- The National Human Rights Commission (NHRC) in a report flagged the “inhuman and deplorable” condition of all 46 government-run mental healthcare institutions across the country.
- The report notes that the facilities are “illegally” keeping patients long after their recovery, in what is an “infringement of the human rights of mentally ill patients”.
- These observations were made after visits to all operational government facilities, to assess the implementation of the Mental Healthcare Act, 2017 (MHA).
What does the MHA, 2017 say?
- The MHA, 2017 “centered the agency of individuals, acknowledged their right to live as part of a community [under Section 19], and focused on rehabilitation,”
- Under Section 19 of the Act, the government was made responsible for creating opportunities to access less restrictive options for community living — such as halfway homes, sheltered accommodations, rehab homes, and supported accommodation.
- The Act also discourages using physical restraints (such as chaining), unmodified electro-convulsive therapy (ECT), and pushes for the right to hygiene, sanitation, food, recreation, privacy, and infrastructure. More importantly, the Act recognised that “people have a capacity of their own — unless proven otherwise
- Additionally, under Section 5, people are empowered to make “advance directives”. They can nominate a representative for themselves, thereby potentially helping to eliminate absolute forms of guardianship in favour of supported decision-making.
- This is barring cases where the person needs a higher degree of care and support. Experts note this was the first time a psychosocial approach to mental health was adopted.
- The Act acknowledged that external factors — such as income, social status, and education — impact mental well-being, and therefore, recovery needs a psychiatric as well as a social input.
What are the challenges?
- While the MHA safeguards the rights of people in mental healthcare establishments, enforcement challenges remain. Almost 36.25% of residential service users at state psychiatric facilities were found to be living for one year or more in these facilities, according to a 2018 report by the Hans Foundation.
- Under the MHA, 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.
- Fernandes notes that in a majority of States, “these bodies are yet to be established or remain defunct…Further, many States have not notified minimum standards which are meant to ensure the quality of MHEs.
- The Act takes on a human rights lens by shifting the obligation of care onto different stakeholders — including caregivers, government institutions, police officials, and mental health practitioners.
- Poor budgetary allocation and utilisation of funds creates a scenario where shelter homes remain underequipped, establishments understaffed, and professionals and service providers not adequately trained to deliver proper healthcare,
- While Section 19 recognises the right of people to “live in, be part of, and not be segregated from society,” there have been no concrete efforts towards implementation
- The dearth of alternative community-based services further complicates access to rehabilitation.
SOURCE: THE HINDU, THE ECONOMIC TIMES, PIB