[Polity] Rights of Persons with Mental illness and [Public Health] Mental Healthcare Bill: Features, Criticism

Mrunalpolity23 Comments

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  1. Two issues with Mental illness
  2. #1: Taboo
  3. #2 Abuse
  4. What is Mental Illness?
  5. Examples of Mental Illness
  6. Rights given to Mentally ill patients
  7. Right to Non-discrimination
  8. Right to live with dignity
  9. Confidentiality
  10. Free treatment
  11. Right to Humane Treatment without cruelty
  12. Right to Personal Contacts & communication
  13. Right to Information
  14. Right to make Complaints
  15. No punishment for Suicide Attempt
  16. Right to Legal Aid
  17. Duties of Government
    1. Authority #1: Mental Health Review Commission
    2. Authority#2: State Panels of the Mental Health Review Commission
    3. Authority#3: State Mental Health Authority
    4. Duties of Police Officers
    5. Duties of Prison Authorities
  18. Diagnosis and treatment
  19. Independent patients: Advanced Directives
  20. Incapable patient
  21. Minor Patient
  22. Compulsory registration of Mental Health Establishments
  23. Medical Research on Patient

Two issues with Mental illness

#1: Taboo

  • Mental illness is curable just like a physical disease. Although there are some diseases where 100% cure is not available but still with the use of drugs and therapy, a patient can serve as a productive member of the society.
  • Yet there exists lot of stigma and misunderstanding in the society.
  • By and large, society believes that if a person was mentally ill, he will remain mentally ill forever. Therefore such person has hard time finding a job/bride/getting accepted by the society.

#2 Abuse

  • Sometimes the relatives of mentally ill persons, are interested in lodging him into the asylum forever- to grab his property.
  • Sometimes family members donot send the mentally ill person to the asylum fearing that his brothers and sisters won’t find suitable marriage partners. Then such person is forcibly confined at home, sometimes even chained and ill-treated.
  • There are many bogus mental health care institutes, where patients are ill-treated, sometimes even sexually abused.

The Draft Mental Healthcare bill, tries to fix both this issues.

What is Mental Illness?

  • a disorder of mood, thought, perception, orientation and/or memory.
  • Includes mental conditions associated with the abuse of alcohol and drugs, but excludes mental retardation (e.g.Down’s syndrome).
Examples of Mental Illness
Name Symptoms
Paranoia Patient has deep conviction that everyone, including his or her closest family members, wants to injure or destroy him.
Heavy Depression Patient feels that life is so dreary and unhappy that it is better to commit suicide.
Anorexia person has an intense fear of gaining weight. He severely restricts food intake and usually becomes extremely thin.
Phobia intense and persistent fear of a specific object for example telephone, spiders etc.
Obsessive-Compulsive Disorder(OCD) Common obsessions include fears of contamination from germs, doubts about whether doors are locked or appliances are turned off, hoarding vast amounts of useless materials, and repeating words or prayers internally. Such persons keeps repeating same activity over and over again.
Schizophrenia A person with schizophrenia has difficulty telling the difference between real and unreal experiences, logical and illogical thoughts, or appropriate and inappropriate behavior. He avoids social contacts, hears voices inside his that command him to act in strange or unpredictable ways.
Dementia/Alzheimer’s Disease In the early stages, patient experience some memory loss  then to a decrease in thinking ability such as decision making. Later such patient cannot perform daily activities or recognize his loved ones, because of damage in brain cells.

Rights given to Mentally ill patients

The draft Mental healthcare bill gives following Rights
Right to Non-discrimination

  • Public and private insurance providers cannot deny medical insurance to a person because he has (or had) medical illness.
  • Mentally ill patient is entitled to the use of ambulance services in the same manner and quality as provided to persons with physical illness.

