The landmark Mental Healthcare Act, 2017 was passed unanimously by the Lok Sabha in March, 2017. The legislation was introduced in August 2013 in the Rajya Sabha by the Congress-led United Progressive Alliance (UPA), and received the Rajya Sabha’s approval in 2016. What the legislation did was path-breaking — it changed the way Indian policy approached mental health issues, including providing for a patient-centric perspective, instead of a criminal-centric one, to suicide and called for decriminalisation of Section 309 (punishment for attempt to suicide) of the Indian Penal Code. The Act also repealed the Mental Health Act, 1987 which did not administer care for patients of mental health issues.
As the new mental health legislation goes through implementation, there are still issues looming in the treatment and care of patients on the ground, and this is something that the implementation of the Act has not yet been able to touch.
On 10 July, 2017, the Supreme Court asked the central government to implement the guidelines on the rehabilitation of patients who have been cured of mental illnesses, but continue to languish in mental health asylums as their families are unwilling to take them back. The apex court had asked the Centre in February 2017 to establish a uniform national policy to foresee the aftercare and release of patients after they had been cured of mental afflictions. According to the court, because the issue featured in the concurrent list of the Constitution, the central government, along with the states, has the authority to frame the rules and guidelines.
The Supreme Court bench consisting of Chief Justice JS Khehar and Justice DY Chandrachud stated that the central government and 21 states including Andhra Pradesh, Kerala and some union territories have to ensure that the guidelines are implemented within a year, and they would also have to file a status report with the registry.
The bench disposed of a Public Interest Litigation (PIL) filed by GK Bansal stating that he could move the court again if the guidelines were not implemented within a year. This PIL had brought up the issue of the release of 300 individuals from a plethora of mental institutions in Uttar Pradesh, and alleged that these patients still languished in these institutions in abysmal conditions, in spite of being cured of their afflictions. The PIL was intended to move the apex court for directions to “forthwith make arrangements to shift patients, who are absolutely normal and are fit for discharge, from mental hospitals to any other secure place like old age homes, etc."
Finally, a national rehabilitation policy
Following this PIL, in June 2016, a bench of the Supreme Court, comprising of the then chief justice TS Thakur and Justice AM Khanwilkar, had issued notices to six states — Uttar Pradesh, West Bengal Rajasthan, Kerala, Jammu and Kashmir and Meghalaya — to seek the release of such patients who needed to be integrated with the mainstream society after their treatment. It was also decided that a national policy for the rehabilitation of such individuals would be framed, adopted and implemented.
The aforementioned guidelines were submitted by a committee that was led by the secretary of Department of Empowerment of Persons with Disabilities, and they recommended that there is an obligation on state governments to establish and manage rehabilitation and shelter homes for patients who have been released from mental asylums and facilities, and whose families are not ready to take them back in.
The guidelines suggest that such rehabilitation homes should be instated outside hospitals, and that there should be a house in-charge, an office assistant, a social worker, a vocational instructor, two helpers, two caregivers, a psychiatrist, an occupational therapist and housekeeping and security staff. The suggested guidelines also state that cultural activities may be conducted for the residents. Moreover, it is suggested in the guidelines that the rehabilitation homes should follow the social-care model, wherein there are efforts to reintegrate such persons into mainstream society and rehabilitation is beyond just residential efforts.
Lack of clarity on rehabilitation remains a problem
It should be noted that no definition of “rehabilitation” has been provided anywhere in the Indian policy documents. In fact, India does not yet have a policy to rehabilitate victims of human trafficking. The Trafficking of Persons (Prevention, Protection and Rehabilitation) Bill, 2016 that underlined and sought to introduce such mechanisms did not get prioritised at the Winter Session of the Parliament in 2016. Without an understanding of what rehabilitation would entail, and without adequate policy vocabulary on the issue, the implementation of such guidelines is not realistically possible.
Moreover, the guidelines look at the establishment of another institution for the relocation of former patients, which can at best only be considered as an infrastructural arrangement. The guidelines do not talk about how rehabilitation would be more than just providing residential facilities. A national policy that is centred around reintegration of individuals does not mention how such reintegration would be carried out. Would there be a tie-up with a vocational institutes or will there be a possibility of recruitment in future? What would happen to those individuals who are unable to take up training or education after treatment? How would rehabilitation be defined for them? The guidelines are allegedly a uniform national policy but do not refer to any national data on this issue.
Lastly, and most significantly, the guidelines do not refer to the Mental Healthcare Act 2017. The act is a rights-based legislation and ensures the right to equality of treatment, protection from inhuman and degrading treatment, free legal services, access to medical records and complain regarding deficiencies in provision of mental healthcare. The guidelines or any future policy instruments on mental health patients would, therefore, be strengthened if connected to the act, and its implementation would be more nuanced. However, the guidelines do not do this.
The guidelines need to be reviewed and strengthened to reflect a human rights-based approach to mental health, reintegration and rehabilitation because without such strengthening, its implementation would be incomplete and the issue of former mental health patients will continue to exist.
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Updated Date: Jul 18, 2017 19:43:09 IST