that the provision which
decriminalized 'suicide' had become a part of the said Bill.
24. The Committee heard the views of Dr. Shekhar Saxena, Director, Department
of Mental Health and Substance Abuse, World Health Organization, Geneva,
Switzerland on 11th October, 2013. Dr Saxena delineated the following points
on the said Bill: (i) the present Bill laid emphasis on the quality aspect and
encouraged transparency in the field of Mental Health unlike previous Acts, (ii)
laid emphasis on ECT treatment not to be given to children; (iii) the terms
'Advance Directive' and 'Nominated Representative' are in line with the United
Nations Convention on Rights of Persons with Disabilities(UNCRPD).
Clause-by-Clause Examination of the Bill 25. During the course of the examination of the Bil l the Committee took note of
concerns, suggestions and amendments as expressed by various
experts/stakeholders duly communicated them to the Ministry for its response.
Committee's observations and recommendations contained in the Report reflect an
extensive scrutiny of all the viewpoints put forth before it. Upon scrutiny of the
replies received from the Ministry, various amendments to the said Bil l have been
suggested by the Committee which are discussed in the succeeding paragraphs.
26. Clause 1(3) and 1(4) 1 . ( 1 ) This A c t may be c a l l e d the M e n t a l H e a l t h Care A c t , 2 0 1 3 . (2) I t s h a l l e x t e n d to the w h o l e o f I n d i a . (3) The p r o v i s i o n s of t h i s A c t , except the p r o v i s i o n s of sections 3 3 , 45 a n d 73, s h a l l come i n t o f o r c e w i t h i n a p e r i o d of three months f r o m the date on w h i c h i t receives the assent of the P r e s i d e n t . (4) The p r o v i s i o n s of sections 33, 45 a n d 73 s h a l l come i n t o f o r c e w i t h i n a p e r i o d of n i n e months f r o m the date on w h i c h it receives the assent of the P r e s i d e n t .
27. Suggestions The provisions of this Act, except the provisions of sections 33, 45 and 73, shall
come into force within a period of three months from the date on which it
receives the assent of the President. The provisions of sections 33, 45 and 73 shall
come into force within a period of nine months from the date on which it receives
the assent of the President. In this respect, it is important that usage of the
phrase "within three months" may be confusing as the exact date is not fixed and
could be anytime within three months. Moreover, no procedure such as
notification in the gazette by the Central Government has been prescribed in the
Bill as a means of notifying to the general public that the Bill has become
effective. Thus either there should be fixed/ determinable date on which the Bill
comes into effect or the Bill should clearly provide that the date on which the
Central Government notifies in the gazette would be the date from which the law
would be implemented.
28. Ministry's Response The Ministry has agreed and stated that this Bil l shall come into force 9 months
from the date on which it receives the assent of the President, or any earlier date if
so notified by Government.
29. Recommendation of the Committee
The Committee acknowledges that the Ministry has accepted the suggestion
regarding amendments to clause 1(3) and (4). The Committee is of the view
that the new provisions would lend greater clarity and coherence to the
operation of the proposed Act and serve the intended purpose. The
Committee, therefore, recommends that the proposed amendment may be
incorporated in the Bill.
30. CLAUSES 2 (1)(f) (f) " c l i n i c a l p s y c h o l o g i s t " means a p e r s o n — (i) h a v i n g a r e c o g n i s e d qualification i n C l i n i c a l P s y c h o l o g y f r o m a n i n s t i t u t i o napproved a n d r e c o g n i s e d , b y the R e h a b i l i t a t i o n C o u n c i l o f I n d i a , c o n s t i t u t e d u n d e r s e c t i o n 3 o f the R e h a b i l i t a t i o n C o u n c i l o f I n d i a A c t , 1 9 9 2 ; or
(ii) h a v i n g a Post G r a d u a t e degree in P s y c h o l o g y or A p p l i e d P s y c h o l o g y a n d a M a s t e r o f P h i l o s o p h y i n C l i n i c a l P s y c h o l o g y o r m e d i c a l a n d s o c i a lp s y c h o l o g y o r M a s t e r s o f P h i l o s o p h y i n m e n t a l h e a l t h a n d s o c i a l p s y c h o l o g y o b t a i n e d after c o m p l e t i o n o f a f u l l time c o u r s e o f t w o years w h i c h i n c l u d e ss u p e r v i s e d c l i n i c a l t r a i n i n g o r d o c t o r a t e i n c l i n i c a l p s y c h o l o g y w h i c h i n c l u d e ss u p e r v i s e d c l i n i c a l t r a i n i n g , f r o m any u n i v e r s i t y r e c o g n i s e d by the UniversityG r a n t s C o m m i s s i o n e s t a b l i s h e d u n d e r the University G r a n t s C o m m i s s i o n A c t , 1956;
31. Suggestions Since Clinical Psychology professionals work with persons with Mental Illness
(acute and chronic), the "Clinical Psychologists" are brought under the purview of
the RCI Act and their registration with RCI has been made mandatory (In Clinical
Rehabilitation Register, maintained by the Council).
Currently, no university, department, hospital, association, partnership, NGO, or
corporate body without a valid recognition by the Council, under the provision of
RCI Act, 1992, conduct, offer or offer to conduct any of Clinical Psychology
training courses, unless these entities are approved by the Council for the function
stated.
The RCI defines "Clinical Psychologists" as follows i. A Professional Qualification in Clinical Psychology recognized by the RCI,
from time to time, obtained from RCI approved institutions and granted by
an University recognized by University Grants Commission as per Section 11
and 12 of RCI Act, 1992.
ii. Registration in the Central Rehabilitation Register (CRR) as per Section 13 of
RCI Act, 1992.
In defining "Clinical Psychologists" in the proposed Bil l , the RCI Act, 1992 has
been over ruled by including degrees like 'Master of Philosophy in Mental Health
and Social Psychology' of 'Ph.D. in Clinical Psychology' as qualification for
Clinical Psychologists, whereas RCI, the apex body does not recognize them. In
view of this, it is suggested to remove this section 2(l)(f)(ii) from the Bill . The
terms in sub-clause (ii) of clause (f) which reads as "doctorate in clinical
psychology which includes supervised clinical training" in the current version of
the Bil l may be omitted since Ph.D. in any branch of Psychology including so
called "Clinical Psychology" is NOT RECOGNISED by the Council as
professional qualification on various counts. Thus, there is scope of serious legal
ramifications and a flawed legislation thus defeating the very purpose for which
the Bil l is being prepared.
32. Response of the Ministry: The Government accepts the suggestion of RCI and section 2 (1) (f) will be amended accordingly : The amended section 2 (1) (f) shall read as follows : Clinical psychologist means -
(i) having a recognized qualification in clinical psychology from an institution approved and recognized by the Rehabilitation Council of India, constituted under Section 3 of the Rehabilitation Council of India Act, 1992 ; or
(ii) having a Post Graduate degree in Psychology or Applied Psychology and a
Master of Philosophy or medical and social Psychology or Master of Philosophy in
mental health and social psychology obtained after completion of a full time course
of two years which includes supervised clinical training from any University
recognized by the UGC established under the University Grants Commission Act,
1956 and approved and recognized by the Rehabilitation Council of India Act, 1992.
33. Recommendation of the Committee The Committee recommends that the Ministry may bring the suggested
amendment in the clause.
34. Clause 4 (1) 4. (1) E v e r y p e r s o n , i n c l u d i n g a p e r s o n w i t h m e n t a l i l l n e s s s h a l l be deemed to have capacity to make d e c i s i o n s r e g a r d i n g h i s m e n t a l h e a l t h care or t r e a t m e n t , i f such p e r s o n has a b i l i t y t o , — (a) u n d e r s t a n d the information r e l e v a n t to the m e n t a l h e a l t h care or t r e a t m e n t d e c i s i o n ; (b) r e t a i n t h a t information; (c) use or w e i g h t h a t information as p a r t of the process of m a k i n g the m e n t a l h e a l t h care o r t r e a t m e n t d e c i s i o n ; a n d (d) c o m m u n i c a t e h i s d e c i s i o n b y any means ( i n c l u d i n g t a l k i n g , u s i n g s i g n l a n g u a g e o r any o t h e r m e a n s ) .
35. Suggestions The clause seeks to place onerous requirements on persons with mental illness to
show that they have the capacity to make decisions related to their mental health
treatment and care. To be deemed to have capacity, a person with mental illness is
required to show that she/he is able to understand information relevant to mental
health or treatment decisions, retain that information, use or weigh such
information in decision-making and communicate her/his decision. If any of the
four mentioned criteria is not fulfilled then the person will not be 'deemed' to have
capacity to make mental health treatment and care related decisions. Despite the
stated objective of the Bil l to respect the autonomy and promote active
participation of persons with mental illness in decision-making, section 4 creates a
presumption in law against the capacity of person with mental illness. Section 4,
especially section 4(b) and (c), in their application, will exclude, amongst others,
persons with Alzheimer's and dementia.
