THIS DISSERTATION IS SUBMITTED IN PARTIAL FULFILLMENT OF THE ACADEMIC

REQUIREMENTS FOR THE SEMINAR PAPER, IXTH SEMESTER

RESEARCH DISSERTATION
ON

MENTAL HEALTH: A CRITICAL ANALYSIS OF POLICIES AROUND THE WORLD

UNDER THE SUPERVISION AND GUIDANCE OF: SUBMITTED BY:

PROF. (DR) EQBAL HUSSAIN SYED UMAIR AHMED ANDRABI
PROFESSOR OF LAW B.A LL.B (HONS.)
JAMIA MILLIA ISLAMIA UNIVERSITY REG NO: 14B164

Faculty of Law, Jamia Millia Islamia

Table of Contents
Acknowledgment .................................................................................................................. 4
Research Methodology .......................................................................................................... 5
WORKING TITLE OF THE STUDY .............................................................................................. 6
RESEARCH PROBLEM ......................................................................................................................6
RESEARCH OBJECTIVES .......................................................................................................... 7
HYPOTHESIS .......................................................................................................................... 8
RESEARCH QUESTIONS........................................................................................................... 8
SCOPE OF THE STUDY ............................................................................................................ 8
RESEARCH METHODOLOGY.................................................................................................... 9
TENTATIVE CHAPTERISATION............................................................................................... 10
Chapter 1: Introduction: Towards Understanding the Problem ............................................. 10
Chapter 2: International Legal Framework ........................................................................... 10
Chapter 3: Indian Mental Healthcare Act 2017: Critical Analysis ........................................... 10
Chapter 4: Global Perspectives............................................................................................. 11
Chapter 5: Judicial Treatment of Mental Illnesses................................................................. 11
Chapter 6: Conclusion & Recommendations ......................................................................... 11
LITERATURE REVIEW............................................................................................................ 12
WORKING BIBLIOGRAPHY .................................................................................................... 14
Mental Health: A Critical Analysis of Policies around the world with special reference to
Canada, South Africa and The United States of America ....................................................... 16
Chapter I: General Introduction .................................................................................................... 16
Chapter II: International Legal Framework .................................................................................... 20
INTERNATIONAL CONVENTIONS OR INSTRUMENTS ON DISABILITY AND MENTAL HEALTH .... 22
The International Classification of Diseases (ICD) ................................................................. 23

2
 Chapter III: Indian Mental Health Care Act, 2017: Critical Analysis ................................................. 27
Chapter IV: Global Perspectives ........................................................................................... 39
Chapter V: Judicial Treatment of Mental Illnesses ................................................................ 41
Chapter VI: Conclusion and Recommendations ..................................................................... 51
Bibliography ........................................................................................................................ 54
CASES CITED: ....................................................................................................................... 55
BOOKS REFERRED: ............................................................................................................... 56
ARTICLES REFERRED:............................................................................................................ 57
WEBSITE VISITED: ................................................................................................................ 60

3
ACKNOWLEDGMENT

A major assignment such as the present one would not have been possible without help from
other people. I would especially like to thank Prof. (Dr) Eqbal Hussain for encouraging me to
write on the topic and clarifying my doubts. I would also like to extent my gratitude to the Feroz
Xerox point who catered to my printing and copying needs at hours ranging from early in the
morning to during lunch hours. In addition to Feroz sahab, I would also like to thank the helper
at the Library who helped me find and locate relevant books in order to fuel my research for this
Dissertation.

4
RESEARCH METHODOLOGY

The author has chiefly depended on primary sources such as cases, statutes, and international
conventions in the process of undertaking research on this topic. The methodology used for this
research paper is doctrinal in nature. The author will focus, both, on theoretical and pre-existing
empirical research. The observations contained in this research paper are reflective of an analysis
of secondary sources of information, not excluding previously concluded reports and analysis
made by various entities. Such sources will include but will not be constrained to international
soft law instruments such as guidelines, conventions, treaties, best practices and documents,
government reports, health policies, precedents etc. The observations shall be distributed
amongst different chapters which will be concluded in the last part of this research paper.
Sources quoted/referred to in this research paper are deemed reliable; however, the author does
not guarantee their accuracy.

5
WORKING TITLE OF THE STUDY

Mental Health: A Critical Analysis of Policies around the World.

RESEARCH PROBLEM

The area of Mental Health is quite different from the general health as far as the treatment given
to the former and the attitudes regarding it is concerned. As per the statistics from the World
Health Organisation, India is reeling under a grave mental health crisis and the attitude of the
people in general and stigma associated with it amongst the Indian population needs change at
the grass root level. Such pervasive stigma is also proving to be an obstruction to the people
suffering from mental health issues getting treatment from competent professionals.

While the qualitative change will take a long time in the country, there seems to have been a
paradigm shift in the policy framework towards this issue in the country. The Parliament recently
enacted the Indian Mental Healthcare Act 2017 which replaced the existing framework under the
similar 1987 Act. This Act has for the first time created a justiciable right to mental healthcare
and therefore takes a rights-based approach to the different facets of mental health.

However, whether the Act adopts the traditional custodial approach to mental healthcare as
opposed to the required contemporary therapeutic approach requires a detailed analysis of the
2017 Act.

The present research aims to critically analyse the Mental healthcare Act 2017 juxtaposed with
the previous legislative framework under the 1987 Act. A critical analysis of the legal regime
apart from undertaking necessary steps to bring a gradual change in the attitudes of the people is
needed because the legislation plays a much important role in addressing the discrimination
between mentally and physically disabled and recognizing the problem plaguing our society.

A Mental Health legislation provides a legal framework for integration of those suffering from
mental illnesses, improves their access to care, legitimizes their illnesses, gives direction to the
policy of the government and affirms their civil liberties.

6
The objective behind choosing these countries is to analyse the Mental Healthcare policies in
countries which are perceived to be forward looking in the matters of attitudes towards Mental
Health. It is also pertinent to note that India and United States of America statistically have the
highest number of people suffering from issues of Mental Health. A dispassionate analysis of the
policies towards Mental Health around the world would show whether the interests of persons
with mental illnesses are adequately safeguarded.

RESEARCH OBJECTIVES

The objective of this study is to examine the Mental Health policy and legislative framework in
key jurisdictions of India, United States of America, Canada and South Africa.

The specific objectives of this research paper are:

1. To critically examine the Mental Health Policy with special focus on Indian Mental
Healthcare Act 2017;

2. To identify the feasibility of the therapeutic model of Mental Healthcare vis-à-vis the
traditional custodial model of Mental Health care;

3. To examine the role of community participation in meting out treatment to those

suffering from various Mental illnesses and to identify legislative and policy solutions
and further steps that ought to be undertaken for changing attitudes of the people towards
Mental illnesses;

7
HYPOTHESIS

This research hypothesizes that the Mental Healthcare Act 2017 does not adequately deal with
the stigma associated with the Mental illnesses in India and have many negative consequences.
This research further hypothesizes that the rules and regulations contained in the Mental
Healthcare Act 2017 does not adequately address different facets of the issue of Mental
Healthcare.

RESEARCH QUESTIONS

The research proposes to address the following questions:

1. Is the Indian Mental Healthcare Act 2017 a right step to address the issue of Mental
illnesses and curbing of the discrimination between people suffering from mental
illnesses and physical illnesses?

2. Can any lessons be learned from the policy models of Mental Healthcare as prevalent in
United States of America, Canada and South Africa?

3. How can the role of community participation be strengthened in meting out treatment to
those suffering from various Mental illnesses?

SCOPE OF THE STUDY

The study undertaken by the author will critically analyze the Indian Mental Healthcare Act 2017
vis-à-vis the 1987 Act. The findings of this analysis shall be then juxtaposed with the
international best practices, soft law instruments, policy framework prevalent across countries of
the world.

8
RESEARCH METHODOLOGY

The methodology adopted for this research paper is doctrinal in nature. The researcher will focus
on both theoretical and pre-existing empirical research. The findings contained in the research
paper reflect an analysis of secondary sources of information, including previously completed
reports and analyses prepared by different organizations. Such sources shall include but will not
be limited to international soft law instruments such as guidelines, conventions, treaties, best
practices documents etc., government reports, health policies, judgements etc. The inferences
shall be distributed amongst different chapters which will finally be culminated in the conclusion
part of the research. Sources quoted or referred to in this paper are deemed reliable; however, the
author does not guarantee their accuracy.

9
TENTATIVE CHAPTERISATION

In order to fulfil the aims and objectives as have been stated above, the tentative chapterisation
will be as enumerated below. Nonetheless, it may be added that the same is tentative and may be
subject to modification, revision or alteration, if necessary.

CHAPTER 1: INTRODUCTION: TOWARDS UNDERSTANDING THE PROBLEM

This chapter will deal with the issue of Mental Healthcare and the surrounding stigma and
stereotype. This chapter will further establish a conceptual framework for the study as well as the
evolution and steady change in attitudes towards Mental Healthcare in India. Further, this
chapter shall also examine the problems of adjustment faced by those suffering from Mental
illnesses, different determinants of Mental Health and the attitudes towards the same prevalent in
India.

CHAPTER 2: INTERNATIONAL LEGAL FRAMEWORK

This chapter will presuppose that Mental Health and human rights are inextricably interlinked
and as such a recognition by the human rights instruments goes a long way in tackling Mental
illnesses. This chapter will deal with different international human rights instruments, best
practices and other similar soft law instruments and their role in protecting those suffering from
Mental illnesses. The endeavor shall be to also deal with the regional conventions and
instruments which recognize Mental Healthcare and address the same.

CHAPTER 3: INDIAN MENTAL HEALTHCARE ACT 2017: CRITICAL ANALYSIS

This chapter will critically analyse the Indian Mental Healthcare Act 2017 vis-à-vis previous
1987 legislation Mental Health Act 1987. The chapter will also analyse the corresponding rules
and regulations and assess if the Act is successful bring the paradigm shift which is infact
required in India insofar as Mental Healthcare is concerned. The chapter will also examine other

10
existing legislations and their treatment of Mental illnesses and Mental Health. However, the
primary focus shall be on the Indian Mental Healthcare Act 2017.

CHAPTER 4: GLOBAL PERSPECTIVES

This chapter will examine the legislative and policy framework adopted by the stakeholders in
other jurisdictions such as United States of America, Canada and South Africa and will draw the
best practices and solutions which can also be adopted in India. A comparative analysis of this
kind will help in identifying how these jurisdictions have tackled the taboo subject of Mental
Health and whether there are any new concepts which ought to be emulated in India.

