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Thank you all very much. Dr Webster, Dr Jenny, Dr G.

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And all other friends, it's wonderful to be here.

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Thank you for giving me the opportunity.

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Now this the whole conference is called Mental Health in India Bridging the Gap and this particular session, the Mental Health Act in India.

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What next? And what I propose to do and I'll try and be as brief as I can is.

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When one talks about the mental health situation in India, one could start at different places depending on where one comes from,

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you know, persons living with the illness would start somewhere. Caretakers and families would start somewhere.

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Psychiatrists would start somewhere else.

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But as I was saying earlier, I've spent most of my life in government and I look at this from the from policy, from the policy side.

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And one very important thing which happened in India in recent years was the passing of the Mental Health Care Act of 2017.

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It finally came into law in 2017, but work began on it in 2010.

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And it's it's it's important. It's very significant. And I'd like to use that as the starting point.

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And I'd like to say something about what were the dominant themes that we considered that went into the making of the act, important issues,

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the act flags and where exactly we are now up because and I will say something about this that we were,

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were the assumptions we made justified were the expectations we had.

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Have they been borne out? And I think these are these are questions that we all need to talk about now.

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Two very big teams dominated the the the framing of the Mental Health Care Act.

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Of the first of these was visibility. And in fact,

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the exercise itself came out as a fallout of the United Nations Convention on the

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Rights of Persons with Disabilities RBD of 2007 and India having signed and ratified.

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We may even have been the first country to have ratified it. We're very good at ratifying U.N. documents and having signed and ratified CERP,

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it became incumbent on governments to see what the national legislation needed to be amended and.

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Early in 2010 is when this exercise began looking at the country's mental health, the Mental Health Act of 1987,

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to see what, what, how it needed to respond to our plea and what amendments I needed to be made.

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It at that point of time, it was still thought that. A few amendments were all that was necessary to the act and that nothing very

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much more needed to be done and we realised very quickly and I hope so on.

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It's I won't say more about this when he speaks that this was this job was not going to get done with just a few amendments.

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And as I said, the exercise began in January. Maybe by about June, we were clear that.

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A new law had to be written if Typekit had to be not only CERP compliant,

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but also more responsive to what by then were clear as the big issues facing persons living with mental illness.

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Now, this dialogue or lack of dialogue with the disability sector remains and will continue because

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there are huge issues with exactly the same time that we began this exercise the other day,

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the concerned ministry and Government of India began amending the Persons with

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Disabilities Act of 1995 because that also had to change in response to CRT.

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And there were many fights and many of these disputes related really to the contentious Article 12 of the RBD,

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which which basically states that all persons with disability at all times shall be assumed to have legal capacity.

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And as you can imagine, this led to all sorts of disputes.

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The whole nature of disability Indian laws to the current disabilities legislation also recognises mental illness as one of the types of disability.

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But this is a very difficult question. Is mental illness disabling?

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Do all people with mental illness regard themselves as disabled?

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Some do. Many don't. Some regard themselves as disabled at some times, not at other times.

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Parents, caregivers, families have a different take on whether the mental illness of someone they live with is disabling or not.

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So this whole business of disability and mental illness will continue to remain with us and I

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don't believe there is a there is no harmonious understanding of of where we are on this matter.

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Let me also say here's something that I've said often in gatherings like this,

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I've always believed the script was written draughted, negotiated and approved by people from the physical disability sector.

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Because everything in that applies like beautifully to physical disabilities,

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because the issue of building capacity is a non-issue when you're talking about physical disability.

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And it doesn't seem to have occurred to very many people that it could become an issue

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when you're talking about persons with disability arises out of mental illness.

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So that is one big set of issues that dominated the discussion and continues to remain a big issue.

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The other big issue, of course, was rights of the persons with illness and.

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This is something I'm personally very glad about that I do believe that the Mental Health Care Act of 2017,

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when it finally came out, did represent a very significant movement establishing the rights of persons with illness.

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This is not something that Indian jurisprudence. Adopts as a matter, of course, the Mental Health Care Act of the Mental Health Act of 1987,

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which was considered a very progressive and remarkable legislation for its time,

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was remarkable only in that it was marginally better than the Lunacy Act of 1912 nigh than 1987.

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Legislation did not think to establish the rights of persons with an illness and continue to take the broad line

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that persons with the illness needed to be treated for their own good personal illness needed to be treated,

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preferably in institutional surroundings, for their own good and in breaking this, this notion.

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And setting out from the start, which is why really here we couldn't really amend the act.

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We had to rewrite the act again was because our starting point changed that.

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Every person with illness has rights.

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And at all times, you must respect those rights, and those rights include the right to be not treated if that is what that person wants and to.

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India does not have legislation which guarantees the rights to health care.

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But we we have succeeded in putting in place legislation that guarantees you the rights to mental health get.

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And we hope that this will become a significant landmark and that more and more

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progressive legislation will come up that recognises the rights of persons affected.

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One quick point also about again, the understanding of the rights of persons with the illness varies enormously.

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Between sheeting between mental health professionals, which could include psychiatrists, psychiatric nurses, eye-catching social workers.