Right to live with dignity

  1. All persons with mental illness have a right to live in, be part of and not be segregated from society.
  1. A person cannot be labeled as mentally ill merely because
  • He took past treatment or hospitalization  in mental health establishment
  • His behavior is in non-conformity with moral, social, cultural, work or political values or religious beliefs prevailing in a person’s community
  1. proof of a person’s current or past treatment for mental illness shall not by itself be ground for granting divorce
  2. No person with mental illness shall continue to remain in an asylum, merely because he does not have a family or is not accepted by his family or is homeless. It’ll be responsibility of the Government  to provide them shelter/community homes.
  3. Mentally ill person cannot be locked up in police custody or in jail.

Right to Confidentiality

  • No person or authority shall classify that a person has (or had) a mental illness, except for purposes directly relating to the treatment of mental illness. For example, a newspaper cannot write a report like “Thieves robbed Mr.X but he unable to recall their faces because of dementia.”
  • A person with mental illness has a right to confidentiality in the context of his mental health, mental health care and physical health care.
  • Protection of privacy, in particular for women – during and after treatment.
  • Right to confidentiality also applies to all information stored in electronic format / website / in public or private sector.

Right to Free treatment
Government shall provide budgetary allocations so that

  1. No person with mental shall have to travel long distances to access mental health services.
  2. Free treatment to Mentally ill person who are poor (with or without BPL card) or destitute or homeless.
  3. As a minimum, essential medicines shall be available free of cost to all persons with mental illness at all times at health establishments.

Right to Humane Treatment without cruelty

  1. No patient shall be subjected to any cruel, inhuman or degrading treatment in a mental health establishment
  2. Not to be forced to undertake work in a mental health establishment
  3. to not be subject to compulsory tonsuring (shaving of head hair).
  4. not be forced to wear uniforms provided by the hospital.
  5. To be protected from all forms of physical, verbal, emotional and sexual abuse.
  6. No Electro-convulsive therapy or shock therapy for minors
  7. For adult patient- ECT/Shock therapy only with use of anesthesia.
  8. No Sterilization of men or women
  9. No chaining of the patients
  10. provision for food, space, and articles of personal hygiene during the stay in hospital.
  11. have facilities for leisure, recreation, education and religious practices.

Right to Personal Contacts & communication

  1. A patient in mental asylum has the right to refuse or receive visitors.
  2. He shall be allowed to make a reasonable number of telephone/mobile phone calls at reasonable times of the day.
  3. He shall be allowed send and receive mail and email.

Right to Information

  1. A person with mental illness and his Nominated Representative shall have the right to know the nature mental illness and the proposed treatment plan including the side effects of drugs.
  2. If the patient is unable to understand such information because of his illness, still his nominated representative can ask for the information.
  3. When the treatment is complete, the ex-patient can ask for all the details regarding the treatment and medicines given to him.

Right to make Complaints

  • A mentally ill person or his nominated representative can complaint for Deficiencies or poor quality of treatment given in the hospital to the State Mental Health Authority
  • and if not satisfied with the response he can approach State Panel of the Mental Health Review Commission

No punishment for Suicide Attempt

  • Any person who has attempted to commit suicide shall be examined by a psychiatrist.
  • If the psychiatrist certifies that the person has a mental illness, then such person cannot be prosecuted for attempted suicide under Indian Penal Code (Section 309).


  • This can only be described as a stop-gap arrangement.
  • The section 309 of Indian Penal Code should be deleted. No person should be tried for attempting suicide, irrespective of what psychiatrist says about his mental condition.
  • The only countries in which attempt to suicide is punishable are India, Pakistan, Bangladesh and Malaysia. The penalty had its roots in the religion that considered life and death as godly acts over which man should not have any control, notwithstanding the legality of capital punishment.
  • But Scientific studies have proved that a person attempting suicide is a victim of circumstances and deserves sympathy and psychiatric treatment, rather than punishment.

Right to Legal Aid

  • Person with mental illness shall be entitled to receive free legal services to exercise any of the rights given to him.

Duties of Government

  • Through television, radio, print and online media, display ads to create awareness and reduce stigma associated with mental illness.
  • Government  shall setup following authorities for securing the rights of Mentally ill patients.

