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Salient Features of the Mental Healthcare Act, 2017


The World Health Organization, in its latest report, has claimed that over 300 million people in the world live with depression which is an increase of more than 18% between 2005 and 2015. Dr Henk Bekedam who is the World Health Organization representative to India, said in an interview that 56 million Indians suffered from depression in 2015 which is about 4.5% of the country’s population. Though there is no official figure for the people suffering from the mental illness in the country, yet, as per the  National Mental Health Survey of India, 2015-16, the prevalence of depression among the urban working population was found to be 7.07%; with a lifetime prevalence of 13.13% . According to a 2016 Lancet report, only one of 10 individuals in the country gets treated for mental health. There are 0.3 psychiatrists per 1,00,000 people in India. As per the report, the country has mere 443 public mental hospitals, and six states, mainly in the northern and eastern regions with a combined population of 56 million people, are without a single mental hospital. 
Prime Minister Shri Narendra Modi, in his latest monthly radio broadcast, ‘Mann Ki Baat’, also highlighted the issue of mental health and depression and spoke on the importance of people suffering from depression to talk about it.
In the past three years, the NDA government has taken a number of steps to improve the mental well-being of the people. On 28 March 2017, the Parliament passed the Mental Healthcare Bill, 2016 which will be repealing the existing Mental Health Act, 1987. The bill was already passed by the Rajya Sabha in August, 2016. After receiving the assent of the President on the 7th April, 2017, the Mental Healthcare Act, 2017 has come into existence.
The Act is aimed to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto. The Act has been formulated in line with the Convention on Rights of Persons with Disabilities and its Optional Protocol which was adopted by the United Nations on the 13th December, 2006 in New York and came into force on the 3rd May, 2008. India signed and ratified this Convention in 2007 making it necessary to align and harmonize the existing laws with the Convention.
The Act defines “mental illness” as a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognize reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs. However, it does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterized by sub-normality of intelligence.
The Mental Healthcare Act, 2017 states that mental illness will be determined in accordance with nationally or internationally accepted medical standards including the latest edition of the International Classification of Disease of the World Health Organization.
Political, economic or social status or membership of a cultural, racial or religious group cannot be the basis of determining the mental illness of a person. Non-conformity with moral, social, cultural, work or political values or religious beliefs prevailing in a person’s community can also not be the reasons to determine the mental illness.
Rights of Persons with Mental Illness
The Act guarantees every person right to access mental healthcare and treatment from mental health services run or funded by the Government. It will help in providing mental health services of good quality at affordable cost. It will also ensure that the mental health services are geographically accessible and are provided without discrimination.
Persons with mental illness living below the poverty line or who are destitute or homeless will be entitled to mental health treatment and services free of any charge and at no financial cost at all mental health establishments run or funded by the Government.
Right to Confidentiality: As per the Act, person with mental illness will have the right to confidentiality in respect of his mental health, mental healthcare, treatment and physical healthcare. It also restricts release of information in respect of mental illness. Without the consent of the person with mental illness no information can be released to media by the mental health establishment. However, all such persons with mental illness will have the right to access their basic medical records.
Right to legal aid: It also guarantees a person with mental illness will be entitled to receive free legal services to exercise any of his rights given under this Act.
The Act also recognizes the right to live with dignity; right to community living; right to personal contacts and communication; protection from cruel, inhuman or degrading treatment; treatment equal to persons with physical illness..
Every insurer is bound to make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.
Advanced Directives
The Act states that every person will have the right to specify how he would like to be treated for mental illness in the event of a mental health situation. An individual will also here the right to specify who will be the person responsible for taking decisions with regard to the treatment, his admission into a hospital, etc.
It also says that a medical practitioner or a mental health professional shall not be held liable for any unforeseen consequences on following a valid advance directive.
As per the Act, a person with mental illness will not be subjected to electro-convulsive therapy without the use of muscle relaxants and anaesthesia. Also, electro-convulsive therapy will not be performed for minors. It also restricts use of sterilisation on such persons. They shall not be chained in any manner or form whatsoever under any circumstances.
According to the Act, a person with mental illness will not be subjected to seclusion or solitary confinement. Physical restraint may only be used, if necessary.
