Three years on, India’s progressive Mental Healthcare Act is dogged by gaps in implementation

With the death by suicide of Sushant Singh Rajput in June, a conversation about mental health briefly became part of the national discussion, only to be stifled by conspiracy theories. But for a few days, it forced many Indians to acknowledge the mental health challenges faced by many of their compatriots – and how indifferent the authorities are to them.

Even though India in 2017 passed a much hailed and progressive Mental Healthcare Act, some of its provisions remain woefully unimplemented. The need for quality mental healthcare, though, cannot be overstated.

According to a study in 2017 in Lancet Psychiatry, 14.3% of India’s population (or 197.3 million people) suffered from mental disorders. The National Crime Records Bureau says that 139,123 people died by suicide in 2019, an increase of 3.4% from the previous year. However, the budget for 2020-’21 allocates a mere Rs 40 crores to the National Mental Health Programme, the same figure as for the previous year. In fact, funds for the premier National Institute of Mental Health and NeuroSciences, Bengaluru, were actually cut.

Inadequate funds

In the 2020-’21 health budget, the National AIDS and STD Control Programme has been allotted Rs 2,900 crore. Almost all other tertiary care programmes including elderly healthcare, tobacco control have been allotted much more than Rs 40 crores.

Furthermore, this figure is substantially lower than the cost of implementing the Mental Healthcare Act – Rs 94,073 crore, as estimated by doctors of NIMHANS and Spandana Healthcare, Bengaluru. The authors have based this analysis on cost of hiring mental health professionals, establishing statutory agencies under different sections of the Act and the cost of treatment (including outpatient treatment costs, inpatient costs, rehabilitation services and long-term shelter homes).

India spends 0.05% of the total healthcare budget on mental health each year while developed countries spend 4%-5% annually.

It isn’t just the Central government that seems to have a lackadaisical attitude to mental health. States are equally negligent.

For instance, under Section 73 of the Mental Healthcare Act, states have an obligation to constitute quasi-judicial Mental Health Review Boards consisting of a district judge, representative of the district collector, psychiatrists, medical practitioners, persons with mental illness or organisations working in the field of mental health. The board has wide-ranging powers, including the power to adjudicate complaints regarding deficiencies in care and services, inspect mental health establishments and cancel their licences and impose penalties in case their orders are defied.

But more than three years since the enactment of the legislation, several states are yet to constitute these boards. Among them are Manipur, Madhya Pradesh and Punjab, which have a higher prevalence of mental disorders than the national average.

Lack of basic machinery

In addition, some states have neither notified their Mental Healthcare Rules nor constituted a State Mental Healthcare Authority as required under the Act. The State Mental Health Authority is responsible for registering and supervising all mental health establishments in the state, registering clinical psychologists, mental health nurses, psychiatric social workers and developing service provision norms for various types of mental health establishments in the state. According to the Ministry of Health and Family Welfare, only 19 states of India’s 28 states had instituted these authorities by August 2019.

In 2018, though the Uttrakhand High Court directed the state government to constitute a State Mental Healthcare Authority and Mental Health Review Board, this has not yet been done. The Delhi High Court and the Karnataka High Court have also rebuked their states for failing to comply with the provisions of the Act.

As a consequence of states failing to set up the basic machinery, other problems have arisen: registers not being maintained online, grievances about doctors’ decisions and complaints about deficiencies in servies going unaddressed.

The courts have also faced difficulties in deciding cases due to absence of a State Mental Healthcare Authority and Mental Health Review Board. They have had to create ad-hoc or temporary boards to examine petitioners to decide whether their stays in psychiatric hospital need to continue.

Political ignorance

In a country like India, where the political leaders quickly used Sushant Singh Rajput’s death to sensationalise it to suit their political agendas, can one really expect public support for mental health issues?

When the Union Ministry of Labour didn’t think twice last month before tweeting a meme saying “D for Drugs, D for Depression” with a distorted picture of actor Deepika Padukone, who has been public about her mental health challenges, how can one expect public empathy for mental illness from our leaders? After all, politicians routinely take digs at each other by using phrases like “pagal hogaye hain” (this person has gone mad), “mental hospital mein bhejna hai” (send them to the mental hospital) and referring to their rivals as “psychiatric patients”.

Covid-19 has further worsened the situation. In a study published in the Indian Journal of Psychiatry, two-fifths of respondents in a survey were experiencing common mental disorders due to lockdown and the pandemc. India cannot afford to ignore the suffering of millions of citizens. It must make mental health a priority.

October 10 is World Mental Health Day.

Ritika Goyal is a student at National University of Study and Research in Law, Ranchi.