The Delhi government and the Delhi Police are under pressure from the High Court concerning implementation of the Mental Health Care Act 2017.
A two-judge bench comprising Chief Justice D. N. Patel and Justice C. Hari Shankar has sought a response from both bodies within four weeks concerning the legislation and whether its provisions are being adequately enforced in the national capital. The hearing was in response to a public interest litigation (PIL) filed in the High Court last month by activist Amit Sahni.
“The 2017 Mental Health Care Act marked a legislative shift when it comes to mental health. Replacing the Mental Health Act 1987, the new law issued a number of guarantees to those with mental health conditions…however, on many of these points, the Delhi government’s response has been stalled”
The PIL demands, among other things, the establishment of a mental health authority at the state level in the national capital and of review boards at the district level, as per Section 73 of the Act. This is to ensure that the Act is being properly enforced with the objective of ensuring the dignity and human rights of those with mental health disorders are supported and recognised.
The 2017 Mental Health Care Act marked a legislative shift when it comes to mental health matters in India. Replacing the Mental Health Act 1987, the new law issued a number of guarantees to those with mental health conditions, including
- Affordable treatment (free of charge to those who cannot afford it)
- The assurances of rights such as confidentiality, informed consent and living within a community
- A ban on inhumane treatment such as being held in chains and administering electroshock therapy to minors
- The decriminalisation of suicide
- A ban on discrimination
- Free legal services to ensure these rights can be fully exercised
However, on many of these points, the Delhi government’s response has been stalled. As well as failing to convene the state-level body on mental health mandated by the Act, the State Legal Service Authority has yet to institute programmes ensuring that those with mental illness can avail legal services if required.
“A sizeable proportion of Indian adults hold prejudicial attitudes regarding mental health. As such, even if treatment is available, many may be reluctant to seek it owing to the fear of ostracisation from their families and communities. This is why the anti-discrimination aspect of the Mental Health Care Act is of such importance”
Across India, approximately 150 million Indians are in need of mental healthcare but there is a treatment gap of between fifty and seventy percent – in many ways thanks to the shortage of personnel. India’s population with mental illness are serviced by 898 clinical psychologists and 3,800 psychiatrists. The treatment gap may be even higher. President Ram Nath Kovind stated in December 2017 that as few as ten percent of Indians who require mental health treatment may be able to access care.
Compounding the issue is stigma. As pointed out by Shah, “due to the social stigma attached to mental ill-health, people with mental health problems can experience discrimination in all aspects of their lives.”
This is borne out by statistics, with studies finding that a sizeable proportion of Indian adults hold prejudicial attitudes regarding mental health. As such, even if treatment is available, many may be reluctant to seek it owing to the fear of ostracisation from their families and communities. This is why the anti-discrimination aspect of the Mental Health Care Act is of such importance and must be properly enforced. To change attitudes, meanwhile, much needs to be done to promote public awareness.
The Mental Health Care Act was indeed a game-changer in working towards ending the marginalisation of and discrimination against individuals with mental health. It has led to key progress, such as the direction of the Insurance Regulatory and Development Authority of India (IRDAI) to health insurance firms that companies must insure mental health conditions on the same level as physical ailments. However, it is clear that there is a long way to go for the benefits of the law to be fully realised by those for whom it was intended to help.
“People who experience mental health problems recover fully, or are able to live with and manage them, especially if they get appropriate treatment,” says Shah. For this to be a reality for all individuals with mental health conditions in India, the Mental Health Care Act must be enforced – both in Delhi and nationwide. Vigilance by authorities, the courts, and citizens is imperative to ensure this.