The Mental Healthcare Act 2017 of India: A challenge and an opportunity
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 The Mental Health Act, 1987 was repealed in 2018 and the new Act is The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)
Future of mental health
Asian J. Psychiatr.
(2018)- The World Health Organisation. Country Profile: India....
2015-16: Prevalence, Pattern and Outcomes. NIMH ANS Publication
(2016)- et al.
National Mental Health Survey of India, 2015–16. Prevalence, Pattern and Outcomes
(2016) - et al.
Prevalence, severity and unmet need for treatment of mental disorders in the Health Organization World Mental HealthSurveys
JAMA
(2004) The Mental Health Act
(1987)The Mental Healthcare Act, 2017. The Gazette of India (Extraordinary), Part II Section I
(2017)
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 PsychiatryCitation 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
Improving Mental Health on College Campuses: Perspectives of Indian College Students
2022, Behavior TherapyHarnessing 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 PsychiatryCitation 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 HealthChange in attitude of ASHAs towards persons with mental illnesses following participation in community based rehabilitation project
2019, Asian Journal of PsychiatryCitation 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).