In today’s age, one cannot deny the importance of mental health along with physical well-being. Mental health has proven to strengthen the relationships in society, building endurance for physical and mental pain, discovering the full potential of oneself and maintaining one’s physical health too.
However, in India we observe a social stigma attached to the mental health which consists of prejudicial behaviour and ill-treatment of individuals with mental illness. We hear stories about black magic and priests being used to treat mental illness. Therefore, awareness and promotion of importance of mental health and establishing proper mental health establishments for admission, treatment and rehabilitation of patients was a need of the hour.
Government issued the National Mental Health Policy, 2014 along with the existing Mental Healthcare Act, 1987. However, it was falling short of success because of poor implementation, lack of awareness and insufficiency of infrastructure.
National Institute of Mental Health and Neurosciences (NIMHANS) conducted a National Mental Health Survey in the year 2015-16 wherein it provided a mirror to the government regarding the state of mental health in India. According to the survey, 15% of Indians above 18 years need active interventions for one or more mental health issue. Middle aged population are mostly affected by common mental disorders, severe mental disorders and substance abuse.
World Health Organisation estimated that the age-adjusted suicide rate per 100,000 population is 21. Mental health workforce in India (per 100,000 population) include psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers (0.07).
Therefore, a fresher outlook and mechanism was required to achieve the stated goals. The Mental Health Care Act, 2017 was passed by both Houses of the Parliament and received presidential assent in April, 2017. The Act is not triggered by one single event or a report but a culmination of various reports by national and international organisations depicting India’s poor progress towards treating mental illness and promotion of mental health care and huge public outcry over government’s inability to address such reports and take conducive steps.
The Act has been brought into force with a vision to guarantee quality treatment and rehabilitation services to mentally ill people in India. It also guarantees the availability of such treatment at no cost to the poor and homeless at government run or funded establishments. It is a welcome step in the right direction and we hope to see the implementation of the provisions made under this Act. In order to create more awareness about the rights and benefits that this Act provides to mentally ill people and also the obligations of various stakeholders in the mental health care ecosystem we have put together a succinct FAQ.
What is a mental illness? Is there any illustrative list of mental illnesses covered under the Act? Who all are covered under this Act?
The Act defines mental illness as a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life and mental conditions associated with the abuse of alcohol and drugs. The definition does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by sub-normality of intelligence. The Act does not provide a list of mental illness covered but is guided by the broad definition provided.
The Act seeks to provide mental healthcare to patients of mental illness which includes analysis and diagnosis of a person's mental condition and treatment as well as care and rehabilitation of such person for his mental illness or suspected mental illness.
It further provides for admission, treatment, discharge and rehabilitation for independent patients and supported patients. Independent patients are those who have the capacity to make mental healthcare and treatment decisions or require minimal support in making decisions, while supported patients are those who have a severe mental illness characterized by attempts of causing self harm and/ or have a propensity towards violence and/ or are not capable of self care.
An independent patient shall be given treatment with his informed consent. The supported patient will be subjected to treatment on the basis of an advance directive, if any, given by the patient or with his informed consent with the support of his nominated representative.
What are mental health establishments? Are there any registration/ license requirements for such establishments? What are the procedural requirements for establishments treating mental illness which are already in existence and registered with relevant authorities?
The Act provides that every person or organisation who proposes to establish or run a mental health establishment shall register the said establishment with-
Central Mental Health Authority, if under the control of the Central Government
Relevant State Mental Health Authority, if not controlled by Central Authority and present in that state
Mental health establishment has been defined as any health establishment, including Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy establishment (by whatever name called), either wholly or partly, meant for the care of persons with mental illness, established, owned, controlled or maintained by the appropriate Government, local authority, trust, whether private or public, corporation, co-operative society, organisation or any other entity or person, where persons with mental illness are admitted and reside at, or kept in, for care, treatment, convalescence and rehabilitation. It also covers any general hospital or general nursing home.
In case, a mental health establishment has been registered under the Clinical Establishments (Registration and Regulation) Act, 2010 or any other law for the time being in force in a State, such mental health establishment shall submit a copy of the said registration along with an application in such form to the relevant State or Central Authority, as the case maybe. The relevant Authority will then issue a certificate of registration to such establishment under the 2017 Mental Health Act.