It is suggested that there be a presumption in favour of persons with mental illness and that the section be altered as follows:
Every person, including a person with mental illness shall be deemed to have capacity to make decisions regarding his mental health care or treatment unless it is proved that
(a) The person is unable to understand the information that is relevant to making a decision about the treatment, admission or personal assistance service, and
(b)The person is unable to appreciate the reasonably foreseeable consequences of a decision or lack of decision.
36. Ministry's Response The Ministry accepts this suggestion and suggests that Section 4 be changed as follows : Section 4 (1) shall read as follows Every person, including a person with mental illness shall be deemed to have capacity to make decisions regarding his mental health care and/or treatment unless it is proved that a) The person is unable to understand the information that is relevant to making adecision about the treatment, admission or personal assistance service, and
b) The person is unable to appreciate the reasonably foreseeable consequences of a decision or lack of decision. c) Unable to communicate his decision by any means (including talking, using sign language or any other means) Section 4 sub-sections (2), (3) and the Explanation remain the same.
37. Recommendation of the Committee The Committee observes that there is merit in the reservations expressed with
regard to Clause 4 and the Ministry, has agreed to incorporate the necessary
changes and thus, uphold the constitutional norm of equality. It also reflects
the principle of self-determination which gives right to a person with mental
illness to make mental health care and treatment decisions. The Committee,
therefore, recommends that the new/alternate clause as proposed by the
Ministry in respect of Clause 4(1), may be included in the Bill.
38. Clause 11(1) and 11(2)
11. (1) Where a m e n t a l h e a l t h professional or a r e l a t i v e or a c a r e - g i v e r of a p e r s o n desires n o t t o f o l l o w a n a d v a n c e d i r e c t i v e w h i l e t r e a t i n g a p e r s o n w i t h m e n t a l i l l n e s s , such m e n t a l h e a l t h professional or the r e l a t i v e or the c a r e - g i v e r of the p e r s o n may make an a p p l i c a t i o n to the c o n c e r n e d B o a r d to review, alter, modify or c a n c e l the a d v a n c e d i r e c t i v e . (2) Upon receipt of the a p p l i c a t i o n u n d e r s u b - s e c t i o n (1), the B o a r d may, after g i v i n g a n opportunity o f h e a r i n g t o a l l c o n c e r n e d p a r t i e s ( i n c l u d i n g the p e r s o n whose a d v a n c e d i r e c t i v e is in q u e s t i o n ) , e i t h e r uphold, modify, a l t e r or c a n c e l the a d v a n c e d i r e c t i v e after t a k i n g i n t o c o n s i d e r a t i o n the f o l l o w i n g , namely:— (a) w h e t h e r the a d v a n c e d i r e c t i v e was made by the p e r s o n o u t o f h i s o w n f r e e w i l la n d f r e e f r o m f o r c e , u n d u e influence o r c o e r c i o n ; o r
(b) w h e t h e r the p e r s o n i n t e n d e d the a d v a n c e d i r e c t i v e to apply to the presentc i r c u m s t a n c e s , w h i c h may be different f r o m those a n t i c i p a t e d ; or
(c) w h e t h e r the p e r s o n was sufficiently w e l l informed to make the d e c i s i o n ; or (d) w h e t h e r the p e r s o n h a d capacity t o make d e c i s i o n s r e l a t i n g t o h i s m e n t a l h e a l t h care or t r e a t m e n t when such a d v a n c e d d i r e c t i v e was made; or (e) w h e t h e r the c o n t e n t of the a d v a n c e d i r e c t i v e is c o n t r a r y to o t h e r l a w s or c o n s t i t u t i o n a l p r o v i s i o n s . 39. Suggestions The proposed clause allows a mental health professional or relative or care-giver
to override an advance directive where they 'desire 'not to follow it. Such a person
may make an application to the Board to review, or cancel the advance directive. It
is suggested that it should be mandatory to make an application to the Board to
review the decision to not follow the advance directive. The provision is too broad
and vague, since nearly anybody can challenge an advance directive, merely on a
subjective 'desire'. Though the decision to override the advance directive has to be
reviewed by a Board, the burden of proof regarding the validity of the advance
directive as well as their capacity lies on the person with mental illness. The
provision overrides the right to autonomy and consent of a person with mental
illness. The right to autonomy stems from the right to dignity, which is an inherent
part of the right to life guaranteed under Article 21 of the Constitution of India.
40. Ministry's Response The Ministry accepts this suggestion and proposes the following changes: 11 (1) Where a mental health professional or a relative or a care-giver of a person desires not to follow an advance directive while treating a person with mental illness, such mental health professional or the relative or the care-giver of the person shall make an application to the concerned Board to review, alter, modify or cancel the advance directive. 11(2) Upon receipt of the application under sub-section (1), the Board shall, after giving an opportunity of hearing to all concerned parties (including the person whose advance directive is in question), either uphold, modify, alter or cancel or otherwise determine the applicability of the advance directive after taking into consideration the following, namely:— (a) whether the advance directive was made by the person out of his own free will and free from force, undue influence or coercion; or (b) whether the person intended the advance directive to apply to the present circumstances, which may be different from those anticipated; or (c) whether the person was sufficiently well informed to make the decision; or (d) whether the person had capacity to make decisions relating to his mental health care or treatment when such advanced directive was made; or (e) whether the content of the advance directive is contrary to other laws or constitutional provisions. 41. Recommendation of the Committee: The Committee recognizes the fact that if Clause 11(1) and (2) is not amended,
it may become tool of exploitation of person with mental illness and dilute
their rights. Thus, the Committee endorses the proposed amendments to
Clause 11(1) and (2) and recommends that the changes may be suitably made
in the Bill so that the Board be required to examine the bonafides of the
decision to override the advance directive in a holistic manner.
42. Clause 18(4)
18(4) Without p r e j u d i c e to the g e n e r a l i t y of r a n g e of services u n d e r s u b - s e c t i o n (3),such services s h a l l i n c l u d e — (a) p r o v i s i o n o f a c u t e m e n t a l h e a l t h care services such as o u t p a t i e n t a n d i n p a t i e n t services; (b) p r o v i s i o n of half-way homes, s h e l t e r e d a c c o m m o d a t i o n , s u p p o r t e d a c c o m m o d a t i o n ; (c) p r o v i s i o n f o r m e n t a l h e a l t h services t o support f a m i l y o f p e r s o n w i t h m e n t a l i l l n e s s or home based r e h a b i l i t a t i o n ; (d) h o s p i t a l a n d c o m m u n i t y based r e h a b i l i t a t i o n establishments a n d services; (e) p r o v i s i o n f o r c h i l d m e n t a l h e a l t h services a n d o l d age m e n t a l h e a l t h services. 43. Suggestions In Clause 18(4)(b), the terms "half-way homes", "sheltered accommodation" and
"supported accommodation" have been not defined in the Bill . Further, in Clause
18 (4)(d) the term "community based rehabilitation establishments and services"
too has not been defined. It will be in order to either define these concepts under
the Bil l or instead allow the Central Authority or State Authority to frame rules for
establishment of these institutions. Therefore, sub-clause (4) of Clause 18 may be
modified as follows:
"(4) Without prejudice to the generality of range of services under sub¬ section (3), such services shall include-(a) (b) Provision of half-way homes, sheltered accommodation, supported accommodation, as may be prescribed: (c) (d) Hospital and community based rehabilitation establishments and
services, as may be prescribed: (e)
44. Response of the Ministry The Ministry has suggested that the words "as may be prescribed" may be inserted at the end of Clause 18(4) (b) and (d). 45. Recommendation of the Committee While endorsing the inclusion of the words "as may be prescribed" to Clause
18(4) (b) and (d), as proposed by the Ministry, at the Committee's behest, the
Committee recommends that the Government should carry out the proposed
modifications in the Bill.
46. Clause 21(2) 2 1 (2) The I n s u r a n c e R e g u l a t o r y D e v e l o p m e n t A u t h o r i t y e s t a b l i s h e d u n d e r the
I n s u r a n c e R e g u l a t o r y D e v e l o p m e n t A u t h o r i t y A c t , 1 9 9 9 s h a l l endeavour t o ensure
t h a t all i n s u r e r s make p r o v i s i o n s for m e d i c a l i n s u r a n c e for t r e a t m e n t o f m e n t a l
i l l n e s s on the same basis as is a v a i l a b l e for t r e a t m e n t of p h y s i c a l i l l n e s s .
