THE NEW DEAL-INCREDIBLE JOURNEY OF THE MAKING OF INDIA’s NEW-NEW MENTAL HEALTH LEGISLATION

Parliament House ImageTonight the Google search “Lok Sabha Passess Mental Health Bill” returned me 1,72000 search hits. Closely following it was “Rajya Sabha Passes Mental Health Bill” with 1,05,000 hits.

Before I proceed further let me step back to Circa 2009, when the google search “India Celebrates World Mental Health Day” by me on 15th October, had given just two obscure hits, of one small function each in India’s fringes-one at Gauhati and another at Srinagar.

Enraged then I had allowed News Paper Mint to a story on my long  suffering from debilitating bipolar disorder (http://www.livemint.com/Home-Page/N3HhIzcx9wn45FAY11imUN/Akhileshwar-Sahay–Life-lessons-from-one-man8217s-fight.html). It was closely followed by  Whole Mind India Foundation  (WMIF) as a national aggregation dedicated to de-stigmatize mental illness. Soon was the emergence of Group for  Suicide Prevention in India (GSPI) in January, 2010.

Both these movements began initially on social media-Face Book.

I will return to the story of 2010, a bit later.

By now it is known to all, that Progressive and Historic Mental Health Care Bill, after glowing tribute to its by Members of Lok Sabha cutting across party lines was passed unanimously by voice vote exactly at 18:09;36 Hours of 27th March, 2017. Earlier the Bill was passed by the Rajya Sabha on 8th August, 2016 in the Monsoon Session. Now country awaits the accent of the President to the Bill to herald a New Era.

I will come to what happened in Lok Sabha later in this Blog.

Also, this is the first of the many articles that I would be writing on nuances of what makes this Bill a path braking one. But this piece is exclusively devoted to the “Historical Journey Of the Making of this Epoch Making Bill”

Undoubtedly,  it is  The New Deal- A New New progressive Mental Health Care Bill, 2016  When the Lok Sabha was debating the Bill on 24th and 27th March, 2017 over nearly six hours, I stayed glued to the Lok Sabha TV.  After all it was an “Audacious Dream Coming True” for me in person and for entire Mental Health Community  in general.

Before I move further, it is time for tribute to the tenacity of Two persons.

Their name would soon be relegated to the history,-

First person’s name is Keshav Desiraju, an erudite (alumni of Cambridge University and Harvard Kennedy School of Public Policy), visionary bureaucrat, a person of impeccable honesty and total integrity, a man of action and a dedicated public servant. He took the cause of Mental Health to his heart first as Additional Secretary, Government of India, Ministry and Health and then as its Secretary. His contributions to the cause were legion, and they deserve a separate article on its own, but his most seminal contributions were giving the nation- National Mental Health Policy and Mental Health Care Bill, 2013 as was introduced to the Rajya Sabha in 2013.

The second person is Dr Soumitra Pathare Lead Author of the Bill (the Bill has his imprint but not the name). It was in early 2010, that Dr Soumitra Pathare with his colleague  Dr Jaya Sagade of Centre for Mental Health Law and Policy Indian Law Society, Pune came forward to shoulder the onerous  responsibility to recast Mental Healthcare Act, 1987.

The journey there after was both tortuous and raucous.

Original intent was not to bring a brand new Bill but  amend the Mental Health Care Act, 1987. The journey to frame Amendments began in early 2010, and by 23rd May, 2010 second draft of the Amendment was ready and put up for comments by all.

Few will  know ever that the journey of path-breaking Mental Health Care Bill, 2016 began haltingly  in 2010 not to write a brand new Bill but as bare Minimum Amendments to the Mental Health Care Act, 1987 and on 23rd May,  2010, second draft of proposed Amendments was released for consultation.

The process of drafting the Bill that started thus originally with Amendments to 1987 Act, underwent widest possible, regional consultations (four) and by December 2010, it took the shape of proposed New Mental Health Care Bill instead of Amendment to the 1987 Act,.