Authority #1: Mental Health Review Commission

  • HQ: Mumbai


  1. President =serving/ retired Chief Justice of a High Court
  2. Psychiatrist with at least 15 years experience
  3. a person with mental illness or representative of persons with mental illness and,
  4. representative of families and care-givers to persons with mental illness or NGO in the field of mental health, and
  5. One member with a background in public health administration.


  • Appoint and remove members of the State Panels
  • Give guidance to the State Panel
  • Advise the Central Government on matters relating to the promotion and protection of rights of persons with mental illness

Authority#2: State Panels of the Mental Health Review Commission


  1. Chairman: Serving / retired District Judge
  2. Representative of the District Collectors
  3. healthcare professionals
  4. Persons with past mental illness/ care givers/ NGOs


  • It’ll entertain the complaints from mentally ill persons / their nominated representatives.
  • In exceptional circumstances, the State Panel shall accept an application made verbally over telephone from a person admitted to a mental health establishment.
  • It’ll have judicial powers to call for evidences, witnesses.
  • It can impose punishment ranging from six months to two years and/or fine from Rs 10,000 to Rs five lakh
  • Visit jails to make sure no mentally ill person is forcibly lodged in it.
  • Registration, renewal and modification of advanced directives (and maintain electronic database) and give that database to concerned psychiatrist. (explained in bottom part of this article)

Authority#3: State Mental Health Authority

  • This will be made up of Secretary, Department of Health, State Government and other Government officials.

Functions of State Mental Health authority

  1. Inspect and register all mental health establishments in the state.
  2. maintain and publish (including online on the internet) a register of such establishments.
  3. supervise all mental health establishments in the State and receive complaints about deficiencies in provision of services.
  4. make rules and regulations for the registration of clinical psychologists, mental health nurses and psychiatric social workers in the State.
  5. Train judicial officers, police officers, mental health professionals etc. about the provisions and implementation of this Act.
  6. Advise the State Government on all matters relating to mental health care and services.

Duties of Police Officers

Wandering people

  • If the police officer believes that xyz person wandering around his area, and has mental illness -then he shall to take him to the nearest public health establishment. Two situations can happen

Situation 1:

  • If the psychiatrist certifies that xyz person has mental illness, then
  • Police officer shall lodge an FIR of missing person, try to find the relatives/family members of that patient.
  • he’ll produce the patient in front of magistrate, and magistrate will send him to a mental asylum for treatment.

Situation 2:

  • If the psychiatrist certifies that xyz person doesn’t have mental illness, then
  • Such person will be sent to either his home or to Government establishment for homeless people.
  • In either situation, a homeless/wandering person cannot be locked up in police custody.

Cruel family members

  • If the police officer believes that xyz person living (not wandering) in his area, has some mental illness but he is forcibly confined in his home or neglected or mistreated by his family members. (just like Anupam Kher in the movie “Betaa”)
  • Then the police officer shall bring this matter before a Magistrate, who shall decide the future course of action.

Duties of Prison Authorities

  • The Medical officer of every jail shall send quarterly reports to the State Panel that there are no prisoners with mental illness in my jail.

All sounds well and good until now. But still the experts are criticizing this bill heavily, why?

Let’s examine those provisions of the bill.

Diagnosis and treatment

There are two types of patient:

Independent patients: Advanced Directives

  1. Those in a early stage / mild disease. They are aware of what they’re doing and they’re capable of making decisions e.g. “yes I feel I’ve xyz disease and I need to get treated”
  2. These people can write an application called “advanced directives” this is similar to property will. It lists the directives like where do you want to get treatment, who is your nominated representatives to decide treatments or legal actions on your behalf etc.
  3. State Panels of the Mental Health Review Commission will keep this database and provide it to the concerned hospital or psychiatrist.

Incapable patient

  1. Those who are suffering from some severe mental disease/emergency situation
  2. They’re completely dependent on family and relatives for every decision.
  3. Such person can be admitted to a mental care institute on the written consent by his guardian/nominated representative. But he cannot be kept in the institute for more than 30 days. After every 30 day, the psychiatrists will have to give certificate whether he is treated or required further medical care.
  4. State Panels of the Mental Health Review Commission will keep an eye on such cases.


