Elsevier

Asian Journal of Psychiatry

Volume 44, August 2019, Pages 25-28
Asian Journal of Psychiatry

The Mental Healthcare Act 2017 of India: A challenge and an opportunity

https://doi.org/10.1016/j.ajp.2019.07.016Get rights and content

Highlights

  • The Mental Healthcare Act India (2017) replaced the Mental Health Act of 1987.

  • This new Law marks a major shift in the way mental healthcare is delivered, as it aims to protect and promote the rights of people during the delivery of mental healthcare.

  • Within this Act, a capacitous individual cannot be coerced into receiving treatment for mental illness; admissions can be ‘independent’ or ‘supported’ and ‘supported admission’ replaces involuntary admissions of the previous legislation.

  • State mental health authorities and regional mental health review boards will play a major role in the implementation of the new Act.

  • It upholds patient autonomy, dignity, rights and choices during mental healthcare and thus marks a bold step in India’s mental health legislation.

Abstract

The Mental Healthcare Act 2017 replaced the Mental Health Act 1987, subsequent to India’s ratification of the United Nations Convention on the Rights of Persons with Disabilities in 2007. The Mental Healthcare Act (MHCA) 2017 upholds patient autonomy, dignity, rights and choices during mental healthcare and thus marks a bold step in India’s mental health legislation. This new Law marks a major shift in the way mental healthcare is delivered, as it aims to protect and promote the rights of people during the delivery of mental healthcare. Within this Act, a capacitous individual cannot be coerced into receiving treatment for mental illness and inpatient admissions can be ‘independent’ or ‘supported’. ‘Supported admission’ replaces involuntary admission from the previous legislation. State mental health authorities and mental health review boards will play a major role in the implementation of the new Act. The Mental Healthcare Act 2017 is aimed at bringing about radical transformation to mental healthcare in India.

Introduction

The Mental Healthcare Act 2017 is a bold step in a new direction for mental health legislation in India. India is the second most populous country in the world and is home to a sixth of the world’s population. (The World Health Organisation, 2019). India became an independent country in 1947 and a Republic in 1950. India is a union of 29 States and seven Union Territories. Individual States are ruled by democratically - elected State governments. Although most healthcare is funded by the individual State governments, rather than the Central government of India, mental health legislation enacted by the Parliament of India is applicable to all States and Union Territories in India. A recent National Mental Health Survey (NMHS) estimated the one-time prevalence of any mental illness in India to be 10.6% (2016) (National Mental Health Survey of India et al., 2016; Gururaj et al., 2016). NMHS estimated the treatment gap for mental health disorders in India to be 83%. This is in keeping with the estimated treatment gap by the WHO consortium (2004). (Demyttenaere et al., 2004)

Section snippets

Mental health legislation in India

British India (prior to 1947) had several legislations governing mental health care (Lunacy Acts, Indian Lunacy Act, etc.). The Republic of India enacted The Mental Health Act 1987 (The Ministry of Health and Family Welfare, Government of India, 1987), to replace its colonial predecessor, The Indian Lunacy Act, 1912. The Mental Health Act, 1987, did not contribute much towards protection of the rights of the mentally ill. The Mental Health Act, 1987 was repealed in 2018 and the new Act is The

Core principles of India’s new mental healthcare act

Mental Healthcare Act 2017, upholds patient autonomy, dignity, rights and choices during mental healthcare. For the first time in the country’s history, access to mental healthcare is described as a right of every citizen. In contrast, physical healthcare is still not stated as a right for every Indian citizen. This is commendable for a country like India with large unmet psychiatric need (Demyttenaere et al., 2004). Capacity to make decisions regarding mental healthcare for oneself has a

Discharges

All discharges from hospitals need to be coupled with discharge care planning involving patients, clinicians and nominated representatives. Compulsory community-based treatment is not possible under this Act. However, the legislation binds the State to provide easily accessible community mental health care and rehabilitation services. Individual States and Union Territories are expected to create specific rules under the Act regarding service provision. If the minimum services provided by the

Mental Health Review Boards

These Boards consist of a District Judge Equivalent, independent psychiatrists, other independent clinicians and lay people. Though there is a provision for an independent psychiatrist to be a member of the Board, the Board can potentially be constituted even without a psychiatrist. In addition to mandatory independent reviews and appeals by patients and nominated representatives, the Boards are also entrusted with responsibilities of review of advance directives, review of nominated

Miscellaneous provisions

There is a distinct provision for emergency mental healthcare by any registered medical practitioner for a maximum period of 72 h or until a mental health assessment is completed (whichever is earlier). It is clarified that advance directives do not apply to emergency situations.