47. Suggestions
Clause 21 of the MHCB aims to obtain equality for persons with mental illness by
treating them at par with persons with physical illness. However this equality is
only limited to equality in emergency facilities; ambulance services; living
conditions and health services. When it comes to medical insurance which is one of
the areas of discrimination, Clause 21(2) only mandates "IDRA to endeavour to
ensure that all insurers make provisions for medical insurance for treatment of
mental illness on the same basis as is available for treatment of physical illness."
48. Ministry's Response
The term "shall endeavour" was inserted on the insistence of the Dept of Financial Affairs. However, change has been made as below:
The Insurance Regulatory Development Authority established under the Insurance
Regulatory Development Authority Act, 1999 shall (delete "endeavour to'')
ensure that all insurers make provisions for medical insurance for treatment of
mental illness on the same basis as is available for treatment of physical illness.
49. Recommendation of the Committee
The Committee notes that Clause 21(2) which seeks to provide for
acceptance of medical insurance policies for persons with mental illness by the
insurance companies the same way as for physical illness is intended to
eliminate the existing discriminatory provisions and would provide a great
relief to persons with mental illness and their families. The effect is however,
diluted by the word "shall endeavour". The Committee, therefore, endorses
deletion of the word "endeavour" and recommends that as agreed to by the
Ministry, at the Committee's behest, the word "shall" may be retained in the
Bill.
50. Clause 23(2)
23 (2) A l l h e a l t h p r o f e s s i o n a l s p r o v i d i n g care o r t r e a t m e n t t o a p e r s o n w i t h m e n t a l i l l n e s s s h a l l have a duty to keep a l l such information confidential w h i c h has been o b t a i n e d d u r i n g care o r t r e a t m e n t w i t h the f o l l o w i n g e x c e p t i o n s , namely:— (a) r e l e a s e of information to the n o m i n a t e d r e p r e s e n t a t i v e to e n a b l e h i m to fulfil h i s d u t i e s u n d e r t h i s A c t ; (b) r e l e a s e o f information t o o t h e r m e n t a l h e a l t h p r o f e s s i o n a l s a n d o t h e r h e a l t h
p r o f e s s i o n a l s to e n a b l e them to p r o v i d e care a n d t r e a t m e n t to the p e r s o n w i t h m e n t a l i l l n e s s ; (c) r e l e a s e of information i f i t is necessary to p r o t e c t any o t h e r p e r s o n f r o m h a r m or v i o l e n c e ; (d) only such information t h a t is necessary to p r o t e c t a g a i n s t the h a r m identified s h a l l be released; (e) r e l e a s e of information in the case of life t h r e a t e n i n g emergencies w h e r e such information is urgently needed to save l i v e s ; (f) r e l e a s e of information upon an order by c o n c e r n e d B o a r d or the C o m m i s s i o n orH i g h C o u r t or Supreme C o u r t or any o t h e r s t a t u t o r y a u t h o r i t y competent to do so; a n d
(g) r e l e a s e of information in the i n t e r e s t s of p u b l i c safety a n d security.
51. Suggestions
Clause 23(2)(e) is very vague and leaves scope for ambiguity and confusion in
implementation stage. It does not specify why, when and how much information is
to be released. It simply says that release of information in the case of life
threatening emergencies where such information is urgently needed to save lives.
52. Ministry's Response
The Ministry has proposed the following changes in 23(2)(e) "(e) release of information if it is necessary to protect any other person from harm or violence provided that only such information that is necessary to protect against the harm identified shall be released;" 53. Recommendation of the Committee
The Committee observes that the clause 23(2) in the Bill deals with the right to
confidentiality in respect of a person with mental illness. Therefore, any scope
of ambiguity will defeat the purpose of this clause to keep all such information
confidential which has been obtained during care or treatment by health
professionals providing care or treatment to a person with mental illness. Any
exception to such important clause should be carefully framed with clear
intentions so as to avoid conflict and confusion at the implementation stage.
The Committee therefore recommends that the proposed changes may be
incorporated in the Bill.
54. Clause 25 1 ) A l l persons w i t h m e n t a l i l l n e s s s h a l l have r i g h t t o access t h e i r m e d i c a l r e c o r d s . (2) The p s y c h i a t r i s t in charge of such records may w i t h h o l d specific information in
the m e d i c a l records i f d i s c l o s u r e w o u l d r e s u l t i n , — (a) s e r i o u s m e n t a l h a r m t o the p e r s o n w i t h m e n t a l i l l n e s s ; o r (b) l i k e l i h o o d of h a r m to o t h e r persons. (3) When any information in the m e d i c a l records is w i t h h e l d f r o m the p e r s o n , the
p s y c h i a t r i s t s h a l l inform the p e r s o n w i t h m e n t a l i l l n e s s o f h i s o r her r i g h t t o apply to the c o n c e r n e d B o a r d f o r an order to r e l e a s e such information
55. Suggestions
The Clause does not specify or define 'serious mental harm' or 'likelihood of
harm' and in what form this access is to be provided . This provision is to be
seriously reconsidered in view of potential of it being misused.
56. Ministry's Response Serious mental harm or likelihood of harm is a judgement to be made by the
psychiatrist and will have to be justified by the psychiatrist if this decision is
challenged by the person with mental illness. The way this provision may be
misused has not been specified.
57. Recommendation of the Committee The Committee recommends that the scope of misuse of medical records may
be relooked and suitably addressed before finalising the Bill.
58. Clause 27(2)
27(2) It s h a l l be the duty of m e d i c a l officer or p s y c h i a t r i s t in c h a r g e of a m e n t a l
h e a l t h e s t a b l i s h m e n t to inform the p e r s o n w i t h m e n t a l i l l n e s s t h a t he i s e n t i t l e d to
f r e e l e g a l services u n d e r the L e g a l Services A u t h o r i t i e s A c t , 1 9 8 7 o r o t h e r r e l e v a n t
l a w s or u n d e r any order of the c o u r t i f so o r d e r e d a n d p r o v i d e the c o n t a c t d e t a i l s
of the a v a i l a b i l i t y of services.
59. Suggestions
Clause 27 (2) is insufficient when read in relevance to Clauses 109 and 111
which brings within its ambit persons who 'may have a mental illness'. It imposes
duty only on the medical officer or psychiatrist in charge of a mental health
establishment to inform the person with mental illness that he is entitled to free
legal services. The purpose of clause 111 is to divert people from the criminal
justice system into the health care system. Section 111 sub-section (1) clause (a)
mentions that the person shall be dealt with in accordance with the provisions of
this Act and therefore all the rights protections in this Bil l will become applicable.
However, Clause 27 (2) does not impose any responsibility on the magistrate or
police officer to inform the person about his right to legal aid with respect to
Section 111. Thus, there is scope of arbitrariness application.
60. Ministry's Response
Taking into account the concerns expressed here, the Ministry proposes the
following:
It shall be the duty of the magistrate, the police officer, person in charge of a
custodial institution, medical officer or psychiatrist in charge of a mental health
establishment to inform the person with mental illness that he is entitled to free
legal services under the Legal Services Authorities Act, 1987 or other relevant laws
or under any order of the court if so ordered and provide the contact details of the
availability of services.
61. Recommendation of the Committee
The Committee observes that it is important to amend clause 27 (2) so that
for want of information or due to their ignorance people with mental illness
are not deprived of legal remedies and rights guaranteed to them through
various provisions of the Bill. The Committee is of the view that the suggested
changes will address the concerns regarding arbitrariness. The Committee,
therefore, recommends that the amendments to Clause 27(2) as agreed to by
the Ministry, at the Committee's behest, may be duly incorporated in the Bill.
62. Clause 65(4)
(4) Every mental health establishment shall, for the purpose of registration and continuation of registration, fulfil—
(a) the minimum standards of facilities and services as may be specified by regulations made by the Central Authority;
(b) the minimum qualifications for the personnel engaged in such establishmentas may be specified by regulations made by the Central Authority; (c) provisions for maintenance of records and reporting as may be specified by regulations made by the Central Authority; and (d) any other conditions as may be specified by regulations made by the Central Authority.
63. Suggestions
As per Clause 65 (4) of the Bil l , Central Authority appears empowered to make regulations in relation to, i n t e r a l i a , minimum standards of facility and services, minimum qualification of personnel engaged in such establishment, provisions regarding maintenance of records and reporting etc.
