In India, Mental Healthcare Act of Parliament received the assent of the President on the 7th of April 2017 and came into force in 2018. The Act provides mental healthcare and services to people with mental illness and also protects, promotes, and fulfills the rights of such persons during the delivery of mental healthcare and services. Under this act, Mental illness was determined in accordance with such nationally or internationally accepted medical standards, that of the World Health Organisation (WHO), or others that were notified by the Central Government.
Recently , all 46 government-run mental healthcare facilities across the nation were described as being in “inhuman and deplorable” condition by the National Human Rights Commission (NHRC) in a report. According to the report, the clinics are “illegally” holding individuals long after they have recovered, which is an “infringement of the human rights of mentally ill patients.” These observations were made following visits to all government facilities that were in use to evaluate the implementation of the Mental Healthcare Act (MHA) 2017.
“MHA 2017 acknowledged their right to live as a part of the community and focused on rehabilitation,” says Ms. Priti Sridhar, CEO of Mariwala Health Initiative (MHI). Under section 19 of the Act, the government was made responsible for creating various opportunities to access less restrictive options for community living such as sheltered accommodations, rehab homes, and halfway homes. The use of physical restraints such as chaining was prohibited. The person can nominate a representative for themselves and the act acknowledged that external factors such as income, social status, and education impact mental well-being. Therefore, recovery needs psychiatric as well as social input.
What are the health care challenges faced?
While the MHA protects people’s rights in mental healthcare facilities, enforcement issues persist. According to 2018, Hans Foundation research, about 36.25% of residential care users in state mental hospitals had been there for one year or longer.
All states are obliged under the MHA to create a State Mental Health Authority and Mental Health Review Boards (MHRBs), which can further design standards for mental healthcare institutes, monitor their operations, and ensure they conform with the Act. Ms. Fernandes observes that in the majority of states, “these bodies have yet to be constituted or are defunct… Moreover, several states have failed to notify basic norms intended to assure the quality of MHEs.” Ms. Sridhar adds that the Act adopts a human rights perspective by moving the responsibility of care to many stakeholders, such as carers, government institutions, police officers, and mental health practitioners. Improper budgetary allocation and utilization of funds results in shelter homes that are underequipped, facilities that are understaffed, and professionals and service providers who are not appropriately qualified to offer basic healthcare, she noted.
According to Ms. Fernandes, while Section 19 recognizes the right of persons to “live in, be a part of, and not be separated from society,” there have been no real efforts toward implementation. The scarcity of alternative community-based alternatives hampers access to rehabilitation even more. Poor budgetary allocation and utilization of funds create a scenario where shelter homes remain underequipped and establishments understaffed.
The Mental Health Care Act is an important piece of legislation because it safeguards and advances the rights of people who suffer from mental illness (PMI), paving the way for a brighter future for all of them. Yet, it has some flaws in terms of PMI autonomy, the range of mental diseases covered by the legislation, and the safety of providing such autonomy to minors. The state of one’s mind is just as crucial as one’s body. So, having access to and being able to properly regulate mental healthcare services is crucial. Thus, we need to work towards enacting a comprehensive law on the prevention and treatment of mental diseases.
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