CHAPTER 5: JUDICIAL TREATMENT OF MENTAL ILLNESSES

It is trite that the judiciary plays an important role in law making and interpretation in India. As
such, this chapter shall examine the judicial pronouncements relating to Mental Healthcare and
Mental illnesses. The endeavor in this chapter shall be to address right to health and judicial
pronouncements in civil law, criminal law, evidence law as well as other legislations such as
Medical Termination of Pregnancy Act, 1971 and Protection of Children from Sexual Offences
Act, 2012 (POCSO).

CHAPTER 6: CONCLUSION & RECOMMENDATIONS

This chapter forms the conclusion and recommendatory part of the study and will lay down that
aspect in an overall manner. The author will also offer some recommendations to improve the
attitudes towards Mental Healthcare prevalent in India.

11
LITERATURE REVIEW

1. Patel, Vikram, and R. Thara, eds. Meeting the mental health needs of developing
countries: NGO innovations in India. Sage Publications India, 2003.

This book deals in detail with the programmes adopted by various Non-Governmental
Organisations in India. The book exhaustively deals with the challenges and stigma
faced by professionals working in this field and the problems faced in rehabilitation of
those suffering from various mental illnesses. The book also has a chapter dealing with
the role of the community and how the role of community ought to be strengthened,
especially if mental illnesses have to be tackled in rural areas of the country. This book
is a useful treatis eon the subject as it does not lose sight of the Indian idiosyncrasies
faced by any NGO who is actively working in India, including issues such as
programmes sustainability and the difficulty in ensuring that the benefits of such
programmes trickle down to the masses as well as bringing a much needed change in the
deeply seated prejudices of the people.

2. Jacob, K. S., P. Sharan, I. Mirza, M. Garrido-Cumbrera, Soraya Seedat, Jair Jesus Mari,
V. Sreenivas, and Shekhar Saxena. Mental health systems in countries: where are we
now?, The Lancet 370, no. 9592 (2007): 1061-1077.

This article fills a much needed gap in the research related to Mental Healthcare as far as
it examines why low income and middle income countries such as the countries in Africa
and South East Asia have a poor infrastructure for mental health systems. This research
finds that mental health resources in such countries is related to general health, economic
and developmental indicators and therefore unless mental health is actively prioritized
irrespective of low resources, there cannot be any tangible improvement in mental health
systems of such countries. The research also calls for enhanced monitoring of the
situation in such countriesto advance global mental health.
3. Duffy, Richard M., and Brendan D. Kelly. India's Mental Healthcare Act, 2017: Content,
context, controversy. International journal of Law and Psychiatry (2018).

This article critically examines the Indian Mental Healthcare Act 2017 and the relevant
rules and regulations. The article also reflects on the ongoing controversies about
measures such as muscle relaxants and anesthesia. The article advocates a greater need
for continued engagement with all stakeholders and concludes that the new legislation,
despite certain misgivings, offers substantial potential benefits not only to India but to
other countries as well as that seek to subscribe to the United NationsConvention on the
Rights of Persons with Disabilities and reform their Mental Healthcare systems.

4. World Health Organization. "Improving health systems and services for mental
health."(2009).

This book provides detailed guidance as to how to strengthen mental health systems
within the context of overall health systems in a country. This book, structured in the
form of a guide, provides detailed guidance about how to formulate Mental Health policy,
plans, programmes, legislations, advocacy initiatives, information systems as well as
Mental Heath Financing. As such, this book provides international best practices and
standards coupled with their endorsement by the World Health Organisation.

13 | P a g e
WORKING BIBLIOGRAPHY

Books:

(i) Malcolm N. Shaw, International Law (Cambridge University Press, Cambridge,

6thedn., 2008).

(ii) Patel, Vikram, and R. Thara, eds. Meeting the mental health needs of developing
countries: NGO innovations in India. (Sage Publications India, 2003).

(iii) Pathare, Soumitra. Mental health legislation & human rights. Vol. 5. (World Health
Organization, 2003).

(iv) Perlin, Michael L. "Mental Disability Law in a Comparative Law Context." Disability
and Equality Law. (Routledge, 2017. 247-272).

(v) Ratanlal Dhirajlal, Law of Crimes (Bharat Law House Private Limited, New Delhi,
25th edn., vol. 1, 2005).

(vi) World Health Organization, Mental health: facing the challenges, building solutions:
report from the WHO European Ministerial Conference. (WHO Regional Office
Europe, 2005).

(vii) World Health Organization. "Improving health systems and services for mental
health."(2009).

Articles:

(i) Choudhary Laxmi Narayan and Deep Shikhalin, “Indian legal System and Mental
Health”, Indian J Psychiatry 2013;55:177-81.

(ii) Duffy, Richard M., and Brendan D. Kelly. "Concordance of the Indian mental
healthcare act 2017 with the World Health Organization’s checklist on mental health
legislation." International Journal of Mental Health Systems 11.1 (2017): 48.

14 | P a g e
 (iii) Duffy, Richard M., and Brendan D. Kelly. India's Mental Healthcare Act, 2017:
Content, context, controversy. International journal of Law and Psychiatry (2018).

(iv) Jacob, K. S., P. Sharan, I. Mirza, M. Garrido-Cumbrera, Soraya Seedat, Jair Jesus
Mari, V. Sreenivas, and Shekhar Saxena. Mental health systems in countries: where
are we now?, The Lancet 370, no. 9592 (2007): 1061-1077.

(v) James T. Antony, “Mental Health Legislation: A Journey Back to “Madhouses

Era”?”, Indian J Psychiatry 2016;58:114-8. 20.

(vi) James T. Antony, “On Drafting a New Mental Health Act”, Indian J Psychiatry 2010
Jan-Mar; 52(1): 9–12.

(vii) Kapur, Ravindra Lal. "The story of community mental health in India." Mental health:
An Indian Perspective 1946–2003 (1946): 92-100.

(viii) Padmanathan, Prianka, and Mary J. De Silva. "The acceptability and feasibility of
task-sharing for mental healthcare in low and middle income countries: a systematic
review." Social science & medicine 97 (2013): 82-86.

15 | P a g e
MENTAL HEALTH: A CRITICAL ANALYSIS OF POLICIES AROUND THE
WORLD WITH SPECIAL REFERENCE TO CANADA, SOUTH AFRICA AND THE
UNITED STATES OF AMERICA

Chapter I: General Introduction

The realm of Mental Health is starkly different from general health as far as the treatment
meted out to the former and the attitudes towards it is concerned. Statistics from the World
Health Organisation suggest that India is reeling under a severe mental health crisis and the
attitude of the stereotypes and stigma associated with it amongst the Indian population needs
widespread change. Such pervasive stigma is also proving to be an impediment in the people
suffering from issues of mental health getting treatment from mental health professionals.

While the qualitative change will take a long time in the country, there seems to have been a
paradigm shift in the policy framework towards this issue in the country. The Parliament
recently enacted the Indian Mental Healthcare Act 2017 which replaced the existing
framework under the similar 1987 Act. This Act has for the first time created a justiciable
right to mental healthcare and therefore takes a rights-based approach to the different facets
of mental health. However, whether the Act adopts the traditional custodial approach to
mental healthcare as opposed to the required contemporary therapeutic approach requires a
detailed analysis of the 2017 Act.

Mental disease is observed as a stigma in most of the culture. People of different age, gender
or socio-economic status may suffer from mental illness. At least twenty percent of people
pass through mental disorders in some way or the other during their lifetime. Stigma towards
mentally ill people is a matter of great concern. This affects on their ability to perform duties,
their revival, treatment procedure and support they receive, and their recognition in the group
of people.

Depression can be defined as a clinical disorder which may be caused by various social
factors. Most experts agree that while depression disorders decrease with age, depression
symptoms decrease. The relationship between age and depression symptoms is curvilinear:

16 | P a g e
younger and older people have the highest number of depression symptoms whereas middle
aged people have the lowest1.

The problem is not prevalent in adults but is also emerging in the children. Despite the strong
commitment to child protection enshrined in the Indian Constitution and child related
policies; the country‘s progeny is at profound risk. The mental health problems cause great
suffering to the child, their families, and communities and great loss to the society and nation.
A healthy childhood lays the foundation for a healthy adulthood. Children and adolescents
are valuable assets to families and nations and thus their overall wellbeing is a matter of a
grave concern.2

Both late-life mental disorders were attributed to abuse, neglect, or lack of love on the part of
children towards a parent. There was evidence that the system of family care and support for
older persons was less reliable than has been claimed. Care was often conditional upon the
child‘s expectation of inheriting the parent‘s property. Care for those with dependency needs
was almost entirely family-based with little or no formal services. Unsurprisingly, fear for the
future and in particular dependency anxiety was commonplace among elderly3.

The continuing discrimination between the mentally and physically disabled has not yet been
adequately addressed through legislation. The guarantee against discriminating between
persons with mental disabilities and those with physical disabilities, discrimination amongst
various forms and degrees of disabilities, and discrimination between the disabled and the
non-disabled have all to be regarded as equally sacrosanct and inviolable. In the absence of a
comprehensive anti-discriminatory law, the Mental Health Act continues to legalize
involuntary treatment and institutional care.

The disability rights movement in India has achieved laudable goals on various fronts, but its
greatest pitfall has been the neglect of the rights of persons with mental disabilities. This is a
direct outcome of the lack of a strong leading organization, it is also due to the absence of a
collective voice of several service focused organizations. This trend in the movement has

1
Sumita Saha and Ruby Sain, Depression among the Elderly 39 (2012).
2
Usha. S. Nayar (ed.), Child and Adolescent Mental Health 338 (2012).
3
Vikram Patel and Martin Prince, ―Ageing and mental health in a developing country: who cares? Qualitative
studies from Goa, India‖, Psychol. Med., 2001(31):29-38

17 | P a g e
created the lacunae in the law, both in letter and spirit. The gist of this prime criticism is that
the law currently in force has not done and cannot do justice to the mentally disabled4. The
history of mental health legislations in India clearly demonstrate that though this need has
long been recognized, legislative attempts to address the problem have not been satisfactory5.

In India, as in other parts of the world, the traditional approach to the care of the mentally ill,
during the last 200 years, was custodial rather than therapeutic. This system was built by the
then rulers in the mould of the mental health care delivery system of contemporary Britain.
To build a chain of mental hospitals and to introduce Western healing practices in them were
conceived and executed by the East India Company. In the early phase of their development,
(in late 18th century), mental hospitals were meant exclusively for the soldiers, who fought
for their British masters against the Indian princes, the civilian officers of the East India
Company and the white settlers6.

In 1959-60 an attempt was made, under instruction from the Government of India, to suggest
amendment to the 1912 Act. But the experts failed to reach a consensus. For about two
decades the Government made no further efforts for enactment of a new law on mental
health. During this period great strides were taken in the advancement of knowledge and
understanding of the nature of mental disorders. Attitudes of the society towards mentally ill
persons had changed remarkably.