However, delegation of this power solely to Central Authority to the exclusion of the State Authority militates against the concept of multi-layered regulation. This is also required as the local exigencies play a major role in any public health planning and regulation. The State Authorities will be in best position to understand the requirements and practical difficulties in their own state, and the regulations made by them will be more suited to administration. This is even more important as the implementation of the regulation will, in fact, be undertaken by the State Authorities. In view of the same, it is only proper that any regulation made for regulating the mental health establishment also involves the State Authorities. This may be achieved in various ways, such as:
a) The regulations made by Central Authority must be made in consultation with State Authorities. This may pose practical challenges as there will be numerous State Authorities to be consulted, and consequently the regulation making process may get unduly delayed.
b) The regulations made by Central Authority may be modified by the State Authority with its own local jurisdiction.
c) The State Authority may be empowered to make regulations for mental health establishment within the jurisdiction of its own state. This may pose difficulties of implementation as many State Authorities may lag behind in framing their own regulations.
The power to the State Authority to modify the regulations for registration made by Central Authority may be the most suitable via-media. While such amending
regulations of the State Authority will need to be placed before the State Legislature, a further level of scrutiny may be built by requiring the Governor to ratify the regulations made by the State Authority for them to be effective.
In view of the above, we suggest addition to the following proviso to Clause 65(4) of the Bil l :
" P r o v i d e d t h a t the State A u t h o r i t y may modify, a l t e r or a m e n d any r e g u l a t i o n made by the C e n t r a l A u t h o r i t y in so far as such r e g u l a t i o n applies to any m e n t a l h e a l t h e s t a b l i s h m e n t w i t h i n the j u r i s d i c t i o n of the State A u t h o r i t y (not b e i n g a m e n t a l h e a l t h e s t a b l i s h m e n t u n d e r the C e n t r a l G o v e r n m e n t ) . P r o v i d e d further t h a t no r e g u l a t i o n made by the State A u t h o r i t y modifying, a l t e r i n g or a m e n d i n g the r e g u l a t i o n s made by the C e n t r a l A u t h o r i t y s h a l l be effective unless ratified a n d approved by the G o v e r n o r . "
64. Ministry's Response Every mental health establishment shall, for the purpose of registration and
continuation of registration, fulfil—
(a) the minimum standards of facilities and services as may be specified by regulations made by the (word Central deleted) Authority; (b) the minimum qualifications for the personnel engaged in such establishment as may be specified by regulations made by the (word Central deleted) Authority; (c) provisions for maintenance of records and reporting as may be specified by regulations made by the (word Central deleted) Authority; and (d) any other conditions as may be specified by regulations made by the (word Central deleted) Authority. 65. Recommendation of the Committee
The Committee notes that the amendment suggested by the Ministry is not
clearly framed. There is scope of ambiguity in interpretation. The
Committee, therefore, recommends that while retaining the amendments
proposed by the Ministry, the term Authority may be explicitly defined.
66. Clause 81
Each Board shall consist of-
(a) a District Judge, or an officer of the State judicial services who is qualified to
be appointed as District Judge or a retired District Judge who shall be
chairperson of the Board;
(b) representative of the District Collector or District Magistrate or Deputy
Commissioner of the districts in which the Board is to be constituted;
(c) two members who shall be mental health professionals of whom at least one
shall be a psychiatrist;
(d) two members who shall be persons with mental illness or care-givers or
persons representing organisations of persons with mental illness or care-
givers or non-governmental organisations working in the field of mental
health.
67. Suggestion
Both the members of the Mental Health Review Board proposed under the
above clause should be psychiatrists as a psychiatrist, being a specialist is better-
equipped to protect the interests of the patient.
68. Recommendation of the Committee
The Committee notes that out of the two members proposed under
Clause 81(c), at least one shall be a psychiatrist. The Clause, however, does
not clearly spell out who the other "mental health professional" shall be.
Keeping in view the fact that the Mental Health Review Boards have been
envisaged to play a critical role in protecting the interests of persons with
mental illness, the Committee feels that the second "mental health
Professional" proposed under Clause 81(c) needs to be a qualified medical
practitioner so that the two qualified medical professionals appointed under
this Clause are able to share their expertise with the rest of the Board and
enable it to take appropriate decisions. The Committee, therefore,
recommends that the Ministry may make necessary amendments in Clause
81(c).
69. Clause 99(11)
99(11) I f a p e r s o n w i t h m e n t a l i l l n e s s has made an a d v a n c e d i r e c t i v e , i t s h a l l be
t a k e n i n t o a c c o u n t before the commencement of t r e a t m e n t .
70. Suggestions
Mental illness is a chronic illness, the patient has to undergo treatment for a long
time, and insisting admission in a Government hospital for more than 90 days or
more than 120 days and waiting for a decision from the District Review
Commission is definitely cumbersome procedure. There are conditions where the
patient does not want to get treated and has to be forced to get treated. Secondly,
there are certain legal situations. When the patient claims to be unaware of what he
had done, a different set of rules will govern him.Medical treatment without the
informed consent of the person amounts to cruel, inhuman and degrading treatment
and is a violation of the rights to dignity, consent, autonomy and bodily integrity
under Article 21 of the Constitution.
71. Ministry's Response
For purposes of clarity in Section 99, the Ministry proposes the following amendment to Section 99 sub-section 11 to read as follows
E v e r y p e r s o n w i t h m e n t a l i l l n e s s a d m i t t e d u n d e r t h i s s e c t i o n s h a l l b e p r o v i d e d t r e a t m e n t after t a k i n g i n t o a c c o u n t , (a) A n A d v a n c e D i r e c t i v e i f any; o r
(b) informed consent of the p a t i e n t w i t h the support of h i s n o m i n a t e d r e p r e s e n t a t i v e subject to the p r o v i s i o n s of s u b - s e c t i o n 12.
72. Recommendation of the Committee
The Committee feels that for purposes of clarity in Section 99 it is important
to bring the amendment to Clause 99 (11) and remove the fallacies. The
Committee, therefore, endorses the changes suggested by the Ministry and
recommends that the same may be carried out in the Bill to remove the
lacunae and make it in consonance with Article 21 of the Constitution.
73. Clause 100(2) to (9)
(2) The l e a v e referred to in s u b - s e c t i o n (1) s h a l l n o t be extended b e y o n d the p e r i o d o f the d u r a t i o n o f a d m i s s i o n p e r m i s s i b l e u n d e r s e c t i o n 9 6 o r s e c t i o n 9 8 o r s e c t i o n 9 9 , as the case may be. (3) The m e d i c a l officer or p s y c h i a t r i s t in c h a r g e of the m e n t a l h e a l t h e s t a b l i s h m e n t s h a l l o b t a i n the consent of the n o m i n a t e d r e p r e s e n t a t i v e before t a k i n g a d e c i s i o n of g r a n t i n g l e a v e . (4) The m e d i c a l officer or p s y c h i a t r i s t in charge of the m e n t a l h e a l t h e s t a b l i s h m e n t may in w r i t i n g c a n c e l the l e a v e of absence of the p e r s o n w i t h m e n t a l i l l n e s s a d m i t t e d in such e s t a b l i s h m e n t if he c o n s i d e r s it appropriate to do so in the i n t e r e s t of such p e r s o n . (5) I f the p e r s o n w i t h m e n t a l i l l n e s s , on expiry o f the p e r i o d o f h i s l e a v e or on c a n c e l l a t i o n of h i s l e a v e of absence u n d e r s u b - s e c t i o n (4) does n o t r e t u r n to the e s t a b l i s h m e n t , the m e d i c a l officer or p s y c h i a t r i s t in charge of the m e n t a l h e a l t h e s t a b l i s h m e n t s h a l l f i r s t c o n t a c t the p e r s o n o n l e a v e a n d h i s n o m i n a t e d r e p r e s e n t a t i v e . (6) I f the p e r s o n w i t h m e n t a l i l l n e s s a n d h i s n o m i n a t e d r e p r e s e n t a t i v e f e e l t h a t c o n t i n u e d a d m i s s i o n in the m e n t a l h e a l t h e s t a b l i s h m e n t i s n o t necessary, t h e n , such p e r s o n a n d h i s n o m i n a t e d r e p r e s e n t a t i v e s h a l l c o m m u n i c a t e the same t o the m e d i c a l officer or p s y c h i a t r i s t in charge of the m e n t a l h e a l t h e s t a b l i s h m e n t , w h o s h a l l f o r m a l l y d i s c h a r g e such p e r s o n f r o m the m e n t a l h e a l t h e s t a b l i s h m e n t . (7) If the m e d i c a l officer or p s y c h i a t r i s t in charge of the m e n t a l h e a l t h e s t a b l i s h m e n t has r e a s o n t o b e l i e v e t h a t the p e r s o n r e q u i r e s o n g o i n g a d m i s s i o n t o a m e n t a l h e a l t h e s t a b l i s h m e n t a n d the n o m i n a t e d r e p r e s e n t a t i v e agrees w i t h the assessment o f such m e d i c a l officer or p s y c h i a t r i s t , a n d such p e r s o n w i t h m e n t a l
i l l n e s s refuses to r e t u r n to the h o s p i t a l on expiry of l e a v e or c a n c e l l a t i o n of h i s l e a v e of absence, the m e d i c a l officer or the p s y c h i a t r i s t in c h a r g e of the m e n t a l h e a l t h e s t a b l i s h m e n t s h a l l report to the P o l i c e Officer in charge of the p o l i c e s t a t i o n w i t h i n the l i m i t s o f whose j u r i s d i c t i o n the m e n t a l h e a l t h e s t a b l i s h m e n t i s s i t u a t e d , to convey the p e r s o n to the m e n t a l h e a l t h e s t a b l i s h m e n t . (8) I f the p e r s o n w i t h m e n t a l i l l n e s s referred to in s u b - s e c t i o n (7), is n o t conveyed by the P o l i c e Officer f o r any reasons, to the m e n t a l h e a l t h e s t a b l i s h m e n t w i t h i n one m o n t h of the expiry of h i s l e a v e or c a n c e l l a t i o n of h i s l e a v e of absence, as the case may be, such p e r s o n s h a l l be deemed to have been d i s c h a r g e d f r o m such m e n t a l h e a l t h e s t a b l i s h m e n t . (9) The p r o v i s i o n s o f s u b - s e c t i o n (8) s h a l l n o t p r e c l u d e r e a d m i s s i o n o f the p e r s o n w i t h m e n t a l i l l n e s s i n a c c o r d a n c e w i t h the p r o v i s i o n s o f t h i s A c t .
