September 11, 2018
The new Act adopts a rights-based approach & places obligations on the central & state governments to put infrastructure, resources & budgets.
The World Health Organization (WHO) estimates India has only 0.3 psychiatrists, 0.07 psychologists & 0.12 nurses available per 1,00,000 people.
The National Mental Health Survey, 2016, estimated that over 85% of people with common mental disorders such as depression or anxiety disorder & 73.6% of people with severe mental disorders such as psychosis or bipolar disorder don’t receive any mental healthcare & treatment.
There is also a wide variability in availability of mental health services — while urban areas have some services, the situation is dire in rural areas, as the case of Dhaval illustrates.
Since the 1980s, the National Mental Health Programme & the District Mental Health Programme have sought to bridge this gap, by integrating mental healthcare at the primary level of the public health system.
However, this faces significant implementation challenges & resource constraints. The public mental health system faces infrastructure gaps, financial deficits (India spends less than 1% of its total health budget on mental health) & socio-cultural barriers, such as the stigma that Dhaval’s mental illness carries which results in improper psycho-social support.
Several cases of human rights violations of people with mental illness have been documented over the years, including inappropriate or forced treatment, sub-human living conditions in hospitals, inappropriate use of physical restraints & seclusion in care facilities.
In this landscape, The Mental Healthcare Act, 2017 (MHCA) is a historical intervention which, if implemented well, can prove to be a game-changer.
Two specific features stand out. First, the act adopts a rightsbased approach. It places obligations on mental health services & prescribes procedures that ensure that mental health professionals offer treatment in accordance with a person’s will & preferences.
The law provides for the right to make advance directives— a person may state how they wish to be treated (or not) in the eventuality that they have a mental illness & can’t make decisions for themselves at that point.
Additionally, the law recognises an entire gamut of rights relating to confidentiality, access to medical records, protection from cruel treatment and non-discrimination based on social markers, including sexual orientation.
These rights are to be protected at all times when a person is undergoing mental healthcare & treatment as an admitted patient or otherwise. Any violation or deficiency in services can be reported before the Mental Health Review Boards. Non-compliance with any of these provisions will result in punishment & imposition of penalties.
Another significant aspect is that this is the first law in India which has mandated universal mental healthcare for all citizens. Indian legislation until now hadn’t recognized a right to healthcare as a universal right. Access to mental healthcare stresses on affordability, quality & non-discrimination.
How does the law envision this? It offers a decentralized model, placing obligations on the central & state govts. to put infrastructure, resources and budgets in place to bridge the deficit in mental health services and facilities.
This includes integrating mental healthcare at the primary, secondary & tertiary levels, setting up community-based rehabilitative facilities, offering free mental healthcare to below poverty line families, like Savitabai’s, & providing free essential medicines, among other things.
The act also places an obligation on insurance firms to provide health insurance to persons with mental illness on the same basis as other physical illness.
The current mental health landscape in India is bleak, but there’re many organisations & individuals working to transform it. Take our experience: Since 2017, we have worked on a project called Atmiyata, which is a community mental health intervention in Mehsana district of Gujarat that trains community volunteers to provide lay counselling, referrals & linkages with social benefits to individuals in distress.
Today, our outreach extends to over 1 million people. Involving the community through scaled-up grassroots-led approach is both an opportunity & a challenge, but it’s one way in which stakeholders like us can help actualize the law’s mandate for universal mental healthcare.