Stigma associated with mental disorders also was on the wane. There was growing demands
and aspirations of the people to get better facilities and less rigid procedures for admission,
treatment and discharge of mental patients. As far as possible mentally ill persons should be
treated at par with any other sick person and the environment should be natural and familiar.
This collective view was bolstered up by the principles of Alma Ata Declaration of 1978. The
Government could hardly ignore this changed climate of opinion and responded to the
concerted pressure of the people, professionals and policy makers by introducing the Mental
Health Bill in parliament in 1981. It was referred to a joint Committee of Members of
Parliament in 1982. Before the Committee could come to a decision the Lok Sabha was
dissolved on 31st December, 1984. In 1985 a new Joint Committee went into the Bill, elicited

4
Shruti Pandey, Priyanka Chirimar, et. al., Disability and the Law 373 (2005)
5
Seshadri Harihar and Hiramalini Seshadri, ―Needed: New Mental Health Act‖, The Hindu, Jan. 30, 2005
6
Gauranga Banerjee , ―The Law and Mental health: an Indian perspective‖, Mental Health Reviews (2001),
available at: http://www.psyplexus.com/excl/lmhi.html

18 | P a g e
public opinion, suggested some amendments and adopted it on 24th April, 1986. This
amended Bill was passed by the Rajya Sabha on 26th November, 1986 and by the Lok Sabha
on 19th March, 1987. The amendments made by the Lok Sabha were agreed to by the Rajya
Sabha on 22nd April, 1987. The president‘s assent was received on 22nd May, 1987, and it
became the Mental Health Act, 1987.

The proceeding with discrimination between the mentally and physically incapacitated has
not yet been enough tended to through enactment. The assurance against separating between
people with mental handicaps and those with physical incapacities, discrimination among
different structures and degrees of inabilities, and discrimination between the crippled and the
non-debilitated have all to be viewed as similarly hallowed and sacred. Without a complete
enemy of biased law, the Mental Health Act keeps on authorizing automatic treatment and
institutional consideration .

Different judgments concerning people with the psychological instability and inabilities are
for the most part as Public Interest Litigation wherein prominent legal advisers and
individuals from common society have moved toward the Apex Court to mediate in the
organization and support of emotional wellness specialist organizations and foundations.
Truth be told, when the standard of 'locus standi' was loose, the act of recording Public
Interest Litigation rose with various cases being documented looking for the Courts
intercession in the administration of state-run emotional wellness organizations, in the
interest of the mentally sick detainees. The Apex Court has consistently asked into the day-
today running of government healing facilities where the basic human rights of the patients
were abused and their confinement appeared to be unremitting because of the hard mentality
of the experts.

19 | P a g e
 Chapter II: International Legal Framework

According to WHO‘s Mental Health Atlas of 2005 a meta–analysis of 13 psychiatric

epidemiological studies (n = 33 572) yielded an estimated prevalence rate of 5.8% in the
world. Organic psychosis (0.04%), alcohol/drug dependence (0.69%), schizophrenia (0.27%),
affective disorders (1.23%), neurotic disorders (2.07%), mental retardation (0.69%) and
epilepsy (0.44%) were commonly diagnosed7. Epilepsy and hysteria were common in rural
communities. According to Nandi et.al. in 2000 reported that psychiatric morbidity decreased
from 11.7% to 10.5% over 20 years in a rural setting. Another author Rao reported that
mental morbidity was present in 8.9% of the elderly (above 60 years), with depression being
the most common disorder (6%). Psychiatric morbidity was associated with physical
diseases. The rate of dementia was reported to be in the range of 0.8% to 3.4% and that of
Alzheimer‘s disease in the range of 0.6% to 1.5%. Gender (female) and age were associated
with higher prevalence rates. Almost 6.9% of children were assessed as having disabilities.
There are 50 million children under 18 years who could benefit from specialist services. As
regards adolescents, 20 million are projected to have a severe mental disorder. Unfortunately
90% of children with a mental health disorder are not receiving any specialist services. There
are limited child and adolescent mental health services in India. Mostly such services are
restricted to urban areas.8 In India, neuropsychiatric disorders are estimated to contribute to
11.6% of the global burden of disease (WHO, 2008).

Glancing back at history we make out that during the mid 19th century, William Sweetzer
was the first to accurately define the term ‘Mental Health‘, which can be seen as the
precursor to modern approaches to the work on promoting positive mental health.9

Isaac Ray, one of thirteen founders of the American Psychiatric Association, further defined
‘mental hygiene‘ as an art to preserve the mind against incidents and influences which would
inhibit or destroy its energy, quality or development10.

7
WHO, Mental Health Atlas (2005) available at:
http://apps.who.int/globalatlas/predefinedReports/MentalHealth/Files/IN_Mental_Health_Profile.pdf
8
P. C. Shastri, ―Promotion and Prevention in Child Mental Health‖, Indian J Psychiatry, 2009 Apr-Jun;
51(2):88–95.
9
Bilqis Shair, ―Historical Perspective on Mental Health,‖ available at:
http://www.greaterkashmir.com/news/2012/May/18/historical-perspective-on-mental-health-9.asp

20 | P a g e
In 1909 the National Commission of Mental Hygiene was made. From 1919 onwards, the
internationalization of exercises of this Commission prompted the establishment of some
national associations concerned with mental hygiene in France and South Africa in 1920, in
Italy and Hungary in 1924. From these national associations, the International Committee on
Mental Hygiene was made and later superseded by the World Federation of Mental Health.

Every international document, be it the Universal Declaration of Human Rights, U.N.

Declarations on the Rights of Disabled and Mentally Retarded Persons or the Principles for
the Protection of persons with Mental Illness and the Improvement of Mental Health Care,
broadcasted or received, by and large, by the General Assembly, give that such persons will
be treated at standard with every other person. In 1948, the United Nations through its
Declaration of Human Rights certified the basic principle that a mentally sick person should
consistently be treated with humanity and regard for the inherent dignity of the person.

Each person with a mental illness should have the privilege to practice all thoughtful,
political, social and cultural rights. The Declaration of the Rights of the disabled, which
includes persons with mental illness, was embraced by the United Nations in 1975.

10
Ashleey Amihan R. Vhiennacruz, ―MAPEH IV-----Mental Health and its Characteristics‖, available at:
http://yokohama-ashleey.blogspot.in/2007/06/mapeh-iv-mental-health-and-its.html

21 | P a g e
INTERNATIONAL CONVENTIONS OR INSTRUMENTS ON DISABILITY AND
MENTAL HEALTH
1. The United Nations Charter, 1945

The United Nations (UN) Charter in its introduction articulates the determination of
the international community to reaffirm confidence in fundamental human rights, and
in the dignity and worth of the human person. One of the central purposes of the
United Nations is to accomplish international co-operation in promoting and
encouraging appreciation for human rights and for fundamental opportunities for all
without distinction. Likewise, the United Nations will advance higher standards of
living, full employment, and conditions of economic and social advancement and
development and universal regard for, and observance of, human rights and
fundamental opportunities for all. The Charter, embraced as a binding arrangement in
1945, requires part states to advocate and to watch the human rights everything being
equal, paying little respect to their racial, gender, ethnic, or religious differences.

India was among the original individuals from the United Nations that signed the
Declaration by United Nations at Washington on 1 January 1942 and likewise took an
interest in the historic United Nations Conference of International Organization at San
Francisco from 25 April to 26 June 1945. As a founding member from the United
Nations, India strongly supports the purposes and principles of the United Nations and
has made significant contributions to implementing the objectives of the Charter, and
the evolution of the United Nations particular projects and agencies.

2. Universal Declaration of Human Rights, 1948

The UN Charter enabled Economic and Social Council to build up commissions in

economic and social fields and for the promotion of human rights. One of these was
the United Nations Human Rights Commission, which, under the chairmanship of
Eleanor Roosevelt, saw to the creation of the Universal Declaration of Human Rights
(UDHR). The Declaration was drafted by representatives of all regions of the world
and encompassed every legitimate tradition. Formally received by the United Nations

22 | P a g e
 on December 10, 1948, it is the most universal human rights document in existence,
delineating the thirty fundamental rights that form the reason for a popularity based
society. Forty eight countries met up at the United Nations held in Paris; they are the
Universal Declaration of Human Rights signatories.

3. Vienna Declaration and Programme of Action, 1993

4. Principles for the Protection of Persons with Mental Illness and the Improvement of
Mental Health Care, 1991

5. Declaration of Madrid, 1996

6. Guidelines for the Promotion of Human Rights of Persons with Mental Disorders,
1996.

7. Mental Health Action Plan, 2013

THE INTERNATIONAL CLASSIFICATION OF DISEASES (ICD)

The International Classification of Diseases (ICD) is the international standard diagnostic

classification for storage and recovery of diagnostic information for clinical, epidemiological
and quality purposes. The ICD-10 additionally gives the premise to the compilation of
national mortality and morbidity measurements by WHO part states. The ICD framework
additionally uses a multi-pivotal framework like DSM. Part five of the ICD-10 identifies with
Mental and Behavioural Disorders. The potential for confusion as a result of two generally
used classification systems has been acknowledged. There has been much international effort
to align the DSM and ICD systems to the point where there is now much consistency between
the systems .The International Classification of Diseases (ICD) now exists in its tenth
revision. Chapter V is relevant for mental and behavioural disorders. The ICD-10
classification for mental disorders consists of 10 main groups11:

11
Tasja Klausch, Supre note 116, available at: http://web4health.info/el/psy-icddsm-what.htm

23 | P a g e
  F00-F09: Organic, including symptomatic, mental disorders.
 F10-F19: Mental and behavioural disorders due to psychoactive substance use.
 F20-F29: Schizophrenia, schizotypal and delusional disorders.
 F30-F39: Mood (affective) disorders.
 F40-F48: Neurotic, stress-related and somatoform disorders.
 F50-F59: Behavioural syndromes associated with physiological disturbances and
physical factors.
 F60-F69: Disorders of adult personality and behaviour.
 F70-F79: Mental retardation.
 F80-F89: Disorders of psychological development.
 F90-F98: Behavioural and emotional disorders with onset usually occurring in
childhood and adolescence.
 F99: Unspecified mental disorder.12

Efficiency can be used to evaluate mental health. It is certainly significant that emotionally
disturbed, neurotic, or inadequate personalities are distinctively lacking in this quality.
Certainly, health of any kind is basic to efficiency, and Jones, for instance, considers
efficiency to be one of the three main parts of mental and normality, the other two being
happiness and adaptation to the real world.

In any case, the concept of efficiency has its own meaning, referring to the use of abilities to
the most ideal impact under the circumstances that exist at the time. Mental efficiency alludes
to the successful use of our abilities for observation, imagination learning, thinking and
choosing, and also the continuous development of mental functions to a more elevated
amount of efficiency. It requires, for instance, using principles and techniques for learning in
a way that advances the quick acquisition of knowledge or abilities. It excludes unnecessary
fantasy thinking or distorted perception.