Unmodified electro convulsive therapy, chaining and sterilization as treatment for mental illnesses are explicitly prohibited. Certain procedures like psychosurgery, ECT for minors and restraints are not prohibited, but

The future

Both mental health professionals and the judiciary are in unchartered territory here. Advance directives, supported decision - making and nomination of representatives are all relatively new issues for mental health professionals in India. The duty of care for a mentally ill person lacking capacity, has shifted from the mental healthcare professional to the nominated carers and the State. States, which were not actively involved in bringing about this key legislation change, and their already

Financial disclosure

We, all authors of this paper, state that we have no financial interests to disclose/declare.

Conflict of interest

None.

Acknowledgement

None.

References (15)

  • R.S. Murthy

    Future of mental health

    Asian J. Psychiatr.

    (2018)
  • The World Health Organisation. Country Profile: India....
  • National Mental Health Survey of India

    2015-16: Prevalence, Pattern and Outcomes. NIMH ANS Publication

    (2016)
  • G. Gururaj et al.

    National Mental Health Survey of India, 2015–16. Prevalence, Pattern and Outcomes

    (2016)
  • K. Demyttenaere et al.

    Prevalence, severity and unmet need for treatment of mental disorders in the Health Organization World Mental HealthSurveys

    JAMA

    (2004)
  • The Ministry of Health and Family Welfare, Government of India

    The Mental Health Act

    (1987)
  • The Ministry of Law and Justice

    The Mental Healthcare Act, 2017. The Gazette of India (Extraordinary), Part II Section I

    (2017)
There are more references available in the full text version of this article.

Cited by (10)

  • Sub-national patterns and correlates of depression among adults aged 45 years and older: findings from wave 1 of the Longitudinal Ageing Study in India

    2022, The Lancet Psychiatry
    Citation Excerpt :

    Future research needs to focus on estimating treatment coverage across the different regions more accurately, assessment of the burden of depression including its disability and economic impact, and understanding the longitudinal course and predictors of depression. India launched the National Programme for Health Care of the Elderly to provide health-care services for older people in 2011 and the first National Mental Health Policy in 2014 with a revised Mental Healthcare Act in 2017 to provide access to mental health-care services.42,43 However, these programmes lack a well-framed health system strategy for screening, diagnosis, and access to mental health-care services, but also universal screening and health-care access for non-communicable disease prevention and control.9,40,41,44,45

  • Harnessing single-session interventions to improve adolescent mental health and well-being in India: Development, adaptation, and pilot testing of online single-session interventions in Indian secondary schools

    2020, Asian Journal of Psychiatry
    Citation Excerpt :

    There have been numerous attempts at expanding access to treatment for individuals in LMICs. These approaches include lay counselor interventions (Patel et al., 2017; Osborn et al., n.d.), school climate interventions (Shinde et al., 2017;Shinde et al., 2018), life skills programs (Mohammadzadeh et al., 2020), cognitive behavioral therapy programs (Selvapandiyan, 2019), guided digital self-help interventions (Michelson et al., 2019), workshops for medical professionals (Sharma and Seshadri, 2020), and mental health care legislation (Namboodiri et al., 2019). There have also been attempts to understand how parenting behaviors influence internalizing and externalizing problems (Sekaran et al., 2020) and implement parent training programs (Mejia et al., 2012).

  • Starting small: Developing child-centric mental health policies

    2020, Starting at the Beginning: Laying the Foundation for Lifelong Mental Health
  • Change in attitude of ASHAs towards persons with mental illnesses following participation in community based rehabilitation project

    2019, Asian Journal of Psychiatry
    Citation Excerpt :

    One of the grand challenges in mental health is to “provide effective and affordable community-based care and rehabilitation” and “develop effective treatments for use by non-specialists, including lay health workers with minimal training” (Collins et al., 2011). Consistent with this, in India, recent legislations and programmes have had specific focus on community-based mental health care and rehabilitation (Namboodiri et al., 2019; Sadh et al., 2019; Ul hassan et al., 2019). Negative attitude of health workers is a deterrent for patients to seek health care (Ibrahim et al., 2014).

View all citing articles on Scopus
View full text