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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

1. 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
2. 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

1. In India, an estimated 150 million people need mental health care and treatment
2. Up to 92% of them (no less than 105 million persons) do not have access to any form of mental health care
3. According to the National Mental Health Survey (NHMS) of India, 2016, India spends less than 1% of its entire health budget on mental health
4. Stigmatisation and discrimination are serious causes of concern
5. 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?

1. 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

1. 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
2. At the same time, promoting innovative models of community mental health care can support the MHCA using existing community resources
3. 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

1. 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
2. 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

1. 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
2. Most importantly, civil society will have to pursue coordinated advocacy efforts with the government in setting up of the necessary infrastructure

Way Forward

1. 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
2. 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