  • From Amendments to the New New Bill:

The preamble of the first Draft of New Mental Health Care Bill, 2010, released for comments on 6th December, 2010 said-

“During the Regional Consultations on the amendments to the MHA, 1987, it became clear that the number of amendments to the MHA 1987 led to multiple repealed sections and this resulted in difficulty in reading the amended Act.

This is now written as a new Act because it allows for certain sections to be moved to the front of the Act and renumbering of sections sequentially. Most importantly it makes for ease of reading and use of the Act.

The contents in this Act are as discussed in the Regional Consultations and are a continuation from the previous draft amendments (Draft 1 and Draft 2) to the MHA, 1987. Suggestions made at the Regional Consultations have been incorporated into this draft wherever appropriate.” 

Thus was completed the one year first leg of the historical journey from Amendment to the Mental Health Act, to the first Draft of Mental Health Care Bill, 2010 released on 6th December, 2010. Though the Bill was assiduously written by Dr. Soumitra Pathare and Dr. Jaya Sagade, this was the draft when their name vanished from the Bill and for all the valid reasons.

  • National Consultation 22nd March, 2011

After taking input from stakeholders on Mental Health Care Bill, 2010, it was presented as Mental Health Care Bill, 2011 to large number of stakeholders in the Second National Consultation on 22nd March, 2011 at the Auditorium of National Institute of Health and Family Welfare, 2013.

I can recall from memory that on the day the auditorium with 365 persons seating capacity was overwhelmingly full. And what a congregation of stakeholders it was draft from all over the country-leading psychiatrists (both government and private), government officials of Ministry of Heath and Ministry of Disability Welfare, clinical psychologists, psychiatrist social workers, psychiatric nurses, Non-governmental Organizations (NGO) working in the field of mental illness, sufferers of Mental Illnesses (yours truly included) and care givers amongst many.

It looks intriguing that only one News Paper then considered it worthy to report the news of happening of the National Consultation (http://www.thehindu.com/news/national/National-consultation-on-new-mental-health-bill-today/article14956297.ece) so woefully low was the interest of media in affairs pertaining to the Mental Illness

And what a marathon consultation it proved to be.

Whole day National Consultation, where more than 300 were present and all wanted to speak. There was a valiant role played by Keshav Desiraju to ensure orderly functioning of the consultation and every one did speak- and there were heated positions taken both by protagonists and antagonists of the bill. Biggest ire of nay-sayers was it was a bill drafted by two individuals.

Then Indian Psychiatry Association considered it had the sole birth right  on any matter even remotely connected with the Mental Illness- clearly the ire was heavy from being left out from a process which was thrown over to the entire country for giving the input. There were angry outbursts from a small but vociferous sections of young survivors of mental illness and few NGOs blaming the Bill was one rooted in the medical model not suited to India.

Needless to say that the National Consultation was inconclusive though a vast treasure  of positive and negative feed-backs were received that  day.

  • Setting of National Mental Health Policy Group

One positive fall out of the raucous and heated National Consultation was setting up of twelve Member, Mental Health Policy Group by Government of India on 15th April, 2011 with Keshav  Desiraju, Additional Secretary as Convener and Member Secretary.  Beauty of this group was it was a committee of equals with no chairman and convener made that position from the word go.

One key point of reference of the Committee was- “To take Draft Mental Health Care Bill, 2010 into account while Drafting National Mental Health Care Policy and Plan” and to recommend changes in the Draft Mental Health Care Bill, if necessary to support the National Health Care Policy and Plan”

At this point i consider it necessary to say few words about the inclusive nature of the Committee. Though other officials of the Ministry including Director General Health attended Committee Meetings it was more to ensure that governmental position was taken into consideration by the committee, else sole official nominee on the Committee was Keshav Desiraju.

Other Members of the Committee included psychiatrists -Dr. Vikram Patel (now Professor at Public Health Foundation of India, Vikram was named later as one of top 50 infuential persons in the world by Time Magazine later) persons  Dr, Anirudh Kala (Clinical Director North India Psychiatry Centre and first President of Private Psychiatry Association),    Dr. Alok Sarin (Senior Consultant Psychiatry Sita Ram Bhartiya Institute); Dr. Sanjiv Jain (Professor of Psychiatry, NIMHANS) and Dr. S. K. Deori (Director, Regional Institute of Mental Health, Tej Pur) in addition to Dr. Soumitra Pathare.

