The Mental Healthcare Act 2017 (MHCA 2017) had been passed by both houses of the Parliament and received Presidential approval in 2017, and came into effect on 7th April 2018. The MHCA 2017 was enacted with the aim to protect and promote the rights of people ailing from mental ill-health. It replaced the existing Mental Healthcare Act 1987, which had drawn much fire for allowing for inhuman treatment of mental ill-health patients.
There are three salient features of the Mental Healthcare Act 2017. Firstly, it regulates the treatment of patients with mental illness, both by prohibiting certain practices and by empowering patients to make decisions about the kind of treatment that they want. Secondly, it alters the legal status of suicide attempts. Finally, it grants the patients basic human rights, as well as greater access to healthcare services. The article aims to critically analyse the extent to and the manner in which these features have uplifted the stakeholders of the Act, i.e. Persons with Mental Illnesses. (PWMI)
On the first level, various practices and methods of treatment have been restricted to regulate the kind of treatment that patients undergo. Electro-convulsive Therapy, a procedure that passes electric currents through the brain to alter the brain chemistry in an attempt to palliate the mental ailment, can now no longer be performed on minors. When performed on adults, they have to be compulsorily accompanied by anesthetics. Patients cannot be made to undergo tonsuring, which refers to the shaving of the head, sterilization or be compelled to wear uniforms provided by the Mental Health Establishment. They may not be restrained with the use of chains, or be put under solitary confinement.
These changes are highly laudable as they have introduced the wave for the much-needed intervention in the treatment procedures of PWMI. The qualifications made with respect to Electro-convulsive Therapy and the prohibition of tonsuring is a huge leap in terms of promoting the safety of medical procedures and uplifting the dignity of the patients respectively.
However, some of these changes have perhaps overlooked the practicalities of dealing with PWMI. For instance, uniform provided by the institution allow for easy identification of the patients, enables better watch for suicidal attempts and ensures that the patient has a sanitized set of clothing to wear, which are matters of paramount importance that should not be compromised on, even in the name of patients’ dignity. Furthermore, uniforms are not discriminatory towards patients with mental illness, as it is a practice often adopted by hospitals even for patients suffering from physical ailments. Hence there is a need to perhaps balance the dignity of the patients, against their safety and medical requirements.
Another method of regulating the procedures of treatment is by empowering patients to make decisions about their treatment. Patients can make an Advance Directive, in which they can indicate the preferences for the kind of treatment they would want to undergo, and the kind of treatment they do not want to undergo. They can also appoint a Nominated Representative to make decisions on their behalf. These provisions are made to pander to the inability of mental health patients to talk to the medical professional about the kind of treatment they want to undergo.
This concept aims to reduce the disparity between patients of physical and mental health, by allowing mental health patients a say in their treatment the same way a patient of physical ill health would. However, patients may not always be capable of making their own decisions. Due to the socio-economic background of people and the lack of structural support available in the country, they often lack the necessary awareness about the matter, access to reliable mental healthcare resources or the capability/education to comprehend the intricacies of these resources. The stigma attached to mental illness further acts as an impediment to learning more about the ailment and taking rational decisions pertaining to the treatment, and people often indicate preferences premised on facile superstitions or emotional proclivity. Even if they possess some level of understanding and knowledge about standard procedures, they will never have the kind of trained expertise, superior knowledge about the condition, up to date awareness of the latest cutting edge solutions, and experience that a psychiatrist treating the patient would. Therefore, the severe restriction placed on the physician by way of the advanced directive may prove detrimental for the patient itself.
In addition to incorporating changes in the medical sector, the Act has also intervened in the legal sphere. Before the Act, attempt to suicide was criminalized under Section 309 of the Indian Penal Code. However, the Act presumes that any attempt to suicide is premised on severe stress at work. Hence it is not a criminal act, but an indication of a need for mental health intervention. Decriminalising the attempt to suicide has now ensured that the trauma and emotional pain suffered by suicide survivors are no longer compounded by harassment and punishment, but alleviated by suitable medical intervention.
Finally, the Mental Healthcare Act establishes several rights for PWMI in various spheres. First and foremost, it ensures basic human rights for all mental ill health patients, including the right to safe environment, basic amenities, confidentiality as well as protection from abuse and inhuman treatment.
The Act also ensures accessibility, affordability and quality in healthcare services. It establishes rights to quality healthcare, and reduces barriers in access to healthcare by providing for free medicines and free treatment for lower-income groups. Mental health care services are to be available in every district of the country. It also mandates insurance companies to provide mental health insurance covers. Legal services to avail of these rights can also be sought free of cost.
However, practical implementation of these rights is impeded due to the socio-economic conditions in the country. There is a severe lack of infrastructure and deficit of trained professionals in many parts of the country. A much larger fraction of the annual budget needs to be devoted to mental healthcare. Most importantly, the realization of these rights can never take place due to the existence of social stigma and prevailing narrative around mental illness. No matter the number of mental asylums that mushroom in the country, as long as the people continue to see mental ailment as something to be ashamed of and swept under the carpet, they will never approach the authorities in availing these rights.
In conclusion, the MHCA 2017 was a groundbreaking step towards the recognition and promotion of mental healthcare in the country, as it is the first legislation that effectively dealt with rights relating to a largely sidelined section of the society. It brought about significant changes in the treatment, protection and empowerment of patients. However, the Act is an intervention that can only come into play at a much later stage of the patient’s diagnosis – primarily once the institutional authorities get involved. In a country like India, which is flooded by stigma, superstitions, social structures and lack of awareness, perhaps there needs to be a greater focus on overcoming these barriers.