Mental health burden is one of the major health concerns worldwide. Limited access to mental health services, lack of awareness of mental health, associated stigma, lower literacy, poverty coupled with the unwillingness or inability of families to care for their mentally-ill family members appear to be the main contributory factors for the prevalence of mental health problems in India. Furthermore, widely prevalent religious beliefs associated with mental illness pose significant obstacles in seeking and finding appropriate mental health care services. In order to address these concerns, numerous policies and pragmatic initiatives have been taken by the GOI.

Mental health legislation has existed in India since the mid-19th century and it has gone through various changes over the years. The Indian Lunacy Act of 1912 was essentially the first law that governed mental health in India. This act focused on the protection of the public from patients with mental illness and this law was concerned only with custodial sentences. Hence, it was an act of protection against people with mental health issues.

The Indian psychiatric society suggested that ILA 1912 was inappropriate due to which another act i.e. Mental Health Act 1987 was passed and gradually implemented. This act defined mental illness in a bit progressive manner giving emphasis on the care and treatment of patients rather than custody. It provided detailed procedures for hospital admission under social circumstances and focused on the protection of human rights. Under this Act people with guardianship can manage the property of people with mental illness.

The criticisms of MHA1987 are mainly related to the legal procedures of licensing admission and guardianship. It was also argued that the issue of human rights was not addressed in this act.  In addition to these, insufficient treatment facilities led to the financial, social, and emotional burden on careers and families of the people with mental health issues. These criticisms led to the amendment of MHA1987 which eventually culminated in the formulation of the Mental health care bill 2013. This 2013 bill repealed the MHA 1987 giving a broader and changed definition of mental illness and tried to fix both the issues of taboo and abuse related to mental illness. The proposed law in the form of MHCB 2013 came after India ratified the United Nations Convention on Rights of Persons with Disability and aims to protect, promote, and fulfill the rights of persons with mental illness.

Mental healthcare Act of 2013 had also envisioned to meet the manpower requirements of mental health care professionals. The key rights being guaranteed under the bill were the right to the manner of treatment, access to public health care, suicide decriminalization, and that the insurance for the mentally ill persons to be treated on the same basis for that of physical illness. This bill also drew criticism because of an over-inclusive definition of mental illness. This will hurt a huge number of victims of minor mental illness and their families, because of a wider prevalence of the associated stigma. This bill was very ambitious but it was practically very difficult to be implemented at the ground level.

In the bill of 2013, there was no mention of the huge resource-mobilization that was required to realize the various promises that the bill was holding out. This act was hence revised. A new mental health care act was notified in 2017. This legislation not only established new procedures and authorities for its implementation, but it also ensured that the law was in line with UNCRPD. The 2017 act ensured that all persons shall have the right to access free mental healthcare facilities and treatments funded by the government.  The Mental healthcare act of 2017 also enunciates the setting up of a national mental health board and also for the establishment of mental health boards at the state level. The law recognized the vulnerability that persons with psychological disabilities face at home. This act allowed for the rights to live with dignity and without discrimination on basis of gender, sex, culture, caste, social or political beliefs, class, or disability to those suffering from mental health issues.

Advanced directive defined in Mental healthcare Act 2017

It also gave the people with mental health issues the right to direct in advance their preferred choice of treatment and also allowed those with mental illness to choose representatives to make decisions on their behalf in case their conditions worsened. This advanced directive would be certified by a medical practitioner or registered with the Mental Health Board.  One of the features of the bill is that the mental healthcare practitioners who are working on a patient can apply to the Mental health board to review/alter/cancel the advanced directive which can possibly be used for malafide purposes.

The changes in the 2017 act abolished illegal or wrongful admission into mental healthcare nursing homes. It also decriminalized the act of attempted suicide. It identified that not all suicides are due to mental disorders; some are due to social issues and some are due to interpersonal issues. The bill prohibits the use of electroconvulsive therapy (ECT) without the use of muscle relaxants and anesthesia for adults. Further, the barbaric practices of chaining a mentally ill patient, their seclusion, or solitary confinement have also been put to an end by the law.

Proper implementation of this progressive bill is one of the key requirements to tackle the issue of mental healthcare in India. Implementation will be the key challenge due to the lack of infrastructure and resources. The problem is aggravated due to a shortage of medical experts, nurses, psychologists, and trained counselors in this field. In India, Mental healthcare expenditure accounts for 0.16 percent of the total union health budget, which is less than that of Bangladesh which spends 0.44 percent. The developed nations’ expenditures amount to an average of 4 percent. The extent of challenges that India faces on the mental healthcare front is huge and requires urgent impactful interventions. It is important that the resources and facilities of mental healthcare are made available in the farthest reaches of the country and technology can play a large role in this outreach. There needs to be a multi-pronged approach to improve the status of mental health in India. All states and non-state actors, along with individuals need to make concerted efforts towards this humanitarian goal.

The author is a student member of the Amity Centre of Happiness.