Policies and Acts Pertaining to Mental Health

A major obstacle for integrating mental health initiatives into global health programmes and
primary healthcare services is lack of consensus on a definition of mental health.1–3 There is little
agreement on a general definition of ‘mental health’4 and currently there is widespread use of the
term ‘mental health’ as a euphemism for ‘mental illness’.5 Mental health can be defined as the
absence of mental disease or it can be defined as a state of being that also includes the biological,
psychological or social factors which contribute to an individual’s mental state and ability to
function within the environment.4 6–11 For example, the WHO12 includes realising one's potential,
the ability to cope with normal life stresses and community contributions as core components of
mental health.

“HARD” AND “SOFT” LAWS GOVERNING OR INFLUENCING MENTAL

HEALTH CARE(13)

“Hard” laws refer to laws that are binding and enforceable internationally or domestically.eg CRPD
“Soft” laws, on the other hand, are not binding.

In India, some of the hard laws pertaining to mental health include The Mental Health Act, 1987;
The Protection of Human Rights Act, 1993; Persons with Disability Act, 1995; The National Trust
Act, 1999; Protection of Women from Domestic Violence Act, 2005; Protection of Children from
Sexual Offences Act, 2012, and related legislations. A prominent statutory legislation regulating
narcotics is the Narcotic Drugs and Psychotropic Substances (NDPS) Act 1985.

Strictly speaking, “soft” laws are not really laws at all; they are rules or policies that are quasi-legal
and not binding. They are defined as having “hortatory” obligations, i.e., statements in the nature of
promises. It is argued that in the course of time, these may become binding. Some examples include
the National Mental Health Policy 2014 and the National Mental Health Programme (with its
operational arm, the District Mental Health Programme)

WHY LEGISLATE MENTAL HEALTH?(14,15)

Mental health legislation plays a crucial role in ensuring well-being of individuals with mental
health conditions

Objectives of mental health legislation(4)—

• Protection and Promotion of Rights: Mental health legislation serves as a framework to

safeguard the rights of individuals with mental health conditions. It codifies principles, values,
aims, and objectives related to mental health policies and plans. Ensuring informed consent,
confidentiality, and family involvement is essential.
• Integrated, Community-Based Care: Effective legislation promotes integrated, community-
based care and support. It emphasizes holistic well-being and quality services accessible to all.

• Alignment with Human Rights Covenants: National mental health legislation should align with
international human rights agreements. This ensures consistency with global standards for the
rights of people with mental health conditions.Governments and legislating bodies need to adopt
rules, regulations and codes of practice for implementing the legislation.3

• Operational Structures and Mechanisms: Implementing mental health legislation requires

establishing operational structures and mechanisms. These support effective enforcement and
monitoring

A TIMELINE OF MENTAL HEALTH LEGISLATION

1. Madhouses Act, 1774

2. Criminal Lunatics Act, 1800
3. County Asylums Act, 1808 (with amendment passed in 1828 and 1845)
4. Lunacy Act, 1845
5. Lunatic Removal Act, 1851
6. The Lunacy (Supreme Courts) Act, 1858
7. The Lunacy (District Courts) Act, 1858
8. The Indian Lunatic Asylum Act, 1858 (with amendments passed in 1886 and 1889)
9. The Military Lunatic Acts, 1877.
10. Indian Lunacy Act, 1912
11. Mental Treatment Act, 1930
12. Mental Health Acts, 1953 and 1983
13. Mental Health Act, 1959 (UK)
14. Community Mental Health Act, 1963 (USA)
15. National Mental Health Programme (NMHP), 1982(INDIA)
16. India’s Mental Health Act, 1987 (INDIA)
17. Medical Certificate for Involuntary Hospitalisation (Indian Mental Health Act, (IMHA) 1987
18. United Nations’ Principles for the Protection of Persons with Mental Illness and the
Improvement of Mental Health Care, 1991
19. Rehabilitation Council of India Act (1992)
20. The Protection of Human Rights Act, 1993
21. The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation)
Act, 1995 (INDIA)
22. District Mental Health Programme (DMHP), 1996
23. World Health Organization’s Mental Health Care Law: Ten Basic Principles, 1996
24. The National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation
and Multiple Disabilities Act, 1999 ( popularly known as National Trust Act)
25. World Health Organization Resource Book on Mental Health, Human Rights and Legislation
(WHO RB), 2005
26. Mental Capacity Act, 2005
27. Mental Health Policy, Plan, and Program, WHO (2005)
28. National Rural Health Mission, 2005 (INDIA).
29. Protection of Women from Domestic Violence Act, 2005(INDIA).
30. UN Convention on the Rights of Persons with Disabilities (CRPD), 2006
31. Mental Health Care Bill, 2011. (Replaced by Mental Health Care Bill 2013)
32. Protection of Children from Sexual Offences Act of 2012:
33. Mental Health (Discrimination) Act, 2013 (England and Wales)
34. National Mental Health Plan-365 (2013).
35. National Mental Health Policy, India (2014).
36. Juvenile Justice (Care and Protection of Children) Act, 2015
37. Rights of Persons with Disabilities (RPWD) Act, 2016
38. Mental Healthcare Act of 2017.
39. National Health Policy of India (NHP, 2017)
40. World Health Organization (WHO) Mental Health Action Plan 2013–2020