74. Suggestions The section perpetuates the perception of people in mental health establishments as
dangerous to society and continues to stigmatize them. Requiring a police officer
to forcibly convey the person back to the mental health establishment against his
will take away all the fundamental rights of a person guaranteed under the
Constitution.
75. Ministry's Response
The Ministry agrees with this suggestion and therefore, recommends the following changes : Section 100 (1) is retained. A l l sub-sequent subsections from (2) to (9) are deleted.
76. Recommendation of the Committee
The Committee appreciates the changes proposed by the Ministry at the
Committee's behest and recommends that necessary changes may be carried
out in the Bill.
77. Clause 101
I f a p e r s o n w i t h m e n t a l i l l n e s s a d m i t t e d t o a m e n t a l h e a l t h e s t a b l i s h m e n t u n d e r t h i s
A c t absents himself w i t h o u t l e a v e o r w i t h o u t d i s c h a r g e f r o m the m e n t a l h e a l t h
e s t a b l i s h m e n t , he s h a l l be t a k e n i n t o p r o t e c t i o n by any P o l i c e Officer at the request
of the m e d i c a l officer or p s y c h i a t r i s t in charge of the m e n t a l h e a l t h e s t a b l i s h m e n t
a n d t a k e n b a c k t o the m e n t a l h e a l t h e s t a b l i s h m e n t i m m e d i a t e l y :
P r o v i d e d t h a t i n the case o f a p e r s o n w i t h m e n t a l i l l n e s s n o t a d m i t t e d u n d e r s e c t i o n
112, the p r o v i s i o n s of t h i s s e c t i o n s h a l l n o t apply after the expiry of a p e r i o d of one
m o n t h f r o m the date of such absence of such p e r s o n f r o m the m e n t a l h e a l t h
e s t a b l i s h m e n t .
78. Suggestions The proposed Bil l still continues its link with the correctional system. The clause
101, chapter XII, on 'leave from the hospital' requires a police officer to accost the
person with mental illness to return to treatment facility. This further serves to
stigmatise the person with mental illness. The section dealing with 'leave' should
be repealed. It also contradicts with person's right to get discharged without any
consent from officer in charge/psychiatrist.
79. Ministry's Response
The Ministry has proposed following changes:
If a person with mental illness whom section 112 applies absents himself without
leave or without discharge from the mental health establishment, he shall be taken
into protection by any Police Officer at the request of the medical officer or
psychiatrist in charge of the mental health establishment and taken back to the
Mental health establishment immediately. Delete the proviso to Section 101.
80. Recommendation of the Committee
The Committee agrees to the changes proposed by the Ministry and
recommends that required modifications may be made in the Bill.
81. Clause 104 (2)
104(2) N o t w i t h s t a n d i n g a n y t h i n g c o n t a i n e d in s u b - s e c t i o n (1), if, in the o p i n i o n of
p s y c h i a t r i s t in charge of a m i n o r ' s t r e a t m e n t , e l e c t r o - c o n v u l s i v e therapy is
required, t h e n , such t r e a t m e n t s h a l l be done w i t h the consent of the g u a r d i a n a n d
p r i o r p e r m i s s i o n o f the c o n c e r n e d B o a r d .
82. Suggestions Although the Bil l prohibits ECT for minors, it may be used if in the opinion of the
psychiatrist in charge of treatment ECT is required. Currently, consent of the
guardian and prior permission of the Board are pre-requisites for ECT for minors.
There is no requirement for informed consent of the guardian before administering
ECT. It is suggested that in granting permission for ECT, the Board should make
an enquiry into the maturity of the minor to understand the nature and consequence
of the treatment. Especially in cases where the minor disagrees with the decision of
the guardian. International best practice suggests that ECT should be done only
after the opinion of a non-treating psychiatrist is sought which is also absent from
the section. It is submitted that, if at all allowed, there should be an accompanying
provision prohibiting the use of ECT on minors below a certain age, as is done in
many countries. However, due to its extreme side effects and its controversial
practice in the treatment of mental illness in minors, a blanket ban on ECT for
minors is suggested as is recommended by the World Health Organisation.
83. Ministry's Response
This provision has been made in consultation with the medical professionals as
there may be rare emergencies when a minor may require this for life saving
purposes. Hence the Bil l provides for this in exceptional circumstances with
adequate protection of the Board. Indian legal system does not recognize the
concept of maturity of minors. The opinion of a non-treating psychiatrist before
administering ECT will happen automatically as a non-treating psychiatrist will be
a member of the District Board which has to give its approval before administering
the procedure. However, it is agreed that the word "informed" is missing in
anything contained in sub-section (1), if, in the opinion of psychiatrist in charge of
a minor's treatment, electro-convulsive therapy is required, then, such treatment
shall be done with the informed consent of the guardian and prior permission of
the concerned Board.
84. Recommendation of the Committee
The Committee is of the opinion that Clause 104 prohibiting certain
treatments, such as unmodified ECT and sterilisation and restrain on chaining
are highly desirable pro human right provisions. The Committee however has
reservations on ECT for minors and recommends that the Ministry must
ensure that all treatments are to be done with informed consent by bringing in
proposed necessary changes in the Bill. Appropriate changes may be made in
the Bill accordingly.
85. Clause 106
(1) The p h y s i c a l r e s t r a i n t or s e c l u s i o n may only be used w h e n , — (a) i t i s the only means a v a i l a b l e to p r e v e n t i m m i n e n t a n d i m m e d i a t e h a r m to
p e r s o n c o n c e r n e d o r t o o t h e r s ; (b) it is a u t h o r i s e d by the p s y c h i a t r i s t in c h a r g e of the person's t r e a t m e n t at the m e n t a l h e a l t h e s t a b l i s h m e n t . (2) P h y s i c a l r e s t r a i n t o r s e c l u s i o n s h a l l n o t be used f o r a p e r i o d l o n g e r t h a n i t i s a b s o l u t e l y necessary to p r e v e n t the i m m e d i a t e r i s k o f significant h a r m .