Contrary to future war-cry of psychiatric community that the Committee did not have psychiatrists as member-six of total twelve members were reputed psychiatrists of the country. And to make the matter clear here itself, committee during its deliberations at least co-opted two more government psychiatrists- Dr. Kishore Kumar Professor of Psychiatry NIHANS and Dr Rajesh Sagar  Professor of Psychiatry All India Institute of Medical Sciences, New Delhi.

The list of other five members of the Committee too was interesting- two public health specialist- Dr. Vikram Gutpa from Sir Ratan Tata Trust and  Dr. Thelma Narayan, (Director SOCHARA-Centre for Public Health and Equity, Society for Community Heath, Awareness, Research and Action),  one care giver activity Dr. Nirmala Sriniwasan (Director Action for Care Giver), one NGO Representative Dr. Vandana Gopikumar, whose pioneering Banyan is an international role model, and one sufferer of Mental Illness cum Activist, yours truly Akhileshwar Sahay

  • To make it Best Practices Bill Committee fought for every line in the Bill for Two Years

After “collaborative working for two years”, putting committee deliberations on internet for public comment bringing many other experts to give their valuable input, the Committee finally gave a final shape to the Bill. Needless to say, at every stage ownership of the bill remained with Soumitra Pathare who took both pat on the back and brickbats even from the committee members with same magnanimity.

It thus became Mental Health Care Bill, 2013 that after the approval of the Union Cabinet was introduced to the Rajya Sabha in the Monsoon Session on  August 19,2013 and was from there referred to the ” Standing Parliamentary  Committee on Health and Family Member”

  • Parliamentary Committee’s Recommendations Accepted by the Government

The thirty member Standing Parliamentary Committee Headed by Honorable Brajesh Pathak (with present Health Minister Mr. Jagat Prakash Nadda as a Member), within three months of  months the of the Mental Health Care Bill, 2013 being referred to it on 20th November, 2013 laid its report to both houses of the Parliament.

In between the Committee had numerous sittings where it had detailed presentation and oral submission from Secretary Health (then Keshav Desiraju), received and studied approximately 58 representations from public and stakeholders, sought the views of state governments (only Delhi bothered to reply) and had written and oral submission from many stakeholders and experts including but not limited to-

  1. Dr Shekhar Saksena, Director Department of Mental Health and Substance Abuse World Health Organization (WHO) Geneva
  2. Dr. K. K. Talwar Chairman Indian Medical Council
  3. Dr. Satish Chandra, Director NIMHANS and Dr. Sudhir K. Khandelwal Professor and Head of Department Psychiatry, A.I.I.M.S Delhi
  4. Prof Amita Dhanda Prof of Disability Studies at NALSAR University of Law
  5. Dr. Indira Sharma Prsident, Indian Psychiatry Society (IPS), Dr. B. S. Chavhan (Chairman IPS),  Dr. V. K. Ashokan President Elect IPS and Dr. T.S.S. Rao Editor in Chief, Indian Journal of Psychiatry
  6. Other experts included Dr. Vikram Patel, Dr. S. K. Deori,  Nirmala Sriniwasan, Vandana Gopikumar (Members of Mental Health Policy Group)

There was one more person, whose written and oral submission was taken by the Committee- it was undersigned, yours truly-Akhileshwar Sahay.

My detailed written submission to the Parliamentary Committee is the subject Matter of my next blog, suffices to bring here the central theme of my written submission. I said-

“Today standing before the August Committee after fifty years of famous “Dream Speech of Dr. Martin Luther King Junior”, I too have a Big Hairy Audacious Dream to bring transformational changes in the Indian Society.

I want a radical change in the manner society treats millions of mentally ill in the country. And I have audacity to say, I want to stamp out the stigma and discrimination embedded in the life of mentally at the soonest.

