The National Human Rights Commission (NHRC) has highlighted serious concerns about the poor state of Mental Healthcare Institutions (MHIs) in India, noting violations of the Mental Healthcare Act (MHA), 2017. The NHRC reports that many patients are held in MHIs even after recovery, breaching Article 21 and failing to uphold international covenants on the rights of persons with disabilities, which India has accepted.
- The Act does not provide for the advance directive to minors, as per Section (5) of the said Act.
- The Centre and State both have responsibilities as per the Act; it does not provide sharing of funds between them.
Background of Mental Healthcare Act, 2017
The Mental Healthcare Act, 2017 (MHA 2017) represents a significant shift in India’s approach to mental health legislation, transitioning from the Mental Healthcare Act of 1987. The previous Act primarily focused on institutionalization, granting disproportionate authority to judicial officers and mental health establishments. This often led to long-stay admissions without informed consent, echoing the colonial-era ethos of the Indian Lunacy Act of 1912.
Mental Healthcare Act, 1987
The 1987 Act emphasized institutionalization, giving judicial officers and mental health establishments the power to authorize admissions. This often resulted in long stays and infringements on patient rights. The act followed the outdated principles of the Indian Lunacy Act of 1912, which stigmatized mental illness and linked it to criminality, leading to a lack of proper care and patient autonomy.
Issues with the 1987 Act
The 1987 Act faced numerous issues, including forced admissions and long stays without patient consent. The link between criminality and madness further stigmatized mental illness. This led to many individuals being held in mental health establishments against their will, isolating them from society and delaying their recovery.
Transition to MHA 2017
The introduction of MHA 2017 marked a significant departure from the past. It dismantled the clinical heritage attached to asylums and shifted the focus towards a more inclusive and rights-based approach. This Act aimed to integrate mental health patients into the community, ensuring better care and protection of their rights.
Key Provisions of MHA 2017
MHA 2017 redefined mental health care in India, aiming to provide better facilities and rights to patients. It defined mental illness as substantial disorders affecting thinking, mood, perception, orientation, and memory, which impair judgment and behavior. The Act also emphasized patient rights and established authorities for better governance.
What is Mental Illness?
The Mental Healthcare Act 2017 defines mental illness as substantial disorders of thinking, mood, perception, orientation, or memory that significantly impair judgment, behavior, and the capacity to recognize reality. It acknowledges the wide range of mental health issues, including those associated with the abuse of alcohol and drugs.
Patient Rights
MHA 2017 provides extensive rights to patients, including the right to make an Advance Directive, access healthcare services, and receive free healthcare. Patients are also entitled to community living, protection from cruel treatment, equality, confidentiality, and legal aid. These provisions ensure that patients are treated with dignity and respect.
Suicide Attempt Clause
The Act includes a significant clause regarding suicide attempts, presuming severe stress in such cases. This provision prevents the investigation or prosecution of individuals who attempt suicide, recognizing the need for compassion and support rather than punitive measures.
Establishment of Authorities
MHA 2017 mandates the creation of Central and State Mental Health Authorities to oversee the implementation of the Act. These authorities are responsible for ensuring compliance with the Act, setting standards, and monitoring the functioning of mental health establishments.
Challenges in Implementation of MHA 2017
Despite its progressive framework, the implementation of MHA 2017 faces several challenges. These include the absence of Mental Health Review Boards (MHRBs) in many states, inadequate budgetary allocation, societal stigma, and a lack of community-based services.
Absence of MHRBs
Many states have not established State Mental Health Authorities or Mental Health Review Boards (MHRBs). The absence of these bodies hinders the enforcement of standards and compliance, making it difficult for individuals to exercise their rights or seek redressal in case of violations.
Budgetary Constraints
Inadequate budget allocation and poor fund utilization are major obstacles. Many mental health establishments remain understaffed and underequipped, and there is a lack of training for professionals and service providers. This undermines the quality of mental healthcare services.
Stigma and Social Issues
Societal stigma and gender discrimination continue to affect mental health care. Many patients are abandoned by their families due to the stigma attached to mental illness. Women, in particular, face higher abandonment rates due to family disruption, marital discord, and intimate violence.
Lack of Community Services
There is a severe shortage of community-based services and rehabilitation opportunities. Although Section 19 of the Act recognizes the right to community living, there have been no substantial efforts towards its implementation. This lack of alternative services complicates access to rehabilitation and social integration.
Related Mental Healthcare Initiatives
Several global and national initiatives aim to improve mental health care. These efforts focus on raising awareness, providing support, and ensuring better care for individuals with mental health issues.
Global Initiatives
International efforts include World Mental Health Day, WHO’s Comprehensive Mental Action Plan 2013–2020, and the Mental Health Atlas. These initiatives aim to promote mental health awareness and integrate mental health into the global health agenda. Sustainable Development Goal (SDG) 3.4 also emphasizes reducing premature mortality from non-communicable diseases, including mental health disorders.
Indian Initiatives
Nationally, programs like the National Mental Health Program, Kiran Helpline, MANAS Mobile App, and Manodarpan play a crucial role in addressing mental health issues. These initiatives provide support, raise awareness, and offer resources for individuals seeking mental health care.
Conclusion
The Mental Healthcare Act, 2017, marks a significant shift in how we approach mental health in India. Yet, its true potential remains unrealized due to implementation challenges and societal stigma. As future civil servants, you have the power to advocate for better mental health policies and ensure the humane treatment of all individuals. Your role is pivotal in transforming this vision into reality.
