In a previous article (“Mental Health and Legislation in India” – https://wp.me/pbOGpV-gi), I had dealt with the very urgent topic of mental health, its SDG connection, the related legislation in India and its salient features. In this article, I intend to shed light upon the various shortcomings of the Mental Healthcare Act, 2017. A reading of the previous article is advised.
The Mental Healthcare Act, 2017 has been instrumental in paving the way for informed and open discussion on the rather taboo topic of mental health in India, and has taken contributed to making the mental healthcare system more robust. However, there are still some areas where it has left some sufferers wanting. Solving these issues has the potential to make the Mental Healthcare Act, 2017 a very effective legislation in a country that is certainly in need of the same.
The Act suffers from some rather peculiar contradictions in its wording. For instance, there is an incompleteness in the definition of a ‘mental health professional’ that has been decried. The current definition of ‘mental health professional’ is restricted to clinical psychiatrists and professionals holding a postgraduate degree in Ayurveda, homoeopathy, Siddha and Unani—all on the clinical side. Although including specialists from non-allopathic fields of medicine is laudable, it is unclear why psychotherapists and psychoanalysts were excluded. These professionals are very important stakeholders in the mental health process, dealing with topics like depression, which are included in the Act, and their exclusion does not bode well for mental healthcare.
Another possible concern is that the over-zealous licensing requirements in the Act may create a ‘license raj’ in the mental healthcare industry. The National Mental Health Policy advocates the integration of mental health into primary health care. However, the act mandates that all establishments must take specific registration for treating PMI; this may come in the way of integrating mental healthcare into general health care and thus the implementation of the policy. Many private hospitals and nursing homes may refuse to treat patients with mental illness as inpatients, explaining that they do not have the registration to do so. The act enthusiastically moves forward (without acknowledging the meagre available resources) to protect and promote human rights of PMIs (persons with mental illness) by mandating registration of the MHE. Hostels, prisons, child protection centres, reception centres, beggars’ homes, religious places and centres run by faith healers would all need to take registration to keep PMIs, which would overly formalize the procedure, drive away potential PMIs and defeat the purpose of the act. It would be prudent to keep the general hospital, primary health centre psychiatry units, and other treatment-providing centres in primary care out of the purview of registration so that the act can be properly implemented, though the psychologists and psychiatrists working under them may be registered.
Another pressing concern is that of provisions regarding electro-convulsive treatment. Section 94 (3) of the legislation (“Emergency treatment”) states that “nothing in this section shall allow any medical officer or psychiatrist to use electroconvulsive therapy as a form of treatment.” This effectively bans the provision of ECT on an emergency basis. Section 94 (4), however, states that “the emergency treatment referred to in this section shall be limited to 72 hours or till the person with mental illness has been assessed at a mental health establishment, whichever is earlier”. In such situations, when the patient lacks capacity, psychiatrists should have been allowed to administer ECT (subject to additional safeguards) as a lifesaving measure. This practice is currently allowed in many countries including England and many Australian states (Western Australia, Northern Territory, Queensland, and South Australia).
Addressing these shortcomings here is extremely necessary for providing effective mental healthcare facilities to the thousands of people in need of it. The shortcomings regarding depression definitely need to be addressed, especially as its prevalence is slowly becoming the rule rather than the exception in today’s society. Ultimately, a mentally healthy society is extremely important for the progress of a nation, and healthcare improvements would go a long way in ensuring the same.
- Yash Saboo, “The Loopholes in Mental Healthcare Act 2017”, TheDaily Eye, https://thedailyeye.info/post.php?id=c61eb6a919531790
- Math, S.B.; Basavaraju, Vinay; Gowda G.S.; et al; “Mental Healthcare Act 2017 – Aspiration to action”, indian Journal of Psychiatry (Year 2019, Vol. 61 Issue 10 Page 660-666)
- Gautam Gulati, Vasudeo Paralikar, Niket Kasar, et al, “A focus group study of Indian psychiatrists’ views on electroconvulsive therapy under India’s mental healthcare act 2017: ‘The ground reality is different’”, Indian Journal of Psychological Medicine (Yr. 2019, Vol. 41 Issue 6 Pg. 507-515)
- Jeanne Snelling, “A review of the literature, the Acts of Parliament and relevant current practices on regulation of the use of ECT in New Zealand and in other like Nations”, ECT Review Group, https://www.health.govt.nz/system/files/documents/publications/ect-reviewgroup.pdf