Health encompasses the composite union of physical, spiritual, mental, and social dimensions.

According to (WHO), “mental health and well-being are fundamental to quality of life, enabling
people to experience life as meaningful, become creative and active citizens.”

The WHO defines mental health as “a state of well-being in which every individual realizes his or her
own potential, can cope with the stresses of life, can work productively and fruitfully.

An Act is originally a bill that concentrates on a particular subject and contains provisions relating to
it, which is proposed in the parliament when it gets approval from both the houses i.e. The Lok
Sabha and the Rajya Sabha and President as well.

Vision:

To promote Mental health prevent mental illnesses, enable recovery from the mental illness,
promote destigmatization and desegregation and socioeconomic inclusion of PWMI by providing
accessible, affordable, and quality health and social care to all persons through their lifespan within a
rights-based framework.

Values and Principles:

The set ethos of the policy was equity, justice, integrated care, evidence-based care, quality,
participatory and rights-based approach, governance, and effective delivery, value-based in all
training and teaching programs, and holistic approach to Mental health.

Goals

1. To reduce distress, disability, exclusion morbidity, and premature mortality associated with
MH problems across the lifespan of the person.

2. To enhance understanding of MH in the country.

Objectives

• To provide universal access to Mental health care.

• To increase access to and utilization of comprehensive MH services by Person with mental

health problems (including prevention services, treatment and care, and support services).

• To increase access to Mental health care especially to vulnerable groups including homeless
persons, person in remote areas, educationally, socially, economically deprived sections.

• To reduce the prevalence and impact of risk factors associated with MH problems.

• To reduce the stigma associated with MH problems.

• To enhance availability and equitable distribution of skilled human resources for MH.

• To progressively enhance financial allocation and improve utilization for MH promotion and
care.
• To identify and address the bio-psycho-social determinants of MH problems and to provide
appropriate interventions.

Why do we need MHCA:

For protecting the rights and dignity of Developing accessible and effective
persons with mental disorders. mental health services.

It provide legal framework to To overcome stigma ,

integrate mental health services discrimination ,exclusion of mentally ill
into the community persons.

To create enforceable standards for high

quality medical care

Mental illness - a substantial disorder of thinking, mood, perception, orientation or memory

that grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the
ordinary demands of life, but does not include mental retardation.

Advance directive -a written document made by a person expressing their wishes

Mental healthcare – analysis, diagnosis and treatment as well as care and rehabilitation of a
person for his mental illness or suspected mental illness.
India did pass the Mental Healthcare Act in 2017, which aimed to provide better mental healthcare
and protect the rights of people with mental illness. Let's delve into its key aspects and implications:

1) Rights-based approach: One of the most significant aspects of the Mental Healthcare Act, 2017 is
its rights-based approach. It recognizes the rights of individuals with mental illness, including the
right to access mental healthcare, right to confidentiality, right to community living, right to legal aid,
and so on. This shift from a paternalistic approach to one centred on the rights of individuals is a
significant step forward.

2) Decriminalization of suicide: The Act decriminalizes suicide attempts, acknowledging that these
actions often stem from underlying mental health issues and should be treated as a medical, not
criminal, concern. This move aims to encourage individuals to seek help without fear of legal
repercussions, thereby promoting early intervention and treatment.

3)Advance directives: The Act allows individuals to draft advance directives specifying their
preferences for treatment in the event that they lose the capacity to make decisions about their
mental health treatment in the future. This empowers individuals to have a say in their treatment
even when they may not be in a position to communicate their preferences later on.

4) Mental Health Review Boards: The establishment of Mental Health Review Boards is another
crucial provision of the Act. These boards are responsible for protecting the rights of individuals with
mental illness, including reviewing admission, treatment, and discharge procedures. This oversight
helps ensure that involuntary admissions and treatments are carried out in accordance with the law
and with due regard for the individual's rights and dignity.

5) Community-based care: The Act emphasizes community-based care over institutionalization

wherever possible. It promotes the integration of mental health services into primary healthcare and
encourages the establishment of halfway homes, group homes, and other community-based
rehabilitation services. This approach aims to reduce stigma, promote inclusion, and provide
individuals with the support they need to live fulfilling lives in their communities.

6)Penalties for non-compliance: The Act imposes penalties for various offenses, including the use of
electroconvulsive therapy (ECT) without anesthesia, failure to maintain records, and unauthorized
disclosure of information. These penalties serve as deterrents and help ensure compliance with the
provisions of the Act.

7)Challenges and implementation: While the Mental Healthcare Act, 2017 represents a significant
step forward in addressing mental health issues in India, its effective implementation poses several
challenges. These include resource constraints, inadequate mental health infrastructure, shortage of
trained professionals, and persistent stigma associated with mental illness. Addressing these
challenges requires concerted efforts from the government, healthcare providers, civil society
organizations, and the community at large.