Compelling control is constantly one of the surest sign of a healthy personality, and this
applies particularly to mental process. An unbridled imagination, such as we see in

12
MHPOD, ―Classification of Mental Disorders‖, available at:
http://www.mhpod.gov.au/assets/sample_topics/combined/Classification_of_Mental_Disorders/objecti
ve1/index.html

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unnecessary fantasy-thinking, is detrimental to mental health because it impedes the relation
between mind and reality. Without such control, obsessions, settled thoughts, fears,
delusions, and other manifestations are probably going to create. Integrity is likewise a basic
normal for good mental health and involves the concept of matching words and
deeds...Others may not concur with your convictions or behaviours, but great mental health
requires being true to yourself by following your words with consistent exercises.

The integration of thought and conduct is paralleled in the mentally healthy person by the
capacity to integrate personal motivations and to maintain control of conflicts and
frustrations. When intentions are not integrated, serious conflict can result...amusement often
conflicts with personal responsibilities or integrity.

The integration necessary to mental health can be strongly supported by positive feelings, and
by a similar rule negative feelings can act to disrupt or even to obliterate mental strength.
Profound feelings of insecurity, inadequacy, guilt, inferiority, threatening vibe and contempt,
jealousy, and envy and signs of emotional disruption, can prompt mental sick health.
Contrary to such feelings are those of acceptance, love, belonging, security, and personal
worth, every last one of which contributes to mental soundness and fills in as a signpost of
mental health. Of these feelings, security is likely the most dominant because of its
unavoidable impact on the relation between the person and reality demands.

Emotional health, therefore, is an integral piece of mental health, and emotional adequacy,
which might be defined as far as the control, profundity, and range of emotional life, is itself
a criterion by which mental health can be evaluated.

Attitudes are fundamentally the same as feelings in their relation to mental health. Invariably,
in an encounter with maladjusted or disturbed personalities, we are forcibly reminded that it
is so important to maintain a healthy outlook regarding life, individuals, work, or reality.
Mental health is incomprehensible in a context of disdain and prejudices, negativity and
cynicism, or despondency and hopelessness. Attitudes such as these are to mental health are
certain microbes and toxins to physical health.

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Mentally healthy individuals assume liability for themselves. They don't point the finger at
others for the end result for them, nor do they consider themselves to be exploited people in
their world. Instead, they settle on decisions on the best way to handle their own issues or
approach others for help when needed. An individual should have oneself realizing drive.
This is the propensity for working hard to one's full limit. Individuals fluctuate incredibly in
their physical, intellectual and social potentials, but it is conceivable to perceive how far an
individual puts to work his own particular potential to accomplish pleasing results.

Mentally healthy individuals acknowledge others as they are and regard individual
differences. They can give and acknowledge love and support. They are sensitive to the needs
of others and are concerned about another person's thoughts and feelings. Mentally healthy
individuals communicate obviously and honestly in order to build honest relationships.

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 Chapter III: Indian Mental Health Care Act, 2017: Critical Analysis

The articles and reasons of the Act, is to align and harmonize the existing laws of the country
with the Convention on the Rights of Persons with Disabilities in 2007, which was received
on the thirteenth December, 2006 at United Nations Headquarters in New York and came
into force on the third May, 2008 and signed and endorsed the said Convention by India on
the first day of October, 2007. An Act to accommodate mental health care and
administrations for persons with mental illness and to ensure, advance and fulfil the rights of
such persons during conveyance of mental health care and benefits and for issues connected
therewith or incidental thereto.13.

Salient features of the Act:

(i) One of the significant contributions of the Mental Healthcare Act, 2017 is the
insertion of the definition of “mental illness”. “Mental Illness” means a
substantial disorder of thinking, mood, perception, orientation or memory that
grossly impairs judgment, behaviour, capacity to recognize reality or ability to
meet the ordinary demands of life, mental conditions associated with the abuse
of alcohol and drugs, but does not include mental retardation which is a
condition of arrested or incomplete development of mind of a person, specially
characterised by sub normality of intelligence.
(ii) “Mental Health Establishment” under the Act means any health establishment,
including Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy
establishment, by whatever name called, either wholly or partly, meant for the
care of persons with mental illness, established, owned, controlled or
maintained by the appropriate Government, local authority, trust, whether
private or public, corporation, co-operative society, organisation or any other
entity or person, where persons with mental illness are admitted and reside at,
or kept in, for care, treatment, convalescence and rehabilitation, either
temporarily or otherwise; and includes any general hospital or general nursing

13
4The Mental Healthcare Act 2017; The Act replaces the Mental Health Act (MHA) of 1987. It was published
on 7th April 2017 in the Official Gazette of India. It provides for protection and restoration property rights of
mentally ill persons. The Act is comprised of 126 Sections and 16 Chapters.

27 | P a g e
 home established or maintained by the appropriate Government, local
authority, trust, whether private or public, corporation, co-operative society,
organisation or any other entity or person; but does not include a family
residential place where a person with mental illness resides with his relatives
or friends;
(iii) Determination of Mental Illness shall be in accordance with such nationally or
internationally accepted medical standards (including the latest edition of the
International Classification of Disease of the World Health Organisation) as
may be notified by the Central Government. The determination shall not be on
the basis of political, economic or social status or membership of a cultural,
racial or religious group etc. and past treatment or hospitalisation shall not
affect the present or future determination. The determination of a person’s
mental illness shall alone not imply that the person is of unsound mind.
(iv) The Act provides that all persons with mental illness are presumed to be able
to make treatment decisions. Patients and young people will be provided with
information and support to make decisions about their treatment and where a
person makes a decision regarding his mental healthcare or treatment which is
perceived by others as inappropriate or wrong, shall not mean that the person
does not have the capacity to make mental healthcare or treatment decision, so
long as the person has the capacity to make mental healthcare or treatment
decision.
(v) Chapter III of the Act enables a person to make an advance directive to record
their treatment preferences about the way the person wishes, to be treated for
not to be treated for, in the event that they become unwell and ceases to have
capacity to make treatment decisions and require treatment. Advance
statements will give patients decide about their treatment. Such an advance
directive may be revoked, amended or cancelled by the person who made it at
any time. In case of minors, the legal guardian shall have right to make an
advance directive in writing and all the provisions relating to advance
directive, mutatis mutandis, shall apply to such minor till such time he attains
majority. The procedure of advance directive shall be reviewed by Central
Mental Health Authority periodically

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(vi) Chapter IV provides that a minor shall have a right to have a right to appoint a
nominated representative
(vii) Chapter V provides the rights to the persons with mental illness. The Act gives
every person the right to access mental healthcare and treatment from mental
health services from the Government. This right shall mean treatment which is
affordable, of good quality, available in sufficient quantity, accessible
geographically, without discrimination on the basis of gender, sex, sexual
orientation, religion, culture, caste, social or political beliefs, class, disability
or any other basis and provided in a manner that is acceptable to persons with
mental illness and their families and care-givers. Such services shall include
provision of acute mental healthcare services such as outpatient and inpatient
services; provision of half-way homes, sheltered accommodation, supported
accommodation as may be prescribed; provision for mental health services to
support family of person with mental illness or home based rehabilitation;
hospital and community based rehabilitation establishments and services as
may be prescribed; provision for child mental health services and old age
mental health services. The appropriate Government shall integrate mental
health services into general healthcare services at all levels of healthcare.
(viii) The persons with mental illness shall also have the right to community living
and where it is not possible for a mentally ill person to live with his family or
relatives, or where a mentally ill person has been abandoned by his family or
relatives, the Government shall provide support including legal aid and to
facilitate exercising his right to family home and living in the family home.
(ix) Another right which is guaranteed under the Act to the persons with mental
illness is the right to protection from cruel, inhuman and degrading treatment.
Every person with mental illness shall have a right to live with dignity and
shall be protected from cruel, inhuman or degrading treatment in any mental
health establishment and shall have the rights, namely, to live in safe and
hygienic environment; to have adequate sanitary conditions; to have
reasonable facilities for leisure, recreation, education and religious practices;
to privacy; for proper clothing so as to protect such person from exposure of
his body to maintain his dignity; to not be forced to undertake work in a

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 mental health establishment and to receive appropriate remuneration for work
when undertaken; to have adequate provision for preparing for living in the
community; to have adequate provision for wholesome food, sanitation, space
and access to articles of personal hygiene, in particular, women’s personal
hygiene be adequately addressed by providing access to items that may be
required during menstruation; to not be subject to compulsory tonsuring
(shaving of head hair); to wear own personal clothes if so wished and to not be
forced to wear uniforms provided by the establishment and to be protected
from all forms of physical, verbal, emotional and sexual abuse.
(x) Under the Act every person with mental illness shall be treated as equal to
persons with physical illness. A child under the age of three years of a woman
receiving care, treatment or rehabilitation at a mental health establishment
shall ordinarily not be separated from her during her stay in such
establishment. It is the duty of every insurer to make provision for medical
insurance for treatment of mental illness on the same basis as is available for
treatment of physical illness.
(xi) A person with mental illness and his nominated representative shall have the
rights to information relating to the provision of this Act or any other law
under which he has been admitted, the nature of the person’s mental illness
and the proposed treatment plan.
(xii) A person with mental illness shall also have the right to confidentiality under
the Act in respect of his mental health, mental healthcare, treatment and
physical healthcare.
(xiii) A person with mental illness shall be entitled to receive free legal aid.
(xiv) A person with mental illness if not satisfied with the services in the mental
health establishment shall have a right to complain to the medical officer,
mental health professional in charge of the establishment, the concerned Board
and to the State Authority.
(xv) Under the Act Government is under an obligation to implement programmes
for the promotion of mental health and prevention of mental illness in the
country and to take all measures to create awareness about mental health and
illness and reducing stigma associated with mental illness.

