Context

• The National Human Rights Commission (NHRC) in a report flagged the “inhuman and deplorable” condition of all 46 government-run mental healthcare institutions across the country.
• The facilities are “illegally” keeping patients long after their recovery, in what is an “infringement of the human rights of mentally ill patients”, the report notes. 
• The report also notes that the perennial shortage of doctors, lack of infrastructure, and proper amenities speak of a very pathetic and inhuman handling by different stakeholders.
• The human rights body’s observations were made after visits to all operational government facilities, to assess the implementation of the Mental Healthcare Act, 2017 (MHCA).

The Mental Healthcare Act, 2017

• The MHCA discourages long-term institutionalization of patients and reaffirms the rights of people to live independently, and within communities. 
• As part of Section 19, the government was made responsible for creating opportunities to access less restrictive options for community living — such as halfway homes, sheltered accommodations, rehab homes, and supported accommodation. 
• The Act also discourages using physical restraints (such as chaining), objects to unmodified electro-convulsive therapy (ECT), and pushes for the rights to hygiene, sanitation, food, recreation, privacy, and infrastructure. 
• Importantly, the Act recognised people have a capacity of their own — unless proven otherwise.

Challenges to Implementation

• While the MHCA safeguards the rights of people in mental healthcare establishments, enforcement challenges remain. 
• Almost 36.25% of residential service users at state psychiatric facilities were found to be living for one year or more in these facilities.
• It is due to absence of community-based services, and social stigma that looks at a person with mental illness as a “criminal” deserving of incarceration. 
• Under the MHCA, all States are required to establish a State Mental Health Authority and Mental Health Review Boards (MHRBs) – bodies that can further draft standards for mental healthcare institutes, oversee their functioning and ensure they comply with the Act. 
• In the majority of the States, these bodies are yet to be established or remain defunct. The absence of MHRBs renders people unable to exercise rights or seek redressal in case of rights violations. 
• Poor budgetary allocation and utilization of funds further create a scenario where shelter homes remain underequipped, establishments are understaffed, and professionals and service providers are not adequately trained to deliver mental healthcare. 

Rehabilitation of recovered people

• While the Act says a person can walk out if they are recovered, in practice, people still need somebody– a caregiver or the state — to take them out. 
• In many cases, families refuse to take them because of the stigma attached to incarceration or the idea that the person is no longer functional in society. 
• Gender discrimination plays a role here: women are more likely to be abandoned due to family disruption, marital discords and violence in intimate relationships.
• Moreover, most people who live in mental healthcare facilities have histories of homelessness, poverty, and a lack of education – and they thus have no place to go after recovery. 
• The dearth of alternative community-based services — in the form of homes for assisted or independent living, community-based mental healthcare services, and socio-economic opportunities – further complicates access to rehabilitation. 

Way Forward

• States have begun experimenting with the model of reintegration and recovery: Chennai’s Institute of Mental Health launched five halfway homes in 2021, where people can access the confidence and skills needed to manage themselves outside a structured institution. 
• Kerala has also started half-way homes and community living centres, providing rehabilitation to people who are abandoned by family members, who don’t wish to return to their families, who have no memory of their families, and those who have mental disabilities and are unable to work.  
• In the absence of rehabilitation, institutions are the only spaces available for many persons living with mental illness.