The >Mental Health Care Bill, 2016, passed by the Rajya Sabha is a watershed legislation that lays down clear responsibilities for the state and has provisions that empower individuals and families. Crucially, it can expand access to treatment, which is dismally poor today. According to a recent review in The Lancet, of gaps in mental health treatment, although both India and China have renewed their commitment to address the problem through national programmes, it is Beijing that has done better in terms of improving coverage. India allocates just over 1 per cent of the Centre’s health budget to mental health, with States making comparable allocations. This situation should change if the provisions of the bill are to be meaningful. The legislation, inter alia , gives everyone the right to access mental health care as well as treatment from mental health services run or funded by the government; it also provides for supply of all notified essential medicines free of cost to those with mental illness, through the government. The situation today is a far cry from what is promised. While the bill says mental health services should be available at the district level, even States with well-functioning district hospitals do not offer regular psychiatric outpatient services, leave alone in-patient facilities. In government hospitals, medication to treat even the more common psychiatric disorders is not always available. These and other deficiencies need not have waited for a law.
In a much-needed change, the Centre has adopted a medicalised approach to attempted suicide, treating it as the outcome of severe stress. The bill rightly blocks the application of the Indian Penal Code section that criminalises it. A duty is also cast on the authorities to care for and rehabilitate such individuals. What this means is that official policy must strive to strengthen the social determinants of health, especially when it comes to universal welfare support systems against catastrophic events in people’s lives. Reliable and free professional counselling must be widely offered. For too long, mental health treatment in India has existed with the colonial legacy of large asylums and degrading confinement. Many who are held in such places have nowhere else to go, as families facing stigma have abandoned them. There is much to be said, therefore, in favour of the halfway home system that the bill provides for, where supportive families, medical care and a better quality of life will help many recover. The success of this more progressive law brought in to replace the Mental Health Act, 1987, will depend ultimately on the community keeping up the pressure on the designated Central and State authorities to implement it in letter and spirit.