In conclusion, the Mental Healthcare Act, 2017 of India marks a paradigm shift in the approach to
mental health, emphasizing rights, autonomy, and community-based care. While its implementation
may face challenges, the Act has the potential to significantly improve the mental health landscape in
India and promote the well-being and dignity of individuals with mental illness.
16 chap 126 sections:

Chap-1

 Mental illness definition

 Advanced directive
 Mental healthcare

Chap-2

 Nationally internationally accepted medical stnd

 No authority shall classify a person w MI except for treatment/matters covered in the act
 Shall not be determined based on cultural, political, religion, economic, social group
 Every person deemed to make indiv decisions for treatment provided they can-understand,
retain & communicate

Chap-3

 Advanced directive (revoked, amended, cancelled by them at any point)

 Indiv (not minor) can decide the way a person wishes to/ wishes not to/ by whom
 Duty of healthcare provider to give treatment based on the AD
 Legal guardian has right to make AD until they attain maturity
 Central authority & mental health review board can make regulation & modifications

Chap-4

 Indiv (not minor) has right to appoint nominate representative (writing on plain paper, sign,
thumb imp & can’t be a minor)
Duties: appoint suitable attendant
Consider wishes & best interest
Access to fam/home based rehab prog
Provide support
Admission & discharge
Seek info on diagnosis & treatment
Right to give/withhold consent for research

Chap-5

 Right to access MHC without DISCRIMINATION

 Provisions:
Outpatient and Inpatient services
Long term care like –Sheltered accommodation and supported accommodation.
Home based rehabilitation.
Hospital and community-based rehabilitation
Free treatment for BPL
Right to community living (Clause 19)
Right to protection from cruel, inhuman and degrading treatment (Clause 20)
Right to equality and non – discrimination. (Section 21 )
 Right to information - The PMI and nominated representative will have the RTI for the clause
under which patient is admitted, nature of illness and treatment options available. (Section
22 )
Right to confidentiality and right to access medical records. (section 23 – 25 )
Right to personal contacts and information - Right to receive and refuse visitors, Right to
receive and make phone calls, send and receive mail through electronic mode including
through email (section 26)
Right to legal aid (section 27)
Right to make complaints about deficiencies in provision of services. (section 28)

Implementing Authorities: Central Mental Health Authority Sec 33-44; State Mental Health
Authority sec 45-56; Mental Health review board:
Promotion of MH and preventive programmes.
Creating awareness and reducing stigma
Take measures for HRD and training.
Co-ordination within appropriate Government

Admission, Discharge & Treatment:

INDEPENDENT Admission:
Any person who considers himself to have mental illness and desire admission
Admitted if the medical officer or Psychiatrist is satisfied that:
1. MI or severity requiring admission
2. Patient should benefit from admission and treatment
3. Request made is under free will and not under any undue influence and has capacity to make
mental health care decisions
4. NR to be present with the minor for the entire duration of admission.
5. Treatment with informed consent of nominated representative.
6. Any admission of a minor which continues for a period of thirty days shall be immediately
informed to the concerned Board.
Discharge:
● On Request.
● Minor becoming Major under-in patient care, can decide as independent patient.
● MHP may prevent discharge of independent person under section 86 for a period of twenty-
four hours if—
o he is unable to understand the nature and purpose of his decisions and requires
substantial or very high support from his nominated representative;
o has recently threatened/ing or attempted/ing to cause bodily harm to himself
o behaved/ing violently towards another person or is causing another person to fear
bodily harm from him.
o showing an inability to care for himself to a degree that places the individual at risk
of harm to himself.
 Leave of absence
o A PMI admitted maybe granted leave from the MHE by the psychiatrist after securing
consent of NR.
o Power with the practitioner to terminate when appropriate to do so.
o If the PMI does not return, contact the person on leave, or Nominated
Representative
 Absence w/o leave/ discharge
o He shall be taken into protection by any Police Officer
o Shall be sent back to the mental health establishment immediately.
 ● If any person absents himself without leave or without discharge from the mental health
establishment:

● He shall be taken into protection by any Police Officer

Emergency Treatment: should be Instituted only if

a) Death or irreversible harm to health

b) Person inflicting serious harm to himself/ others

c) Person causing damage to property.

o Medical treatment to be provided subject to Informed consent of NR.

o After 72 hours the doctor has to decide whether to admit the patient under section
86( which involves Patient giving consent and having capacity) or Section 89 (in which
patient refuses but according to doctor the patient needs to be admitted).

Offences & Penalties:

 Unauthorized institutions will be punished 5000-50000 for 1st time, up to 2 lakhs for 2nd
time.
 Any person who do the work against the Act, are liable to give up to 10,000 or 6 m of jail or
both.

Decriminalization of Suicide:

 Any person who attempts to commit suicide shall be presumed to be suffering from mental
illness at the time of attempting suicide and shall not be liable to punishment under this
section. (i.e. dissolution of IPC 309)

Limitations:

 western concept- reduced role of fam

 advance directives have also been criticized-
o impractical while giving too much autonomy to PMI
o can be used by patients to reject treatment
o increases the work of psychiatrist (less in no)
 no uniform administrative structure for health governance
o requires coordination with several other ministries and departments.
o Lack of coordination between these departments-poor planning, inefficient resource
utilization and significant delays in implementation

Merits:

 NR-
o family members are still considered as the primary caregivers
o fails to recognize the family as a site of violence and triggers for mental health
problems
o gives a relief to many persons with mental illness, especially women and LGBTQ and
intersex persons
 INVOLUNTARY