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(xvi) The said Act calls for the establishment of the Central Mental Health
Authority and State Mental Health Authority for the registration, development
of quality and service norms and supervision of mental health establishments
under the control of Central Government and the State Government
respectively. The Mental Health Review Boards shall be constituted by the
State Authority for a district or a group of districts to register, review, alter,
modify or cancel an advance directive; to appoint a nominated representative;
to visit and inspect prison or jails and to conduct an inspection in the mental
health establishment, etc.
(xvii) Chapter XII of the Act provides for the admission, treatment and discharge of
the persons with mental illness. All the admissions in the mental health
establishment shall be independent admissions (admission of person who has
the capacity to make treatment decisions) except when such conditions exist as
make supported admission unavoidable. Electro Convulsive Therapy (ECT)
shall only be performed with the use of anaesthesia on persons with mental
illness and not be performed on minors. Psychosurgery shall not be performed
as a treatment for mental illness unless the informed consent of the person on
whom the surgery is being performed and approval from the concerned Board
to perform the surgery has been obtained.
(xviii) Chapter XV of the Act deals with the offences and penalties. It provides that
whoever carries on a mental health establishment without registration shall be
liable to a penalty which shall not be less than five thousand rupees but which
may extend to fifty thousand rupees for first contravention or a penalty which
shall not be less than fifty thousand rupees but which may extend to two lakh
rupees for a second contravention or a penalty which shall not be less than two
lakh rupees but which may extend to five lakh rupees for every subsequent
contravention.
(xix) Any person who contravenes any of the provisions of this Act, or of any rule
or regulation made there under shall for first contravention be punishable with
imprisonment for a term which may extend to six months, or with a fine which
may extend to ten thousand rupees or with both, and for any subsequent
contravention with imprisonment for a term which may extend to two years or

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 with fine which shall not be less than fifty thousand rupees but which may
extend to five lakh rupees or with both. Where an offence under this Act has
been committed by a company, every person who at the time the offence was
committed was in-charge of, and was responsible to, the company for the
conduct of the business of the company, as well as the company, shall be
deemed to be guilty of the offence and shall be liable to be proceeded against
and punished accordingly.
(xx) As per the Act people suffering from mental health attempting suicide shall be
presumed, unless proved otherwise, to have severe stress, provided with
treatment and rehabilitation and therefore the act will be exempted from the
provisions of Section 309 of Indian Penal Code.

From the study of the salient features, it appears that the authors of the Mental Healthcare
Act, 2017, have visualized that the new law would be a Magna Carta to free all the mentally
sick everywhere throughout the country. Their rationale has all the earmarks of being that
with the word 'care' inserted in the title; the new law would ensure that each mentally sick
person in India would enjoy the Government's benevolence. Be that as it may, ground truths
are a long way from this. Notwithstanding, a major feedback of the implementation of the
Mental Healthcare Act, 2017, the said Act has such a wide and course book like definition of
"mental illness". According to Dr. J.T Antony, the over-inclusive definition would prompt a
situation where even those with minor disorders would get stepped as mental. Under the said
Statute, the Board can survey, change, adjust or cancel the advance order by making an
application to the concerned Board. But the advance mandate isn't accessible if there should
be an occurrence of emergency treatment. It appears the correct given with one hand and
taken away with the other.

The Act does not accommodate advance mandate to minors, according to Section 5 of the
said Act. Every one of the administrations are to be ensured by both Central and State
governments. The expenditures assessed won't meet the obligations under the Act. It
additionally does not address guardianship of mentally sick persons. There was a provision of
mental health tribunals under the Mental Healthcare Bill, 2013 which is additionally not
incorporated under the Act.

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Mental illness has been defined under various Indian statutes. Mental illness under the Mental
Healthcare Act, 2017 means a substantial disorder of thinking, state of mind, perception,
orientation or memory that terribly impedes judgment, behaviour, ability to recognize reality
or capacity to meet the ordinary demands of life, mental conditions related with the abuse of
liquor and drugs, but does not include mental retardation which is a condition of captured or
incomplete development of mind of a person, exceptionally characterized by sub-normality of
intelligence.

The Hindu Marriage Act defines the expression ‘mental disorder' as mental illness, captured
or incomplete development of mind, psychopathic disorder or any other disorder or
incapacity of mind and includes schizophrenia. Mental illness is defined under Persons with
Disabilities Act, as any mental disorder other than mental retardation. ‘Mentally sick Person'
defined under the Mental Health Act, Section 2(l), as a person who is in need of treatment by
reason of any mental disorder other than mental retardation.

The Indian authoritative administration endeavours to give this protection in three different
ways. One gadget used is to deny legitimateness to lawful transactions involving a person of
unsound mind. Denial of lawfulness means not acknowledging in law a transaction which has
taken place in fact. Thus a contract with person of unsound mind is void. The second
technique is to solidify lawful proceedings till the person of unsound mind regains sanity.
The procedure is utilized in the conduct of criminal proceedings because, in a condition of
unsound mind, an under preliminary would be capable neither to instruct counsel nor take an
interest in the court proceedings. Postponement is therefore given to advance a reasonable
preliminary. The third gadget is to permit someone else to represent the interest of a person of
unsound mind. This representation can occur either through temporary or permanent
arrangements.

In a temporarily arrangement, the surrogate represents the person of unsound mind for a
particular activity or transaction, for instance, the guardian who documents or defends a
litigation. In a permanent arrangement, the surrogate acquires a more general authority to act
for the incapacitated individual. During the subsistence of the surrogacy, persons of unsound
mind cannot act for themselves even during a lucid interval. So it tends to be expressed that
the law interacts with mental disorder, to shield society from the dangerous manifestations of

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mental disorder, to shield persons with mental disorder from exploitation and to adjudge the
extent to which mental disorder negates lawful limit.

In India, there has being extremely recent change that few individuals have begun
acknowledging the relevance of general mental health .Mental health care in India in the
course of the most recent 25 years has been an intense time of development and innovation.
India enters the new millennium with many changes in the social, political, and economic
fields with a urgent need for reorganization of approaches and projects.

The mental health scene in India, in recent occasions, mirrors the multifaceted nature of
developing mental health arrangement in a developing country. The National Health Policy,
2002, unmistakably illuminates the place of mental health in the general planning of health
care. These developments have occurred against the more than 25 yr of efforts to integrate
mental health care with essential health care (from 1975), replacement of the Indian Lunacy
Act, 1912, by the Mental Health Act, 1987, replacement of Mental Health Act, 1987 by
Mental Healthcare Act, 2017, the enactment of the Persons with Disabilities Act, 1995
focusing on the equal opportunities, protection of rights and full participation of disabled
persons and replacement of the Persons with Disabilities Act, 1995, with the Rights of
Persons with Disabilities Act, 2016.

The competence of the therapist to fill the job of mental hygienist brings up additional issues.
Within the field of mental hygiene, specialists confront new functions and objectives;
occasionally they assume or are assigned responsibilities which they are poorly equipped to
fulfill. They have been trained as restorative practitioners, but they are moving from their
therapeutic job to invade such regions as education, sociology and community organization.
Indeed many of the weaknesses in the mental hygiene movement mirror the deficiencies that
specialists have brought to it.

The crux of the issue here is that our model of therapeutic education and training isn't
adequate to meet the demands of the rising burden. The therapist community knows about the
issue, but the issue has not been tended to seriously.

In India, neuropsychiatric disorders are assessed to contribute to 11.6% of the worldwide

burden of malady (WHO, 2008).
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The concept of health is familiar to the point that many of us have never thought much about
what it truly means. Whenever asked, a great many people would define health as the absence
of infection. And in fact, in the event that you look into 'health' in the Merriam-Webster
dictionary, you will find a fundamentally the same as definition as the condition of being
sound in body, mind, or soul; particularly opportunity from physical ailment or pain. While
this common definition of health certainly has justified, I think it's excessively limiting and
reductionist.

Imagine someone, Person A, who is the picture of physical health, he has boundless energy,
impeccable digestion, a sharp mind, and no chronic, inflammatory conditions and
infrequently, if at any time, gets cool and flu. But in other everyday issues, this person is a
disaster area, he has awful relationships, he is egotistical and does not contribute to the lives
of others, he has no sense of humour, infrequently has some good times and is hopeless more
often than not. Now consider someone, Person B, who is in many routes the inverse of Person
A, maybe she has an autoimmune ailment, she struggles with low energy, her digestion is
frail, and she in some cases experiences issues sleeping. But unlike Person A, her life is
incredibly rich and satisfying, she has profound, nourishing relationships with others, she
does meaningful work that has any kind of effect in the world, she is full of happiness and
humour and she adores having a decent time.

Which of these persons is truly healthy? Both? Neither? On the off chance that you needed to
pick between these alternatives, which would you pick? Of course, there is plausibility;
Person C. Person C is healthy physically and additionally mentally, emotionally and socially.
This is certainly what the greater part of us hope for, and it's a consummately natural and
legitimate objective. The issue is that it's not constantly attainable.

Mental health is determined by the way a person feels about himself, towards others and how
he is able to face and adjust to day-today living conditions. Adjustment is not an easy term to
define, partly because it has many meanings, partly because the criterion for evaluating
adjustment have not been clearly defined, and partly because adjustment and its contrary,
maladjustment, have common boundaries which tends to blur the distinctions between

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them.14 Adjustment is a word of many meanings, and it sometimes means different things to
different people. This is because it is complicated and because sometimes it is good and
sometimes it is bad. When it is bad, we usually call it maladjustment. Good or bad, it has
many relations to mental health. Adjustment is often used in preference to the concept of
normality, especially by psychologists with a humanistic orientation who are dissatisfied with
the concept of normality; Szasz is one of these. Many psychologists speak of maladjustment
rather than of abnormality because decisions about who is maladjusted do not seem to require
reference to a fixed moral or evaluative standard.

Problems of adjustment vary in degree. At the normal level are nervousness and worry,
feelings of inferiority, and some lesser degrees of anxiety, and of defensive behaviours. We
all experience these types of failures, and hence in a statistical sense these common problems
of adjustment are normal.15

Anxiety is hardwired into our brains. It is part of the body‘s fight-or-flight response, which
prepares us to act quickly in the face of danger. It is a normal response to uncertainty, trouble,
or feeling unprepared.16 Mild anxiety is vague and unsettling, while severe anxiety can be
extremely debilitating, having a serious impact on daily life. People often experience a
general state of worry or fear before confronting something challenging such as a test,
examination, recital, or interview.

These feelings are easily justified and considered normal. Anxiety is considered a problem
when symptoms interfere with a person‘s ability to sleep or otherwise function. Generally
speaking, anxiety occurs when a reaction is out of proportion with what might be normally
expected in a situation.17

At the most basic level, anxiety is an emotion. Simply stated, an emotion is a subjective state
of being. It is often associated with changes in feelings, behaviors, thoughts, and physiology.
Anxiety, like all emotional states, can be experienced in varying degrees of intensity. For
instance, we might say we are happy. A more intense expression of this same emotion might
be an experience of joy. But unlike the emotion happiness, which has several different words

14
Alexander A. Schneiders, Personality Dynamics and Mental Health: Principles of Adjustment and Mental
Hygiene 32 (1965).
15
B.Von Haller Gilmer, Psychology 427 (1970).
16
Staff at University of Texas at Austin Counseling and Mental Health Center, ―Anxiety‖, available at:
http://cmhc.utexas.edu/anxiety.html
17
Peter Crosta, ―What is Anxiety?‖, available at: http://www.medicalnewstoday.com/info/anxiety/

36 | P a g e
to convey these differing levels of intensity (e.g., intensity ranging from happiness to joy),
anxiety is a single word that represents a broad range of emotional intensity. At the low end

of the intensity range, anxiety is normal and adaptive. At the high end of the intensity range,
anxiety can become pathological and maladaptive.