  • The State Panels will be usually under-staffed, they cannot physically visit and check every patient. And this give ample opportunity to abuse the law for example
  • A private mental institute has profit motive to keep writing reports that person still needs treatment after every 30 days.
  • If the family members/relatives of the patient want to grab his property, they’ll also not raise objection to above practice. In fact they might encourage the private institute to keep the patient lodged in forever.
  • Thus this bill deprives liberty of disabled persons and favours medical professionals and psychiatrists.
  • the role of the judiciary has been taken off and a psychiatrist can decide whether a person can be put in mental asylum or not.

Minor Patient

  • A person less than 18 years shallnot be admitted to mental care institute except in exceptional circumstances.
  • He cannot be given Electro Convulsive Therapy (ECT) or shock therapy.


Banning of Electro Convulsive Therapy (ECT) or shock therapy altogether in minors can be a problem because many a time it is an emergency life-saving procedure. Say a 16-year-old with severe depression is wheeled into the OPD with indications of suicidal ideation; do we not give him ECT? The legal provisions should not affect the medical aspects of care.” (Dr Roy Abraham Kallivayalil, national president of Indian Psychiatry Society)

Compulsory registration of Mental Health Establishments

  • Bill says No person or organization shall run a mental health establishment unless it has been registered with the State Mental Health Authority. You’ve to apply, they visit and inspect your premises and give you the license.


  1. Will lead to license-inspector-bribery raj.
  2. The penalty provisions are not deterrent enough, as there is only a fine of Rs 50,000 proposed on the first offence
  3. There is no scope for general hospital care of psychiatry. Mentally ill persons have to be treated in separate registered institutions.
  4. We have only 4,000 psychiatrists in government and private sector together. Compulsory registration would lead to many private hospitals shutting shop. This would add to the existing shortage of specialists.

Medical Research on Patient

  • Medical professionals can conduct research, on patients with mental illness – including testing of drugs, but only after taking written consent of patient or his nominated representative/ guardian.


  • Private hospitals have profit motive in allowing pharma companies to conduct research. And if such companies offer money to nominated representative/relatives, then imaging the plight of a patient- they will be turned into Guinea pigs.
  • Bill needs more stringent provisions and oversight over medical research on mentally ill patients.
Indian History Freedom Struggle Pratik Nayak

23 Comments on “[Polity] Rights of Persons with Mental illness and [Public Health] Mental Healthcare Bill: Features, Criticism”

  1. Hello sir,

    I wanted to know whether Main pattern examination will be changed by 2013 or not since
    i saw article in Time’s, Agarawal Sir has mentioned examination pattern change is inevitable
    and one of my friend told in 2013 main exam is in november so def there will be pattern change
    sir if you find any information about pattern change please intimate immediatly so that we can stop studyig our own selected option.

    Thank you

    1. Mrunal sir have already intimated that “They(UPSC) are not providing current status/ opinion on exam changes even through RTI act” and knowledge gaining will never get useless. keep more concentration and time on dynamic topics(observed in 2012 papers).

    2. Vijayalakshmi ji,

      Everyone who is preparing for 2013 has the same doubt in mind. This indeed now requires from our side a smart preparation plan before any notification comes from UPSC so that we do not waste our valuable time in discussing it. Looking at the question papers of 2012 it is quite clear that we have to prepare with a very broad framework focusing upon understanding and not mere learning.
      If you are planning to choose a subject which makes a sufficient part of GS mains, so in my view that should be completed before the notification so that you will be having atleast 5 months after CSAT and before Mains to prepare for another optional(in case pattern remains same.

