Written by Prakriti Sharma of Symbiosis School of Liberal Arts, Pune. She is promoting mental health at her campus and has worked extensively in the field of mental health law and policy.
Mental health legislation can step in and provide an avenue for initialised change. It offers a unique opportunity to view mental health from a systematic and wide-scale perspective, especially in allowing access and protection for those that depend on public mental healthcare systems. The Mental Healthcare Act (MHA), 2017, has introduced essential features that put into place significant functions for the promotion of mental health practices, and more importantly, the rights of persons with mental illness.
The Act, mainly procedural, has outlined the procedures for introducing proxy decision-making options, aspiring to establish parity with physical disorders, bringing informed consent to the core of the practice, and decriminalising suicide. When the law executed in the context of medicine and healthcare, treatment decisions made in good faith are overlooked. Ethical and moral significances are inferior to legal validity. This law shows a departure from that thinking, indicating a shift in the thought of the mental healthcare system that places the importance of protecting the patient at the foundation of its construction.
However, effectiveness of the Act is slowed down by a lack of public awareness of the Act itself. It attempts to put into place a large amount of infrastructure without accounting for the fact that there are not enough mental health professionals to support it. India has continuously faced a severe shortage of mental health professionals and the Act (or subsequent amendments) has done nothing to incentivise individuals to take up these careers. Additionally, the MHA only looks at one part of the mental health picture, the extreme and severe end – the point where individuals are admitted to healthcare institutions, what about everything else? There exists a broad spectrum of mental health issues that come before this, affecting a more significant majority of the population that seems to be ignored by this Act, creating a severe disparity in the understanding of the mental illness.
It attempts a top-down approach at slowing the stigmatisation of mental health: by providing mental healthcare infrastructure and resources that will enable people to engage with them, the stigma against mental health might resolve itself. Conversely, the bottom-up approach would look at addressing the stigma first before implementing the practices. It is impossible to decide which method is better conclusively; each has its benefits and limitations.
The Mental Healthcare Act has not existed within the Indian context long enough to say that the approach or even the Act itself does not work, making this a frustrating waiting game that the Indian population does not have the time for.
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