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Wednesday, October 9, 2013

Mental Health Act

Mental Health Act

Mental health act was drafted by parliament in 1987 but it came into effect in all the states and union territories of India in April 1993. This act replaces the Indian Lunacy act of 1912, which had earlier replaced the Indian Lunatic Asylum act of 1858.
The mental health act of 1987 was an Act to consolidate and amend the law relating to treatment and care of mentally ill person, to make better provision with respect to their property and affairs and for maters connected therewith or incidental thereto.
The positive aspect of this Act were that the terminologies that were used in the Act 1912 were Nursing home Asylum, Lunatic and Criminal lunatic which were then changed to Psychiatric hospital, Mentally ill person and Mentally ill prisoner respectively.
Establishment of licensing authorities to provide a check on licensing and working of mental health hospitals, Provision for establishment of new hospitals, provision for out patient care thus avoiding unnecessary detention, simple procedures for admission and discharge, appointment of guardians for maintaining property and person of mentally ill, provision for bearing the expenses of treatment by relatives and government. prohibition on any research on such subjects without proper consent, provision for separate places for children, addicts and convicted persons.
Criticism of the Act
Although change older terminologies to newer ones were good from theoretical aspects, but social stigma attached to the illness, licensing authorities do not have a doctor who may be in a better position to assess the facilities and services of these centers, establishing newer hospitals was a costly affair in developing countries, lots of stress was made on admission and treatment and no provisions for home treatment. In case of no relatives of the ill person then who looks after the patient? If government, then for how long?
Once a person is admitted to mental hospital he is termed insane or mad by the society, no provisions for punishing the relatives and officers requesting unnecessary detention of a person to such hospitals and research on such subjects could be carried out by consent of guardian.
A few suggestion to improve the Act
  • Educating society about the mental illness.
  • Licensing process should be made simpler.
  • Provision for checking the working of licensing authorities and powers vested in them to be limited.
  • Licensing authorities should appoint a doctor preferably a psychiatrist as inspecting officer.
  • Private Doctors and general nursing homes should be allowed to treat such patients at par with recognized centers,
  • Other than children and addicts even separate places are to be provided for elderly, destitute and women
  • Adequate provisions to be provided for longterm treatment and expenses on treatment.
  • Provisions for rehabilitation centers are to be incorporated. Efforts should be there for post
  • Discharge care and rehabilitation.
  • Strict provisions should be there for punishing the individuals requesting unnecessary detention and exploitation of mentally ill.
  • Stress should be on treatment of illness rather than the ill.
  • Treatment should be based on concept of socialization and not on hospitalization.
Every law has its own advantages and disadvantages although existing law gives an excellent approach to the problems of mentally ill. But some of the provisions need a proper rethinking. Therefore, Mental Health Bill- 2013 was introduced in Rajya Sabha by the health minister where a few changes have been made.
It seeks to provide for mental health care for persons with mental illnesses and to protect, promote and fulfill the rights of such persons during the delivery of mental health care and services.
Once the Parliament passes the Bill and it is assented by the President, it will replace the Mental Health Act of 1987.
The key points of this Mental Health Care Bill 2013 are as follows:
(Source: Nirmalya Dutta, Sub editor of

Decriminalizes attempted suicides
Earlier if a person tried to commit suicide s/he was put behind bars (Section 309 of Indian Penal Code). But now the new bill says that if a person has attempted suicide then s/he needs treatment and not jailing.
WHO had estimated 1.8 lakh suicides cases in India every year, but very few studies have been carried out in the country.

The ability to choose treatment options
This bill also gives the person the right to make an 'advanced directive', that is, a person can write a statement explaining how s/he wants to be treated if s/he becomes insane. They can also state whether or not they want to be admitted to an institution or no and they cannot be forced to do so by their doctors or family members. The person can also choose a nominated representative to assist him/her during their treatment.
Medical insurance to cover mental health treatment
This law also states that all insurance companies will have to make provisions for medical insurance for the treatment of mental illness. This will provide legal protection for the one's who are suffering from mental illness.

Ensure equality and dignity for the mentally ill
The of the bill is to safeguard the rights of the mentally ill and to have access to the health care facilities, the right community living, right to protection from cruelty, inhuman treatment and right to equality and non-discrimination.
Ban on archaic and barbaric treatment methods
It bans the very old fashioned practice like electro-convulsive therapy (ECT's) without anaesthesia and restricts psychosurgery and strictly forbids the chaining of mentally ill patients (a practice quite common in many parts of India) and the sterilization of men or women when such a practice is considered a course of action for the treatment of mental illness.
The bill also states that ECT to minors will be given only after permission from the Review Commission on a case-to-case basis.

Stringent penalties are proposed for the ones found running unregistered mental health care establishments. The fine ranges from 50000 Rupees to 5 lakh Rupees depending on the frequency of the offence.
This move will be the new sunshine in the lives of people who need the treatment and hopefully the Bill will become a Law soon but the Bill may need further refinement, and this will happen in due course as part of the legislative process ahead.

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