A few days ago, my fourteen year old daughter was watching a Hindi crime show on television. It showed a lady attempting suicide by jumping off a flyover, when she was stopped just in time by the detective, and she was warned, “Madam, what are you doing? Don’t you know attempting suicide is a criminal offence in India?”
For a moment, I couldn’t decide who looked more confused, the poor lady on the flyover or my daughter, who turned to me to ask why this was a criminal offence. All I could come up with as response was “I know it is a criminal offence, but I don’t really know why. Maybe that’s one way to discourage people from taking their own lives…?”. My response sounded lame, even to my ears.
When I checked later, I found that while an attempted suicide is illegal in some other countries too, the intent is not to “punish” those who have attempted to take their own lives. Rather it is aimed at enabling the state to intervene so that it can assess the mental state of the person, based on which their treatment can be enforced. Someone who has attempted suicide typically does not (or is not supposed to) get arrested, jailed, and tried for the “crime”. However despite the noble intent of discouraging another suicide attempt, viewing an illness from a criminal lens has felt heartless and impractical.
Therefore it was heartening to read about the Mental Healthcare Bill 2016, passed by the Indian Parliament this week that has decriminalized attempt to suicide and acknowledges that a person is suffering from mental illness at that time and will not be punished under the Indian Penal Code. The government shall have a duty to provide care, treatment and rehabilitation to a person having severe stress, and to reduce the risk of recurrence of attempt to commit suicide.
It is being hailed as a landmark and progressive bill that addresses many other crucial factors of mental illness in a patient-centric way and aimed at ensuring that the patient’s interest is safeguarded–
- Definition of mental illness – as a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, and mental conditions associated with the abuse of alcohol and drugs. It does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence.
- Rights of persons with mental illness – The Bill addresses crucial aspects such as the right to access mental health care and treatment; free treatment for such persons if they are homeless or belong to Below Poverty Line. And right to confidentiality and to live with dignity and no discrimination on any basis including gender, sex, sexual orientation, religion, culture, caste, social or political beliefs, class or disability.
- Advance Directive – A person with mental illness shall have the right to make an advance directive that states how he/she wants to be treated for the illness and who his/her nominated representative shall be.
- Mental Health Authority – Set-up a Central Mental Health Authority at national-level and State Mental Health Authority in every State with which all mental health institutes and mental health practitioners including clinical psychologists, mental health nurses and psychiatric social workers will have to be registered.
- Mental Health treatment – specifics of the process and procedure to be followed for admission, treatment and discharge of mentally-ill individuals.
It is high time that India discusses its mental health issues, and the increased focus of the government on mental healthcare is encouraging. Per the findings from the recent National Mental Health Survey conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), at least 13.7 per cent of India’s population has various mental disorders; 10.6 per cent of them require immediate interventions.
They survey also points out that India’s urban areas are most affected with mental illness. And urban areas have a higher prevalence of schizophrenia, mood disorders and neurotic or stress-related disorders. This disturbing scenario could be due to fast-paced lifestyles, experiencing stress, complexities of living, a breakdown of support systems and challenges of economic instability. With continuing urbanisation, the burden is expected to rise and hence, there is a need for an urban specific mental health programme.
The survey also says that despite three out of four persons experiencing severe mental disorders, there are huge gaps in treatment. Apart from epilepsy, the treatment gap for all mental health disorders is more than 60 per cent.
Also, due to the stigma associated with mental disorders, nearly 80 per cent of those with mental disorders had not received any treatment despite being ill for over 12 months. Poor implementation of schemes under the National Mental Health Programme is largely responsible for this.
These are just some of the survey findings, and if you are interested, please do study the survey findings at http://indianmhs.nimhans.ac.in/Documents/reports/Summary.pdf .
Both the survey and the bill cover many critical aspects to do with gaining insights on the various aspects of the illness and its incidence, and its treatment and care. It is important that we understand these and also appreciate that passing the law is but one step. What is also needed is that we as a society – our caregivers, police, family, educational institutions, workplaces, etc. – are sensitised to the illness, to the rights of the mentally ill, and to taking timely action for their care and treatment.