Promotion of Mental Health and Preventive Programmes
The Act directs the Government to plan, design and implement programmes for the promotion of mental health and prevention of mental illness in the country. Measures should be taken to create awareness about mental health and illness and reducing stigma associated with mental illness.
According to the Act, the Government will take measures to address the human resource requirements of mental health services in the country by planning, developing and implementing educational and training programmes. This will be done in collaboration with institutions of higher education and training. The aim will be to increase the human resources available to deliver mental health interventions and to improve the skills of the available human resources to better address the needs of persons with mental illness.
As per the Act, the Government will train all medical officers in public healthcare establishments and all medical officers in the prisons or jails to provide basic and emergency mental healthcare.
Establishment of Central & State Mental Health Authority
The Act directs the Government to set up a Central Mental Health Authority within a period of nine months from the date on which this Act receives the assent of the President.
Functions of the Central Mental Health Authority: The Authority will register all mental health establishments under the control of the Central Government. It will maintain a register of all mental health establishments in the country based on information provided by all State Mental Health Authorities of registered establishments and compile update and publish a register of such establishments.
The Authority will develop quality and service provision norms for different types of mental health establishments under the Central Government. It will supervise all mental health establishments under the Central Government and receive complaints about deficiencies in provision of services. It will maintain a national register of clinical psychologists, mental health nurses and psychiatric social workers based on information provided by all State Authorities of persons registered to work as mental health professionals for the purpose of this Act and publish the list of such registered mental health professionals.
The Authority has also been tasked to train law enforcement officials, mental health professionals and other health professionals about the provisions and implementation of this Act. It will also advise the Central Government on all matters relating to mental healthcare and services.
A fund named the Central Mental Health Authority Fund will be constituted where grants and loans made to the Authority by the Central Government and all fees and charges received by the Authority under this Act will be credited.
The Central Authority will prepare an annual report giving a full account of its activities during the previous year and submit it the Central Government which will lay it  before both Houses of Parliament.
The Act also directs all state governments to establish State Mental Health Authority within a period of nine months.
Mental Health Establishment
Every mental health establishment will  be registered with the relevant Central or State Mental Health Authority.  In order to be registered, the establishment has to fulfill various criteria prescribed in the Act.
The Mental Health Authority will maintain a register of such mental health establishments, registered by it, and it will be called as the Register of Mental Health Establishments.
Mental Health Review Boards
The Act states that the State Mental Health Authority will constitute Mental Health Review Boards which will be chaired by a District Judge, or an officer of the State judicial services who is qualified to be appointed as District Judge or a retired District Judge. The function of the board will be to register, review, alter, modify or cancel an advance directive; to appoint a nominated representative; to receive and decide application from a person with mental illness or his nominated representative or any other interested person against the decision of medical officer or mental health professional in charge of mental health establishment or mental health establishment.
The board will also receive and decide applications in respect non-disclosure of information; to adjudicate complaints regarding deficiencies in care and services; to visit and inspect prison or jails and seek clarifications from the medical officer in-charge of health services in such prison or jail.
The Act has the provision to appeal to the High Court of the State against the decision of the Authority or a Board by any person or establishment aggrieved by its decision within a period of thirty days from such decision.
The Act also fixes the responsibilities of other agencies. As per the Act, every officer in-charge of a police station will take under protection any person found wandering at large within the limits of the police station whom the officer has reason to believe has mental illness and is incapable of taking care of himself. It also directs the officer to take under protection any person within the limits of the police station whom the officer has reason to believe to be a risk to himself or others by reason of mental illness.
If any person with mental illness is ill treated or neglected, then the officer in-charge of the police station, where such person is residing, will have the duty to produce him before a Magistrate whose jurisdiction the person with mental illness resides.
Decriminalization of Suicide
According to the Act, a person who attempts suicide shall be presumed to be suffering from mental illness at that time and will not be punished under the Indian Penal Code unlike before. The government shall have a duty to provide care, treatment and rehabilitation to a person, having severe stress and who attempted to commit suicide, to reduce the risk of recurrence of attempt to commit suicide.
The author is a journalist.
Views expressed are personal.
 Image: Courtesy Google