      Geog, Hist, Pub Ad, Polity – I think they will have sufficient weightage even if the pattern changes. I hope you understand what I am trying to say. Rest prepare well. Nothing gets into a waste specially with UPSC. :p

      1. very true.. Nothing gets into waste specially with UPSC…….. your preparation will not go in vain..:)

  2. Personally, I don’t think there is going to be change in mains 2013.UPSC has already notified the date of commencement of exam and it will be spread around 21 days just like previous years.People are worried about the fact the mains has been delayed by about a month,but please note that prior to ,2012 mains was generally held in last week of october (it started from 29th oct in 2011).Also if UPSC notifies the change even say today or tomorrow , it would defeat the very purpose which the changed pattern sought to accomplish.

    1. KP ji,

      You have made a valid point regarding the spread of exam for 21 days but somehow ironically you have missed the note stated right after the calendar which goes like this :-


      So I feel making a speculation on the basis of no. of days doesn’t make sense. We have to be flexible enough. :)

      1. Please note that only “date of notification and date of exam are liable to alteration if circumstances so warrant” and nothing else. If I guessed it right what u r trying to say is that UPSC will first create such a circumstance by changing the pattern of main and then notify another date of commencement and examination.In the first place if a change of pattern was on the cards this schedule would not have been declared.if another schedule comes out ,it would result in loss of credibility of UPSC.Its image will be reduced to a body with no clear cut vision to implement future plans.

        1. IMO they have a different plan in mind. Upsc has already proposed the changes and waiting for the approval by the cabinet. But since the cabinet Is going after some big reform measures these days, it is not getting time to go through and give green signal to the changes by upsc.
          Dates have been postponed by a month so that even if cabinet approval comes by January, they can effect the changes in 2013 itself but if it gets late, which is common with govt decisions , they will incorporate it with effect from 2014.
          Let’s not wait for the same and carry on. Nothing is a surety as of now.

        2. KP ji,

          Why would they notify another date? The date for notification is on 02.02.2013. I wanted to say that number of days is not a guarantee that pattern won’t change. Even the date of commencement of exam will also not change. They have reserved a slot. Moreover, the schedule gets declared not merely thinking about the Civil Services exam but other exams as well. The very first exam of SCRA is going to be held on 20.01.2013 and hence they had to release the schedule.

    2. It started in october last in 2011 only because that year prelims was on 20th of June. They usually give around 4 months time in every mains but this time more than 5 months.. :)

      1. Even in 2010 & 2009 it started from 29th & 23rd october. The point I am trying to make out is that ,just because mains exam for 2013 has been scheduled a month later than this years , we can’t jump to conclusion that UPSC is going to change the mains pattern.Btw the gap in 2011 between prelims and mains in 2011 was only four month because prelims pattern was changed and CSAT was introduced.Prior to that it was 5 months.So nothing strange with next year schedule.

  3. I don’t know how to post a write-up on a partiular topic on this amazing blog. So, I am posting a summary of one important bill which is doing the rounds i.e. Promotion Quota bill. Hope this helps all of the exam-aspirants.


    1. In 1992, the Supreme Court in the case of Indira Sawhney v. Union of India had held reservations in promotions to be unconstitutional but allowed its continuation for five years from the date of judgment as a special case. The 77th amendment to the Constitution was made in 1995 inserting clause (4A) to Article 16 before expiry of five year which enabled the Government to continue reservation for SCs and STs in promotion which, in the opinion of the State, are not adequately represented in the services.

    2. The 81st amendment was made to the Constitution whereby clause (4/B) was incorporated in Article 16 of the Constitution which permits to treat the backlog reserved vacancies as a separate and distinct group, to which the limit of 50% reservation may not apply.

    3. The 82nd amendment was made to the Constitution whereby a proviso was incorporated in Article 335 of the Constitution which enabled the State to give relaxations/concessions to the SC and ST candidates in the matter of promotion.

    4. Clause (4A) of the Constitution was further modified through 85th amendment so as to give benefit of consequential seniority to SC/ST candidates promoted by reservation.

    5. The validity of all these four Amendments were challenged before the Supreme Court through various writ petitions clubbed together in M. Nagaraj v. Union of India mainly on the ground that these altered the basic structure of the Constitution.