I am conscious, mentally ill of my nation lead  accursed, subjugated, condemned life in darkness, isolation and incarceration and those given one way ticket to hell by declaring them of “unsound mind” become non-citizen, denied right to vote and are debarred from holding offices in nearly 100 existing Statutes. Honorable members, I donot know a person of mental illness (and I have seen hundreds of them if not thousands) who is so incapacitated that is declared a person with “unsound mind” for life. Today mental Illnesses of all forms are curable or manageable with psychiatric, psychological and familial interventions.

I know cleansing societal thought process takes time. It will be decades before desired changes happen. I accept it is a hundred year war, no doubt.

Nonetheless, I dare and dream today:-

“If misfortune strikes my children or grand children, disrupting their life with mental illness in future, society instead of stigmatizing or discriminating them, should judge them for who they are, and their contribution to society. And, not for any mental disorder that affects their life. 

I dream of an India, where sufferers of mental illnesses shall live full of dignity in parity with others in an inclusive environment. And I have dedicated remaining years of my life to actualize this dream.”

In the passage of the revolutionary Bill, I see sowing the seed of actualization of this audacious dream.

  • Rajya Sabha Passes Mental Health Care Bill, 2016

On August, 8, 2016 in the Monsoon Session after debate and praise for the bill from members cutting across the party lines, Rajya Sabha through voice vote unanimously passed the Mental Health Care Bill, 2013 with 134 Official Amendments most arising out of the fact that the Government Accepted all Amendments and Changes proposed by the Standing Committee on Parliament in full. This was the beginning of the multi party support of the Bill.

Also on the day and next few days, the subject Matter of Mental Health and of nuts and bolts of the Bill got notices by mainstream media Print and Visual but largely the coverage in size was muted.

Now Mental Health Care Bill, 2013, duly passed by Rajya Sabha got rechristened as Mental Health Care Bill, 2016

  • Anxious Wait  in the Lok Sabha

Mental Health Care Bill, 2016 was first listed in Lok Sabha in the same Monsoon Session in which the Rajya Sabha Passed it, but it was listed on the last day and the day went in discussion of the critical Kashmir Situation.

During Winter Session of Parliament, frequently  the Mental Health Care Bill, 2016 was listed in Lok Sabha for discussion and passing but sadly, Honorable Members of Parliament had more important agenda, Demonetization, the Winter Session was washed out. Every day I would type in Google- “Lok Sabha Passes Mental Health Bill, and will fall flat glum faced. PRS Legislative Research on behalf kept a daily watch (which it does any way), but every day gave me the news’ “Sir session was washed out”.

It was one hopeless wait, all along even in first half of the Budget Session as for valid reason government had very limited agenda. When the parliament reconvened on Thursday 23rd March, I was overjoyed when  Chikashu from PRS Legislative Research called, “Sir today the Bill is listed in Lok Sabha and there are only two bills.

My heart started beating fast and stayed glued to Lok Sabha TV-but it was not to be-the extended question hour, extra time taken for SC/ST Bill (it was passed only at 1630 hours) and private members business, ensured that the Mental Health Care Bill, 2016 waits for another day.

  • And the D-Day Arrives

The D-day finally arrived on 24th March, 2017 when Honorable Health Minister Jagat Prakash Nadda, introduced the Bill in the Lok Sabha for consideration. There was not much time for discussion that day but the beginning was auspicious.

Erudite Mr. Shashi Tharoor,  in Indian Parliamentary History, became the first Law Make of the country to publicly own up and open up by talking incidence of Mental Illness in his immediate family. Because of the historical importance, his speech is reproduced below-

“‘I can tell you, Mr Chairman, from personal experience that there is nothing sadder than witnessing a close one, a loved one with mental illness at close quarters. I have lived with a victim of mental illness. Like many in that condition, very often such people are in a state of denial.’
‘The National Crime Records Bureau has calculated in 2014 that at least 15 suicides take place in India every hour.”That is too many.’ ‘These 15 instances in every 60 minutes is our collective failure to recognise and solve the problem.”The police should be trained to understand that an attempted suicide is a cry for help.”

