UNDERSTANDING INDIA’S MENTAL HEALTHCARE ACT, 2017

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

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