The Origin and Progression of Mental Health Law

( Duffy and Kelly IMHCA 2017) (16)

The treatment of people with mental illness was highly variable prior to the arrival of formal
legislation. While there is historical evidence that mental illness sometimes elicited compassion,
treatment, support and special legal consideration, there is much greater evidence that it was
generally met with stigma, neglect, marginalisation and gross injustice.

In light of psychiatry’s long-standing relationship with mental health law, legislative reform holds
particular potential for improvement of mental health services and—arguably —achieving a
positive right to mental health and mental healthcare in many countries, including India.

Since the late 1900s there have been signi cant moves in this direction with the United Nations’ (UN) Principles for
the Protection of Persons with Mental Illness and the Improvement of Mental Health Care in 1991, culminating in
the UN Convention on the Rights of Persons with Disabilities (CRPD) which came into effect in 2008. Against this
background, it was apparent that mental health and disability legislation in many countries was in need of reform.
Over the following years, it also became apparent that one country—India—was taking the most dramatic steps in
this direction, seeking explicitly to align its disability and mental health laws with the CRPD. This process resulted in
India’s Rights of Persons with Disabilities Act, 2016 and Mental Healthcare Act, 2017

The United Nations’ (UN) Principles for the Protection of Persons with Mental Illness and the
Improvement of Mental Health Care in 1991 - stated that ‘all persons have the right to the best
available mental healthcare, which shall be part of the health and social care system’ (Principle
1(1)) (UN, 1991). It was the first comprehensive statement of the rights of persons with mental
illness which includes the following key principles:
• All people are entitled to receive the best mental health care available and be treated with
humanity and respect
• There should be no discrimination on the grounds of mental illness. All people with mental
illness have the same rights to medical and social care as others
• Everyone with mental illnesses has the right to live, work, and receive treatment in the
community, as far as possible
• Mental health care should be based on internationally accepted ethical standards
• Each patient's treatment plan should be reviewed regularly with the patient
• There shall be no misuse of mental health skills and knowledge
fi
 • Medication should meet the health needs of the patient and shall not be administered for the
convenience of others or as a punishment
• For voluntary patients, no treatment should be administered without informed consent, subject
to some exceptions (e.g., patients with personal representatives empowered by law to provide
consent)
• For involuntary patients, every effort should be made to inform the patient about treatment
• Physical restraint or involuntary seclusion should be used only in accordance with official
guidelines
• Records must be kept of all treatments
• Mental health facilities must be appropriately structured and resourced
• An impartial review body should, in consultation with mental health practitioners, review the
cases of involuntary patients.[4]

The 1991 statement of principles was important not only for its specific provisions, but also its
acknowledgement of a particular need to protect the rights of persons with mental disorder,
especially persons with enduring mental disorders whose rights have been significantly ignored in
the past. Against this background, the World Health Organization (WHO) went on to articulate
ten basic principles of mental health care law in 1996, further emphasizing many of the 1991
principles, and distilling them into ten key principles:

• All persons should benefit from the best possible measures to promote mental well-being and
prevent mental disorders
• All persons in need should have access to basic mental health care
• Mental health assessments should be performed in accordance with internationally accepted
medical principles and instruments
• All persons with mental disorders should be provided with health care which is the least
restrictive possible
• Consent is needed before any type of interference with a person can occur
• If a patient experiences difficulties appreciating the implications of a decision, although not
unable to decide, the patient shall benefit from the assistance of an appropriate third party of
his or her choice
• There should be a review procedure for any decision made by official, surrogate or
representative decision-makers and health care providers
• For decisions affecting integrity or liberty, with a long-lasting impact, there should be
automatic periodical review mechanisms
• All decision-makers acting in official or surrogate capacity should be qualified to do so
• All decisions should be made in keeping with the body of law in force in the jurisdiction
involved and not on any other basis, or an arbitrary basis.[6]

Specific aspects of the application of these principles were developed further in the WHO
Resource Book on Mental Health, Human Rights, and Legislation 2005 which presents a
detailed statement of human rights issues which, according to the WHO, need to be addressed at
national level.[7] More specifically, the Resource Book includes a detailed “Checklist on Mental
Health Legislation” based, in large part, on previous UN and WHO publications. The checklist is a
companion to the WHO Resource Book on Mental Health, Human Rights, and Legislation and its
objectives are to: (a) assist countries in reviewing the adequacy and comprehensiveness of existing
mental health legislation; and (b) help countries in the process of drafting new law. This checklist
can help countries assess whether key components are included in legislation or policy, and ensure
that the broad recommendations contained in the Resource Book are carefully examined and
considered.

The checklist, although lengthy, detailed and explicitly informed by the UDHR, is not a set of
absolute rules, and is not legally binding. (Soft Law)

The WHO checklist is, rather, designed to work by influencing member states as they redraft and
implement national mental health laws and policies. Given the checklist's close links with the
UDHR and WHO documents outlining the rights of the mentally ill, the authors make the
assumption that the checklist standards will be accepted by the international community and
deemed worth reflecting in national mental health law and policies. The WHO also explicitly states
that some countries may address some or all of these mental health issues in general legislation
(e.g., equality legislation), other forms of (not legally binding) regulation, or mental health policy,
rather than specific mental health legislation.

The Resource Book is especially useful owing to its emphasis on a broad concept of human rights,
encompassing not only just issues relating to the right to liberty but also social rights, which are
commonly neglected among the mentally ill.[8]

To say , Policies should ensure the respect of human rights and take account of the needs of vulnerable groups. Care
should shift away from large psychiatric hospitals to community services that are integrated into general health
services’ (p. 76).

Seven years later, in 2008, the UN Convention on the Rights of Persons with Disabilities
(CRPD) came into effect, aiming ‘to promote, protect and ensure the full and equal enjoyment of
all human rights and fundamental freedoms by all persons with disabilities, and to promote respect
for their inherent dignity’ (Article 1) (UN, 2006). In this context, ‘persons with disabilities include
those who have long-term physical, mental, intellectual or sensory impairments which in interaction
with various barriers may hinder their full and effective participation in society on an equal basis
with others’. The CRPD presented extensive measures designed to protect and promote rights,
many of which have significant implications in the context of mental illness (Kelly, 2014).Against
this background, it was apparent that mental health and disability legislation in many countries was
in need of reform (Gooding 2017).

UNITED NATIONS CONVENTION ON THE RIGHTS OF PERSONS WITH

DISABILITIES (UNCRPD):-

• Driving Force: Influences the latest iterations of mental health law internationally.
• Collaboration: Created in collaboration with non-governmental organizations representing
persons with disabilities.
 • Adoption and Enforcement: Adopted by the General Assembly in 2006 and came into force
in 2008.
• Purpose: Does not create new rights but contextualizes existing rights for people with
disabilities.

As the CRPD was developed, non-governmental organizations representing peo- ple with mental
illness strongly opposed any steps that might limit the legal capacity of people with mental illness
(Melish 2014). Article 12 of the CRPD, which relates to legal capacity, was only agreed on in the
final hours of the last meeting and, up to point, many parties had sought provisions that would
permit involuntary treat- ments in certain contexts (Degener and Begg 2017). This debate has
continued to evolve, as the UN Committee on the Rights of Persons with Disabilities (2014), who
are responsible for interpreting the CRPD, state that ‘forced treatment by psychiatric and other
health and medical professionals is a violation of the right to equal recog- nition before the law’ (p.
11).

