Mental Health Act:
Health encompasses the composite union of physical, spiritual, mental, and social dimensions according to the World Health Organization (WHO), which recognizes that “mental health and well-being are fundamental to quality of life, enabling people to experience life as meaningful, become creative and active citizens.” Mental health is significantly different from general health as in certain circumstances mentally ill people may not be in a position to make decisions on their own. According to a study conducted by the National Institute of Mental Health and Neurosciences, India, in 2016, across 12 different states, the prevalence of depression for both current and lifetime is 2.7% and 5.2%, respectively. Approximately 1 in 40 and 1 in 20 people are suffering from past and current episodes of depression all over the country.
On March 27, 2017, LokSabha in a unanimous decision passed the Mental Healthcare Act 2017 which was passed in RajyaSabha on August 2016 and got its approval from Honorable President of India on April 2017. The new act defines “mental illness” as a substantial disorder of thinking, mood, perception, orientation, or memory that grossly impairs judgment or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs. Another highlight of this Act is to protect the rights of a person with mental illness, and thereby facilitating his/her access to treatment and by an advance directive; how he/she wants to be treated for his/her illness. Earlier with the Mental Health Act (MHA) 1987, there was a start for human approach for treating mental disorders with provisions for human rights but without emphasis on issues like consent. Provisions for voluntary admissions and special circumstances were started. As it involved the department of police and honorable courts in admission and discharge procedures, it had failed to remove virtual criminal flavor on admission of patients with mental illness. There was no time frame for maximum period of inpatient hospitalization for persons admitted involuntarily with exception of special circumstances.
The definition of mental illness encompasses in broader sense and is not equated with unsoundness of mind and has to be determined by international classification of diseases (ICD 10) and not by the past treatment or hospitalization. The broader definition of mental illness may lead to persons having milder mental illness to be branded as having mental illness leading to stigma and further may affect the persons for accessing treatment. The clause “mental conditions associated with abuse of alcohol or drugs” signify that de-addiction centres may come under the purview of act unless they specify that they give care for only substance abuse persons.
Suicide attempt can be defined as a non-fatal self-directed potentially injurious behavior with an intent to die. More than one lakh persons (1,35,445) in India lost their lives by committing suicide in the year 2012 alone. The number of suicides in the country during the decade (2002-2012) has recorded an increase of 22.7%. Attempted suicide are at least 20 times more common than the completed suicide.
Decriminalization of Suicide:
According to Section 309 of the Indian Penal Code, “whoever attempts to commit suicide and does any act towards the commission of such offense, shall be punished with simple imprisonment for a term which may extend to 1 year or with fine, or with both.”
By the Mental Health Care Act 2017, which commenced in 2018, the scope of section 309 was limited without repealing it from IPC. The relevant provision reads as, “Notwithstanding anything contained in Section 309 of the Indian Penal Code any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished under the said Code.”India has now decriminalized the attempt to commit suicide and views the issue as one requiring treatment rather than punishment.However, accepted as a progressive move, the MHCA entails that the person attempting the commission of suicide shall be presumed to have severe stress and shall not to be tried and punished unless proved otherwise. The Act also bestows a duty upon the government to provide care, treatment, and rehabilitation to such persons in order to reduce the risk of recurrence of the same.
There is no awareness regarding the laws related to suicide and most of them are against criminalization of suicide. People are not willing to seek official help when they get suicidal ideas. It can be concluded that there is ambivalence and ignorance in the society regarding suicide. Ambivalence could be due to the stigma associated with psychiatric consultation. In the background of these findings, it is reasonable to insist that public health policy makers consider planning programs to increase awareness regarding Sec 115 of MHCA. Ignorance can be removed through media and hospital-based efforts. In conclusion, even after 155 years of implementation of Sec 309 IPC, awareness is very poor. Sec 115 of MHCA will also fail if steps are not taken to increase the awareness. Furthermore, there is a need for follow-up studies to know the outcome in terms of change in suicide rate, seeking help, psychiatry referrals, and epidemiological data. Only time can tell the long-term effect of the implementation of this Act.