Note4students
Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources
From UPSC perspective, the following things are important:
Prelims level: Mental Healthcare Act (MHCA), 2017
Mains level: Ignorance and stigma related to mental health care in India & its impacts on patients
Context
MHCA comes into force
- For the first time in India, universal mental health care is now a justiciable right following the enforcement of the Mental Healthcare Act (MHCA), 2017
- It is for the first time that the law has recognised the right to access health care for citizens — and specifically for mental health
Status of mental health care in India
- In India, an estimated 150 million people need mental health care and treatment
- Up to 92% of them (no less than 105 million persons) do not have access to any form of mental health care
- According to the National Mental Health Survey (NHMS) of India, 2016, India spends less than 1% of its entire health budget on mental health
- Stigmatisation and discrimination are serious causes of concern
- There are numerous documented cases of human rights violations as a result of poor quality of mental health care, forced admissions in mental health hospitals, and a denial of socio-economic rights
How MHCA aims to curb the malfunctioning of the system?
- It mandates the government to provide accessible, affordable, acceptable and high-quality mental health care by
- integrating mental health-care services at each level of the public health system
- establishing mental health facilities in proportion to the population in each State
- providing free mental health-care to socio-economically deprived sections of the population
The government is duty-bound to design and implement mental health promotion and preventive programmes to create awareness about the MHCA using public media
Steps that can be taken for implementation
- The government will have to make appropriate budgetary provisions to plug existing infrastructure gaps
- This will require mapping existing mental health systems in the States for prevailing demand-supply factors for services, identifying shortages in mental health professionals and operational barriers to effective implementation
- At the same time, promoting innovative models of community mental health care can support the MHCA using existing community resources
- For example, the Atmiyata project (being implemented by the Centre for Mental Health Law & Policy) in Mehsana district, Gujarat, trains community volunteers to provide psychological counselling, social care and referral services to those with mental health problems while reaching out to a population of more than one million
- State governments will have to immediately set up and ensure the functioning of State mental health authorities and mental health review boards
- The State authorities are legally mandated to establish regulations for registering mental health establishments and professionals, conducting social audits and defining quality standards for mental health services and facilities
- The mental health review boards, as quasi-judicial bodies, will play a crucial role in ensuring the day-to-day implementation of the MHCA such as monitoring long-stay admissions, registering advance directives, appointing nominated representatives and adjudicating complaints about human rights violations and deficiencies in care/services
- Implementation of the MHCA will be impossible without coordinated efforts on the part of all stakeholders with an interest in mental health care
- Law enforcement officials, judges, mental health professionals and government officials need to be trained as a matter of priority to develop the necessary attitudes and skills for implementing the MHCA
- Most importantly, civil society will have to pursue coordinated advocacy efforts with the government in setting up of the necessary infrastructure
Way Forward
- At a time when the global health discourse has been advocating universal health coverage and the right to health, India has already made this a reality for mental health care
- If well implemented, it will be a pioneering model for universal mental health care across the world and will go a long way to in addressing the mental health concerns of 150 million people