(3) The m e d i c a l officer or p s y c h i a t r i s t in c h a r g e of the m e n t a l h e a l t h e s t a b l i s h m e n t s h a l l b e r e s p o n s i b l e f o r e n s u r i n g t h a t the method, n a t u r e o f r e s t r a i n t o r s e c l u s i o n , j u s t i f i c a t i o n f o r its i m p o s i t i o n a n d the d u r a t i o n o f the r e s t r a i n t or s e c l u s i o n are i m m e d i a t e l y r e c o r d e d in the person's m e d i c a l notes. (4) The r e s t r a i n t or s e c l u s i o n s h a l l n o t be used as a f o r m of p u n i s h m e n t or d e t e r r e n t i n any c i r c u m s t a n c e a n d the m e n t a l h e a l t h e s t a b l i s h m e n t s h a l l n o t use r e s t r a i n t or s e c l u s i o n merely on the g r o u n d of s h o r t a g e of staff in such e s t a b l i s h m e n t . (5) The n o m i n a t e d r e p r e s e n t a t i v e o f the p e r s o n w i t h m e n t a l i l l n e s s s h a l l be informed a b o u t every i n s t a n c e o f s e c l u s i o n or r e s t r a i n t w i t h i n a p e r i o d o f twenty
f o u r h o u r s . (6) A p e r s o n w h o i s p l a c e d u n d e r r e s t r a i n t o r s e c l u s i o n s h a l l be kept i n a p l a c e w h e r e h e c a n cause n o h a r m t o himself o r o t h e r s a n d u n d e r r e g u l a r o n g o i n g s u p e r v i s i o n o f the m e d i c a l p e r s o n n e l a t the m e n t a l h e a l t h e s t a b l i s h m e n t . (7) The m e n t a l h e a l t h e s t a b l i s h m e n t s h a l l i n c l u d e all instances o f r e s t r a i n t a n d s e c l u s i o n , in the report to be sent to the c o n c e r n e d B o a r d on a m o n t h l y b a s i s . (8) The C o m m i s s i o n may make r e g u l a t i o n s f o r the p u r p o s e of c a r r y i n g o u t the
p r o v i s i o n s o f t h i s s e c t i o n . (9) The B o a r d may o r d e r a m e n t a l h e a l t h e s t a b l i s h m e n t to desist f r o m applying r e s t r a i n t a n d s e c l u s i o n i f the B o a r d i s o f the o p i n i o n t h a t the m e n t a l h e a l t h e s t a b l i s h m e n t i s p e r s i s t e n t l y a n d wilfully i g n o r i n g the p r o v i s i o n s o f t h i s s e c t i o n .
86. Suggestions
Seclusion might be used widely on the grounds of shortage of staff. There is no
evidence for efficacy of seclusion. Thus, seclusion should be banned.
87. Ministry's Response Seclusion or solitary confinement of a person with mental illness is banned. Physical restraint may only be used when, -(a) it is the only means available to prevent imminent and immediate harm to person concerned or to others; (b) it is authorised by the psychiatrist in charge of the person's treatment at the mental health establishment. (2) Physical restraint (word 'or seclusion' deleted) shall not be used for a period longer than it is absolutely necessary to prevent the immediate risk of significant harm.
(3) The medical officer or psychiatrist in charge of the mental health establishment shall be responsible for ensuring that the method, nature of restraint (word 'or seclusion' deleted), justification for its imposition and the duration of the restraint or seclusion are immediately recorded in the person's medical notes. (4) restraint (word 'or seclusion' deleted) shall not be used as a form of punishment or deterrent in any circumstance and the mental health establishment shall not use restraint (word 'or seclusion' deleted) merely on the ground of shortage of staff in such establishment. (5) The nominated representative of the person with mental illness shall be informed about every instance of (word 'seclusion' deleted) or restraint within a period of twenty-four hours. (6) A person who is placed under restraint (word 'or seclusion' deleted) shall be kept in a place where he can cause no harm to himself or others and under regular ongoing supervision of the medical personnel at the mental health establishment. (7) The mental health establishment shall include all instances of restraint (word 'and seclusion' deleted), in the report to be sent to the concerned Board on a monthly basis. (8) The Commission may make regulations for the purpose of carrying out the provisions of this section. (9) The Board may order a mental health establishment to desist from applying restraint (word 'and seclusion' deleted) if the Board is of the opinion that the mental health establishment is persistently and wilfully ignoring the provisions of this section. 88. Recommendation of the Committee The Committee accepts the deletion of the word "seclusion" from Clause 106
(2) (3) (4) (5) (6) (7) and (9) and hopes that it would bring more clarity in the
said Clause with regard to the rights of persons with mental illness to dignity
and liberty. The Committee, therefore, recommends that the deletions as
proposed by the Ministry may be carried out in the Bill.
89. Clause 108 (1) The p r o f e s s i o n a l s c o n d u c t i n g r e s e a r c h s h a l l o b t a i n f r e e a n d informed consent f r o m a l l persons w i t h m e n t a l i l l n e s s f o r p a r t i c i p a t i o n i n any r e s e a r c h i n v o l v i n g i n t e r v i e w i n g the p e r s o n o r p s y c h o l o g i c a l , p h y s i c a l , c h e m i c a l o r m e d i c i n a l i n t e r v e n t i o n s .
(2) In case o f r e s e a r c h i n v o l v i n g any p s y c h o l o g i c a l , p h y s i c a l , c h e m i c a l or m e d i c i n a l i n t e r v e n t i o n s t o b e c o n d u c t e d o n p e r s o n w h o i s u n a b l e t o g i v e f r e e a n d informed consent b u t does n o t r e s i s t p a r t i c i p a t i o n in such r e s e a r c h , p e r m i s s i o n to c o n d u c t such r e s e a r c h s h a l l b e o b t a i n e d f r o m c o n c e r n e d State A u t h o r i t y . (3) The State A u t h o r i t y may a l l o w the r e s e a r c h to p r o c e e d based on informed consent b e i n g o b t a i n e d f r o m the n o m i n a t e d r e p r e s e n t a t i v e o f persons w i t h m e n t a l i l l n e s s , i f the State A u t h o r i t y is satisfied t h a t — (a) the p r o p o s e d r e s e a r c h c a n n o t be p e r f o r m e d on persons w h o are capable of g i v i n g f r e e a n d informed consent; (b) the p r o p o s e d r e s e a r c h is necessary to p r o m o t e the h e a l t h of the p o p u l a t i o n r e p r e s e n t e d by the p e r s o n ; (c) the p u r p o s e of the p r o p o s e d r e s e a r c h is to o b t a i n k n o w l e d g e r e l e v a n t to the
p a r t i c u l a r h e a l t h needs o f persons w i t h m e n t a l i l l n e s s ; (d) a f u l l d i s c l o s u r e of the i n t e r e s t s of persons a n d o r g a n i s a t i o n s c o n d u c t i n g the
p r o p o s e d r e s e a r c h i s made a n d there i s no conflict o f i n t e r e s t i n v o l v e d ; a n d (e) the p r o p o s e d r e s e a r c h f o l l o w s all the n a t i o n a l a n d i n t e r n a t i o n a l g u i d e l i n e s a n d r e g u l a t i o n s c o n c e r n i n g the c o n d u c t of such r e s e a r c h a n d e t h i c a l approval has been o b t a i n e d f r o m the i n s t i t u t i o n a l e t h i c s c o m m i t t e e w h e r e such r e s e a r c h i s to be c o n d u c t e d . (4) The p r o v i s i o n s of t h i s s e c t i o n s h a l l n o t r e s t r i c t r e s e a r c h based study of the case notes of a p e r s o n w h o is u n a b l e to g i v e informed consent, so l o n g as the a n o n y m i t y of the persons is secured. 90. Suggestions
Persons participating in such research must also be given the right to withdraw
their consent during any stage of the research to give meaning to their rights to
dignity, autonomy, consent and bodily integrity. Similarly, the nominated
representative should also have the right to withdraw their consent during any
stage of the research.
It is submitted that the current guidelines for the State Authority to permit research
and medical intervention are not sufficient. The State Authority should make an
inquiry into the potential harm and benefits that may be caused to the concerned
person.
91. Ministry's Response
The Ministry has proposed amendments as under: (b) the proposed research is necessary to promote the mental health of the
population represented by the person; (c) the purpose of the proposed research is to obtain knowledge relevant to the particular mental health needs of persons with mental illness; (5) Persons p a r t i c i p a t i n g in r e s e a r c h s h a l l have the r i g h t to w i t h d r a w t h e i r
consent a t any stage o f the r e s e a r c h . In c i r c u m s t a n c e s m e n t i o n e d u n d e r s u b - s e c t i o n (3), i f a n o m i n a t e d r e p r e s e n t a t i v e has g i v e n informed consent f o r the p e r s o n w i t h m e n t a l i l l n e s s to p a r t i c i p a t e in r e s e a r c h , the n o m i n a t e d r e p r e s e n t a t i v e s h a l l have the r i g h t to w i t h d r a w t h i s consent at any stage of the r e s e a r c h .