How does the Act envisage to protect and promote mental health patients? What are the rights of such patients?
The Act is comprehensive in protecting the right of the mentally ill patients and protection and promotion of mental health. Some of the important provisions are-
Determination of mental illness
Mental illness shall be determined in accordance with nationally or internationally accepted medical standards including the latest edition of the International Classification of Disease of the World Health Organisation or any other standards as notified by the Government.
Mental illness of a person will not be determined on the basis of their political, economic or social status or membership of a cultural, racial or religious group, non-conformity with moral, social, cultural, work or political values or religious beliefs prevailing in a person’s community.
A person will be classified as a person with mental illness for purposes of treatment of such illness only. Every person with mental illness shall be treated as equal to persons with physical illness in the provision of all healthcare.
Nominated Representative of a mentally ill patient
Every person has the right to appoint a nominated representative. The duty of such representative would be-
consider the current and past wishes, the life history, values, cultural background and the best interests of the person with mental illness,
provide support to the person with mental illness in making treatment decisions,
have right to seek information on diagnosis and treatment of the mental illness;
have access to the family or home-based rehabilitation services on behalf of and for the benefit of the person with mental illness;
be involved in discharge planning;
apply to the mental health establishment for admission in case of supported patient or in emergency situation.
Rights to access to treatment
A patient will have the right of access to treatment from Government controlled or funded establishments at all times. It includes availability, affordability and quality of treatment.
Provision of Essential Drugs free of cost
The appropriate Government (State/Centre) shall notify a ‘Essential Drug List’ and all medicines on the Essential Drug List shall be made available free of cost to all persons with mental illness at all times at health establishments run or funded by the appropriate Government starting from Community Health Centres and upwards in the public health system.
Right to information and confidentiality
The patient and his nominated representative have the right to information regarding the criteria of admission, treatment plan, side effects of such treatment and may also file an application to review such admission with the Mental Health Review Board. All such information is required to be kept confidential.
Rehabilitation of mentally ill person if abandoned by family
In case a mentally ill person has been abandoned by his family, the government is required to provide such a person with adequate legal support so as to help the person gain access to his/her family home.
Treatment for poor, homeless and destitute people
Persons with mental illness living below the poverty line, whether or not in possession of a below poverty line card, or who are destitute or homeless shall be entitled to mental health treatment and services free of any charge and at no financial cost at all mental health establishments run or funded by the appropriate Government and at other mental health establishments designated by it.
How can the patients file a complaint regarding deficiency of provision of care, treatment and services?
Filing of complaints: Any person with a mental illness or his nominated representative, has been given the right to complain regarding deficiencies in provision of care, treatment and services by a mental health establishment to the following authorities (in the order of precedence below):
(a) the medical officer or mental health professional in charge of the establishment
(b) the concerned Mental Health Review Board of the district or group of districts
(c) the State Authority.
Judicial Intervention: It should be kept in mind that the provision of making complaint does not deprive a person’s right to seek judicial remedy for violation of his rights in a mental health establishment or by any mental health professional either under this Act or any other law for the time being in force. Therefore, the person may directly approach court for remedy if circumstances so warrant.
Free Legal Aid services: A person with mental illness shall be entitled to receive free legal services to exercise any of his rights given under this Act. It shall be the duty of a magistrate, police officer, person in charge of a custodial institution or medical officer or mental health professional in charge of a mental health establishment to inform the person with a mental illness that he is entitled to free legal services and provide the contact details of the availability of services.
The successful implementation of this Act will depend upon an equal participation by the citizens as well as the establishments engaged in the care of the mentally ill. We hope that we all be more mindful of people around, recognise their mental health and navigating them to self-help or professional help or in some cases, just lending an ear to them.
Akshita Goel
If you or anyone you know needs free legal aid in Delhi/ NCR/ Bangalore/ Mumbai in relation to a mental health issue, please feel free to contact us at help@cornelliachambers.com. We could also assist you with judicial intervention in such matters, if required.
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