Innovations:
1. Affirmation of Positive Rights:
◦ Shifted focus from regulating involuntary treatment to providing healthcare and
protecting various rights.
2. Enhanced Decision-Making:
◦ Changed the paradigm from substitute decision-making to supported decision-making.
◦ Shifted the decision-making framework from promoting perceived ‘best interests’ to
maximizing ‘rights, will, and preferences’.
3. Empowerment and Agency:
◦ Empowered persons receiving mental healthcare, providing them with more agency.
◦ Led to an expansion in research on coercive practices, potentially reducing
involuntary treatments.
Criticisms:
1. Concerns from Mental Health Professionals:
◦ Not universally embraced; concerns about the absolute prohibition on coercive
treatments.
2. Impact on Rights and Treatment:
◦ Interpretation of the CRPD, especially General Comment on Article 12, may
undermine the rights of people with disabilities.
◦ Absolute need for informed consent in all contexts may deprive many people of
treatments.
◦ Affirming full legal capacity at all times may result in increased incarceration of
people with acute episodes of illness.
◦ Potential deprivation of the right to life and increased stigmatization.
3. Design Limitations:
◦ CRPD was not designed to address the needs of people with acute episodes of mental
illness.
◦ Preamble does not reference the Principles for the Protection of Persons with Mental
Illness and the Improvement of Mental Health Care (UN 1991) or other mental health-
specific documents.
Over the following years, it also became apparent that one country—India—was taking the most
dramatic steps in this direction, seeking explicitly to align its disability and mental health laws with
the CRPD, despite the clear resource challenges it faces in these areas (Sachan 2013; Patel et al.
2016). The CRPD was passed by the UN General Assembly in 2006. It was signed and ratified by
India in 2007.

• India’s Rights of Persons with Disabilities Act, 2016 received the assent of the President of India
on 27 December 2016 and was commenced in effect on 15 June 2017. The purpose of the 2016
Act is ‘to give effect to the United Nations Convention on the Rights of Persons with Disabilities
and for matters connected therewith or incidental thereto’. The extensive legislation presents a
broad range of rights-based provisions aimed at giving effect to the CRPD and improving the
rights of persons with disabilities in India.

• In 2017, on 7 April, India’s Mental Healthcare Act, 2017 (MHCA) received Presidential assent
and it was formally commenced on 29 May 2018. Like the 2016 Act, the 2017 legislation notes
that ‘it is necessary to align and harmonise the existing laws with’ the CRPD and goes on to
present a broad range of rights-based provisions explicitly informed by the CRPD, making India’s
MHCA one of the most interesting and potentially progressive pieces of mental health legislation
in the world (Kalmegh et al. 2018; Duffy and Kelly 2019b; 2019c). Perhaps the most dramatic
right articulated in the 2017 Act, however, is a right to mental healthcare. The legislation states
that ‘every person shall have a right to access mental healthcare and treatment from mental health
services run or funded by the appropriate Government’ (Section 18(1)), i.e. ‘services of affordable
cost, of good quality, available in sufficient quantity, accessible geographically, without
discrimination on the basis of gender, sex, sexual orientation, religion, culture, caste, social or
political beliefs, class, disability or any other basis and provided in a manner that is acceptable to
persons with mental illness and their families and care-givers’ (Section 18(2)).

It was a difficult balance held by Indian legislators in adhering to the CRPD while still delivering
practical, humane and implementable legislation. The Indian legislation was shaped by the UN and
WHO standards and the Indian legislators deviated from these guidelines somewhat.

Indian legislators have, for example, included pragmatic tools for the protection and treatment of
the acutely mentally ill (‘supported admission’). While some of these provisions might be at odds
with certain interpretations of the CPRD, they have dramatically revised Indian mental health
legislation to bring it into greater accordance with core CRPD principles. India’s revisions are also
cognizant of the potential negative consequences of an overly literal application of the CRPD. As a
result, implementation of India’s MHCA will hopefully demonstrate how low- and middle-income
countries can realize modern, rights-based mental health law and provide an example for the rest of
the world.