92. Recommendation of the Committee
The Committee appreciates that the Ministry has accepted the suggestions
and proposed amendments in the Bill. The proposed amendments may be
incorporated in the Bill
93. Clause112 (1) A n o r d e r u n d e r s e c t i o n 3 0 o f the P r i s o n e r s A c t , 1 9 0 0 o r u n d e r s e c t i o n 1 4 4 o f
the A i r F o r c e A c t , 1 9 5 0 , o r u n d e r s e c t i o n 145 o f the A r m y A c t , 1 9 5 0 , o r u n d e r
s e c t i o n 143 or s e c t i o n 1 4 4 of the Navy A c t , 1957, or u n d e r s e c t i o n 3 3 0 or s e c t i o n
335 of the Code of C r i m i n a l P r o c e d u r e , 1 9 7 3 , d i r e c t i n g the a d m i s s i o n of a p r i s o n e r
w i t h m e n t a l i l l n e s s i n t o any s u i t a b l e m e n t a l h e a l t h e s t a b l i s h m e n t , s h a l l b e sufficient
a u t h o r i t y f o r the a d m i s s i o n of such p e r s o n in such e s t a b l i s h m e n t to w h i c h such
p e r s o n may be lawfully transferred f o r care a n d t r e a t m e n t t h e r e i n .
(2) The m e d i c a l officer of a p r i s o n or j a i l s h a l l send a q u a r t e r l y report to the c o n c e r n e d B o a r d certifying t h e r e i n t h a t there are n o p r i s o n e r s w i t h m e n t a l i l l n e s s in the p r i s o n or j a i l . (3) The B o a r d may v i s i t the p r i s o n or j a i l a n d ask the m e d i c a l officer as to why the
p r i s o n e r w i t h m e n t a l i l l n e s s , i f any, has been kept in the p r i s o n or j a i l a n d n o t transferred f o r t r e a t m e n t t o a m e n t a l h e a l t h e s t a b l i s h m e n t . (4) The m e d i c a l officer in charge of a m e n t a l h e a l t h e s t a b l i s h m e n t w h e r e i n any
p e r s o n referred to in s u b - s e c t i o n (1) is d e t a i n e d , s h a l l once in every six m o n t h s , make a s p e c i a l report r e g a r d i n g the m e n t a l a n d p h y s i c a l c o n d i t i o n o f such p e r s o n to the a u t h o r i t y u n d e r whose
o r d e r such p e r s o n i s d e t a i n e d .
94. Suggestions Under clause 112, Chapter XIII, Prisoners with mental illness needs to be guarded
by the State authorities. Since prisons have all facilities, all prisoners with mental
illness could be treated in the hospital section of jails. Treating personnel in
Mental Health need to move to Prisons as part of integration of services and
community extension initiatives. A prison set-up coming to a hospital is not a very
practical move.
95. Ministry's Response Section 112 does not require that persons should be moved out of the prison
compound to access mental health care. There can be mental health establishments
in the medical wing of prisons and persons with mental illness are cared for in
these areas.
96. Recommendation of the Committee
The Committee feels that the reply of the Ministry does not address the
concern in an explicit manner and there is need to ensure that there is no
ambiguity whatsoever in the clause. The Clause should spell out details in a
more explicit manner so as to avoid confusion and conflict in the
implementation. The Committee, therefore, recommends that the Ministry
may re-examine the concern raised with regard to Clause 112 and address the
same appropriately.
97. Clause 113
If it appears to the p e r s o n in charge of a State r u n c u s t o d i a l i n s t i t u t i o n ( i n c l u d i n g
b e g g a r s homes, o r p h a n a g e s , women's p r o t e c t i o n homes a n d c h i l d r e n homes) t h a t
any r e s i d e n t of the i n s t i t u t i o n has, or is likely to have, a m e n t a l i l l n e s s , t h e n , he
s h a l l take such r e s i d e n t of the i n s t i t u t i o n to the nearest m e n t a l h e a l t h e s t a b l i s h m e n t
r u n o r f u n d e d b y the appropriate G o v e r n m e n t f o r assessment a n d t r e a t m e n t , a s
necessary.
98. Suggestions Apart from those sections relating to transfer, the Mental Health Care Bil l does not
apply in custodial care institutions including prisons. Individuals with mental
illness in prisons and other State run custodial institution (e.g. beggars homes,
orphanages, women's protection homes and children homes), should be monitored
under the Act.
99. Ministry's Response
The Ministry has suggested following changes:
If it appears to the person in charge of a State run custodial institution (including
beggars homes, orphanages, women's protection homes and children homes) that
any resident of the institution has, or is likely to have, a mental illness, then, he
shall take such resident of the institution to the nearest mental health establishment
run or funded by the appropriate Government for assessment and treatment, as
necessary. The m e d i c a l officer in charge of the m e n t a l h e a l t h e s t a b l i s h m e n t s h a l l
be r e s p o n s i b l e f o r assessment of the p e r s o n a n d the t r e a t m e n t needs of the p e r s o n
w i t h m e n t a l i l l n e s s s h a l l b e addressed i n a c c o r d a n c e w i t h the p r o v i s i o n s o f t h i s A c t
as applicable in the p a r t i c u l a r c i r c u m s t a n c e s .
100. Recommendation of the Committee
The Committee is of the opinion that people in custodial institutions are very
vulnerable to abuse of their rights. Thus, keeping in view their special
circumstances, proposed amendments are very much warranted. The Ministry
has accepted the suggestions and come out with the amendment and the
Committee accepts it. The Committee, recommends that the addition in
Clause 113 as agreed to by the Ministry, at the Committee's behest, may be
suitably incorporated in the Bill.
101. Clause 114(1) 114. (1) N o t w i t h s t a n d i n g a n y t h i n g c o n t a i n e d in any o t h e r law f o r the t i m e b e i n g in
f o r c e , a person's c u r r e n t or past a d m i s s i o n to a m e n t a l h e a l t h e s t a b l i s h m e n t or a
person's c u r r e n t o r past t r e a t m e n t f o r m e n t a l i l l n e s s s h a l l n o t b y itself, w i t h o u t
p r e j u d i c e to the p r o v i s i o n s o f any law f o r the t i m e b e i n g in f o r c e or custom or
usage g o v e r n i n g p e r s o n n e l l a w s o f such p e r s o n , be a g r o u n d f o r d i v o r c e .
102. Suggestions Sub-clause (1) of Clause 114 starts as a 'notwithstanding' clause, however, towards
the end it turns into a clause which does not prejudice other laws for the time being
in force. This creates confusion as to the status of this provision. If this provision is
to operate notwithstanding other laws for the time being in force, there is no need
for a without prejudice clause, and if this law is not intended to prejudice any other
law for the time being in force, this provision is not required.
The right to divorce flows from other laws and these laws have their own
intricacies. At a time when divorce laws are being liberalized to ensure that
unhappy and unworkable marital relations are allowed to end, if this provision is
intended to close a right to divorce available under divorce laws, it may have other
unintended consequences. It is best that any change to marital laws be undertaken
as separate exercise and only after its consequences have been sufficiently
analysed. Further, certain forms of mental illness are grounds for divorce under the
respective personal laws. Therefore, an amendment to such legislations may be
required to give full effect to this provision, if it is decided to retain the same.
103. Ministry's Response
The Ministry proposes an amendment to Clause 114 by deleting sub-clause(l).
104. Recommendation of the Committee The Committee accepts the suggestion of the Ministry to delete sub- clause 1 of Clause 114 from the Bill. The Committee recommends that this amendment may be carried out in the Bill.
105. Clause 123 (1) N o t w i t h s t a n d i n g a n y t h i n g c o n t a i n e d i n t h i s A c t , the p r o v i s i o n s o f t h i s A c t s h a l l , t a k i n g i n t o c o n s i d e r a t i o n the c o m m u n i c a t i o n , t r a v e l a n d t r a n s p o r t a t i o n difficulties, apply to the States of Assam, M e g h a l a y a , Tripura, M i z o r a m , Manipur, N a g a l a n d , A r u n a c h a l P r a d e s h a n d S i k k i m , w i t h f o l l o w i n g modifications, namely:— (a) u n d e r s u b - s e c t i o n (3) of s e c t i o n 8 0 , the p r e s i d e n t of the C o m m i s s i o n may c o n s t i t u t e a s i n g l e B o a r d f o r a l l the States; (b) in s u b - s e c t i o n (2) of s e c t i o n 88, reference to the p e r i o d of "seven days", a n d in s u b - s e c t i o n (3) of t h a t s e c t i o n , reference to the p e r i o d of " t w e n t y - o n e days" s h a l l be c o n s t r u e d as "ten days " a n d "thirty days ", respectively; (c) in s u b - s e c t i o n (9) of s e c t i o n 96, reference to the p e r i o d of "seventy-two h o u r s " s h a l l be c o n s t r u e d as "one h u n d r e d twenty h o u r s " , a n d in sub-sections (3) a n d (12) of t h a t s e c t i o n , reference to a p e r i o d of "seven days" s h a l l be c o n s t r u e d as "ten days "; (d) in s u b - s e c t i o n (3) of s e c t i o n 97, reference to the p e r i o d of "twenty-four h o u r s " s h a l l be c o n s t r u e d as "seventy-two h o u r s "; (e) in clauses (a) a n d (b) of s u b - s e c t i o n (9) of s e c t i o n 9 8 , reference to the p e r i o d of "three days" a n d "seven days" s h a l l be c o n s t r u e d as "seven days" a n d "ten
days" respectively; (f) in s u b - s e c t i o n (3) of s e c t i o n 9 9 , reference to the p e r i o d of "seven days" a n d in s u b - s e c t i o n (4) of t h a t s e c t i o n , reference to the p e r i o d of " t w e n t y - o n e days" s h a l l be c o n s t r u e d as "ten days " a n d "thirty days " respectively; (g) in s u b - s e c t i o n (4) of s e c t i o n 103, reference to the p e r i o d of "seventy-two h o u r s " s h a l l be c o n s t r u e d as "one h u n d r e d twenty h o u r s " .