‘It is not a crime. Who is going to tell this to the police, Mr Minister?'”

It became clear on the very first day in Lok Sabha that the subject had made an emotional connect when Member after Member starting lauding the bill, its intent and its clauses, some clamor for changes and amendments notwithstanding. Amendments asked for were on expected lines the one that was official version of Indian Psychiatry Society-more interestingly from where they would bring anesthesia experts for ECT. This not withstanding, the debate was involved and positive.

  • And Prime Minister Enters the Ring-He Sings Mere Man Ki Baat:

On 10th October, 2015, on the occasion of the World Mental Health Day,  in desperation, I had  sent an Open Letter to Prime Minister Narendra Modi titled-“Of Madness and  Sadness-An Open Letter to Prime Minister”. My desperation had reason-an  abridged version of that  Open Letter  earlier I had submitted to be published in a prominent national daily (Indian Express) to coincide its publication with 6th August, 2015 the day India entered Fifteenth Year of ghastly monumental Tragedy of Erwadi .  The national daily to which I had sent the piece  prides at “Journalism of Courage” and kept the article with the caveat, it will wait for a news-peg to coincide with the publishing.

Months passed but the news-peg did not arrive and then I sent the Letter to Prime Minister. It was a long three page letter and I will post as a separate blog soon. But there was a desperate plea by me to Prime Minister to take the first-baby step in his “Man-Ki-Baat”. The relevant paragraph of my letter to PM is reproduced below-

“Societal problems regarding stigma against mental illness are nuanced and far-reaching. Only you Prime Minister can turbo-charge carpet-bombing of sustained measures involving all.  Awareness matters. Let the big-bang communication start with the  baby-step- your “Man-Ki -Baat” and you motivate all game changers to be part of this immediate change which India needs. Tomorrow will be too late”

I am not sure whether the letter reached the Prime Minister or not. Or if it reached at all whether he could read it or not, he was busy in Bihar elections. But on 26th March, 2017 after a year and half he granted my wish in a manner i could not have asked more. In his Man ki Baat on 26th March, 2017, Prime Minister, Narendra Modi created history when he said-

“This year on the occasion of World Health Day on the 7th of April, United Nations has focused on Depression, which is the theme this year. We are familiar with this word, depression. According to one estimate, more than 35 crore people in the world suffer from depression. The problem is that we are unable to fully comprehend it even amongst those around us, and perhaps we also hesitate to talk about it openly, with our family and friends. The person suffering from depression too doesn’t speak out himself as he feels a sense of shame about it.

I want to tell my countrymen, that depression is not incurable. There is a need to create a psychologically conducive environment to begin with. The first mantra is the expression of depression instead of its suppression.

Share openly what you are going through, with your colleagues, friends, parents, brothers, and teachers. Sometimes one is overcome by a sense of loneliness – – – students living in hostels are particularly vulnerable to it.

We are fortunate that we have been raised in joint families, large families, where there is communication, which eliminates the chances of getting into depression. But I would still like to tell parents that if you notice your son or daughter or any other member of your family – – – earlier the entire family used to dine together. But if someone in the family says, “No, I will eat later.” He doesn’t come to the dining table. When the entire family is going on an outing, he just says, “No, I don’t want to come today.” He professes a desire to be alone. Have you ever wondered why he does so?

You can be sure that this the first step towards depression. If he prefers to stay away from a group, and tends to be all by himself, do make an effort to ensure that this does not happen. He should be given an opportunity to be amongst people with whom he speaks openly. Try to encourage him to express himself, to reveal and bring out his insecurities and complexes while engaging him in light-hearted happy conversation. This is a very good way of dealing with it.

Depression can be the root cause of many mental and physical ailments. Just as diabetes can be the root cause of all sorts of diseases, depression too, destroys all our abilities to sustain, to fight, to display courage and to take a decision.

Your friends, your family, your surroundings, and environment, all these can prevent you from going into depression and if you unfortunately has gone into it, they can also pull you out of it.

