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IntroductionMental health has long been a neglected and stigmatized aspect of public health in India. However, over the years, there has been a significant shift in societal attitudes towards mental health, leading to the development and evolution of mental health and law policies. This article provides an overview of how mental health laws were developed and enacted in India and also the major reforms and case laws which lead to structural changes in the mental health care system.
Mental health law and policy in India have undergone significant changes, showing a growing awareness of the importance of mental well-being. These changes have resulted in legal reforms, policy actions, and landmark rulings that aim to promote mental health, protect rights, and improve access to quality mental healthcare services. Despite the remaining challenges, these developments indicate a move towards reducing stigma and creating a supportive environment for people with mental illnesses
Need for Legislation for Mental HealthPeople with mental illness are vulnerable to abuse. Their basic rights are violated by different elements of society such as family, caregivers, mental health institutions, community, and other administrative and legal authorities. The rights of these people need to be protected and hence there are legislative provisions that act as protective mechanisms - policies and statutes.
History of Legislation for Treatment of Mental Illness The ancient Indian medical system, Ayurveda provides a detailed explanation of mental disorders. The system of treating mentally ill people in asylums was brought to India by the British. After the Crown's takeover in 1858, laws were passed to regulate the treatment of mentally ill people in India, following were the acts-
o Lunacy (Supreme Courts) Act, 1858
o Lunacy (District Courts) Act, 1858
o Indian Lunatic Asylum Act, 1858
o Military Lunatic Acts, 1877
Laws and Regulations in India Concerning Mental Health in IndiaNational Mental Health Program 1982: The Government of India launched the National Mental Health Program to address mental health issues at a national level. The program aimed to provide mental health services, create awareness, and integrate mental health into primary healthcare.
Mental Health Act, 1987: This was the primary legislation governing mental health in India before the Mental Healthcare Act, of 2017. The 1987 Act focused on the involuntary detention and treatment of individuals with mental illness and did not adequately address issues related to human rights, treatment standards, and community-based care.
District Mental Health Program (DMHP): This program was launched in 1996 to provide mental healthcare services at the district level. It aims to make mental health services accessible, especially in rural and underserved areas.
The DMHP was based on the ‘Bellary Model’ with the following components:
o Early detection & treatment.
o Training: imparting short-term training to general physicians for diagnosis and treatment of common mental illnesses with a limited number of drugs under the guidance of specialists. The health workers are being trained in identifying mentally ill persons.
o IEC: Public awareness generation.
o Monitoring: the purpose is for simple Record Keeping.
National Trust Act 1999: This act was enacted for the welfare of people with autism, cerebral palsy, mental retardation and other disabilities. It aimed to empower them to live independently. The act envisions creating equal opportunities for persons with mental illness in society and lays down the procedure for the appointment of guardians and trustees after the death of their parents.
Ratification of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) (2007): India ratified the UNCRPD, which recognizes the rights of persons with disabilities, including those with mental disabilities. This led to a growing recognition of the need to reform mental health laws and policies in line with international standards.
National Mental Health Policy, 2014: The policy was formulated to enhance mental health services in India. It focuses on the promotion of mental health, the prevention of mental illnesses, and the provision of accessible and affordable mental healthcare. The policy also highlights the need for mental health awareness campaigns and training programs for healthcare professionals.
Mental Healthcare Act, 2017: The Mental Healthcare Act, of 2017, is a landmark legislation that replaced the outdated Mental Health Act, of 1987. The new Act brought about significant changes to mental health law and policy in India. It introduced a rights-based approach, focusing on the protection of the rights and dignity of individuals with mental illness. It emphasized access to mental healthcare, voluntary admissions, advance directives, and the decriminalization of suicide.
Mental Health Rules, 2018: In 2018, the government formulated the Mental Health Rules to provide further guidance and operational details for the implementation of the Mental Healthcare Act, 2017. The rules outline procedures related to mental health establishments, admission processes, mental health review boards, and other aspects of mental healthcare.
Mental Health Rules, 2020: These rules were framed under the Mental Healthcare Act, 2017, to provide further guidelines for the implementation of the act. They outline the procedures for the appointment of mental health professionals, the functioning of mental health review boards, and the documentation and reporting requirements for mental healthcare establishments.
Major Incidents and Case LawsErwadi fire tragedy
The incident that shook the conscience of the country, violated human rights and brought major changes in mental health care in India. On August 6, 2001, 28 patients at a home for mental care died as they were chained and could not escape when a fire broke out at the center. This incident brought to light the suffering of mentally ill people and demanded reforms in mental health care.
Mental health and suicide
Suicide was considered a criminal offence under Section 309 of the Indian Penal Code. However, in the case of Gian Kaur v. State of Punjab (1996), the Supreme Court decriminalized suicide, recognizing that individuals attempting suicide often do so due to mental health issues and should be treated with empathy and compassion rather than punishment.
SC in support of Mental Health
In a recent judgement, SC upholds the need for judges to be sensitive to the gravity of mental health issues and said that the judiciary should not treat the mental health of a person with a “one-size-fits-all” approach.
Insurance Cover for Mental Illness-
Mental health issues were not covered under health insurance. However, this has changed as the Insurance Regulatory and Development Authority of India (IRDAI) has made it mandatory for all insurance companies to cover mental disorders under the insurance plan from November 1, 2022.
Issues to be addressed related to Mental Health LawAccording to World Health Organization (WHO), mental illness makes up about 15% of the total disease conditions around the world[SM1] . It also says that India has one of the largest populations affected by mental illness.
Impact of COVID-19
The pandemic has further accelerated the number of persons with mental illness. It hurt people’s mental health. India Today reported a 20% increase in mental health cases in India post-imposition of the lockdown in March 2020. The quarantine imposed has induced acute panic, anxiety, obsessive behaviours, paranoia and depression which will have long-term consequences on people’s health. This needs to be addressed and curative measures have to be undertaken.
Shortage of mental healthcare workers
Lack of trained human resources hampers effective mental health care delivery. As per WHO, the mental health workforce in India (per 100,000 population) includes psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers (0.07).
Lack of primary mental health care
Just as mainstream Primary Healthcare centers, there need to be primary mental healthcare units working at the bottom level. This will provide people with easy access to mental health care.
Lack of awareness and sensitivity
Society needs to be sensitized about mental health. People who receive mental health treatment are termed ‘lunatics’ by society, this shows the lack of awareness among the people. The stigma around mental health is a major hurdle which hinders the development of the mental health care system till grass root level.
Measures to be takenIndia has the highest suicide rate in the world. Also, the increasing crime and drug addiction rate has a direct relation to mental health.
Investment in mental health care
Funds have to be allocated for the development of mental health infrastructure. Both Central and State governments should make commitments towards achieving improvement in mental health care.
Effective implementation of policies
Proper implementation of the DMHP is the key to resolving many critical issues that mental healthcare delivery faces in India.
ConclusionThrough landmark judgments and legal reforms, India has taken significant strides towards promoting mental health care, decriminalizing suicide, and ensuring access to treatment and support services. However, there is still much work to be done in eliminating stigma, improving accessibility, and developing a holistic approach to mental health. The intersection of mental health and law will continue to evolve, requiring a multifaceted approach that integrates legal, medical, and social perspectives to develop a more inclusive and empathetic society.
References
§ What India must do to solve its mental health crisis?, Health News, ET HealthWorld (indiatimes.com)
~Authored by Rutuja Bhor