In India, it has been calculated that 7.3% of teenagers suffer from a mental disease. Numerous variables can contribute to the emergence of a psychiatric condition, which can then interfere with daily functioning and generate distress that impairs it. A person’s upbringing, parenting methods, social interactions, and local environment can all have an impact on their social roles and obligations. On April 7, 2017, the President gave his vote on the Mental Healthcare Bill and with that, the MENTAL HEALTH CARE ACT 2017 came into existence. This Act provides for the persons who are suffering from mental illness with healthcare and services to protect their rights. This Act came to existence in order to harmonize and put into alignment the local Mental Healthcare Act 1987 with the Convention on Rights of Persons with Disabilities and its Protocol which was adopted by the UN on December 13th, 2006, and came into force on May 3rd, 20081.
WHAT IS MENTAL HEALTHCARE?
The Act specifies the following as the definition of mental illness: “a significant mental disorder caused by alcohol or drug abuse that seriously affects thinking, mood, perception, orientation, or memory, as well as judgment, behaviour, the ability to recognise reality, or the ability to meet daily demands. However, it does not classify mental retardation, a condition in which a person’s mental growth is slowed down or stopped altogether and is particularly marked by low IQ, as a mental disorder2.”
The 2017 Mental Healthcare Act intends to offer mental healthcare services to people who are suffering from mental illness. By preventing harassment or discrimination, it guarantees that these people have the right to live their lives with dignity. This bill has a lot of helpful qualities, but it also has certain drawbacks and is not perfect for the Indian situation. The right to live in dignity, free from sex, religious, cultural, or caste discrimination, is stated in this law. Every person has a right to privacy regarding their disease and medical care. According to new regulations, ECT cannot be administered without anesthesia, and ECT is not available for minors. Such patients shall not be sterilized, and neither shall they be isolated or kept in solitary confinement.
This law makes mental health services more widely accessible. This right is designed to guarantee that services are easily available, reasonably priced, and of high quality. Additionally, it requires that mental health services be built and made accessible in each and every region of the nation. However, the state governments will bear a significant financial burden unless the federal government contributes a higher share of the budget to incur the expense due to the already subpar medical infrastructure at the district and subdistrict levels.
- Rights of those who suffer from mental illness
Everybody will be able to use services for mental healthcare. Such services must be of a high standard, practical, reasonable, and available. Additionally, this law aims to safeguard these people from cruel treatment, give them access to free legal services, guarantee their privacy when it comes to their medical data, and give them the opportunity to complain if any provisions aren’t up to par.
Advance Directive: Under this law, a person with a mental illness has the legal authority to designate a representative and to make decisions about how they wish to be treated for their sickness. This instruction needs to be approved by a doctor.
- Role of the Central Authority for Mental Health
All mental healthcare facilities under the control of the central government will be listed and registered, and it will fund and oversee the provision of high-quality services for various types of such facilities. It will also include a list of all the medical specialists who should be contacted in an emergency.
- Decriminalization of Suicide Attempt
There is a lack of knowledge regarding the laws relating to suicide, and the majority of them are opposed to making suicide a crime. When having suicidal thoughts, some are unwilling to seek out professional assistance. There is ambivalence and ignorance about suicide in society. The stigma attached to seeking psychiatric help may be the cause of ambivalence. It is legitimate to demand that public health policymakers take these findings into account when developing programs to raise knowledge of Sec. 115 of the MHCA. Through media and hospital-based initiatives, ignorance can be dispelled3.
Awareness is still quite low even after 155 years of Sec. 309 IPC deployment. If steps are not taken to raise awareness, Section 115 of the MHCA will likewise be invalidated. Follow-up studies are also required to determine the results in terms of changes in the suicide rate, requests for assistance, referrals to psychiatry, and epidemiological statistics. The impact of this Act’s implementation, in the long run, can only be determined with time.
Section 309 IPC: “Anyone who makes an attempt at suicide or takes any action that contributes to the commission of this type offence is subject to simple custody for a time that may not exceed one year [or a fine, or both] as a penalty4.
According to Section 115,
(1) anyone who attempts suicide is deemed to be suffering from severe stress unless proven otherwise and is not subject to a trial or punishment under Section 309 of the Indian Penal Code.
(2) The appropriate government has a responsibility to offer care, therapy, and rehabilitation to a person who tried suicide due to extreme stress in order to lower the likelihood of another attempt.
- Certain other agencies are responsible
If a police officer in charge of a police station has reason to believe that a mentally ill person is being mistreated or neglected, he must report to the Magistrate. The bill also requires a police officer in charge of a police station to protect any wandering person; such a person will be examined by a medical officer and, based on the results of that examination, will be admitted to a mental health establishment, taken to her residence, or to an establishment for homeless people.
- Financial repercussions
Violations of this Act’s provisions will result in imprisonment for up to 6 months or a fine of Rs. 10,000, or both. Repeat offenders may face penalties of Rs. 50,000-5 lakhs or 2 years in jail.
OBJECTIONS TO THE ACT
According to Section 5 of the Act, minors are not entitled to an advance directive. Both the central and state governments are required to guarantee all services. The anticipated costs do not cover all of the bill’s requirements. According to the Act, both the Center and the State have obligations but a fund-sharing arrangement is not provided. Despite the fact that the financial situations in each State vary, the federal government must guarantee sufficient finances to fulfill its legal commitments. The Act states that a person may continue to reside in a mental health facility as an independent patient if they no longer want an order of supported admission, but it is unclear for what reason.
CHALLENGES TO BE ADDRESSED
India has the highest rate of suicide in the world. The high rate of crime and drug addiction in India is also linked to poor mental health. The pandemic has revealed previously unseen mental health issues, exposing flaws in existing mental health infrastructure and laws/policies. This pandemic has served as a wake-up call that India’s mental healthcare system requires strengthening and additional support from the Central or State governments. In India, there is an utter absence of inclusive mental healthcare and a failure to implement the DMHP. The effects of the COVID-19 pandemic on people’s mental health are visible, and this is only the beginning. Unless we make serious commitments to accumulate capital in mental health right now, the situation will deteriorate.
The current healthcare system is ineffective, and we lack the necessary infrastructure and professionals, which harms living conditions and the treatment of mental illness. One of the key features of the act is the decriminalization of suicide attempts, along with the Advance Directive concept and a ban on all treatments that gave these mentally ill people nightmares. The act also attempts to fix the institution system by enlisting institutions and ensuring that they adhere to the standards set by the authorities in the act.
The new Mental Healthcare Act 2017 is intended to change India’s fundamental approach to mental health issues, including a sensible patient-centric approach to healthcare rather than a criminal-centric one. The guidelines should be revisited in three areas: primary prevention, reintegration, and rehabilitation because their implementation would be insufficient without these improvements, and the problem of formerly ill people would persist. To be optimistic about the measure, one must wait and see how it is implemented.
- Mental Healthcare Act, 2017.
- Decriminalization of suicide as per Sec 115 of MHCA, 2017, (2018) Indian J. Psychiatry, 10.4103/psychiatry.IndianJPsychiatry_335_17.
- Indian Penal Code 1860, s 309.
This article is written by Sneha Sakshi, a second-year BBA LLB student of Symbiosis Law School, Pune.