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Persons with the illness themselves, families, caregivers, guardians and institutional authorities, and everyone has a different take.

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I personally was most surprised by.

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How vehemently the family caretaker Guardian group reacted to this notion that the person with the most has rights.

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That and you see the argument always was, this is my child, this is my wife, this is my husband.

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I mean, who knows? Who cares more than I do? And it's a difficult question.

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Equally, there were persons with illness who who resisted the notion that family was the inevitable caretaker.

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You know. Anyone except my mother, you know, what kind of response that many people to the list would come out with.

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So it was interesting because and it was also interesting that the process we followed in draughting, the legislation was so public that,

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you know, everything was repeatedly endless rounds of discussion, online discussion, face-to-face meetings where a lot of these issues came out.

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So there are these two broad issues that you must always remember disability and the relationship between mental illness

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and disability and the rights of persons with living with illness as teams that will continue to drive this whole debate.

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Now, given that there are some specific points in the law which become important from the point of view of where we are going to be going from here.

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Some important legal concepts that you built into the law and some important administrative steps that need to be taken now.

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There are many things in this law and. But there are three aspects which I would like to call attention to which.

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Because they were. Unknown in our in our in our lawmaking process, this one is given the given the given the.

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Utmost importance of recognising the rights of persons with the illness we have built into the law.

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Two concepts one of an advanced directive and one of a nominated representative, as I said, and these concepts don't exist in Indian law.

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The Advance Directive basically says that any person, not necessarily a person with the most, any person, any time can leave.

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Instructions and directive on how that person would like to be treated in the event

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that the person was not in a position to express it so that if this person was say.

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In the grips of mental illness and unable to express a view could leave a statement saying, I do not wish to be treated.

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I do not wish to be taken to an institution. I do not wish to be given medication.

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Or indeed, I please take me to an institution. Please give me medication.

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So-and-so is my doctor. Now, this is important because it gives primacy to the fact that the wishes of the person are at all times

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more important than the wishes of the treating doctor or the family or the caregiver or anybody else.

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And finally, the notion of an advance directive is the notion of a nominated representative.

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But if I, for whatever reason,

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am not in a position to express a view so and so who need not be family is my nominated representative who will take all decisions on my behalf.

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So that is to what I regard as very important legal provisions that we've built into the law.

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The third, which is also very important, is. What what the law has to say on the matter of attempt to suicide.

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Now many people say that the mental health laws criminalise suicide in India, which is not actually true.

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Attempted suicide continues to remain a criminal offence under the Indian Penal Code.

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We are one of a very sorry list of countries along with Malaysia, Nigeria,

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Pakistan and somebody else where attempted suicide is still a criminal offence.

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And that was not a law that we could do anything about from the Health Ministry.

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But what we weren't able to do in this act was to say that attempted suicide.

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Any person who attempts suicide should be regarded as being under severe stress and that before any other action is taken against this person,

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this person should be taken to treatment. Now.

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It is true that I don't believe anybody in India has ever been convicted in a court, but having attempted suicide.

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But the probe, the provision that exists is enough to cause a lot of harassment.

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And so therefore our law tries to say that.

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Please think of this person as somebody who is under severe stress and see what needs to be done before you do anything else.

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Now these three legal sort of constructs within the act, there are many administrative measures which the Act introduces.

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Firstly, we the setting up of a central mental health authority.

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Setting up a state mental health authorities and the setting up of district boards,

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now why these are important is the district boards, if I can start with those.

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These are the very, very important purpose because those boards are meant that, if any,

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the law does not say that a person with illness will under no circumstances be institutionalised.

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The law recognises that there will be some persons. Whose illness at some point of time is so acute as to need institutional care.

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It has tried to temper this with the provision for advanced directive with the provision for a nominated representative,

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but recognises that there may be a situation and it's quite strict.

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I mean, you need.

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The opinion of two distinct positions before and the conditions under which the person is kept constitutional saw a very severely restricted.

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But the district board was created specifically for any person who has even given these safeguards who has been admitted to an institution.

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Of a place where a person can go in a pill saying, I have been admitted.

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Please explain to me why, please let me go.

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And therefore it serves a very important purpose that even after some person has been taken into an institution facility for treatment,

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that there is the option for that person to say, I want out of here.

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And it's that district board itself, the way it is constituted, and the law includes the person with the illness.

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Also on the board, who may be expected to understand the situation more a little more from the perspective of the person appealing to the board.

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So there is the district board, there's the state authority, there's a central authority, the old teaching establishments,

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whether the psychiatric wards and general hospitals, nursing homes are expected to be registered under these authority because it.

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Now this law, there's more to the law, but I mean,

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this is just the points I'd like to highlight the the the legal constructs in

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the law and the various administrative measures that would allow this law,

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despite the fact that parliament should debate and you can be very contentious.

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This law actually won support across the floor.

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It was originally moved in parliament by the previous government and was taken up for debate and passing by the Indian government.

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But then there was actually very little opposition and many members of Parliament cutting across party lines spoke.

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In favour of the law and it got passed.