(2) The p r o v i s i o n s of clauses (b) to (g) of s u b - s e c t i o n (1) s h a l l a l s o apply to the States o f Uttarakhand, H i m a c h a l P r a d e s h a n d Jammu a n d K a s h m i r a n d the Union t e r r i t o r i e s o f Lakshadweep a n d A n d a m a n a n d N i c o b a r Islands.
106. Suggestions
Chapter XVI section 123 makes provision for a single Board for 8 North Eastern
states. Keeping in view the difficulties of connectivity and terrain a single board
would never be able to take on this onerous responsibility. It is not understandable
for whose convenience one Review Board (NE region) has been proposed for an
area spreading across 262,230 sq kms. It is proposed that this provision for a single
board for NER be discontinued. In States like Assam every district should have a
board like in other parts of the country. As an alternative, all districts having
District Mental Health Program should have a Mental Health Review Board in the
rest of the states of North East Region if district level board are not possible.
107. Ministry's Response This is only an enabling provision which was made on the basis of suggestions
from stakeholders at the regional meeting held in the North-East. It is not
compulsory that there is only one Board for the North Eastern states and it is
possible to have separate District Boards for the North Eastern States as well as all
districts in Assam.
108. Recommendation of the Committee
The Committee feels that ambiguity in this regard should be removed. The
Committee recommends that necessary drafting modifications may be made in
the clause so that the intent behind the clause that this is only enabling
provision and it is possible to have separate district boards for the North¬
Eastern States including Assam, is reflected in the Bill.
109. Clause 124
P r e s u m p t i o n of m e n t a l i l l n e s s in case of a t t e m p t to c o m m i t s u i c i d e by p e r s o n . 124. (1) N o t w i t h s t a n d i n g a n y t h i n g c o n t a i n e d in s e c t i o n 3 0 9 o f the I n d i a n P e n a l Code, any p e r s o n w h o attempts to c o m m i t s u i c i d e s h a l l be presumed, unless p r o v e d o t h e r w i s e , to be suffering f r o m m e n t a l i l l n e s s a t the time o f a t t e m p t i n g s u c i d e a n d s h a l l n o t b e l i a b l e t o p u n i s h m e n t u n d e r the s a i d s e c t i o n . (2) The appropriate G o v e r n m e n t s h a l l have a duty to p r o v i d e care, t r e a t m e n t a n d r e h a b i l i t a t i o n t o a p e r s o n , h a v i n g m e n t a l i l l n e s s a n d w h o a t t e m p t e d t o c o m m i t s u i c i d e , to r e d u c e the r i s k o f r e c u r r e n c e o f a t t e m p t to c o m m i t s u i c i d e .
110. Suggestions The decriminalization of persons attempting to commit suicide is a welcome step.
However, the lack of criteria for what may constitute 'an attempt to commit
suicide' is vague and ambiguous. As opined by the Supreme Court of India in P.
Rathinam v. Union of India [1994 AIR1844] people may attempt suicide for a
number of reasons, which may not necessarily be related to their mental health.
The section therefore becomes open to arbitrariness and is in violation of article
14 of the Constitution.
Three issues which we feel will arise with the enactment of Section 124: A. The unintended consequence of the law creating this presumption of mental
illness is that a person who has attempted suicide will now be subject to
'mental health treatment'.
B. There are serious concerns with regard to the issue of abetment of suicide, which is punishable under Section 306 IPC. C There are concerns with regard to the role played by institutionalization in silencing victims of domestic violence. 111. Ministry's Response
The Ministry has proposed following amendments Title of the Section : P r e s u m p t i o n of severe stress in case of a t t e m p t to c o m m i t s u i c i d e
(1) N o t w i t h s t a n d i n g a n y t h i n g c o n t a i n e d in Section 3 0 9 o f the I n d i a n P e n a l Code a n d the Code o f C r i m i n a l P r o c e d u r e , any p e r s o n w h o attempts to c o m m i t s u i c i d e s h a l l be presumed, unless p r o v e d o t h e r w i s e , to have severe stress at the t i m e of a t t e m p t i n g s u i c i d e a n d s h a l l n o b e l i a b l e t o p r o s e c u t i o n a n d p u n i s h m e n t . (2) The appropriate G o v e r n m e n t s h a l l have a duty to p r o v i d e care, t r e a t m e n t a n d r e h a b i l i t a t i o n to a p e r s o n h a v i n g severe stress a n d who a t t e m p t e d to c o m m i t s u i c i d e , to reduce the r i s k of r e c u r r e n c e of a t t e m p t to c o m m i t s u i c i d e . 112. Recommendation of the Committee
Though section 124 of the Bill seeks to make a presumption vis-a-vis mental
illness, the stage at which such a presumption operates is unclear. It is
necessary to avoid any scope of ambiguity in both enforcement as well as
interpretation of the clause. The Committee, therefore, accepts the
modifications proposed by the Ministry and recommends that they may be duly
incorporated in the Bill.
113. Clause 126 The C e n t r a l G o v e r n m e n t may, if it c o n s i d e r s so necessary in the i n t e r e s t of persons
w i t h m e n t a l i l l n e s s b e i n g g o v e r n e d b y the M e n t a l H e a l t h A c t , 1987, take
appropriate i n t e r i m measures by m a k i n g scheme f o r the smooth i m p l e m e n t a t i o n of
the p r o v i s i o n s o f t h i s A c t .
114. Suggestions Clause 126 of the MHCB only allows for the Central Government if it considers it
necessary in the interest of persons with mental illness being governed by the
M H A to take appropriate interim measures by making a scheme for the smooth
implementation of the provisions of MHCB. Insofar as MHCB does not address
the issues undertaken by Chapter VI of MHA, this clause is of little assistance.
It is therefore submitted that the MHA cannot be repealed until the question of
property management by persons with mental illness is settled. There is an
inextricable relationship between the economic status of persons with mental
illness and their care and treatment. It is important to ensure that these
connections are duly appreciated before a statute on mental health care is
enacted. Such an examination is especially required because the present Bill, as
this memorandum has attempted to show is neither in harmony with the CRPD
nor with the Indian Constitution.
115. Ministry's Response
The Central Government may, if it considers so necessary in the interest of
persons with mental illness being governed by the Mental Health Act, 1987, take
appropriate interim measures by making necessary transitory schemes ( w o r d s "for
t h e s m o o t h i m p l e m e n t a t i o n o f t h e p r o v i s i o n s o f t h i s Act" d e l e t e d ) .
116. Recommendation of the Committee
The Committee feels that precautionary measures are to be taken before totally
repealing the Mental Health Act, 1987 and accepts the suggestion of the
Ministry.
117. The Committee adopts the remaining clauses of the Bill without any changes. The Bill may be passed incorporating the suggestions made by the Committee.
Miscellaneous
118. The Committee notes that there are as many as 18 clauses of the Bill
which will become sections after enactment which involve expenditure from
the Consolidated Fund of India and Financial Memorandum appended to the Bill
states that it is not possible to estimate the financial burden at this stage but at
the same time the Financial Memorandum does not assure that necessary
allocation shall be made when the provision of the Bill will be implemented.
States will have to implement its provisions, health being a State subject. The
Committee, therefore, recommends that as most of the States are facing
resource crunch it is the duty of the Centre to ensure funds for implementing
the provisions of the Bill and it should be reflected in the Demands for Grants.