While everyone experiences anxiety, not everyone experiences the emotion of anxiety with
the same intensity, frequency, or duration as someone who has an anxiety disorder18. There
are an infinite number of human experiences that cause normal anxiety. Life offers us the
experience of many anxiety-provoking ―firsts‖ -- a first date, the first day of school, or the
first time away from home. As we journey through life, there are many important life events,
both good and bad, that cause varying amounts of anxiety. These events can include things
such as, taking a school exam, getting married, becoming a parent getting divorced, changing
jobs, coping with illness and many others. The discomfort anxiety brings in all of these
situations is considered normal and even beneficial. Anxiety about an upcoming test may
cause you to work harder in preparing for the exam. The anxiety you feel when walking
through a dark and deserted parking lot to your car will cause you to be alert and cautious of
your surroundings, or better yet, get an escort to your vehicle.

While it‘s pretty clear to see that anxiety is normal and even beneficial, for many people it
becomes a problem. The main difference between normal anxiety and problem anxiety is in
the source and the intensity of the experience. Normal anxiety is intermittent and is expected
based on certain events or situations. Problem anxiety, on the other hand, tends to be chronic,
irrational and interferes with many life functions. Avoidance behaviour, incessant worry and
concentration and memory problems may all stem from problem anxiety. These symptoms
may be so intense that they cause family, work and social difficulties. The components of
problem anxiety include the physical responses to the anxiety such as palpitations and
stomach upset, distorted thoughts that become a source of excessive worry and behavioural

18
Matthew D. Jacofsky, Melanie T. Santos, Sony Khemlani-Patel, & Fugen Neziroglu, Normal and Abnormal
Anxiety: What‘s the Difference?‖, available at: http://www.mentalhelp.net/
poc/view_doc.php?type=doc&id=38464&cn=1

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changes affecting the usual way one lives life and interacts with others. Left unchecked,
problem anxiety may lead to an anxiety disorder.19

There is no clear-cut distinction between ‘mental health’ and ‘mental illness’. Those of us
who are normal have periods of depression; we lose our tempers and walk blindly into

problems leaving no avenue of escape. In a similar way, people who have been professionally
classified as mentally ill are at times free of abnormal symptoms.

Mental or emotional health refers to our positive characteristics and overall psychological
well-being. Mentally healthy people are known to deal with stress effectively by being able to
bounce back from adversity.

They are basically content people whose activities and relationships are meaningful. Some
characteristics of mentally and emotionally healthy people are outlined as follows.20

1. Mental efficiency
2. Control and integration of thought and conduct
3. Integration of motives and control of conflict and frustration
4. Positive, healthy feelings and emotions
5. Tranquillity or peace of mind
6. Healthy attitudes
7. Having a positive Self-Concept
8. Taking responsibilities for yourself
9. Having satisfying relationships
10. Adapting to changes
11. Flexibility
12. Tenacity

19
Sheryl Ankrom, ―Is It Normal Anxiety or an Anxiety Disorder?‖, available at:
http://panicdisorder.about.com/od/understandingpanic/a/normprobanxiety.htm
20
James Heather, ―Characteristics of good mental health‖, available at:
http://www.medicaldaily.com/characteristics-good-mental-health-234619

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 CHAPTER IV: GLOBAL PERSPECTIVES

 Principles and Best Practices on the Protection of Persons Deprived of Liberty in the
Americas

Principles and Best Practices on the Protection of Persons Deprived of Liberty in the
Americas' was Adopted by the IACHR at its 131st Regular Period of Sessions, hung
on March 3 – 14, 2008. This document builds up a progression of principles
concerning persons subject to an administration of deprivation of freedom. According
to this instrument deprivation of freedom is any form of detention, imprisonment,
institutionalization, or custody of a person in a public or private institution which that
person isn't allowed to leave voluntarily, by order of or under true control of a
judicial, administrative or any other authority for reasons of humanitarian assistance,
treatment, guardianship, protection, or because of wrongdoings or legitimate offenses.
Accordingly, the definition encompasses not only those denied of their freedom
because of wrongdoings or infringements or non-compliance with the law but
additionally those persons who are under the custody and supervision of other
institutions, where their opportunity to leave voluntarily is limited. Among the
principles indicated in this instrument are those general principles (humane treatment,
equality and non-discrimination, due procedure of law, among others), those
identified with the conditions of detention of persons denied of freedom (health,
sustenance, drinking water, accommodation, hygienic conditions and clothing,
measures against overcrowding, contact with the outside world, work and education,
among others), and finally, the principles identified with the systems of deprivation of
freedom.

 African (Banjul) Charter on Human and Peoples’ Rights (1981)

African (Banjul) Charter on Human and People's Rights is a lawfully binding

document supervised by the African Commission on Human and People's Rights. The
instrument contains a range of important articles on common, political, economic,
social and cultural rights. Clauses pertinent to individuals with mental disorders

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 include Articles 4, 5 and 16, which cover the privilege to life and the integrity of the
person, the privilege to regard of dignity inherent in a human being, prohibition of all
forms of exploitation and degradation (particularly servitude, slave exchange, torture,
and cruel, inhuman or degrading punishment), and the treatment and the privilege of
the matured and disabled to uncommon measures of protection. It expresses that the
matured and disabled will likewise have the privilege to uncommon measures of
protection in keeping with their physical or moral needs. The document guarantees
the privilege for all to enjoy the best attainable condition of physical and mental
health.

 African Court on Human and People’s Rights

The Assembly of Heads of State and Government of the Organization of African

Unity (OAU) – now the African Union – set up an African Court on Human and
People's Rights to consider allegations of violations of human rights, including
common and political rights and economic, social and cultural rights guaranteed under
the African Charter and other relevant human rights instruments. In accordance with
Article 34(3), the Court became effective on 25 January 2004 after ratification by a
fifteenth State. The African Court has the authority to issue binding and enforceable
decisions in cases brought before it.

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 CHAPTER V: JUDICIAL TREATMENT OF MENTAL ILLNESSES

Mental health legislation is essential for protecting the rights and dignity of persons with
mental disorders, and for developing open and successful mental health administrations. They
confront disgrace, discrimination and marginalization in all social orders, and this increases
the probability that their human rights will be disregarded. Mental disorders can some of the
time influence individuals' decision making limits and they may not generally look for or
acknowledge treatment for their issues. Once in a while, individuals with mental disorders
may represent a hazard to themselves and others because of weakened decision making
capacities. The danger of violence or damage related with mental disorders is moderately
little. Common misconceptions on this issue should not be permitted to influence mental
health legislation.

Successful mental health legislation can give a lawful framework to integrate mental health
administrations into the community and to conquer shame, discrimination and exclusion of
persons with mental illness. Legislation can likewise make enforceable standards for
astounding medicinal care, enhance access to care, and ensure common, political, social and
economic rights of persons with mental illness, including a privilege of access to education,
housing, employment and standardized savings. Furthermore, mental health law can build up
guidelines through which a country builds up its mental health approach, or reinforce
previously settled mental health arrangements that look to give successful and available
mental health care through the community. Mental health legislation assumes an important
job in implementing compelling mental health administrations, particularly by utilizing
political and popular will to reinforce national mental health arrangements.

Enactment of mental health legislation can enhance funding of mental health administrations;
make accountability for those responsible for providing mental health benefits and beat
bureaucratic gridlock to ensure compliance with mental health strategies and mandates.
World Health Organization and international guiding principles for mental health care
mandate that every human right, including the privilege to protection, informed consent,
confidentiality, opportunity from cruel and unusual treatment and non-discrimination should
be guaranteed through mental health legislation.

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There is no national mental health legislation in 25% of countries with nearly 31% of the
world's population, although countries with a government arrangement of governance may
have state mental health laws. Of the countries in which there is mental health legislation,
half have national laws that were passed after 1990. About 15% have legislation that was
enacted before 1960, i.e. before the greater part of the currently used treatment modalities
ended up accessible (World Health Organization, 2001)

Mental illnesses and the diagnoses and treatment of the mental illnesses has been all around
documented in Ayurveda, the Charak and Shushrut Samhitas, Vagbhat and Ashtanga
Sangraha and Ashtanga Hridaya. Ayurveda is a science of life and not just an arrangement of
medicine. There are clear descriptions about the side effects, etiology and home grown
medication, oil showers, fumigation, stun treatment, so likewise kindness and humane
attitudes to be shown to the patient. But the legitimate perspectives pertaining to the mental
illness have not been mentioned anywhere in the ancient Indian literature before the advent of
the British.

Mental health legislation was first enacted in India in 1858 dependent on the two English
Acts of 1853. Law relating to the custody of lunatics and management of their domains was
introduced in India through three separate acts, The Lunacy (Supreme Court) Act, 1858, The
Lunacy (District courts) Act, 1858 and Lunatic Asylum Act, 1858. This act was changed in
1883 and more elaborate instructions and guidelines for admission and treatment of lunatics
were outlined.

Mental Health Act, 1987 was drafted by Parliament in 1987 but it became effective in every
one of the States and Union Territories of India in April 1993. The Act supplanted the Indian
Lunacy Act of 1912, which had prior supplanted the Indian Lunatic Asylum Act of 1858.

Later on 29 December, 1990, State Mental Health Rules were confined that would come into
force in a state on the date of commencement of the Mental Health Act, 1987, in that State.
Under the State of Mental Health Rules, each state needed to constitute a State Mental Health
Authority that would act as a licensing body for the establishment of mental health care
centres to ensure the minimum standards of care of the mentally sick.

The targets of the Mental Health Act, 1987 were to set up Central and State authorities, set up
mental doctor's facilities and nursing homes, give a beware of working of these doctor's

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facilities, accommodate the custody of mentally sick persons, shield the general public from
dangerous manifestations of mentally sick, regulate procedure of admission and release,
safeguard the rights, shield citizens from being detained unnecessarily, accommodate the
maintenance charges of mentally sick persons, give legitimate guide to poor mentally sick
criminals at state expenses and change offensive terminologies of Indian Lunacy Act. So
many changes had been introduced in the Mental Health Act, 1987.

The positive changes in the Mental Health Act, 1987 were:

1. A more humane approach to problems of mentally ill persons.

2. Creation of Central and State Mental Health Authorities.
3. Procedure for admission and discharge.
4. Minor could be admitted with the consent of a guardian under the Act.
5. Separate provision for admission of involuntary patients under category “Admissions
under Special Circumstances”.
6. Special centres for special population like drug addicts, under 16 years, mentally ill
prisoners etc.
7. Establishment and maintenance of psychiatric hospitals.
8. Prohibition on any research on subjects without proper consent.

