Mental Health Care Act, 2017 – A Dream Come True-When I deposed on the Bill to the standing committee of parliament on 4th October, 2013

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Above enclosed is the link of the Gazette Notification of the India’s audacious, transformational and revolutionary Mental Health Act, 2017 (Act 10 of 2017) as assented to by The President of India, on the seminal 7th April, 2017, the World Health Day when India joined the World to talk Depression and Mental Illness.

The Mental Health Bill, 2013 as introduced in the Parliament was largely written by my friend Soumitra Pathare (@netshrink on twitter) though many had contributed to make it the best possible legislation in stakeholders consultations and  otherwise.

When nearly a decade I commenced my “Aekla Chalo”  to make some difference to the life and times of Mentally ill in India, the country having a best practices Mental Health Care Act that put Mentally ill at its center was a mere pipe dream.

Hardly did i dream that such an audacious dream could come true in less than a decade.

But destiny, serendipity and zeal and hard work of some individuals (both inside and outside the government) have seen to it that the-“Dream Comes True”.

I do accept that the Act is not perfect. But I am also aware that the perfect is the enemy of the good- all I know that the new Legislation makes the country proud. And we now have to gear towards its implementation.

The Mental Health Care Act, 2017 is close to my heart for numerous  reasons- I am a user survivor of psychiatric services, I have been a care giver and continue to be one, I run a no-holds war against stigma surrounding mental illness, I have a dream of an India and which has zero incidence of suicide and I want India to be a truly inclusive place for its Mentally Ill.

I had my own tryst with the making of the new Legislation-divinity granted me the chance to make  contribution in my own small way during  the national consultation on Bill in 2011 March at Delhi, serendipity catapulted me as Member of the National Mental Health Policy Group where we brought some key refinements to various clauses of the Bill and most importantly  God sent me to the temple of Indian Democracy, the Parliament, where I deposed on the Bill before  the “Standing Parliamentary Committee on Health and Family Welfare”,  and I talked of my Big Dream.

On 4th October, 2013, in my written and oral deposition to the Honorary Standing Parliamentary Committee on Health and Family Welfare, I had talked about my following dream-

“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 do not 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.

So many people have contributed in the making of the Bill (Parliamentary Committee itself suggested 134 Amendments all of which made the Bill more robust and were accepted by the government and parliament) inside and outside parliament and inside and out side the government that it almost became a national festival.

Following i reproduce, verbatim my deposition on the Bill to the Parliamentary Committee on 3rd October, 2013 in Parliament House Annexe:-

ORAL AND WRITTEN SUBMISSION ON MENTAL HEALTH CARE BILL, 2013 to HONORABLE PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE 4th October, 2013

By

Akhileshwar Sahay, EX. I.RA.S.; Masters in Management (Asian Institute of Management, Manila)

Management Consultant, Change Agent and Life Coach

Principal Instigator and Managing Trustee, Whole Mind India Foundation, an Institution dedicated to improve the life and times of Mentally Ill in India

“Respected Honorable Members of the Standing Committee,

I am humbled to stand here before the august Committee to depose on the Mental Health Care Bill, 2013. At the outset I submit after carefully examining the broad objects and reasons and specific provisions, clauses and sub-clauses of the Bill that it is a progressive piece of proposed legislation whose time has arrived.

Truth is, this Bill has come rather late in the day and my prayer to august Committee is that this transformational Bill be converted into legislation (after due scrutiny and proposed changes by the committee) in the Winter Session of Parliament.

Honorable members, the idealist in me want many changes in the Bill.

Nonetheless, I am a realist first who accepts an ideal legislation is more of a utopia.  The proposed Bill has few infirmities which I believe are minor in nature and can be attended to now or later after seeing the “Actual Law at Work”.

But my humble submission is, delay in enactment in pursuit of an ideal Bill shall deny million sufferers of mental illnesses the benefit of this unique contemporary statutory cover for treatment, rehabilitation and protection of their rights.

Mentally Ill and their families have already suffered enough and their suffering is of humongous proportion.

I have a lot to say and the time is limited. I will make every endeavor to stay within the time permitted. Honorable members can stop me any time. Let me begin with what Dr. Bhim Rao Ambedkar, Father of the Indian Constitution had to say on 8th January, 1949 in the Constituent Assembly debate.

He said –

“We all agree that every person who is of unsound mind should be deprived of his vote. We all agree that unsound persons should not be included in the voter list. But the question remains as to who is to determine whether a person is of unsound mind or not. It seems to be that unless the qualification which is introduced in this motion say that a person can be excluded from the electoral roll only when he has been adjudged to be of unsound mind by some impartial judicial authority, seems to be sound proposition. Otherwise, to give the authority to a village Patwari not to enter a certain person in the electoral roll because he thinks that he is of unsound mind is really to elevate a cabin boy to the position of the ship captain”

Honorable Members, framers of the Constitution, were seized of the critical need to ensure that word “unsound mind” often used interchangeably with serious mental illness was not mis-used in the society. But with profound grief and consternation, I submit-

“Six decades have gone by, but the noble intentions and spirit of framers of the Constitution has largely been ignored by “We, the People of India”.

