India’s Mental Healthcare Act

Context

• The National Human Rights Commission (NHRC) flagged the inhuman conditions of government-run mental healthcare institutions.

About

• The report flagged the inhuman and deplorable condition of healthcare institutions that are keeping patients illegally long after their recovery which  is an infringement of the human rights of mentally ill patients.
• The shortage of doctors, lack of infrastructure, and inhuman handling of mental patients were also highlighted.
• Long-term institutionalisation thus not only violates Article 21 of the Constitution which protects personal liberty, but also indicates a “failure of the State Government(s) to discharge the obligation under various international Covenants [such as the United Nations Convention]relating to rights of persons with disabilities which have been ratified by India.

Mental Healthcare

• Mental health care refers to the range of services and treatments provided to individuals who are experiencing mental health challenges or disorders. 
• Mental health care can take many different forms, including therapy, medication, support groups, hospitalization, and other interventions.

Current Mental Healthcare Status

• India:
  • It is estimated that 6-7 % of the population suffers from mental disorders in India.
  • WHO estimates that the burden of mental health problems in India is 2443 disability-adjusted life years (DALYs) per 100 00 population.
  • The age-adjusted suicide rate per 100 000 population is 21.1. The economic loss due to mental health conditions, between 2012-2030, is estimated at USD 1.03 trillion.

• Global:

• As per World Bank, nearly 1 billion people live with a mental disorder and in low-income countries, more than 75% of people with the disorder do not receive treatment. Every 40 seconds, a person dies by suicide. About 50% of mental health disorders start by the age of 14.
• As per WHO Depression is one of the leading causes of disability and suicide is the fourth leading cause of death among 15-29-year-olds.

• People with mental illness may be subject to the UN Convention on the Rights of Persons with Disabilities (CRPD).
• In 2022, WHO launched the World Mental Health Report: Transforming Mental Health for All.
• Mental Health is included in Sustainable Development Goals

What Mental Healthcare Act (NHA), 2017 Says?

• The act provides for the rights of persons with mental illness, including the right to access mental healthcare and treatment, the right to make decisions about their treatment, the right to confidentiality, and the right to legal aid.
• It establishes mental health services at the district level to provide access to mental healthcare and Mental Health Review Boards (MHRBs) to oversee the treatment of persons with mental illness and to protect their rights.
• It decriminalizes attempted suicide, recognizing that suicide is often a symptom of mental illness, and provides care and treatment for persons who attempt suicide.
• It establishes a Central Mental Health Authority and State Mental Health Authorities to regulate mental healthcare and services and to promote mental health.
• The act prohibits the use of Electro-Convulsive Therapy (ECT) without anesthesia and the use of seclusion and restraint in mental health establishments, except in exceptional circumstances.
• The act provides for advance directives, which allow individuals to express their preferences for treatment and care in the event that they are unable to make decisions for themselves.

Challenges implementing the NHA, 2017

• Awareness: Many people, including mental health professionals, are unaware of the legal rights and protections for persons with mental illness.
• Human resources: There is a severe shortage of mental health professionals including psychiatrists, psychologists, and social workers in rural India.
• Defunct Bodies: The State Mental Health Authority and MHRBs are yet to be formed in many states or remain defunct. The defunct MHRBs render people unable to exercise rights or seek redressal in case of rights violation.
• Funding: The implementation of the act requires funds to establish mental health services at the district level, train mental health professionals, and regulate mental healthcare and services.
• Residential service users: Around 36.25% of residential users were found living for one year or more at state Psychiatric facilities as per the 2018 report by Hans Foundation.
• Stigma: Refusal of families to take away patients back to their homes due to the stigma attached to incarceration and the non-functionality of individuals.
• Infrastructure: There is a lack of infrastructure, including buildings and equipment, to establish mental health services at the district level.
• Lack of Community-based services to provide rehabilitation to people who don’t wish to return to their families, have no memory of their families, have mental disabilities, and are unable to work.  

Government of India Initiatives

• National Mental Health Programme (NMHP) in 1982: To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future.
• Mental Healthcare Act, 2017: It provides mental healthcare and services for persons with mental illness in India.
• National Suicide Prevention Strategy
• Rights of Persons with Disabilities Act, 2017: The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled.
• National Tele-Mental Health Programme: To improve access to quality mental health counselling and care services in the country.
• Kiran Helpline: It provides for suicide prevention and can help with support and crisis management.
• World Mental Health Day: To raise awareness of mental health issues around the world and to mobilize efforts in support of mental health.

Way Ahead

• Increase funding for mental health: This includes allocating a larger portion of the healthcare budget to mental healthcare services and providing funding for community-based mental health programs.
• Use technology: 
  • Telemedicine and digital health platforms can be used to increase the accessibility of mental health care services.
  • Online mental health services can make it easier for individuals to access medical care from home at less cost.
• Increase Awareness  Governments can launch public awareness campaigns to increase understanding of mental illness and reduce discrimination about mental illness.
• Implement insurance coverage for mental health: Governments can mandate insurance providers to cover mental health care services and treatments.
• Reduce the cost of medication: Governments can regulate the cost of mental health medications, or provide subsidies for these medications.
• Increase the number of mental health professionals
  • Governments can invest in mental health education and training to increase the number of mental health professionals for Mental Health.
  • They can also provide incentives for mental health professionals to work in areas where there is a shortage of mental health services.
• Integrate mental health care into primary care
  • Primary care providers can be trained to provide basic mental health care services and to recognize symptoms of mental illness.
  • Integrating mental health care facilities can increase the accessibility of mental health care services.

Source: The Hindu