Mental Health Care Act, 2017

Does the Indian Constitution recognise persons with mental illness (PMI)?

The Indian Constitution has various mental health provisions ranging from the Lunacy Acts of 1858 to the most recent, Mental Health Care Act of 2017. The acts preceding the Mental Health Care Act 2017 focused mainly on isolating mentally ill persons and establishing a concrete infrastructure for mental health services like psychiatric hospitals.

What is the Mental Health Care Act?

The Mental Health Care Act, 2017 primarily focuses on the rights of persons with mental illness (PMI). It was enforced on 7th July 2017 to provide adequate mental healthcare and to protect, promote, and fulfil the rights of PMI seeking mental healthcare services.

Why was a new law required?

The Indian Constitution has various laws regarding the well-being of all citizens, yet it falters on the PMI’s rights. The previous legislation includes:

Lunacy (Supreme Courts) Act 1858
Lunacy (District Courts) Act 1858
Indian Lunatic Asylum Act 1858 (amended in 1886 and 1889)
Military Lunatic Act of 1877
Indian Lunacy Act of 1912
Mental Health Act 1987

These laws mainly dealt with the provisions of how to handle mentally ill patients, their judicial evaluation, and focused on building mental asylums. The Mental Health Act of 1987 was a considerable improvement from its preceding legislations. It provided the provision for voluntary admission and setting up of Central and State Mental Health Authorities to regulate the psychiatric hospitals. Yet this act was also criticised as it emphasised more on legal proceedings for licensing, admission, and guardianship of the PMI.

The Indian Government ratified the United Nations Convention for Rights of Persons With Disabilities (UNCRPD) in 2007, which requires the country’s laws to be compliant with the terms of the convention. Thus, the need for a specific law regarding the rights of PMI and the requirement by the UNCRPD led to the replacement of the MHA 1987 with the Mental Health Care Act (MHCA) in 2017.

Pros Vs Cons

The Mental Health Care Act introduced many advanced features; its pros have been listed as follows:

The MHCA aims to provide mental healthcare to all and has provisions for free services to the needy or the homeless irrespective of them having a BPL card.

This act ensures all PMI get equal access to mental health care services without any discrimination or inhumane treatment. Moreover, insurance providers are also required to cover mental illness in the same way as they do for physical ailments.

The act also emphasises the autonomy of PMI, wherein they have the right to voluntary admission and can take decisions regarding their treatment and discharge from the facility.

It decriminalises Attempt to Commit Suicide and has made it the government’s responsibility to offer services for rehabilitation and to ensure further attempts don’t occur.

Electroconvulsive Therapy (ECT) is prohibited for minors and can be used sparingly for adults using necessary anaesthesia and muscle relaxants. Sterilisations for men or women and chaining have also been banned.

It allows the PMI to make an Advanced Directive; which is a written statement expressing the treatment services they want if they become incapacitated due to their illness. Additionally, all PMI (except minors) are allowed to appoint any person as their Nominated Representative to aid in treatment-related decisions.

Though the MHCA might seem to be a step in the right direction, it can still be criticised on some grounds. Some of its cons include:

The act considers only the most severe mental illnesses that impair an individual’s daily life, yet doesn’t consider mental retardation or personality disorders. Thus the act does not consider all mental illnesses.

MHCA is considered to be unrealistically ambitious as it doesn’t acknowledge the lack of infrastructure and mental health professionals that would be required to provide adequate treatment to all PMI.

The autonomy given to the PMI on all decisions regarding their treatment can be misused as individuals may refuse treatment for reasons such as stigma, disregarding the severity of their illness, or impaired decision-making due to illness.

The PMI has the power to cancel or amend the Advanced Directive at will. This might create a hindrance in providing them with adequate treatment when they become incapacitated and revoke the AD impulsively.

When a Nominated Representative is appointed, they have all power to view all medical records of the PMI and make decisions regarding their treatment. This infringes on the autonomy of the PMI and also disregards the confidentiality clause.

Conclusion

The Mental Health Care Act is a progressive step for establishing a better future for all persons with mental illness (PMI), as it protects and promotes their rights. But it does have some shortcomings regarding mental healthcare for minors, mental illnesses that are covered by this act, and the dangers of assigning full autonomy to the PMI regarding their treatment.

Mental health is as important as physical health. Thus, the presence and proper regulation of mental healthcare services are essential. Hence, we should strive towards getting a comprehensive law regarding mental illness and its treatment.

Read more about the rights of PMI here.

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