Mental health is different from general health as in certain circumstances mentally ill people may not be in a position to make decisions on their own. Those who suffer rarely get access to appropriate medical treatment as their families try to hide their condition out of a sense of shame. Over 300 million people are estimated to suffer from depression, equivalent to 4.4% of the world’s total population. According to a study conducted by the National Institute of Mental Health and Neurosciences, 1 in 40 and 1 in 20 people are suffering from the past and current episodes of depression in India. In spite of this big burden of mental health issues, unfortunately, it continues to be misunderstood in developing countries like India.

Care and treatment for people affected by mental illness has moved into a new era in India with the enactment of the Mental Healthcare Act, 2017 (MHCA), which seeks to align and harmonize the existing laws on mental health care. The new Mental Healthcare Act, 2017 rescinds/revoked the existing Mental Healthcare Act, 1987 which had been widely criticized for not recognizing the rights of a mentally ill person and paving the way for isolating such dangerous patients. This act has overturned section 309 of Indian Penal Code and decriminalized attempted suicide by mentally ill person.  It also imposes on the government a duty to rehabilitate such person to ensure that there is no recurrence of attempt to suicide. It also states that a person with mental illness shall not be subjected to electroconvulsive therapy (ECT) therapy without the use of muscle relaxants and anesthesia. Another highlight of this Act is to protect the rights of a person with mental illness, and thereby facilitating his/her access to treatment and by an advance directive; how he/she wants to be treated for his/her illness. The act also outlines the procedure and process for admission, treatment, and subsequent discharge of mentally ill persons.

The Mental Healthcare Act (MHCA), 2017, is enacted with an aim to promote and protect the rights of and improve the care and treatment for people affected by mental illness in India. It ensures that these persons have a right to live life with dignity by not being discriminated against or harassed. The Act purportedly includes substance use disorder (SUD) specifically in the definition of mental illness itself. The Act lays down various rights that include, among others, protection from cruel, inhuman, or degrading treatment in any mental health establishment. This is very important from the perspective of treatment of SUD in the context of India, where human rights violations in the name of addiction treatment are often reported. The inclusion of SUD in the Act slots SUD as a health issue, rather than a law-and-order issue alone. This displays the intent of policymakers toward SUD, which, in itself, is laudable. It is also worth mentioning here that a law is enacted for the first time that will regulate addiction treatment to a great extent in India. Apart from prescribing certain practices that are carried out in the name of the treatment, the Act also makes the mental health authorities responsible for laying down standards to be followed in mental health establishments. The Government of NCT of Delhi has already notified the various minimum standards to be followed for the treatment of persons with SUD. All such measures would definitely help in improving the standards of treatment provided to patients with SUD. The punishment for violating of provisions under this Act will be imprisonment up to 6 months or Rs. 10,000 one or both. Repeat offenders can face up to 2 years in jail or a fine of Rs. 50,000–5 lakhs or both.

Overall, the reaction to this Act has been mixed; it has received both bricks and bouquets from various quarters. The Act has been praised for protecting and upholding the rights of people with mental illnesses. Most importantly, the Act has been lauded for enabling people with mental illness to declare in advance how they can (or cannot) be treated. In addition, the Act empowers them to choose a person to make treatment decisions on their behalf when they are not in a position to do so. On the other hand, concerns have been expressed regarding the difficulties this Act may pose for the psychiatrists who want to genuinely help their patients. Many commentaries and opinion pieces have discussed the implication of this Act on the practices of psychiatry in India.

ARUSHI SRALECH