Mentally Ill in the country are today stigmatized, segregated, discriminated, profiled and mostly  incarcerated at homes, mental hospitals, prisons, beggars homes, streets , frequently chained and other wise dehumanized and worse occasionally  killed like monumental tragedy at Erwadi on 6th 2001, when 28 hapless chained mentally ill men, women and children were charred alive.

A large number of mentally ill also take their life through completed suicide-and those who survive suicide attempt, lead a condemned life.

Ground realities are scary- after 66 years of Independence- India remains rooted in Lunacy Act, 1858 (Lunacy Act, 1912 was a consolidating Act and Mental Health Act, 1987 was window-dressed version of 1912 Act) where as Bharat  remains mired in black magic and other abhorrent practices.

In the Statement of Objects and Reasons of the Bill, Honorable Cabinet Minister for Health and Family Welfare has rightly admitted –

“The Mental Health Act, 1987 was insufficient to protect the rights of persons with mental illness and promote their access to mental health care” it is in this context that, I urge the august Committee to see the object, reason and big-picture of this transformational Bill which puts a “mentally ill person” at the centre and makes a bold attempt to change their status from present “non-person” to one of “dignified existence in society”.

More of this a bit later.

Honorable Members; there is another pressing context to the Bill.

Present statutory limitations, policy vacuum and deep rooted societal stigma have caused grievous injury to mentally ill and their family, while  the curse, course and severity of mental illness has worsened fast- 10% Indians are estimated to suffer from Mental Illness (3% are severely ill). Worse, WHO predicts 1 in 4 of us will suffer at least once in life-time.

If this Bill does not become a statute soon, the country faces a pandemonium.

Today it is other person suffering from mental illness, tomorrow it will be us or our dear ones.

Mental illness is an equal opportunity disease. It attacks viciously people of all castes, class and religion equally, but those at the bottom of the pyramid, poor and destitute suffer most. Such a situation requires an inclusive statute- I believe this Bill passes the inclusive litmus test brilliantly.

I also posit, the Bill is broadly compliant with the spirit of major international conventions including UNCRPD. I wish full compliance was possible – but to me, a person who has great personal stake in the Bill, 100% compliance is utopia, else India an old signatory of HABITAT would not have had so many homeless whose number is only increasing.

Honorable Members, my prayer to you is to look, understand and analyse the need, big-picture, specific clauses and implications of the Bill in above context.

XXXXX

Before briefly commenting on the substantive provisions of the Bill, I seek permission to briefly touch upon-

“Who am I? What is my compact with Mental Illness? And what are my Dreams to stamp out stigma and discrimination attached to mental illness and to improve life and times of fellow country men and women suffering from such ailments?

Honorable Members, I seek your two minute indulgence to the “Dreams I have”, which are organically linked to the Bill and the promised future of persons suffering from Mental Illness.

Today memory takes me back to December, 1986, when as a young Civil Services probationer of Government of India, I was trained in appreciation of Parliamentary Conventions, Procedures and Rules in the same very Parliament House Annexe. But that is the story of a different era.

Back then I did not know “I suffered from debilitating incurable Mental Illness – Manic Depressive Insanity or Bipolar Disorder-which forces me to alternatively face numbing catatonic depression and killer super-storm of mania- both bring me often to the brink of destruction with devastating impact on the family.

I have spent more than 1000 days of adult human existence in vegetative state, where I had no mental capacity, and all decisions of my life had perforce to be taken by my wife.  At the extreme, the illness was so debilitating our two little sons largely grew in single parent family and had to play dad to their dad prematurely.

Honorable Members, “losing mental capacity to take informed decision” is rule rather than exception in severe mental illnesses like Bipolar Disorder, Schizophrenia, and Recurring Unipolar Depression and it is here that I find the provisions of “Advance Directive” in the Bill revolutionary in nature.

Advance Directive enables mentally ill to “Nominate their Representative” who will take decisions on his/her behalf when the capacity to take informed decision is undermined temporarily. It also allows a person suffering from mental illness to decide in advance how he is to be treated or not treated.

Admittedly, following due procedure, the Bill allows for revocation of Advance Directive. Nonetheless, the sufferer has a time-bound remedy available to get relief from the Review Board/ Commission.

Advance Directive is a novel concept which empowers mentally ill persons.  It is possible, in actual operation of provisions some teething trouble arises but the Bill has inbuilt safeguard that requires Statutory Commission to review functioning of Advance Directive and make suitable changes to the procedure. I consider it sufficient to prevent any inadvertent misuse.