Mental health legislations were initially drafted to safeguard the public from dangerous
patients by isolating them from the public. A change in outlook from custodial care to
community care has occurred due to:

(i) Advances in medical technology in assessment and treatment of mental

disorders;
(ii) The human rights movement;
(iii) World Health Organization’s (WHO) definition of health; and
(iv) Preventive, curative, rehabilitative approaches and mitigation of disability.

The Constitution of India ensures equality, opportunity, justice and dignity all things
considered and certainly mandates an inclusive society for all including persons with
handicaps. As citizens of India, the mentally sick are entitled to each one of those human and
fundamental rights which are guaranteed to every last citizen by the Constitution of India, to

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the extent their incapacity don't prevent them from enjoying those rights or their enjoyment is
explicitly or impliedly banned by the constitution by any other Statutory law .

In the event that the rights of the mentally sick are to be assured and secured, a few players
from differing zones of society need to assume an active job. In this section, we examine the
particular job of the judiciary in addressing a portion of the basic mental health care needs of
the country. There is a dynamic relationship between the concept of mental illness, the
treatment of the mentally sick and the law. As Jonas R. Rappeport has noted, for the
therapists the court is "another house with its different intentions, objectives and rules of
conduct. While the therapists are concerned principally with the diagnosis of mental disorders
and the welfare of the patient, the court is often mainly concerned with determination of
competency, dangerousness, diminished responsibility and the welfare of society. Various
provisions relating to unsoundness of mind cannot take influence without a judicial
pronouncement.

The Right to Health is a fundamental right of each citizen in the country. Courts in India have
over and over extended that there untruths a positive duty on the piece of the government to
advance health in the general public. Mental health is an integral and inseparable piece of
health.

Hence, the ancient Roman adage, mens sana in corpora sano, meaning, a healthy mind in a
healthy body'. This reasoning was the bedrock of the Bhore Committee Report of 1946 and
the premise of formulating the National Mental Health Program, path in 1982. Initially the
Supreme Court of India enforced appropriate to health among the general population through
various public interest litigations which preceded the Indian judiciary. With the progression
of time the judiciary found that privilege to life under Article 21 is incomplete without ideal
to live with human dignity which includes various other rights like the privilege to education,
the privilege to job, the privilege to health and housing and so on.

In Bandhua Mukti Morcha v. Union of India21, which was relating to the workers of the stone
quarries and crushers working in an unhealthy environment, the Supreme Court held that:

21
AIR 1984 SC 802, Judgement delivered by Hon‘ble P.N. Bhagwati, R.S. Pathak and Amarendra Nath Sen, JJ

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 “It is the fundamental right of every one in this country, assured under the
interpretation given to Article 21...to live with human dignity, free from exploitation.
This right to live with human dignity enshrined in Article 21 derives its life breath
from the Directive Principles of State Policy and particularly clauses (e) and (f) of
Article 39 and Articles 41 and 42 and at the least, therefore, it must include protection
of the health and strength of workers, men and women, and of the tender age of
children against abuse, opportunities and facilities for children to develop in a healthy
manner and in conditions of freedom and dignity, educational facilities, just and
humane conditions of work and maternity relief.”

Thus appropriate to health turned into a piece of fundamental rights and impliedly secured
under Article 21 of the Indian Constitution which manages protection of life and personal
freedom. It sets out that no person will be denied of his life or personal freedom aside from
according to procedure built up by law. The question of this fundamental directly under
Article 21 is to prevent encroachment upon personal freedom and deprivation of life aside
from according to procedure built up by law. Ideal to life means the privilege to lead
meaningful, finish and dignified life. It doesn't have confined meaning. It is something more
than surviving or animal existence.

In Vincent Panikulangara v. Union of India22, the Supreme Court on the right to health care
observed that:

“ maintenance and improvement of public health have to rank high as these are
indispensable to the very physical existence of the community and on the betterment
of these depends the building of the society of which the Constitution makers
envisaged. Attending to public health in our opinion, therefore is of high priority,
perhaps the one at the top.”23

In the historic judgment, Consumer Education and Resource Centre v. Union of India,24 the
Supreme Court has held that:

22
AIR 1987 SC 990, Judgement delivered by Hon‘ble Rangnath Misra and M.M. Dutt, JJ
23
Id. at 995, para 16
24
(1995) 3 SCC 42, Judgement delivered by Hon‘ble Judge K. Ramaswamy

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 “The expression ‘life’ in Article 21 does not connote mere animal existence. It has a
much wider meaning which includes right to livelihood, better standard of life,

hygienic conditions on workplace and leisure.25 The right to health and Medical care
is a fundamental right under Article 21 of the constitution and make the life of the
workman meaningful and purposeful with dignity of person. “Right to life in Article
21 includes protection of the health and strength of the worker.26 The State, be it
Union or State Government or an industry, public or private is enjoined to take all
such action which will promote health, strength and vigour of the workman during
period of employment and leisure and health even after retirement as basic essentials
to life with health and happiness. The right to life with human dignity encompasses
within its fold, some of the finer facets of human civilization which makes life worth
living.”

In the case of Chandan Kumar Banik v. State of West Bengal,27 the Supreme Court observed
that the inhuman conditions of the mentally ill in the Mental Hospital at Mankundu in the
District of Hooghli. The Court ordered the directions for discontinuing the practice of tying
up the patients with iron chains and ordered drug treatment for them. The Court held that:

“This case was an application, which had its origin as a Public Interest Litigation in a
letter addressed to the Supreme Court on the basis of a press publication with a
photograph showing mentally ill patients chained in a State Hospital in West Bengal.
Thereafter a notice was issued to the State Government of West Bengal and an
affidavit was filed in reply to this notice. The Court appointed a Committee to inspect
this mental hospital located at Amankundu in the District of Hooghli and to write a
report about the conditions prevailing there.”

In Re: Death of 25 Chained in Asylum Fire in T.N. v. Union of India and Ors.,28 the Supreme
Court Bench issued directions pursuant to the suggestions of the Amicus Curiae29 appointed

25
Id. at 68 para22.
26
Id. at 70 para 24
27
(1995) Supp (4) SCC 505, Judgement delivered by Hon‘ble Ranganath Misra, P.B. Sawant and K. Ramaswamy,
JJ
28
AIR 2002 SC 979, Judgement delivered by Hon‘ble M.B. Shah, B.N. Agrawal and Arijit Prasayat, JJ.
29
Literally, friend of the court. A person with strong interest in or views on the subject matter of an action, but
not a party to the action, may petition the court for permission to file a brief, ostensibly on behalf of a party

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by the Court, to investigate the plight of mentally ill persons in various mental asylums, after
the unfortunate event in which 25 inmates died in a fire as they were chained to their beds

and could not escape. The directions issued by the Apex Court for strict implementation of
the provisions such as Sections 3, 4, 6 and 8 of Mental Health Act, 1987 were : ―

(i) Every State and Union Territory must undertake a district-wise survey of all
registered/unregistered bodies, by whatever name called, purporting to offer
psychiatric mental health care. All such bodies should be granted or refused
license depending upon whether minimum prescribed standards are fulfilled or
not. In case license is rejected, it shall be the responsibility of the SHO of the
concerned police station to ensure that the body stops functioning and patients
are shifted to Government Mental Hospitals. The process of survey and
licensing must be completed within 2 months and the Chief Secretary of each
State must file a comprehensive compliance report within 3 months from date
of this order. The compliance report must further state that no mentally
challenged person is chained in any part of the State.
(ii) The Chief Secretary or Additional Chief Secretary designated by him shall be
the nodal agency to coordinate all activities involved in implementation of the
Mental Health Act, 1987. The Persons with Disabilities (Equal Opportunities,
Protection of Rights and Full Participation) Act, 1995 and The National Trust
for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and
Multiple Disabilities Act, 1999. He shall ensure that there are no jurisdiction
problems or impediments to the effective implementation of the three Acts
between different ministries or departments. At the Central level, the Cabinet
Secretary, Government of India or any Secretary designated by him shall be
the nodal agency for the same purpose.
(iii) The Cabinet Secretary. Union of India shall file an affidavit in this Court
within one month from date of this order indicating:-

but actually to suggest a rationale consistent with its own views. Quoted in, The Free dictionary, ―Amicus
Curiae‖, available at: http://legal-dictionary.thefreedictionary.com /amicus+ curiae

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 a. The contribution that has been made and that proposed to be made under
Section 21 of the 1999 Act which would constitute corpus of the National
Trust.
b. Policy of the Central Government towards setting up at least one Central
Government run mental hospital in each State and Union Territory and
definite time schedule for achieving the said objective.
c. National Policy, if any, framed under Section 8(2)(b) of the 1995 Act.

(iv) In respect of States/Union Territories that do not have even one full-fledged
State Government run mental hospital, the Chief Secretary of the State/Union
Territory must file an Affidavit within one month from date of this order
indicating steps being taken to establish such full- fledged State Government
run mental hospital in the State/Union Territory and a definite time schedule
for establishment of the same.

(iv) Both the Central and State Governments shall undertake a comprehensive
awareness campaign with a special rural focus to educate people as to
provisions of law relating to mental health, rights of mentally challenged
persons, the fact that chaining of mentally challenged persons is illegal and
that mental patients should be sent to doctors and not to religious places such
as Temples or Dargahs.
(v) Every State shall file an affidavit stating clearly:
a. Whether the State Mental Health Authority under Section 3 of the 1987
Act exists in the State and if so, when it was set up.
b. If it does not so exist, the reasons therefore and when such an Authority is
expected to be established and operationalised.
c. The dates of meetings of those Authorities, which already exist, from the
date of inception till date and a short summary of the decisions taken.
d. A statement that the State shall ensure that meeting of the Authority take
place in future at least once in every four months or at more frequent
intervals depending on exigency and that all the statutory functions and
duties of such Authority are duly discharged.

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 e. The number of prosecutions, penalties or other punitive/coercive measures
taken, if any, by each State under the 1987 Act.30

In Saarthak Registered Society and another v. Union of India31, the Supreme Court passed
the following directions:

1. Every State and Union Territory shall undertake an assessment survey and file the
report on the following aspects:

o Estimated availability of mental health resources including psychiatrists,

psychologists, psychiatric social workers and nurses in both public and private
sector.
o Type of Mental Health Delivery System available in the State including
available bed strength, outpatient and rehabilitation services.
o An estimate of the Mental Health Services that would be required considering
the population of the State and the incidence of mental illness.
2. The Chief Secretary of each State and Administrator or Commissioner of every UT to
file affidavit stating clearly;
o Whether any minimum standards have been prescribed for licensing of Mental
Health Institutions in the State or UT and in case such minimum standards
have been prescribed, full details thereof32;
o Whether each of the existing registered Mental Health Institutions in the
State/UT whether private or run by the State meet the basic minimum
standards as on date of passing this order and if not, what steps have been
taken to ensure compliance of licensing conditions33;
o Number of unregistered bodies providing psychiatric/mental health care exist
in the State and whether any of them comply with minimum standards;
o Whether any mentally challenged person is found to be chained in any part of
the State or UT;
4. The report on the Need Assessment Survey and affidavit was to be submitted to the
Health Secretary, Union of India within a stipulated time. The Health Secretary was to
compile them and present it to the Court. Further Union of India was directed to:

30
AIR 2002 SC 979, at 980-981, para 8.
31
AIR 2002 SC 3693, Judgement delivered by Hon‘ble M. B. Shah, Bisheshwar Prasad Singh and H.K. Sema, JJ.
32
Id. at 3693, para 2.
33
Id. at 3693-3694, para 2.