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Now we have got the law, we have got not much rejoicing amongst some of us because what seemed what began in January 2010 finally ended in July 2017,

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seven years and a bit of which for reasons we don't have to go into now.

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Two years were completely wasted. But seven years we got the law through.

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Now where are we now? I mean, this just becomes very important for us now.

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Some of the big debates continue, the disability debate continues,

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the rights debate continues because it's not just there are some persons within limits who believe very strongly that.

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At no stage down under no circumstances will they accept any kind of treatment.

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We're not talking just about institutional treatment, no treatment.

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And that comes up again and again and again that it is my rights not to be treated.

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That is an issue that we need to remember. But it is on these.

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The legal constructs and the administrative mechanisms we put in that the situation is all very, very unclear now.

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I personally would like to see. The provisions regarding advance directives nominate a representative and a person

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attempting suicide to be treated is under stress to be challenged in court.

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Right.

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You should go to court and we do need to see a court ruling on them because it is only through precedents and you know that the case is built up.

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If somebody has left lays down an advance directive and if the family or caregiver objects saying that not all this is wrong

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and this should not be followed if the treating doctor wants to use advance directive because that's what the law says.

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If the family says no, the negative was written under pressure or whatever and the matter goes to court.

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I would like to see what the court rules because until such time as we have precedents being built up.

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Likewise, for a nominated representative,

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if a person with illness nominates Person X as the winner and then this person's relative says, No, I should be.

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This is an important issue because quite often there are issues of property, all sorts of things involved.

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Somebody challenges this art, and I am the only person I am the next of kin,

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I should be the person taking these decisions, and I would like to see the court rule on that.

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Likewise, in the suicide situation,

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if somebody is taken for treatment because the law says this person should be regarded as being under severe stress.

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I'd like to see another wing of the police department saying, no, no, no,

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this person needs to be booked under three zero nine of the IPC because it is only through this that there will that opinion public not public option,

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legal opinion will change, public opinion will change that.

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The notion that these are inbuilt rights promised by the law will be established and that is something that,

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to my knowledge, has not yet begun to happen.

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I, I I would like to think that quietly, these things are happening that people are leaving are writing down advanced directives,

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that people are nominating representatives and that these documents are being upheld normally.

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As for the law, whenever it's come up, but I'm not sure that that is actually the case.

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So we need to see where these things go. The administrative side is a little more difficult because.

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The sentimental letter has been set up. It's hopeless.

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It has been set up and we have luxury from the Banyan and London to set up the Banyan is a member of the CMJ and their tour,

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the one which is perhaps about the only reasonable person there is on that.

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So they have followed that word for word in how it is to be constituted.

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And they have created a body that just it's been created, so the boxes have been ticked off.

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But it's not doing anything, it is not doing what it was supposed to do now.

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So Mr. just tells me the 19 states have set up state authorities.

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Some are better, some are not so good. But we have to wait and see. The law very clearly sets out what their duties are, what they should be doing.

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Then are a lot of times they should be aware of where the treatment of persons with mental illness is taking place.

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What is happening? Are there qualified persons and things like this?

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Because these are all jobs, which this is a different story, not the Medical Council of India failed to do.

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But the state misled authorities under this law are empowered to ensure that there is.

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Well-functioning system in place for the treatment of personal illness,

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very little is known so far, it's taken them a while two years to set up the authorities.

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And. We don't actually know what's happening, we know even less about the constitution of the district boards,

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which are from the point of view of persons with list of the most crucial.

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Those are the boards that the person on the list has recourse to in the event of an issue.

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And underlying all of this is that all this takes government funding.

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Have the central and state governments shown in their budgetary papers a significant increase in the funding available to do these various things?

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And the answer is no, we have not seen this. It is true that there has not been a significant increase in funding for the health sector as a whole,

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but there certainly hasn't been increased for funding in the mental health sector.

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So these authorities, which are to be set up, these district boards, which are to be set up.

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In fact, without these structures, the functioning of the act itself,

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howsoever progressive and wholesome and forward looking at is the implementation is not going to happen unless

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investments are made in setting up these bodies and training the persons who are required to work with these body.

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That I think we have to wait and watch. Is this going to happen?

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If so, when is it going to happen? So these are all big questions.

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So. I can insure all I'd like to say is.

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I think India did well in putting in place the legislation that it has done.

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But it's almost as though we have run out of steam. But all our all our efforts, our energies went into.

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Framing a law with the view that, look, this is the long term requires the positioning of a well framed,

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progressive, people oriented, rights oriented law. But now everyone in the system has to pick up this law and run with it.

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The not not too many signs of that is happening, so we need to see more civil society groups getting involved.

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You know? Awareness taking the law, taking to citizens groups, talking about making people aware of what the law says,

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what the law promises them, more stuff, going to court my rights to mental health treatment,

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which the law promises to be, to be taken to court and for the court to rule, saying that yes,

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the law gives this person the right to treatment and directs the concerned state government to provide the treatment.

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So these are the sorts of things we keep we need to see happening and inshallah, these things will happen.

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Thank you.