Honorable Members, 15-25% of sufferers of Bipolar Disorder, the mental illness with which I suffer, commit suicide. Scientists concur about 50% of sufferers make one or more suicide attempts. Denial of illness, non-conformity with medication and lack of access to treatment cause havoc.

I myself was not supposed to be here with before the august committee. My place was in the grave, where my more than one aborted suicide attempts should have taken me to. Even when alive my Turbulent Mind is such, my real place like million other sufferers lies in asylums or staying incarcerated elsewhere.

It is destiny, my doctors, family, friends, employers and colleagues have created a broad rainbow coalition around me that ensures that I am present before you as an “on going concern”.

I submit,  globally research has established  90% of the  people who commit  or  attempt suicide suffer from mental illness-fifty percent of the 90% are those who are confirmed cases of  mental illness and in balance 50 mental illness can be traced back through psychological autopsy.

I pray to august Committee to look at Suicide prevention related provisions in the Bill as bold attempt to decriminalize suicide in a legislative environment where draconian 309 of the Indian Penal Code still remains in the statute book.

XXXXX

Braving all the storms of my tumultuous topsy-turvy life and Turbulent Mind, today I stand before you with a big   dream in my heart. The dream is over-ambitious, and burns with the same or more passion and ferocity as Dr. Martin Luther King Junior II had in his famous “I have a Dream” speech.

Honorable Members, the world just celebrated the Fiftieth Anniversary of the audacious “I have a dream” speech Dr. King where he said-

“I have a dream that one day every valley shall be exalted, every hill and mountain shall be made low, the rough places will be made plain, and the crooked places will be made straight, and the glory of the Lord shall be revealed, and all flesh shall see it together”.

Dreaming for equality of desegregation and voting rights for blacks in America, King Junior concluded with

“I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character”.

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.

XXXXX

Honorable Members, let me address few substantive provisions of the Bill. When I read between the lines of the Bill, I find in it an echo of my Dream. I list few of the averments of the Bill that are first baby steps towards actualization of my dream-

–     All persons with mental illness shall have capacity to make mental health care or treatment decision but may require varying levels of support from their nominated representative to make decision

–     The determination of a person’s mental illness shall alone not imply or be taken to mean that the person is of unsound mind.

–     Right of mentally Ill person to make Advance Directive and to revoke the same.

–     Right of mentally ill to live in and not be segregated from society.

–     Persons with mental illness to have a right to live with dignity.

–     Persons with mental illness to be treated equal to persons with physical illness in the provision of health care.

–     Governmental Responsibility to provide adequate resources including human resources within fixed time frame, including free treatment to persons with mental illness below poverty line.

–     Various duties enjoined upon the government to make life of mentally ill worth living including effective programmes to reduce associated stigma.

–     Empowered Statutory Central and State Mental Health Authority, Mental Health Boards at District level, and National Commission with representations of sufferers, care-givers and NGOS with time bound grievance redressal mechanism.

–     A bold attempt to provide psycho-social-medical support to survivors of Suicide attempt and decriminalizing suicide attempts, by taking them out of the ambit of Section 309 of the Indian Penal Code.

–     The provision of the Bill to have overriding effect not withstanding anything inconsistent therewith contained in any other law for the time being in force.

XXXXX

Honorable Members I propose no changes to the Bill, though my wish list is long.

I have followed the Bill formulation process closely for three years. I have examined its different versions. Every version has been a marked improvement over the previous one.

I have seen the Bill framing has undergone widest possible stakeholders consultation – five regional and one national consultation.  All versions of the Bill have been accessible for comments on Ministry website. I believe, the Bill in its present form has accommodated most valid observations and presents itself as a best practices Bill which meets contemporary demands, expectations and aspirations.

Idealist in me has long wish list of changes to the Bill. But I also know, ideal is the enemy of good and time for those changes will come later.

As time changes further Amendments to the Act will happen and I have patience to wait.

After all 118 Amendments have already been carried to the Constitution of India since its promulgation.

Mental Health Care Bill 2013, too once enacted can be further improvised with time.

XXXXX

To sum up Honorable Members, when on 6th August evening, 2010 at Rajghat I lit the first “Candle of Hope” with hundreds others, my status was one of an acutely mentally ill person. Unbeknownst to me, on that day, on my mere call, tens of thousands across different cities of India “Lit the Candle of Hope for Mentally Ill” at Gandhi statute and silently observed “India’s First Mental Health Awareness Day” and brought me to national stage of movement of long war to change life and times of mentally ill.

My dream on 6th August, 2010 was to bring the subject matter of mental illness to national mainstream.

I stand humbled today. With a contemporary best practices Bill before Parliament “my first dream has come true”.

The war is long and is to be fought on multiple fronts including homes and society, but my big hope today is, my “Big Hairy Ambitious Dream” too will be actualized sooner than later.

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