DICTATION EXERCISE - 38

Hon. Chairman Sir, I thank you for giving an opportunity to speak on a very important and beautiful legislation which our Parliament is going to pass. I fully support this Bill and take this opportunity to congratulate both the Governments- the UPA Government and the NDA Government -for bringing such a comprehensive Bill to protect and promote the interests of persons having mental disorder. This is a model legislation as far as this Parliament is concerned. I am saying so because we have seen how the Finance Bill has been approved by this House. As far as this Bill is concerned, it had the scrupulous scrutiny of its entire provisions. The matter had also gone for the scrutiny of the Standing Committee. The Standing Committee had a very detailed discussion and submitted several recommendations. Most of the recommendations of the¹⁴⁰ Standing Committee have been approved by the Government. All the stakeholders have been taken into confidence; the States were consulted.¹⁶⁰ Detailed discussions took place in Rajya Sabha. Now, it has come for consideration before the Lok Sabha. So, this will establish the fact that in order to have a fruitful and effective legislation definitely scrupulous and micro level scrutiny of each and every provision of the Bill is highly essential. That is why we are able to have a good and beautiful legislation. This is a perfect legislation. Hence, I fully support the Bill and also take this opportunity to congratulate the Minister for bringing such a comprehensive Bill for the consideration of this House.

One of the major reasons for mental illness or mental disorder is the lifestyle factors such as lack of physical exercise, unhealthy eating, inappropriate use²⁸⁰ of technology, night shift duties increasing the rate of depressing, anxiety disorders, and substance abuse. It is surprising to know that in India six to seven per cent of the population is suffering from mental illness. Further, one to two³²⁰ per cent of population suffers from severe mental disorders such as schizophrenia, bipolar disorder, and alcohol and drug abuse. When we consider the number of persons affected or suffering from mental illness, the medical infrastructure available to address mental illness is very poor. India has got just 0.3 psychiatrists for one lakh people when compared to 1.7 psychiatrists per one lakh people in China. This means, over 50 per cent of the mentally ill persons in India do not have access to mental healthcare. That is the real, factual situation prevailing in our country. In this background, how can we⁴²⁰ address the issue of mental healthcare and how are we to address it? A holistic approach is highly essential so as to address the issue of mental healthcare for which we have announced the National Mental Health Policy in the year 2014. It also gives a direction that the mentally ill person should be given a life of dignity and⁴⁸⁰ access to sound medical and psychiatric care. Persons with mental illness constitute a vulnerable section of our society and are subject to social stigma and discrimination. This has to be dealt with. So, mental healthcare, social stigma and discrimination, and also rehabilitation are aspects which are well addressed in the Mental Healthcare Bill, 2016.

I am now coming to the provisions of the Bill. India has ratified the United Nations Convention on the Rights of Persons with Disabilities in the⁵⁶⁰ year 2007. This Bill is to comply with the commitment which we have made in the UN Convention. The Mental Health Act, 1987 which is an existing legislation unfortunately is not sufficient to meet the purpose which is being enunciated in the UN Convention on the Rights of Persons with Disabilities. Hence, we have to repeal that Act also. Coming to the provisions of the various clauses and the provisions of the Bill, the long title of the Bill is⁶⁴⁰ itself very comprehensive. The entire scope and ambit of the Bill is well embedded in the long title itself. That is why I say that this is a very good drafting of the legislation. Each and every provision of the Bill has been well scrutinized and it is a pucca and perfect Bill. The long title as well as each⁷⁰⁰ and every clause of the Bill is perfect and pucca because it has had a detailed scrutiny done by Parliament and outside the Parliament also. I have moved 13 amendments. I request the hon. Minister to kindly go through the amendments. Out of these 13 amendments, six amendments will help the Government and make the provisions more clear. I urge upon the Government to kindly consider these amendments in a positive manner. With these words, once again I wholeheartedly support this Bill for having such a beautiful and comprehensive legislation which the 16th Lok Sabha is going to pass.⁸⁰⁰

Hon. Chairman Sir, at the outset, I would like to say that I support this Bill. My points which I want the hon. Minister to consider is that in this particular Bill there is no clear mention about the drug rehabilitation⁸⁴⁰ centre. There is no mention as to how they should be managed and whether they should be registered under the Bill. My suggestion is that the management should have a psychiatrist or an addiction psychiatrist specialist on board. They should be responsible for the therapies a patient undergoes at these centres. Secondly, the term for admission, detention, treatment and discharge should be as in any psychiatric unit. However, many times a patient though capable of making an independent decision, has an intense desire to consume the substance in a substance abuse. So, the decision should be in consultation with nominated authority of patient or family. Thirdly, there is no mention about how we should go about in this care⁹⁶⁰ of persons with mental illness in the community. This Bill is completely silent on care of persons with mental illness in⁹⁸⁰ the community. My suggestion is that a provision of psychiatrist or a clinical psychologist, at all primary healthcare centres, should be made. They should visit PHC centres at least once a week on a rotational basis. This one year mandatory service for fresh PG of psychiatry should be implemented rigorously and this particular provision of PG of psychiatry should be made in this Bill.

The fourth point is the process of licence. The National Mental Health Policy advocates the integration of mental health into general and primary care. Now, this particular Bill mandates that all establishments to take licence from treating patients. So, by asking for licence under Section 65, many private hospitals, nursing homes and general hospitals will refuse to treat patients with mental illness. So, can the Government consider or have a re-look at this whole insistence¹¹²⁰ on having a licence? Madam, my next point is advanced directives. The problem with this step is that this is too hasty and ill-conceived in our country. Let me remind the hon. Minister that these advanced directives will be counter-productive and this will lead to many issues.

It is because the Cochrane Database of Systematic Review on Advance Treatment Directives for People with Mental Illness has reported that there are a few data available to make definitive recommendations to introduce it. Even in the western world, this has certainly not had its intended affect. Coming to the nominative representative, the insistence on nominative representative breaks the very backbone and fabric of the family. So, the Bill needs to make provision that at least one member needs to be present with the patient during the in-patient treatment because family members around¹²⁶⁰ the patient would, in a way, lead to a lot of psycho-education, supervised medication and the rehabilitation process would be¹²⁸⁰ much faster.

Another issue is about Mental Health Review Board. Why should the judiciary be involved in this? The judiciary itself is incapable of clearing their backlog. Again you are insisting the involvement of the judiciary. I do not think this is required that the judiciary should be part of this Mental Health Review Board. My suggestion would be that this Board should comprise independent psychiatrists, family care givers and recovered patients. It is because this will go a long way in getting to know the real facts. Another alternative I propose is to create a Board of Visitors at each hospital. Lastly, as regards right to confidentiality under Chapter V of this Bill. This is a fundamental right.¹⁴⁰⁰ My suggestion to the hon. Minister is that this information should only be given to the family members and that too in verbal form. Written documents or medical records should be shared with only legal authorities on obtaining a written request.¹⁴⁴⁰

As regards permission for research, it says that the State authority should give permission. You please delete it and incorporate ICMR guidelines because too many regulations can undermine the whole research. The final point is about what my hon. friends have said regarding mental health. My opinion is that the definition of mental health is very broadly covered under the National Mental Health Policy. The WHO definition is also quite clear. Can the Government incorporate the definition of mental health as has been given by the National Mental Health Policy and WHO? As has rightly been pointed out by¹⁵⁴⁰ other colleagues, it leaves out obsessive compulsive disorders, depressions and other disorders. So I hope that the hon. Minister will take note of these few points which I have mentioned over here. I support the Bill.¹⁵⁷⁵