UN and Mental Health Legislation (Duffy and Kelly IMHCA 2017)

Since its foundation in 1945, the UN has taken many steps to improve the well-being of people with
mental illness. This has occurred through the Universal Declaration of Human Rights (1948) and
the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental
Health Care (1991) primarily.While the Universal Declaration of Human Rights and the other initial
human rights instruments related to mental illness only indirectly, the Convention on the Rights of
the Child (1989) provided more detailed consideration of the topic.
In 2006, the CRPD included mental illness under the umbrella of disability and this inclusion is
currently transforming mental health legislation internationally. While much of this change is
positive, protecting the rights and maximizing the agency of people with mental illness, there are
concerns that an excessively rigid interpretation of the CRPD could reduce access to treatment and
lead to stigmatization and criminalization of the mentally ill. The 1991 UN Principles for the
Protection of Persons with Mental Illness and the Improvement of Mental Health Care were, by
contrast, written with more nuanced consideration of the needs of people with mental illness, but
lacked the legal weight of the CRPD.

The World Health Organization and Mental Health Law

Since 1948, the WHO too has done much to shape the evolution of mental health law. Their initial
measures were often indirect, but they have recently assertively articulated the importance of
legislation in health, including mental health. The inclusion of mental disorders in the International
Classification of Diseases (ICD) since 1949 has helped standardize mental health nomenclature in
legislation (WHO, 1949). Later iterations of the ICD, including descriptions of conditions, further
improved diagnostic reliability. In 1996, the WHO’s Mental Health Care Law: Ten Basic Principles
was one of the organiza- tion’s earliest attempts to directly shape mental health legislation (WHO,
1996). From 2001, Project Atlas helped to identify countries without mental health legislation and
countries with grossly outdated laws (WHO 2001b). The WHO has sought to address these deficits
recently as part of the WHO Mental Health Action Plan 2013–2020 (WHO 2013).

The World Health Organization Mental Health Action Plan 2013–2020

(2013)

The Mental Health Action Plan 2013–2020 was the first mental health action plan released by the
WHO (WHO 2013; Saxena and Setoya 2014). It aims to support countries in developing laws
‘consistent with international and regional human rights instruments’ (p. 11). Published after the
introduction of the CRPD, the Action Plan makes multiple references to legislation, but, in contrast
to earlier WHO documents, focuses solely on a subset of rights and does not make provisions for
involuntary treatment. For example:
The action plan emphasizes the need for services, policies, legislation, plans, strategies and
programmes to protect, promote and respect the rights of persons with mental disorders in line with
the International Covenant on Civil and Political Rights, the International Covenant on Economic,
Social and Cultural Rights, the Convention on the Rights of Persons with Disabilities, the
Convention on the Rights of the Child and other relevant international and regional human rights
instruments (p. 7)
In aligning with these interna- tional human rights standards, the Mental Health Action Plan omits
detailed consid- eration of protection during use of coercive measures, review policies and capacity
(all of which were addressed in the WHO’s Ten Basic Principles and the WHO RB).
Even so, the Mental Health Action Plan 2013–2020, along with the QualityRights toolkit (WHO
2012), was one of the first WHO documents apparently to oppose coercive treatments.
Despite this issue, the Action Plan usefully highlights the absence of mental health legislation in
many jurisdictions, especially in low- and middle-income countries.

The Action Plan envisages legislation as a tool to facilitate access to mental healthcare and as a
mechanism for addressing inequalities and deficits in service provision. In a broader sense, the
WHO acknowledges that legislation is a vital tool for the realization of all healthcare goals—not
just in mental health (WHO 2017). Psychiatry, with its long history of familiarity with legislation,
may be especially well placed to harness legal provisions to improve the quality of life of people
with mental health problems (Duffy and Kelly 2017c). The most direct attempt at influencing
international mental health law came in 2005 with the WHO’s Resource Book on Mental Health,
Human Rights and Legislation. This provided extensive consideration of what should be addressed
in mental health law and policy, and examined coercive treatments in detail. With the publication of
the CRPD in 2006, the WHO Resource Book was withdrawn. Even so, the Resource Book remains
the most comprehensive consideration of the leg- islative needs of people with mental illness.
QualityRights is now the CRPD-concordant WHO publication relating to mental health, including
mental health legislation, and it contains an evaluation toolkit and teaching modules, among other
resources.

