India is the seventh largest country in terms of area and the second largest in terms of population. Consequently, the provision of healthcare to the 1.3 billion individuals in India, who sprawl across a vast size, presents a number of visible obstacles. India's health system continues to underperform in comparison to other countries, many of which are less developed, and it is ranked 145th among 195 countries in terms of access to and quality of healthcare. Furthermore, there are significant disparities among Indian states. Mental healthcare presents unique obstacles. Anxiety, depression, bipolar disorder, schizophrenia, substance use disorders, and neurodevelopmental disorders are among the mental health disorders that affect approximately 6-7 percent of the population. Although mental healthcare has made substantial progress in recent decades, there is still a lack of financial and human resources. The health budget for the current financial year (FY 2024-25) is approximately 2% of the total budget, while the mental health budget is approximately 1% of the total health budget. Inadequate resourcing, stigma, and discrimination, as well as perceived coercion and variable adherence to legal formalities regulating care, are among the diverse and complex challenges that India faces.
Magnitude of the Problem
Mental illness refers to the psychological and emotional condition of an individual. Good mental health, also known as mental soundness, pertains to the condition of possessing a harmoniously functioning mind, accompanied by sentiments of assurance and self-worth. A mental illness is a disorder that significantly affects an individual's cognitive functions, perception, and behaviour. The topic of mental health has garnered considerable attention and sparked extensive discussions in recent years, as society becomes increasingly aware of the difficulties associated with it. Mental disorders have an impact on individuals across various age groups, socio-economic statuses, and geographical regions, affecting people from all different origins and lifestyles. Mental health discourse in India has emerged very recently, however underlying attitudes and taboos continue to exist. According to the National Health program in Kerala, approximately 6% of the population is afflicted with mental illnesses, while 20% encounter emotional and behavioral challenges. India holds the distinction of having the highest suicide rate globally, with an annual report of over 260,000 cases. According to data from the World Health Organization (WHO), the suicide rate in India is 10.9 per 100,000 inhabitants on average. Addressing mental health concerns is essential for creating awareness of mental health and tackling the increasing public health concern. Mental disorders manifest in diverse forms and varying levels of intensity, and can be classified into two broad categories: common and severe mental disorders. These diseases vary from psychosis, which is caused by a chemical imbalance in the body, to neurosis, which is a result of inadequate attitudinal learning during the developmental years. Individuals struggling with mental health disorders endure profound psychological distress and anguish, as these conditions often impede their ability to lead fulfilling lives. People may encounter difficulties in maintaining personal relationships, pursuing academic or career opportunities, and participating in social activities. Moreover, mental health disorders exert a substantial influence on the overall functioning of communities and the nation. The economy is significantly affected by decreased productivity, both in professional and domestic contexts. Psychopathological conditions sometimes lead to regular absences, reduced work efficiency, and protracted inability, all of which negatively impact workplace productivity and economic progress. Moreover, the increasing prevalence of depression and anxiety disorders is intensified by societal pressures, which are caused by the substantial stigma associated with mental health issues. People suffering from mental problems may face prejudice, which can deter them from getting help and lead to feelings of social isolation. Moreover, mental health treatment can be costly, and there is a shortage of mental health professionals, including psychiatrists, psychologists, and social workers, making it difficult for many people, especially those living in rural areas, to access these services.
The Mental Health Care Act: An Overview
A significant step towards improving mental health care in India are governed primarily by the Mental Healthcare Act, 2017 explicitly to comply with the United Nations Convention on the Rights of Persons with Disabilities. It grants a legally binding right to mental healthcare to over 1.3 billion people, one sixth of the planet's population. Mental Health Care Act, 2017 adopts a rights-based approach to mental healthcare and treatment by placing obligations on the government and mental health professionals to protect the rights of persons with mental illness.
The legislation offers a clear delineation of mental illness and mental health institutions, along with updated criteria for determining treatment choices. The Act also examines legal provisions that provide individuals with mental illness the ability to articulate their treatment preferences and designate representatives to act on their behalf. Moreover, it emphasizes the importance of ensuring the accessibility of mental health treatment and extending complete social privileges to individuals with mental health illnesses. Further, the Act introduces the creation of government entities to oversee mental health services, the establishment of committees to evaluate admissions, updated protocols for voluntary and involuntary treatment, new regulations on treatment provision, restraints, and research, and the removal of criminal consequences for attempted suicide.
This legislation signifies a substantial advancement in terms of the rights and safeguards provided to individuals with mental diseases in the delivery of mental health treatment and services, as well as related problems. Nevertheless, the execution of this plan encounters obstacles such as insufficient financial resources, a shortage of skilled staff, and a restricted level of public knowledge. The objective of HCA 2017 is to facilitate socio-cultural and structural transformations in addressing mental health concerns in India.
Future Directions for Mental Health Care in India
The main goal of the new legislation in India is to improve mental health services and infrastructure, in line with the United Nations' Convention on the Rights of Persons with Disabilities, and to elevate the position of those with mental diseases. However, there are certain challenges that must be resolved, including the distribution of resources for mental health services, the appropriateness of approved care procedures, and the potential for inconsistent outcomes. There is an ongoing debate about specific solutions that require ongoing engagement with multiple parties, including patients, families, the Indian Psychiatric Society, and non-governmental organizations. Despite these obstacles, the new legislation offers significant potential benefits for India and other countries.
Conclusion: Towards a Healthier Society
The enactment of the Mental Healthcare Act, 2017, has created an exceptionally supportive environment for transforming mental health care in India over the past decade. This key legislation signifies a progressive nation while presenting significant challenges and opportunities. It provides a comprehensive framework to ensure the right to mental health care, protect patient rights, and enhance service access. This framework allows for integrating mental health care into broader health systems, raising awareness, and reducing stigma. However, challenges such as securing sufficient funding, training mental health professionals, and addressing regional infrastructure needs remain. Successfully addressing these challenges could lead to significant improvements in mental health care delivery, turning the Act's promises into real benefits for individuals and communities. At this crucial moment, India has the chance to turn these visions into action and revolutionize mental health care services. This legislative framework lays the groundwork for a more compassionate and effective mental health care system in the country.
The Author is Director, School of Law, Fairfield Institute of Management and Technology New Delhi
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