Mental Healthcare Act, 2017

Context

Recently the National Human Rights Commission (NHRC) shared a report stating that the condition of all the government-run mental healthcare institutions across the country is “inhuman and deplorable”.

• There are 46 government-run mental healthcare institutions out of which 3 are run by the Union government and the remaining 43 by State governments.

Probable Question

 Highlight the important provisions of India’s Mental Healthcare Act, 2017. (150 words, 10 marks)

Highlights of the NHRC Report

• It notes that there is an “infringement of the human rights of mentally ill patients”. It is because the facilities are “illegally” keeping patients for a longer duration, even after their recovery.
• The report also states that there is a "very sad and inhumane handling by multiple stakeholders" due to the ongoing doctor shortage, inadequate infrastructure, and amenities.
• There is a violation of Article 21 of the Constitution which protects personal liberty, and various international Covenants [such as the United Nations Convention]relating to the rights of persons with disabilities, as per the report. The violation is due to long-term institutionalization.

About Mental Healthcare

• Mental health includes our emotional, psychological, and social well-being influencing our thoughts, emotions, and behaviors. 
• Every period of life, from childhood and adolescence to maturity, is vital for mental health. 
• However, it is affected by numerous factors that affect mental health, such as Biological factors (such as genes or brain chemistry), experiences with trauma or abuse during the life history of mental illness in the family
• Asylums were places where “abnormal” and “unproductive” behavior was studied as an individual phenomenon, isolating the individual from society. 
• The intervention is meant to correct an inherent deficit or “abnormality”, thereby leading to “recovery”.
• Under mental health care there is another phenomenon called ‘psychiatry’, which established a normal/abnormal distinction based on societal norms, which is what many today see as stigma. 
• Mental healthcare in India is protected under Mental Healthcare Act, 2017(MHA).

Background of the Mental Healthcare Act, 2017(MHA)

• Before MHA,2017, the Mental Healthcare Act, 1987 which embodied the ethos of the colonial-era Indian Lunacy Act of 1912, prioritized the institutionalization of mentally-ill people and did not afford any rights to the patient.
• Drawback of the MHA, 1987: It provided disproportionate authority to judicial officers and mental health establishments to authorize long-stay admissions often against the informed consent and wishes of the individual. 
• As a result, several persons continue to be admitted and languish in mental health establishments against their will.
• The right to live independently and in their communities is doubly guaranteed under the Rights of Persons with Disabilities Act of 2016. 

About the Mental Healthcare Act, 2017(MHA)

• Implementation of MHA: In order to evaluate the implementation of the 2017 Mental Healthcare Act, the human rights organization visited all active government facilities (MHA). 

Significant Provisions of MHA, 2017

• As part of Section 19, the government was responsible for creating opportunities to access less restrictive options for community living such as halfway homes, sheltered accommodations, rehab homes, and supported accommodations.
• Under Section 5 of  the Act, people are empowered to make “advance directives”. They can nominate a representative for themselves, thereby potentially helping to eliminate absolute forms of guardianship in favor of supported decision-making. 
• Mandates: All States are required to establish a State Mental Health Authority and Mental Health Review Boards (MHRBs) bodies that can further draft standards for mental healthcare institutes, oversee their functioning and ensure they comply with the Act.

Significance

• Stigma: In 2017, the MHA in essence dismantled the clinical heritage attached to asylums. ys. 
• Discourage Long-term institutionalization: The MHA emphasizes patients' right to live independently and in their communities, calling it a "watershed moment for the right to health movement in India."
• Discourages using physical restraints: The Act discourages using physical restraints (such as chaining), and objects to unmodified electro-convulsive therapy (ECT), instead it encourages the rights to hygiene, sanitation, food, recreation, privacy, and infrastructure. 
• Psychosocial approach: Experts noted that this was the first time a psychosocial approach to mental healthcare was adopted. 
• Consider Environmental factors: The Act acknowledged that environmental factors such as income, social status, and education impact mental well-being, and therefore, recovery needs psychiatric as well as social input. 
• Consider patients’ rights and will: The Act has shifted from providing only treatment to centering the rights and the will of the person. 

Challenges to implementation

Non-compliance to MHA regulations

• Further, many States have not notified minimum standards which are meant to ensure the quality of MHEs.

Absence of community-based services

• The Act shifted the obligation of care onto different stakeholders including caregivers, government institutions, police officials, and mental health practitioners. 
• Poor budgetary allocation and utilization of funds further create a scenario where shelter homes remain underequipped, establishments are understaffed, and professionals and service providers are not adequately trained to deliver mental healthcare.
• 55.4% of people who lived in mental healthcare facilities were referred to by the police or magistrates as most people have histories of homelessness, poverty, and a lack of education and they thus have no place to go after recovery. 
• The dearth of alternative community-based services in the form of homes for assisted or independent living, community-based mental healthcare services, and socio-economic opportunities further complicates access to rehabilitation.

Social stigma

• It looks at a person with mental illness as a “criminal” deserving of incarceration. 
• In many cases, families refuse to take them because of the stigma attached to incarceration or the idea that the person is no longer functional in society.

Absence of MHRBs

• In many states establishment of State Mental Health Authority and Mental Health Review Boards (MHRBs) bodies are yet to be done or remain defunct.

Gender discrimination plays a role here

• Women are more likely to be abandoned due to “family disruption, marital discords and violence in intimate relationships,” according to a  study. 
• Many long-term patients at mental healthcare institutions, especially women have no place to go. 

Conclusion

• The new Mental Healthcare Act 2017 is intended to change India, the world's second-most populous nation and one of the world's fastest-growing economies, in terms of its fundamental approach to mental health issues, including a sensible patient-centric approach to healthcare rather than a criminal-centric one. 
• Primary prevention, reintegration, and rehabilitation are three areas where the guidelines need to be revisited since without these improvements, their execution would be insufficient and the problem of formerly ill people would still persist. 
• In order to be positive about the measure, it is necessary to wait and see its implementation.

News Source: The Hindu

https://www.thehindu.com/sci-tech/health/explained-does-indias-mental-healthcare-act-2017-protect-ppatients-rights-and-dignity-in-institutionsarticle66503295.ece

Frequently Asked Questions about Mental Healthcare Act, 2017

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