    6. While upholding the validity of the amendments, the court held that the state is not bound to make reservation for SCs/STs in matter of promotion. However, if they wish to exercise their discretion, the state will have to satisfy the requirement of; (a) backwardness of the particular SC and ST group; (b) inadequate representation of the said group; and (c) efficiency of administration as mentioned in Article 335 of the Constitution.

    7. At the centre of the controversy surrounding the Promotion Quota Bill is a judgment delivered by a two-judge bench of the Supreme Court in U.P Power Corporation Ltd. v. Rajesh Kumar in April 2012.

    8. The Supreme Court struck down the UP Government Seniority Rules which provided for reservations in promotions. The court, relying upon the judgment of M. Nagraj case, held that the state government had not undertaken any exercise to identify whether there was backwardness and inadequate representation of Scheduled Castes and Scheduled Tribes in the state government services.

    9. In order to render the ineffective the basis on which the judgment of M. Nagraj case was pronounced the central government has introduced the Constitution 117th Amendment Bill, 2012. The Bill seeks to substitute Article 16(4A) of the Constitution of India.

    10. The Bill provides that all the Scheduled Castes and Scheduled Tribes notified in the Constitutional shall be deemed to be backward.

    11. Article 335 of the Constitution states that the claims of the Scheduled Castes and Scheduled Tribes have to be balanced with maintaining efficiency in administration. The Bill states that provision of the amendment shall override the provision of Article 335.

    12. The bill has been passed by the Rajya Sabha a few days back and has now been taken up for discussion and debate in Lok Sabha.

    13. If passed, the Bill will empower the state governments to provide reservation in promotions for government employees belonging to SC/ST without showing any empirical evidence as to the (a) backwardness of the particular SC and ST group; (b) inadequate representation of the said group; and (c) efficiency of administration as mentioned in Article 335 of the Constitution so as to justify the reservation in promotions (Possibly a lethal political weapon in hands of likes of Mayawati, Kaunanidhi etc. to use this as a bait to serve their political interests).

    For a critical analysis of this issue please refer to the following link

    http://www.thehindu.com/opinion/lead/winning-the-case-for-promotion quotas/article3863068.ece

  4. Is autism included under this Rights of Persons with Mental illness and [Public Health] Mental Healthcare Bill?

    1. I don’t believe it can be, neither can other Autistic Spectrum Disorders (ASDs) like Asperger’s Syndrome. This Bill mentions psychiatric treatments and drugs eventually leading to a cure. So far as I know, ASDs don’t have a “cure”. The behaviour can only be regulated.

  5. Does this mental health care bill is also applicable to those mentally retard persons due to drug addictions? Is there any law in india that prohibit mentally retards from inheriting their family’s property or wealth?

  6. This is regarding IPC section 309 – Case booked against persons who attempt suicide. The rationale behind this is to prevent dummy suicides say like “if you don’t give me seat or job in so and so i will jump”. Case slapped against such will prove to be a deterrent.

    But it’s no lie that suicide attempts are done out of mental depression or other factors and in such cases a case should if at all needs to be booked only after an analysis of the situation by a psychiatrist or a cop who is amply trained to identify whether it is bogus or genuine. Very strong and scientific principles or guidelines needs to be provided for identification of bogus or real. If it cannot be judged by the cop, the same should be identified by experts constituted.

    So, a person who attempts suicide out of depression, will he have to go through all of these? Isn’t it cruel? It is but not if done in a kind and rational manner, also people can be provided with appropriate care if medical or psychological or of any other kind.

    Discussion regarding the same are welcome.

    P.S : I have viewed the issue from all the stake holders – the attempted and the police. I don’t take any sides so any comments of personal nature will be ignored.

  7. Hey friends,

    I am fresher and i want to prepare for IPS. will you please prefer me any book or any suggestion regarding this. i am awaiting for your valuable reply…..

  8. hi! ur articles r really helpful. n uve done an amazing job with the comments bar on the right, providing an option to minimize it. is it possible to do the same with the one on the left. its a little distracting(quite a bit actually!). thanks a tonne!!

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