Mental Healthcare Legislation 2017 – India
On March 27, 2017, the Lok Sabha (Lower House of the Indian Parliament) unanimously passed the Mental Healthcare Act, 2017. The Act had earlier been passed by the Rajya Sabha (Upper House) in August 2016 and received the President of India’s assent in April 2017.
Key Features of the New Act Include: –
- Decriminalisation of Attempt to Suicide: The Act states, “Notwithstanding anything contained in Section 309 of the Indian Penal Code, any person who attempts to commit suicide shall be presumed, unless proven otherwise, to be suffering from severe stress and shall not be tried or punished under the said Code.”
- Establishing the Rights of Persons with Mental Illness:
The Act safeguards the rights of individuals with mental illness by ensuring their access to treatment and allowing them to issue an advance directive—specifying how they wish to be treated during the course of their illness. [1] -
Ban on Electroconvulsive Therapy Without Safeguards:
The Act bans the use of electroconvulsive therapy (ECT) on adults unless it is administered with anesthesia and muscle relaxants to ensure patient safety and dignity. -
Right to Mental Healthcare:
Every person has the right to access mental health services that are affordable, of good quality, easily accessible, and provided with dignity. The Act emphasizes protecting the rights of individuals with mental illness and mandates that government-run or government-funded services meet these standards.
Protection from Inhuman Treatment & Right to Advance Directives:
The Act also aims to protect individuals with mental illness from inhuman or degrading treatment. It grants them the right to make an advance directive, allowing them to specify how they wish to be treated and to appoint a nominated representative. This directive must be reviewed and approved by a qualified medical practitioner.
This Act further seeks to protect such persons from inhuman treatment
- Right to make Advance Directives – This provision empowers a mentally ill person to have the right to make an advance directive that explains how she/he wants to be treated for the requisite illness and who her/his nominated representative shall be. This directive must be vetted by a medical practitioner.
- Mental Health Establishments:
The Act mandates that all mental health establishments be registered with the appropriate Central or State Mental Health Authority. It also requires the government to establish a Central Mental Health Authority at the national level and a State Mental Health Authority in each state. Additionally, all mental health professionals—including clinical psychologists, psychiatric social workers, and mental health nurses—as well as mental health institutions, must be registered with the relevant authority.
Functions of Mental Health Authorities:
The responsibilities of the Central and State Mental Health Authorities include:
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Registering, supervising, and maintaining a record of all mental health establishments;
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Developing quality standards and service norms for these establishments;
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Maintaining a registry of qualified mental health professionals;
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Providing training to law enforcement personnel and mental health professionals on the provisions of the Act;
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Receiving and addressing complaints related to deficiencies in mental health services; and
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Advising the government on matters concerning mental health policy and implementation.
To obtain registration, mental health establishments must meet specific criteria outlined in the Act.
The legislation also details the procedures for the admission, treatment, and discharge of individuals with mental illness.[2]
The new Act defines mental illness as a substantial disorder in thinking, mood, perception, orientation, or memory that significantly impairs judgment or the ability to cope with the ordinary demands of life. It also includes mental conditions resulting from alcohol and drug abuse.
The Bill outlines measures to regulate voluntary admissions, stating that such admissions must be for a specified period and under the supervision of a qualified psychiatrist.
It is estimated that 6–7% of the country’s population is affected by some form of mental illness, with 1–2% experiencing severe conditions.
The Act includes special provisions for women and children. Women are not to be separated from their children unless absolutely necessary. Additionally, electroconvulsive therapy (ECT) is prohibited for children and may only be administered to adults under anaesthesia and with the use of muscle relaxants.
One of the key objectives of the Bill is to ensure access to mental healthcare, treatment, and rehabilitation in a manner that upholds the rights and dignity of individuals with mental illness.
Responsibilities of Other Agencies:
The Act mandates that a police officer in charge of a police station must report to the Magistrate if there is reason to believe that a person with mental illness is being mistreated or neglected. Additionally, the officer is responsible for taking into protective custody any individual found wandering in public spaces. Such individuals must be examined by a medical officer, and based on the findings, may either be admitted to a mental health establishment, returned to their residence, or taken to a shelter for homeless persons.
