Year : 2016  |  Volume : 58  |  Issue : 4  |  Page : 483--484

Mental Healthcare Bill, 2016: Concerns required to be addressed


Choudhary Laxmi Narayan 
 Consultant Psychiatrist, Gaya, Bihar, India

Correspondence Address:
Choudhary Laxmi Narayan
Consultant Psychiatrist, Gaya, Bihar
India




How to cite this article:
Narayan CL. Mental Healthcare Bill, 2016: Concerns required to be addressed.Indian J Psychiatry 2016;58:483-484


How to cite this URL:
Narayan CL. Mental Healthcare Bill, 2016: Concerns required to be addressed. Indian J Psychiatry [serial online] 2016 [cited 2020 Aug 11 ];58:483-484
Available from: http://www.indianjpsychiatry.org/text.asp?2016/58/4/483/196717


Full Text

Sir,

The Guest Editorial titled, “Mental Health Care Bill, 2016: A boon or bane?” published in the July-Septemper (volume 58) issue of your esteemed journal provides an excellent critical appraisal by describing the positive features of the Bill as well as highlighting the probable difficulties expected to be created by the Bill in the delivery of mental healthcare. It is rightly said that the major task would be to effectively formulate the rules which takes into account the opinions of all stakeholders and is in the best interest of the person with mental illness (PMI).[1]

I would like to point out that the nomenclature has now been changed to Mental Healthcare Bill (MHCB), 2016 (i.e. the word “health care” is combined and now “healthcare”) by the amendments introduced by Rajya Sabha.[2],[3]

It is important to mention that the provisions regarding judicial inquisition as described in the Chapter VI in the Mental Health Act – 1987 (MHA-87) have been dropped in the MHCB. It is because of the fact that after adoption of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), all persons with disability including the PMI are to have rights, equally with others, to own or inherit property, movable or immovable and to control their financial affairs.[4] The provisions regarding guardianship for the PMI have now been included in the Right of Persons with Disabilities Bill, 2014 (RPWD Bill), which has now been passed by both the houses. The Section 13 of the RPWD Bill authorizes any District Court to record a finding that a mentally ill person is incapable of taking care of himself/herself and of taking any legally binding decisions on his/her own. It should be noted that the RPWD Bill uses the term “mentally ill person” and not “persons with mental illness” as in the MHCB. After recording the finding, the court shall make an order for appointment of a limited guardian to take care of such mentally ill person and take all legal binding decisions on his/her behalf in consultation with such person. The district court may grant plenary guardianship to the mentally ill person under extraordinary situations where limited guardianship may not be awarded. The plenary guardian may take all legally binding decision on his/her behalf without any obligation to consult such person.[5] Now, as the RPWD Bill, 2016 has been passed by both the houses of the Parliament, it would come into force after notification by the Central Government from a certain appointed date. As the section 13 of this Bill starts with the phrase “Notwithstanding anything contained in any other law for the time being in force”, the provision of the section 13 would prevail over the provisions of judicial inquisition of the MHA-1987. But it is not clear what would happen to proceedings already started and the orders already passed under the MHA-1987. Section 111 of the RPWD Bill, which gives power to the Central Government to remove difficulties, may come out to be helpful in this respect.

Concerns have been raised that blanket requirement of registration of all places of where the PMI are admitted, reside at or kept in for care, treatment, convalescence, or rehabilitation would invite a sort of “license raj” of harassing mental health-care providers. It is prudent to keep general hospital psychiatry units (with open units only) to be kept out of the requirement of registration.[6] The Rajya Sabha has introduced a clause in the Section 65 (Registration of MHE) which reads as follows, “Provided that the Central Government, may, by notification, exempt any category or class of existing mental health establishments from the requirement of registration under this Act.” It is suggested that the word “existing” should be deleted in this clause as it may create some confusion in this respect. This provision would enable the government to take necessary steps as and when required for the cause of betterment of mental healthcare and the government may exempt any class or category of units providing mental healthcare from the requirement of registration as per the need of times without going into long process of legislative amendment.

It is worth mentioning that the representation of psychiatrists in both the central and the state authorities as provided in the MHCB is quite inadequate. It should be acknowledged that in any matter of mental healthcare, the professionals in the field must have proper representations as their advices are very important in the matter. However, unfortunately, it is not so. There is no representation of psychiatrists from the private sector in the central authority, and associations of psychiatrists are not represented in any of the authorities. The matter requires to be given due consideration so that the psychiatrists have proper representations in these authorities.

It has been rightly pointed out that medically accepted treatment procedures, such as electroconvulsive therapy (ECT), should not be banned.[1] ECT is one of the most effective treatments in the first episode psychosis and in emergency situations. The treatment decision should be left to the treating psychiatrist with the consent of the family members. It is also rightly pointed out that the family members need to be involved to the greatest extent in the mental healthcare and family support should be encouraged as it provides moral, emotional, and physical support to the PMI.[7]

If the concerns as mentioned above are addressed properly, it will be highly beneficial in the welfare of PMI.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Rao GP, Math SB, Raju M, Saha G, Jagiwala M, Sagar R, et al. Mental health care bill, 2016: A boon or bane? Indian J Psychiatry 2016;58:244-9.
2The Mental Healthcare Bill, 2016, as Passed by Rajya Sabha. Available from: http://www.prsindia.org/uploads/media/Mental-Health/Mental-health-care-as-passed-by-RS.pdf. [Last accessed on 2016 Oct 21].
3Sabha R. Notice of Amendments, the Mental Health Care Bill; 2013. Available from: http://www.prsindia.org/uploads/media/Mental-Health/Mental-health-care-Notice-of-Amendment.pdf. [Last accessed on 2016 Oct 21].
4Narayan CL. The Rights of Persons with Disabilities Bill, 2014 and persons with mental illness. Indian J Psychiatry 2014;56:411-2.
5The Right of Persons with Disability Bill, 2014. Available from: http://www.prsindia.org/billtrack/the-right-of-persons-with-disabilities-bill-2014-3122/. [Last accessed on 2016 Oct 21].
6Narayan CL, Shikha D, Narayan M. The Mental Health Care Bill 2013: A step leading to exclusion of psychiatry from the mainstream medicine? Indian J Psychiatry 2014;56:321-4.
7Avasthi A. Preserve and strengthen family to promote mental health. Indian J Psychiatry 2010;52:113-26.