Mental Healthcare Act

History of Mental Health Reforms in India

• Ancient India: Ancient Indian texts such as the Atharvaveda (an ancient scripture) and the Charaka Samhita (an
ancient medical treatise) mention mental health and the treatment of mental illnesses. Ayurvedic medicine, an
ancient Indian system of medicine, also addressed mental health conditions through herbal treatments and
lifestyle management.
• Dosha Imbalance: According to Ayurveda, everyone has a unique constitution, or Prakriti, determined by the
balance of the three doshas: Vata (air and space), Pitta (fire and water), and Kapha (earth and water).
Imbalances in these doshas can contribute to mental health issues. For example, excess Vata may lead to anxiety
and insomnia, excess Pitta may manifest as anger and irritability, and excess Kapha may result in lethargy and
depression. Ayurvedic treatments aim to balance the doshas through diet, lifestyle practices, herbs, and
therapies tailored to an individual's constitution.
• Traditional Healing Practices: India has a rich tradition of mental health care that includes the use of traditional
healers, religious leaders, and folk remedies. Some of these practices, while culturally significant, are not always
based on evidence-based medicine.
• British Colonial Period: During British colonial rule in India, Western medical approaches were
introduced.
• Post-Independence Reforms: After gaining independence in 1947, India made efforts to reform
its mental health care system. The Indian Lunacy Act of 1912 was replaced by the Mental Health
Act of 1987. This legislation aimed to protect the rights of individuals with mental illnesses and
improve mental health services.
• Community-Based Care: In recent years, there has been a shift towards community-based
mental health care. This approach recognizes the importance of integrating mental health
services into primary healthcare and involving families and communities in the care of individuals
with mental health conditions.
• National Mental Health Program (NMHP): The Government of India launched the NMHP in 1982,
aimed at providing mental health services, promoting mental health, and integrating mental
health into general healthcare. The program has evolved and expanded over the years.
• Mental Healthcare Act, 2017: The Mental Healthcare Act, 2017, was a significant milestone in the
history of mental health care in India. This law aimed to protect the rights of individuals with
mental illnesses, decriminalize attempted suicide, and provide a legal framework for mental
healthcare services in the country.
 INDIAN LUNACY ACT, 1912
• The Indian Lunacy Act of 1912 was a piece of legislation that governed the treatment and care of
individuals with mental illnesses in British India. It was primarily concerned with the
establishment and management of mental asylums and the legal procedures for the detention
and treatment of individuals with mental disorders.
 Key provisions of the Indian Lunacy Act of 1912 included:
 Establishment of Asylums: The act provided for the establishment of mental asylums, which were
institutions for the care and treatment of individuals with mental illnesses. These asylums were
intended to provide a safe and structured environment for those deemed "lunatic" or "mentally
ill."
 Definition of "Lunatic": The act defined who could be considered a "lunatic" and thus subject to
its provisions. It included those who were considered insane, delusional, or suffering from other
forms of mental illness.
• Certification and Detention: The act established procedures for the certification and detention of
individuals with mental disorders. It outlined the role of medical practitioners, known as "Medical
Officers for Mental Diseases," in diagnosing and certifying a person's mental illness.
• Guardianship and Trusteeship: The act allowed for the appointment of guardians or trustees for
individuals who were incapable of managing their affairs due to mental illness.
• Offenses and Penalties: The act contained provisions for offenses related to the maltreatment of
individuals with mental illnesses, and it specified penalties for violations of the law.
• The Indian Lunacy Act of 1912 was replaced by the Mental Health Act of 1987,
which introduced several reforms and aimed to provide greater protection for the
rights of individuals with mental illnesses in India.
 What is MHA 2017?
• This Act defined mental illness as “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, mental conditions associated with the abuse of
alcohol and drugs.”
• It also provides the right of patients to access facilities that include rehabilitation services in the
hospital, community, and home, sheltered and supported accommodation.
• It regulates the research on PMI (Persons with Mental Illness) and the use of neurosurgical
treatments.
Case 1: Informed Consent and Advance
Directives:
• Priya, a 35-year-old woman with bipolar disorder, has experienced multiple episodes of severe
depression and mania. She is currently stable but worries about the possibility of future relapses.
Application of Mental Healthcare Act:
Priya decides to create an advance directive outlining her preferences for treatment in the event of
a future mental health crisis. She specifies her treatment preferences, including preferred
medications, therapies, and interventions. Under the Mental Healthcare Act, healthcare providers
are required to respect Priya's advance directive and obtain her informed consent before
administering treatment, ensuring that her preferences are honored even if she is unable to
communicate them at the time.
Case 2: Rights of Individuals with Mental Illness:

• Rajesh, a 50-year-old man with schizophrenia, is admitted to a psychiatric hospital for involuntary
treatment after experiencing a psychotic episode. He expresses concern about his rights and
autonomy being violated.
• Application of Mental Healthcare Act: Rajesh's rights are protected under the Mental Healthcare
Act, which mandates that individuals with mental illness are entitled to dignity, autonomy, and
freedom from discrimination. The mental health review board conducts a review of Rajesh's case
to ensure that his involuntary admission and treatment are justified and comply with the
provisions of the Act. Rajesh is provided with legal aid and support to advocate for his rights and
preferences throughout his treatment process.
 Rights under MHA

• Right to Make an Advance Directive (Patient can state how to be treated or not to be treated for
the illness during a mental health situation).
• Right to Access to Healthcare Services.
• Right to free-of-cost healthcare services.
• Right to live in a community.
• Right to protection from cruel, inhuman and degrading treatment.
• Right not to be treated under prohibited treatment.
• Right to equality and non-discrimination.
• Right to information.
• Right to confidentiality.
• Right to legal aid and complaint.
 Initiatives Related to Mental Health
 World Mental Health Day. (10th October)
 WHO’s Comprehensive Mental Action Plan 2013-2020
 Mental Health Atlas (Publication)-The Mental Health Atlas contains a wide range of data and
information related to mental health, including:
 Statistics on the prevalence, burden, and impact of mental disorders worldwide.
 Information on mental health policies, legislation, and regulations in different countries.
 Data on mental health financing, resources, and services, such as the availability of mental
health professionals, psychiatric facilities, and community-based programs.
 Profiles of mental health systems and services in individual countries, including strengths,
challenges, and areas for improvement.
 Case studies, best practices, and recommendations for promoting mental health and
addressing mental illness at the national and global levels.
 Sustainable Development Goals (SDG 3.4)