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 o Frame a policy and initiate steps for establishment of at least one Central
Government run Mental Health Hospital in each State.
o Examine the feasibility of formulating uniform rules regarding standard of
services for both public and private sector Mental Health Services.
o Constitute a committee to give recommendations on the issue of care of
mentally challenged persons who have no immediate relatives or who have
been abandoned by relatives.
o Frame norms for non-government organizations working in the field of mental
health and to ensure that the services rendered by them are supervised by
qualified/trained persons.
5. All State Governments were also directed to frame policy and initiate steps for
establishment of at least one State Government run Mental Health Hospital in each
State.
6. Two members of the Legal Aid Board of each State were appointed to make monthly
visit to such institutions to help the patients and their relatives in applying for
discharge if they have been fully discharged.
7. Two members of the Legal Aid and Judicial Officer would explain their rights to
patients and their guardians at the time of admission to the institutions.
8. Form a Board of Visitors as required under the Mental Health Act to every State or
private institution at least once a month.
9. Envisage a scheme for rehabilitation process for people who are not having any
backing or support in the community.

In response to the Court's order to evaluate the situation of mental health benefits in the
country, the Ministry did a survey of the government run mental doctor's facilities, and
additionally other mental health administrations, or the absence of such administrations,
which gave inputs to formulating a re-strategized national mental health program in the 10th
Five Year Plan. Further expansion of the DMHP occurred in the eleventh plan. In July, 2016
the Supreme Court issued notice to six state governments of UP, Kerala, Rajasthan, West
Bengal, Meghalaya and Jammu and Kashmir on the issue of arrival of more than 300 persons
from mental doctor's facilities. The direction came after a petitioner asserted that more than
70 inmates in Bareilly's mental clinic, 29 in Varanasi, 41 in Shillong had recuperated but
were forced to live with mentally sick persons.

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 CHAPTER VI: CONCLUSION AND RECOMMENDATIONS

The inherent vulnerability of those with mental health issues and the shame of being a burden
on society, it is essential that human rights are acknowledged for this population. The reports
demonstrate that individuals with mental health issues are abused and marginalized due to the
nature of their illness. This trend is attributed to a number of factors including culture,
ethnicity, religion, language, and destitution. Although there are ongoing discourses over the
treatment of individuals diagnosed with mental illness and those exhibiting mental health side
effects around the world, note that the seriousness of abuse differs starting with one culture
then onto the next dependent on inherent convictions.

Furthermore, India's horrid record of rights violations of the mentally sick was glaringly
uncovered with the passing of twenty-five patients at an asylum in Tamil Nadu. The absence
of human rights or their violations, as seen in the Erwadi disaster and comparable cases, does
not originate from a shortcoming in existing Indian or international law as such; but is the
result of social disgrace, prejudice, and other social and economic factors linked with mental
illness. Each human body and mind has an integrity which is inviolable.

Mental health has been hidden behind a curtain of shame and discrimination for too long. The
time has come to bring it out into the open. The magnitude, suffering and burden as far as
handicap and expenses for individuals, families and social orders are staggering. Over the
most recent couple of years, the world has turned out to be more mindful of this enormous
burden and the potential for mental health gains.

According to World Health Organization, it is assessed that roughly 500 million individuals
all around are influenced by mental illness, liquor addiction and drug addiction . In India,
neuropsychiatric disorders are evaluated to contribute to 11.6% of the worldwide burden of
diseases. In Canada, it is trusted that mental illness will influence roughly 20% of the
population in their lifetime.

Depression is a common illness worldwide, with an expected 350 million individuals

influenced. One out of ten individuals suffers from major depression and just about one out of
five persons has suffered from this disorder during his or her lifetime. By 2020, depression
will be the second leading cause of world incapacity and by 2030; it is required to be the

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biggest contributor to sickness burden . Suicidal behaviours have been related with
depressive manifestations . Consistently more than 800,000 individuals bite the dust by
suicide according to the World Health Organization. Moreover, suicide is the 10th leading
cause of death in the United States, accounting for the passing of around 43,000 Americans in
2014.

Today, the mental disorders are among one of the leading causes of the diseases and
incapacity in the world, it has turned out to be necessary to generate the awareness of mental
health particularly in countries like India where an excessive number of misconceptions are
existing. For instance the most common misconception is that the India has low percentage of
the population suffering from mental disorder and needs to be handled first so the
congeniality to mental health administrations can be enhanced. The concept of mental health
in India encompasses only the treatment of seriously mentally sick person conceded in the
mental doctor's facility; otherwise it has no implications to them. Though, the morbidity rate
of mental disorders is surprisingly high in India. In India, there has been an exceptionally
recent change that few individuals have begun acknowledging the relevance of general
mental health.

International human rights instruments are important in the context of mental health because
they are the only source of law that legitimizes international scrutiny of mental health
arrangements and practices within a sovereign country and likewise because they give
fundamental protections that cannot be taken away by the ordinary political process. Mental
health and human rights are inextricably linked. They are complementary ways to deal with
the betterment of human beings. Some measure of mental health is indispensable for human
rights because only the individuals who have some reasonable level of functioning can
engage in political and public activity.

Beginning in the 1970s, the United Nations built up a number of comments, declarations,
resolutions, and guidance documents that have elaborated on the application of general rights
to persons with mental handicaps. This evolution has occurred gradually, incrementally, and
often inconsistently. Most significantly, the United Nations has affirmed principles that
straightforwardly apply to the rights of persons with mental incapacities.

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In order to encourage the understanding and implementation of the United Nations Principles,
WHO published guidelines to the human rights of persons with mental disorders. The
guidelines include an agenda to encourage the quick assessment of human rights conditions at
the nearby and regional levels.

A further document that guides the implementation of the United Nations Principles is
entitled Mental Health Care Law: Ten Basic Principles. It depends on a similar analysis of
national mental health laws and portrays ten basic principles for mental health legislation
independent of the cultural or lawful context. There are annotations on the implementation of
the principles.

The ten basic principles are:

1. Promotion of mental health and prevention of mental disorders,

2. Access to basic mental health care,
3. Mental health assessment in accordance with internationally accepted principles,
4. Provision of the least restrictive type of mental health care,
5. Self-determination,
6. Right to be assisted in the exercise of self-determination,
7. Availability of review procedures,
8. Automatic periodic review mechanism,
9. Qualified decision-makers and
10. Respect for the rule of law.34

34
WHO, Mental Health Legislation & Human Rights, 17 (2003), available at:
http://www.who.int/mental_health/resources/en/Legislation.pdf

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 BIBLIOGRAPHY
STATUTES:

 The Mental Healthcare Bill, 2013.

 Section 2(S), The Mental Healthcare Act, 2017.
 Section 13(1), Explanation (A), The Hindu Marriage Act, 1955.
 Section 2(Q), The Persons With Disabilities (Equal Opportunities, Protection Of
Rights And Full Participation) Act, 1995, See Dr. S. K. Awasthi And R. P Kataria,
Law Relating To Protection Of Human Rights 115 (2000).
 The Mental Healthcare Act 2017; The Act Replaces The Mental Health Act (Mha) Of
1987. It Was Published On 7th April 2017 In The Official Gazette Of India. It
Provides For Protection And Restoration Property Rights Of Mentally Ill Persons.
The Act Is Comprised Of 126 Sections And 16 Chapters.
 This Committee, Known As The Health Survey And Development Committee, Was
Appointed In 1943 With Sir Joseph Bhore As Its Chairman.... It Made Comprehensive
Recommendations For Remodelling Of Health Services In India, Quoted In Nhp,
India, Available At: Https://Www.Nhp.Gov.In/Bhore-Committee-1946_Pg
 The Mental Healthcare Act, 2017, S. 11

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 CASES CITED:

 Sheela Barse V. Union Of India, (1993) 4 Scc 204; In Re: Death Of 25 Chained
Inmates In Asyum Fire In Tamil Nadu V. Union Of India, Air 2002 Sc 979.
 Air 1984 Sc 802, Judgement Delivered By Hon‘Ble P.N. Bhagwati, R.S. Pathak And
Amarendra Nath Sen, Jj
 Air 1987 Sc 990, Judgement Delivered By Hon‘Ble Rangnath Misra And M.M. Dutt,
Jj
 Air 2002 Sc 979, At 980-981, Para 8.
 Air 2002 Sc 3693, Judgement Delivered By Hon‘Ble M. B. Shah, Bisheshwar Prasad
Singh And H.K. Sema, Jj.
 (1995) Supp (4) Scc 505, Judgement Delivered By Hon‘Ble Ranganath Misra, P.B.
Sawant And K. Ramaswamy, Jj
 Air 2002 Sc 979, Judgement Delivered By Hon‘Ble M.B. Shah, B.N. Agrawal And
Arijit Prasayat, Jj.
 (1995) 3 Scc 42, Judgement Delivered By Hon‘Ble Judge K. Ramaswamy

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 BOOKS REFERRED:

 Sumita Saha And Ruby Sain, Depression Among The Elderly 39 (2012).
 Usha. S. Nayar (Ed.), Child And Adolescent Mental Health 338 (2012).
 Vikram Patel And Martin Prince, ―Ageing And Mental Health In A Developing
Country: Who Cares? Qualitative Studies From Goa, India‖, Psychol. Med.,
2001(31):29-38
 Shruti Pandey, Priyanka Chirimar, Et. Al., Disability And The Law 373 (2005)
 Seshadri Harihar And Hiramalini Seshadri, ―Needed: New Mental Health Act‖, The
Hindu, Jan. 30, 2005
 P. C. Shastri, ―Promotion And Prevention In Child Mental Health‖, Indian J
Psychiatry, 2009 Apr-Jun; 51(2):88–95.
 Jose Bertolote, ―The Roots Of The Concept Of Mental Health‖, World Psychiatry
(2008);7(2):113–116.
 Khawaja Abdul Mutaquim, Protection Of Human Rights: National And International
Perspectives 138 (Edn.1st, 2004)
 Alexander A. Schneiders, Personality Dynamics And Mental Health: Principles Of
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