Rights groups object to Mental Healthcare Bill provisions

New Delhi: On the eve of World Mental Health Day, a section of disability rights groups have raised strong objection to certain provisions of the newly-drafted Mental Healthcare Bill, including on involuntary admissions, saying they are "anti-patient" and can be misused.

These groups will tomorrow stage a protest outside the Health Ministry office in Nirman Bhawan, asking the Government to intervene and stop the legislation as it promotes `institutionalisation` of mental health care facilities and dilutes the rights of persons suffering from mental illness.

While stating that as far as possible all admissions into mental health institutions should be independent voluntary admissions, the law allows for involuntary admissions "when such conditions exist as make supported admission unavoidable".

Disability groups are against involuntary admissions which are literally forced admissions and can be misused against people with mental illness. The groups are also advocating community mental healthcare and an end to establishment of more institutions such as psychiatric facilities. That is also what is stated by UNCRPD (UN Convention on Rights of Persons with Disability), which India ratified in 2007.

"While the world community is talking about de- institutionalising mental health sector, the Bill proposes that anyone can set up mental health institutes. The penalty provisions for such institutes set up without permission are not deterrent enough, as there is only a fine of Rs 50,000 proposed on the first offence," said Javed Abidi, Convenor, Disabled Rights Group (DRG).

A petition submitted by such groups says, "We have been very critical of the recent Mental Health Care Bill that your Ministry has recently proposed...We demand that the Mental Health Care Bill process be stopped immediately."

"Our main concern about the Bill is that it maintains status quo on mental asylums, liberalising the laws for involuntary commitments. The MHC Bill makes a mockery of medical ethics and patient consent. In the last couple of years alone, media has exposed gross human rights violations within these institutions," they said.

"The right to choose any kind of treatment or refuse has been removed in a step wise manner in the Bill," said Abidi, adding that "the Advance Directive procedure in the Bill is complex and impossible to achieve."

Advance Directive is a will of sorts which anyone can write in advance to mention the kind of treatment he/she wants or does not want in case of mental illness in future.

However, the law also gives caregivers, relatives and NGOs the right to seek cancellation of such directives by appealing before the Mental Health Review Commission, which has been proposed in the new law and takes away the role of judiciary in admission and discharge of mentally ill people into institutions.

The Bill aims at humanising the treatment of mental illnesses and proposes to give patients the right to choose in advance the kind of treatment and recommends use of electric shocks in rare cases.

The government also proposes to ban electro convulsive treatment (ECT) (electric shocks) for minors as well as its direct administering to adults and has recommended its use only in rare cases only under general anaesthesia.

It also proposes grant of medical insurance for patients who till now are not covered for insurance.

The Bill also seeks to broaden the definition of mental illness and recommends decriminalisation of suicide and proposes to ban tonsuring (of heads) of the sick under treatment in mental homes.

The NGOs, including the National Alliance on Access to Justice for People Living with Mental Illness (NAAJMI), say that a person has to prove to have `capacity` to be able to exercise choice and autonomy.

"This is contrary to all medical ethics.... It provides for proxy decision making, by a nominated representative. It even allows research without consent," they said.

The Bill also proposes to bring Mental Health Review Commissions at district, state and national levels.

In case of any violations of the provisions of proposed law, the Bill proposes imprisonment ranging from six months to two years and/or fine from Rs 10,000 to Rs five lakh, sources said.

The Bill, however, gives relatives the right to move a quasi-judicial body; the Mental Health Review Commission to appeal against a mentally ill`s decision to refuse treatment in case such a person is a threat to his own life or to that of the others.

"When the person recovers after treatment, that right will revert to him," the draft law says.

"The law is pro-people. It says if anyone needs admission to a hospital, he or she should be given the same. Treatment of mental illnesses would have to be mandatory in all government-run and funded institutions and those below poverty line will get free treatment," Health Ministry sources said.

They said once the Bill becomes a law, people wandering about in streets cannot be put into a mental asylum by force. "A person will have the right to refuse treatment. Only when a person with mental illness is not in a position to make a choice, this right will be temporarily exercised by a person of their choice and will revert back to them once they have recovered after treatment," sources say.


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