Mental Healthcare Act, 2017 [Introduction] Mental Health Care Legislation

Mental Healthcare Act, 2017

There is no health without mental health. Recently conducted National Mental Health Survey quoted a prevalence of 13.7% lifetime and 10.6% current mental morbidity. To address this mammoth problem, an aspirational law was enacted titled “Mental Healthcare Act, 2017” (MHCA 2017). The act is progressive and rights based in nature.

The preamble of Mental Healthcare Act, 2017 promises to provide mental healthcare and services for persons with mental illness (PMI) and to protect, promote, and fulfill the rights of such persons during delivery of mental healthcare and service

The heart and soul of this legislation are in Chapter 5 which safeguards the patients’ right to access a range of mental healthcare facilities (such as inpatient and outpatient services; rehabilitation services in the hospital, community, and home; halfway homes; sheltered accommodation; and supported accommodation). If the services are not available, PMI are entitled to compensation from the state. Right to community living, right to confidentiality, right to access medical records, right to protection from cruelty and inhumane treatment, and right to equality and nondiscrimination are all ensured by the law. The act seeks to ensure that mental healthcare facilities are available to all. Those below the poverty line, whether in possession of BPL (below poverty line) card or not, the destitute, and the homeless will be entitled to free mental health treatment. The act provides the right to confidentiality and protection from cruel, inhumane, and degrading treatment, in addition to the right to live in a community and avail free legal aid. It bans electroconvulsive therapy (ECT) without anesthesia and any type of ECT to children and restricts psychosurgery. However, the act mainly focuses on the rights of the persons with mental illness (PMI), only during treatment in hospital but is not equally emphatic about continuity of treatment in the community. The act fails to acknowledge and foster the role and contribution of family members in providing care to PMI. Although there are many positive aspects to the MHCA 2017, it may impact adversely on the mental health care in India. This article focuses on the shortcomings and challenges of the act and also makes attempts to offer alternatives considering the available resources and ground reality. Concepts such as “Advance directives” and “Nominated representatives” appear to be very attractive, idealistic, and aspirational, but not evidenced based in the Indian context considering the resources.

It is prudent for the lawmaker to account for the culture of the land, newer scientific developments in the mental health field, analyze the met-unmet needs of the patients and families, and make provisions to bridge the treatment gap. There is also a need to make provisions to enhance the resources and skill building among professionals/workers in the field of mental health, to provide comprehensive healthcare services, to promote mental health and well-being, and to make provisions for adequate financial support/budget (for plan and nonplan expenditures). The need of the hour is a law that can be implemented in practice and can cater to the health needs at all levels of prevention (primary, secondary, and tertiary) while also protecting the rights of the family, professionals, and end users.