What is the Mental Health Act 2017
Did you know that just a few years ago, the mental health law in India allowed judicial officers and mental health establishments to authorise long-stay admissions of persons with mental illness (PMI) — often against the informed consent and wishes of the individual?
This law, known as the Indian Mental Health Act 1987, also mandated rigid and tedious license criteria for psychotherapists.
It was only from May 29, 2018, onward — when the current Mental Healthcare Act, which received assent from the President of India on April 7, 2017, came into effect — could PMIs refuse to be institutionalised against their will. Hence, many experts view the Mental Healthcare Act 2017 as “a watershed moment” or historical change of course in the right direction for mental legislation in India.
Mental health laws deal with any individual suffering from any ailment or disability of mind and who needs treatment. The Mental Health Act 1987 in India came into force in 1993, replacing the Indian Lunacy Act 1912.
When it comes to mental health in India, the “Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic” study published in Lancet public health estimates an increase of around 35% in anxiety and depression cases in India during the COVID-19 pandemic.
The Mental Healthcare Act 2017 defines “mental illness” as a “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”.
Revisions Made in the Mental Healthcare Act 2017: An Overview
The Mental Healthcare Act 2017 aims to radically transform mental healthcare in India. This new law marks a paradigm shift in the proposed delivery of mental health care in the country.
In its opening statement, it states it is “an act to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto.”
Hence, it lays emphasis on patient autonomy, dignity, rights, and choices during mental healthcare. Rights under the Mental Healthcare Act 2017 include:
- Right to access mental health care
- Right to community living
- Right to protection from cruel, inhuman and degrading treatment
- Right to equality and non-discrimination
- Right to information
- Right to confidentiality
- Restriction on the release of information in respect of mental illness
- Right to access medical records
- Right to personal contacts and communication
- Right to legal aid
- Right to make complaints about deficiencies in the provision of services
Moreover, the Indian Mental Healthcare Act 2017 mandates accessibility to mental health services for individuals. It also mandates the provision of mental health services be established and available in every district of the country.
Let us take a look at some of the key differences between the Mental Health Act 1987 and 2017.
1. Rights-based approach: The Mental Healthcare Act 2017 enshrines a number of rights for persons with mental illness, thus moving away from the criminal-centric view to a patient-care approach focusing on the human rights of PMIs. Hence, unlike its predecessor, the Mental Healthcare Act 2017 upholds that a PMI cannot be coerced into receiving treatment for mental illness.
2. Decriminalisation of suicide: The Mental Healthcare Act 2017 also decriminalises suicide attempts. The act states that “any person who attempts to commit suicide will be presumed, unless proved otherwise, to be suffering from severe stress, and the government will have a duty to provide care, treatment and rehabilitation for such a person to reduce the recurrence of the event.”
3. Meets the international standard: The Mental Healthcare Act 2017 provides the legal framework for providing services to protect, promote and fulfil the rights of people with mental illnesses. These are in line with the United Nations Convention on the Rights of People with Disabilities (UNCRPD) of 2006.
4. Provision of community care: The Mental Health Act 1987 did not provide any weight to the social unit of the PMI. As a result, many individuals did not accept and address their mental health issues in the past. The current mental healthcare act in India offers moves from custodial to community care. Hence, PMIs can now opt for community-based psychiatric care. The act also encourages them to live and work in the community.
5. Provisions of mental health institutions and practitioners: The Mental Health Act 1987 failed to provide rehabilitation guidelines, objectives, and mandates for PMIs that had been discharged after treatment. The Mental Healthcare Act 2017, under section 18, requires that each state provides easily accessible mental healthcare for all individuals. Section 103 of the current act also specially provides for the care, treatment, and counselling of prisoners.
6. Provision of mental health review boards: Mental health review boards are tasked with the responsibility to resolve violations of the Mental Healthcare Act 2017 and ensure that mental health care services of good quality are accessible.
7. Restricts the use of electroconvulsive therapy (ECT): The Mental Healthcare Act 2017 restricts the usage of electroconvulsive therapy (ECT). The act legally prohibits the administration of the unmodified ECT vide its section 95 (1), which states that “Notwithstanding anything contained in this Act, the following treatments shall not be performed on any person with mental illness—(a) electroconvulsive therapy without the use of muscle relaxants and anaesthesia; (b) electroconvulsive therapy for minors.”
8. Regulates the use of research on PMIs: In section 99, the new mental healthcare act regulates the research on PMIs. It also mandates a specification of the nature of the study as in psychological, physical, chemical, or medical intervention, and also gives the participant the right to withdraw the consent at any time during the research period.
9. Provision for medical insurance: Section 21 (4) of the Mental Healthcare Act 2017 upholds that insurers should provide medical insurance for treating mentally ill patients at par with insurance provided for other ailments.
The on-ground reality in the mental health care system after the Mental Healthcare Act 2017 was passed:
In a country such as India, where stigma related to mental health is still wide and prevalent, successful implementation of the Mental Health Act 2017 is the need of the hour. Given difficulties in its implementation due to the country’s huge and growing population, the act provides for a 10-year period from its commencement for the government and other stakeholders to meet internationally accepted guidelines for human resources development.
Furthermore, the COVID-19 crisis has disrupted and slowed the implementation of various policies and programs. However, mental health care and awareness are now gaining much more traction than ever before. Hence, while the Mental Healthcare Act 2017 will bring about the much-needed fundamental changes in mental health issues and care, we will have to wait and watch for widespread and optimal implementation of the act.
However, researchers suggest that psychiatrists and their professional bodies should step up to advocate appropriate and quality mental health care through their role in this vehicle of the current Indian Mental Healthcare Act.
If you or someone you know needs help to understand more about the mental healthcare legislation in India and treatment for mental health disorders, reach out to a mental health professional. You can browse our directory of treatment centres across India here.
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