A Timeline of Mental Health Law (Duffy and Kelly

IMHCA 2017)

In England and Wales, early legislation included the Madhouses Act, 1774, the County Asylums
Act, 1828 and the Criminal Lunatics Act, 1800, all of which concerned the placement or
containment of people with mental illness. The Madhouses Act, 1774 demonstrates how this mass
confinement which attempted to ensure that people in ‘madhouses’ were kept in humane conditions
was initially on a small scale, in houses, but progressed quite quickly to the industrial scale seen
during the asylum era. Criminal Lunatics Act, 1800-established a set procedure for the indefinite
detention of mentally ill offenders (17)

Private institutions for the mentally ill also existed outside the United Kingdom with a diverse
array of establishments in countries ranging from India (Somasundaram 2008) to Germany
(Schmideler and Steinberg 2004). Generally, these establishments were not initially regulated by
legislation, although with increasing levels of deten- tion, legislative underpinnings began to expand
(e.g. the County Asylums Act, 1808 in England and Wales).County Asylums Act, 1808: Initiated
the process of building public asylums.

Later, various treatments became more common and legislation slowly recognized the need to
address care as well as confinement. This is demonstrated by the Mental Treatment Act, 1930,
which evolved into the Mental Health Acts, 1953 and 1983. Some countries, like India, have now
taken the titles of their legislation a step further with the Mental Healthcare Act, 2017 reflecting a
further evolution. To say-This apparent legislative evolution from custody and containment to care and human
rights is noteworthy.

The Asylum Era

In many ways, the rise of the asylums in the nineteenth century began in England, the first country
to legislate for the large-scale building of public state asylums. These replaced and upscaled the
poorly regulated ‘madhouses’ of the 1700s. This process began in earnest with the County Asylums
Act, 1808.In 1845, England replaced the 1808 Act with the County Asylums Act, 1845 and the
Lunacy Act, 1845, which provided a place of refuge for ‘pauper lunatics’ and mentally ill offenders.
The legislation also provided for the inspection of the asylums by the Commissioners in Lunacy.
Patients admitted under the Lunacy Act, 1845 did not have a right to challenge their detention in the
courts. Generally speaking, all of these many, many asylums were built with the intention of helping
people with mental illness who could not afford to pay for private care, with the result that the
‘pauper insane’ duly made up the vast majority of inpatients (Miller 2007). These institutions were,
however, soon both overcrowded and under- funded (Piddock 2004); grounds for admission were
often unclear, and if discharge occurred, it was a highly uncertain, protracted process (Luchins
1988). The asylums were also rife with medical illness and many patients died from infectious
diseases such tuberculosis (Anonymous 1902).

Deinstitutionalization
The advent of effective treatments for mental illness, chiefly in the 1950s and 1960s, heralded a
major shift in mental health legislation. The arrival of treatments such as chlorpromazine expanded
the scope of mental health laws from simply containment of mentally ill people, to the provision of
care and treatment. This led to the dismantling of many asylums and vigorous, if variously
successful, efforts to move care to outpatient settings.While many psychiatric hospitals remained
operational into the 1980s, the adoption of more progressive, less coercive laws to facilitate
treatment undoubtedly contributed to the decline of institutional care (Rachlin 1983).

Rights-Based Mental Health Law

The single-most significant force driving rights-based mental health legislation today is the UN
Convention on the Rights of Persons with Disabilities (CRPD) (2006). The Convention has
triggered a number of fundamen- tal paradigm shifts, including replacing substitute decision-
making with supported decision-making, strongly affirming capacity and autonomy, and, according
to one interpretation, banning all coercive treatments (UN Committee on the Rights of Persons with
Disabilities 2014).The CRPD places patients at the centre of all mental health legislation and makes
protecting rights the key driving principle. Good examples of legislation attempting to realize the
CRPD include the Mental Healthcare Act, 2017 in India (Duffy and Kelly 2019).

Despite all these developments, however, more than one-third of countries in the world still have no
formal mental health law, and many others have highly outdated legislation that is not rights-based
and primarily defines involuntary treatments rather than articulating a more positive vision of
mental healthcare (WHO 2018).