Penalties for Non-Compliance:
Violations of the provisions under this Act may result in imprisonment for up to six months, a fine of up to ₹10,000, or both. In the case of repeat offences, the punishment may extend to imprisonment for up to two years, a fine ranging from ₹50,000 to ₹5 lakh, or both.
According to the World Health Organization (WHO), health is a holistic concept that includes physical, mental, spiritual, and social well-being. The WHO emphasizes that “mental health and well-being are fundamental to quality of life, enabling people to experience life as meaningful and become creative, active citizens.”
Mental health differs notably from general health, as individuals with mental illness may, in certain situations, be unable to make decisions independently.
Level of income and incidence of mental illness has a direct relationship. Social stigma also grows as has been found in a survey in nineties in last century. [3]
Mental illness often persists over an extended period and can have a lasting impact, gradually leading to a diminished quality of life.[4]
Mental Healthcare was badly needed as before, those who suffer rarely get access to appropriate medical counselling and treatment as their families try to hide their condition out of a feeling of shame – commonly known as social stigma.
This mindset not only harms individuals with mental illness but also renders them vulnerable to exploitation, abuse, neglect, and social exclusion.[5]
The Global Burden of Disease report indicates that mental disorders contribute to 13% of all disability-adjusted life years (DALYs) lost, with depression being the leading cause of years lived with disability.[6].
It is estimated that over 300 million people worldwide suffer from depression, accounting for approximately 4.4% of the global population. Numerous studies have shown a strong association between mental disorders and a wide range of acute and chronic conditions, including noncommunicable diseases, injuries, violence, and adverse maternal and child health outcomes.
Approximately 14% of the global burden of disease is attributed to neuropsychiatric disorders, largely due to the chronically disabling effects of depression, other common mental disorders, alcohol and substance use disorders, and psychoses. These figures underscore the significant impact of mental health conditions on public health and highlight the urgent need for focused intervention and awareness.
Mental disorders elevate the risk of both communicable and non-communicable diseases, and are associated with a higher likelihood of both unintentional and intentional injuries. Conversely, various physical health conditions can increase the risk of developing mental disorders. This bidirectional relationship, along with comorbidities, complicates help-seeking, diagnosis, treatment, and ultimately affects the overall prognosis. [7]
The prevalence of any cardiovascular diseases is the lowest in adults who are mentally healthy and higher among adults with major depressive episode, with minor depression, with languishing, and with moderate mental health. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Mental health is of utmost important as it has direct bearing on general health. [8]
A 2016 study by India’s National Institute of Mental Health and Neurosciences (NIMHANS), spanning 12 states, found that the prevalence of depression was 2.7% for current cases and 5.2% for lifetime cases. This means approximately 1 in 40 people in India experience ongoing depression, while 1 in 20 have faced it at some point in their lives. .[9]
The survey, also found that 1% of those surveyed had “high suicidal risk.” This figure could be around 76 lakh persons if extrapolated for India. [10]
This survey has shown that the lifetime prevalence of mental disorder is 13.7% as a whole, which would mean at least 150 million Indians are in need of urgent intervention. Mental illness in vulnerable age groups such as adolescent and in geriatric population accounts for more than half of the total burden. [11][12]
India’s Ticking Bomb: Another report regarding the projected burden of mental illness conveys that it will increase more rapidly in India than the other countries over the next 10 years and will account for one-third of the global burden of mental illnesses, a figure greater than all developed countries put together.[13] Even with the heavy toll of mental health disorders, they continue to be stigmatized and poorly understood in countries such as India. [14][15]
As part of developing a mental healthcare model for rural India, a study on detecting and managing priority mental disorders was conducted across 120 villages near the Sakalwara Rural Mental Health Centre in Bangalore District. Over three and a half years, the team provided community-based care using minimal medication, treating 51 schizophrenia patients, 30 acute psychosis cases, 27 manic-depressive psychosis (MDP) cases, and 268 epilepsy patients. [16]
Understanding the financial burden on the community, Government of India has taken several steps like changing the laws with penal actions, launching several programmes to make citizens aware of their mental illness or abnormality, introduced on-line platform to guide the patients and to make available professional help on-line, train more medic and para-medic staffs for in-house treatments, allocated budget to procure modern non-invasive technology like Transcranial Magnetic Stimulation.
Debasis Chaudhuri
