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Law and Practice

Mental Health care in INDIA: Law and Practice

In order to fully understand Anjali's mission and approach, the context that they work in must be understood. In India, mental health is one of the most neglected public sectors with a mental health policy that serves primarily to protect the system's psychiatric staff rather than the needs or rights of the patients. It is a system that is far to over-worked and under-funded to meet the needs of the 20 to 30 million people who are in active need of mental health care. Of the total health budget of India, less than one percent is earmarked for mental health; and of that meager amount most of it is devoted to staff salaries and infrastructure rather than treatment. Another important factor is that many of those who end up in the system have been discarded by their own frustrated families or have simply wandered away from abusive ones. For the vast majority, state-run mental hospitals are the only available treatment because of financial constraints. Because of the lack of resources within the hospitals as well as understanding or concern, there is no distinction made between those who are committed as a result of trauma – from sexual or physical or substance abuse – those with acute illness and those with severe and chronic mental illness.

But the challenges that Anjali faces goes far beyond the systems or even the families' lack of resources. The salient inadequacy of policy relating to mental health issues partnered with the social stigma poses a much bigger obstacle when working toward its mission of human rights. Until the creation of The Mental Health Act of 1987, the only policy in place relating to mental health had been the Indian Lunacy Act of 1912 that allowed the detention of any person suspected of having a mental illness. The Mental Health Act of 1987, enacted in 1993, outlines the procedures and legal property matters relating to the detention of one with a mental illness. It reads as a personnel manual rather than a document meant to outline the rights or treatments available to a person in need. The definitions and rights of each staff member within the system are explained and the processes, by which a person can be institutionalized, voluntarily or involuntarily, are detailed. Although the Act explicitly mentions the right to appropriate treatment and rehabilitation, to personal liberty, and to improved community and family life rather than the life of incarceration, it also empowers the judiciary and the police to take any mentally ill person in custody and remand him or her to a mental hospital. The majority of the Act describes in extensive detail the rights of the government employees rather those of the person in question. No specifics are given as to what types of treatments that need to be available or what rights a person has with regards to their treatment or care while in the hospital or the right to make decisions about them. Thus, patients can be herded from prisons to hospitals without any regard for their present condition or the possibility of reintegration into the community. Nor does the Act provide explanation for changes in treatment with change in condition or improvements in available treatment. Essentially, all the power lies in the hands of the system or the guardians, not the hands of those whose lives are most directly affected.

The involuntarily admission of a person requires no more than the application of a friend or family member to the court with two certificates from medical officers, only one of which needs to be a psychiatrist, stating that the person is mentally ill. It is worth noting that both medical officers can be from the private sector so are not regulated by any overseeing government authority and allowing their diagnoses to be clouded by personal prejudice or corruption. Once inside the same applicant would need to take personal responsibility for the 'patient' in order for him or her to be released once deemed 'cured'. Given the stigma associated with mental illness, there may be as many as thousands of perfectly fit people languishing in mental hospitals because they do not have a family member who is willing to take responsibility for them. It is possible for a 'cured' mental patient to be released in his own care but this requires the assistance of legal counseling, something that is not readily available to those incarcerated, and has only been successfully done once, with the help of Anjali. The critical omissions from the Mental Health Act are far too many to cover in this document but there are a few that are important to highlight. There is no distinction made between the different types or severity of mental illnesses and no mention of mental health care beyond the scope of diagnosable mental illness, nor is there any specific requirements relating to quality or type of care made available to patients. Furthermore, consistent with the complete and total disregard for the fundamental human rights of the people that it relates to, there is no provision for the process of discharge relating to those who come of age while in detention. Aside from the specific deficiencies within this policy it is the general purpose of the Act that is perhaps its greatest fault: the intention of outlining and protecting the rights of the members of the Central Authority for Mental Health Services and not those of the persons who are most directly effected by it. The policy only results in making patients undergo various procedural ordeals, instead of having access to quality mental health care or rehabilitation. Other than the Mental Health Act, 1987, the only other Indian policy that relates to mental health care is the Public with Disabilities Act, 1995 that includes only one line stating that the included rights pertain also to those with mental illness without any further clarification.

Mental Health Care Conditions in India
  • 20-30 million people in active need of mental health care
  • 75,000 patients
  • 37 mental hospitals
  • 3500 trained psychiatrists
  • 100 clinical psychologists and psychiatric social workers
  • 900 psychiatric nurses

Although India has signed onto international covenants of human right both general and specific to mental health issues, the government, both Central and State, has not adjusted its own policies to meet those standards nor enforced its own existing policies. Although on several occasions the issue of both poor mental hospital conditions as well as general lack of adequate policy has been brought to their attention, the government has consistently failed to follow-up. In spite of all the work that Anjali has done until now, the situation at present is grave and needs serious further attention. Below is an outline of the existing Twilight Claims programs and the future plans that Anjali has to continue to amend this inhumane and unjust situation. With a history of stigma and human rights violations working against them, Anjali continues to push forward in order to make the voices of the voiceless heard and the faces of the invisible seen.