There is another way. If you are unable to express yourself to your family and friends, then do one thing, go out in society with a sense of service. Devote yourself with all your heart into helping others and sharing their joys and sorrows. You will find that along with it your own inner sufferings will go on disappearing.

If you try to sympathise with the sufferings of others with a sense of service, a new self-confidence will be born within you. By connecting with others, serving them and serving them selflessly, you will easily be able to shed the weight oppressing your own heart and mind.”

Sunday 26th March, 2017 will go as a red letter day, in the History of de-stigmatization of Mental Illness of India-on this day Prime Minister Narendra Damodar Modi, became the first ever Prime Minister of India, in the Seventieth Year of Independence to passionately, doggedly and openly espouse the cause of Mental Illness in general and growing Depression in Particular and he also espoused inclusive familial, community and societal solution away from the dogma of institutions so deeply ingrained in Indian psyche

  • And the Indian Temple of Democracy Delivers its Verdict

Prime Minister’s Man Ki Baat became the perfect launch pad to set the tone of Lok Sabha debate on Mental Health Care Bill 2016 when it reconvened on Monday. Member by Member lauded bill, few wanted more improvement but all supported the Bill. There was a clamor for speaking on the Bill, and Lok Sabha, did patiently hear all 29 nine members who participated in the debate. I would separately write on who said what, but it was a never before happened scene on Lok Sabha for many years on any Bill. It had never before happened in the country.  Finally at 18:09:36 hours, the Bill was passed unanimously, after clause by clause adoption of the Bill duly rejecting all the Amendments moved by opposition.

Aptly while, replying to the Debate before moving the motion to pass the Bill, Honorable Health Minister Shri Jagat Prakash Nadda gave a powerful Message while referring to the Advance Directives:

 “I hope all of us here in the House are in good mental health. But should any of us sense deterioration, we can nominate beforehand.

  • Road Ahead is a Road Not Traveled

Times of India in its historical lead editorial dated 29th March has described the Bill as “a Positive Legislation-that provides template for sensitive choice based approach to treatment” and it definitely is a path well traveled so far” but make no mistake, the road ahead is uncharted and untraveled. The very first challenge is rules and regulations and excellent bills fall often at the first implementation hurdle. So it is time to UP the Ante both for the government and all the Stake Holders. Time to rest on laurel has not yet come.

Needless to say it is a 100 year tortuous war to banish two millennium old stigma and to provide care and rehabilitating the mentally ill more so destitute and those at the margin at the Bottom of the pyramid

  • I am humbled and continue in my small way to contribute

I was a rather late entrant to Mental Health Movement, who was brought centre-stage of the Mental Health Movement turbo-charged by two power-houses Vandana Gopikumar and Vaishnavi Jayakumar of “The Banyan Fame” and owned by those working selflessly in Mental Health and Disabilities movement for decades self lessly.

My journey as a Mental Health expedetionist humbly started in 2010   with two Editorial Page Articles in The Economic Times-

“Rising Urban and Professional Suicides (http://epaper.timesofindia.com/Repository/getFiles.asp?Style=OliveXLib:LowLevelEntityToPrint_ETNEW&Type=text/html&Locale=english-skin-custom&Path=ETM/2010/01/23&ID=Ar00800)

and

Economic Cost of Mental Illness -An Open Letter to Prime Minister (http://epaper.timesofindia.com/Repository/getFiles.asp?Style=OliveXLib:LowLevelEntityToPrint_ETNEW&Type=text/html&Locale=english-skin-custom&Path=ETD/2010/06/01&ID=Ar01201)

and in the same year as TV Journalist asking Decriminalization of Suicide and repeal of Section 309 IPC (https://www.google.co.in/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=Akhileshwar+Sahay+as+Citizen+Journalist&*

Today I stand numbed and humbled. An audacious dream is achieved and the Carvan Moves on to next stop. More Power to every one who has contributed to the making of this dream Legislation.

And a big thank you to Hon’ble Prime Minister, Hon’ble Health Minister and Parliamentarians belonging to diverse parties who have made this incredible journey a reality from dream

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