TW: The article addresses suicide.
Did you know that until a year ago, a suicide attempt could land Indians living with mental illness in jail? Imagine being depressed enough to attempt ending your life, and landing in prison instead of a care facility. This was the reality for many until the Mental Healthcare Bill decriminalised suicide in 2018.
Amidst the (welcome) deluge of mental health awareness articles on social media, it is easy to forget that, until recently, mental health care laws in India heavily penalised individuals with mental illnesses, leaving them no recourse for treatment. The fight to bring mental health to the forefront of political discourse has been long and hard-fought. Let’s look at the history of mental health laws in India.
The Indian Lunacy Act, 1912
As is evident from the year, this particular act was a British invention. The act, echoing the sentiments of the era it was created in, stressed on the importance of “lunatics” to be “locked away” in asylums. It focused more on removing the mentally ill from society instead of their treatment or cure. Naturally, this out-dated act needed to go, and in 1950, members of the Indian Psychiatric Society (IPS) came together to draft a bill to replace it.
Section 309 Of The Indian Penal Code (IPC)
When India’s constitution came into effect, mental health in the country was still governed by the Lunacy Act of 1912. Section 309 of the IPC further stigmatised India’s people with mental illness by penalising any person who attempted suicide with an imprisonment term of up to a year, or fines, or both. This law contributed significantly to the already rigid stigma surrounding mental illness in India, leading to isolation and discrimination of individuals with mental illnesses as well as their caregivers. In 1971, and again in 2008, the Law Commission of India suggested the deletion of Section 309, but the discourse around suicide remained dominated by pity instead of an understanding of mental health.
Mental Health Act, 1987
After IPS submitted their mental health bill to the government, it took several years for the bill to be passed in 1987, and it wasn’t until 1993 that the Mental Health Act finally came into force. The act laid the foundation for establishing Central and State mental health care authorities and services in the country, as well as safeguard the rights of mentally ill individuals. The act, however, wasn’t without flaws. Not only did it fail to categorise mental health care on the same level as primary health care, but it also took no steps to spread awareness in society.
Mental Healthcare Bill (MHC), 2016
The MHC Bill was first introduced in the Rajya Sabha in 2013 by the then Health Minister Ghulam Nabi Azad. The bill marked a significant departure from previous legislation because, for the first time, political discourse around suicide ventured into understanding mental illness and the rights of individuals with mental illnesses. The bill, first and foremost, decriminalised suicide attempts. It also preserved the rights and dignity of mentally ill individuals by allowing them a say in their treatment and directing the government to provide them access to mental health care services. After the UPA-led Lok Sabha dissolved, the MHC Bill was reintroduced by the NDA-led Lok Sabha in 2016 with several amendments and subsequently passed in 2017.
The Mental Healthcare Act, 2017
The Mental Healthcare Act, passed in 2017, came into effect in May 2018 and replaced the Mental Health Act of 1987. To the joy of most Indian medical practitioners and advocates of mental health, the act decriminalised suicide attempts in India. It also included WHO guidelines in the categorisation of mental illnesses. The most significant provision in the act was “advanced directives”, which allowed individuals with mental illnesses to decide the course of their treatment and also appoint someone to be their representative. It also restricted the use of electro-convulsive therapy (ECT), and banned its use on minors, finally introducing measures to tackle stigma in Indian society.
However, the BJP government’s amendments to the MHC bill has led to some gaping holes in the Act. The exact procedure to execute an “advanced directive”, for example, which laid out details about how and when individuals with mental illness could dictate the terms of their treatment, are missing. The Act also fails to include psychotherapists and counsellors within the purview of mental health professionals, while Ayurvedic and homeopathic doctors make the cut.
Decriminalising suicide is just one step towards alleviating the crushing isolation felt by people with mental illnesses in our country. Passing laws is one thing while implementing them is another.
The stigma around mental illness isn’t just social, it is built into our very systems of politics and healthcare. Until we push for a change in every sphere, there’s still work to do in tackling the epidemic of suicide in India.