Policy and acts pertaining to Indian context

Early Mental Health Legislation in India:-

The first piece of metal health legislation introduced was the Lunatic Removal Act, 1851 (Firdosi
and Ahmad 2016). People of ‘European birth’ who committed crimes but were found to be of
‘unsound mind’ could be removed to ‘any part of the United Kingdom’ (Section 1). The Act gave
the Government of India ‘sufficient warrant and authority for the purpose of removal’ and, on return
to the UK, the person fell under the Criminal Lunacy Act, 1800 (Section 2). The cost of removal
and treatment fell to the East India Company (Section 3), but this cost became a debt that the
removed person then owed (Section 4).

The Lunatic Removal Act was repealed after India gained independence, In 1858, the year that the
rule of India passed from the British East India Com- pany to the British Crown, three mental health
laws were enacted. First, the Lunacy (Supreme Courts) Act,1858 dealt with the judicial evaluation
of mental health in presi- dency towns. These towns were the initial trading ports found by the
British East India Company: Madras, Calcutta and Bombay. Second, the Lunacy (District Courts)
Act, 1858 provided similar legal framework for cases outside of presidency towns. Third, the
Indian Lunatic Asylum Act, 1858 governed detention in asylums (Nambi et al. 2016).The Indian
Lunatic Asylum Act was amended in 1886 and 1889.These laws primarily dealt with the detention
of the mentally ill, the disposal of their estates and the management of ‘pauper lunatics’ (people
with mental illness without the means to pay privately for treatment).

The Indian Lunacy Act, 1912 amended, consolidated, revised and replaced existing mental health
legislation in an attempt to bring Indian legislation in line with the English Lunacy Act, 1890
(amended in 1891) (Somasundaram 1987). The 1912 Act brought an end to the idea of the diverse
asylum, where Indian and European ideas could co-exist, and so the asylums in India became
archetypal colonial institutions (Bhattacharyya 2013). This revision of the legislation was motivated
by a general outcry at the conditions in which people with mental illness were being kept (Narayan
and Shikha 2013). The main parts of the 1912 Act addressed the ‘Reception, care and treatment of
Lunatics’, ‘Care and Treatment’, ‘Proceedings in Lunacy in Presidency-towns’, ‘Proceedings in
Lunacy outside Presidency-towns’, ‘Establish- ment of Asylums’, ‘Expenses of Lunatics’ and
various other ‘Rules’. One of the central fears of the day, and an issue carefully addressed in the
1912 Act, was the improper detention of sane people for nefarious reasons. Section 18(2) pro-
hibited reception orders being ‘made upon a certificate founded only upon facts com- municated by
others’ and required the medical officer to distinguish ‘facts observed by himself from facts
communicated by others’. Each asylum had at least three visitors, one of whom was a doctor. These
people inspected the asylum and met the patients monthly. These monthly inspections were the
closest thing in the Act to a review process for detained patients.The Act gave significant power to
magistrates to make decisions regarding people who were deemed to be of unsound mind. They
could, inter alia, appoint substitute decision-makers, have people committed to an asylum and
detain people pending transfer to asylums. While it may be very far removed from modern rights-
based legislation, there were some provisions for the rights of the mentally ill. In Section 15,
Magistrates were directed to investigate any person with a mental illness who ‘is cruelly treated or
neglected by any relative or other person having the charge of him’. Interestingly, the 1912 Act
made some distinctions between capacity for making different decisions and did not treat decision-
making capacity as a global concept. Sections 49–56 gave the courts ‘power to dispose of lunatic’s
property for certain purposes’ and described a wardship process. There was the potential for the
revision of a declaration of unsoundness of mind should someone’s clinical condition have changed
(Section 60). Despite the focus on how care would be paid for, provisions were made for people
who could not pay for their treatment and who had no assets; under Section 86, their treatment was
paid for by the government.The 1912 Act had many progressive features. It was, for example, one
of the first pieces of mental health law to consider voluntary admissions (Section 4). The 1912 Act
also addressed ‘wandering or dangerous lunatics’, mental illness in the armed forces, and mentally
ill offenders and prisoners.Section 84 began the licencing of asylums at a state level and licences
could be revoked if asylums were not providing effective treatments. In addition, the Act evolved to
a degree over time, e.g. in 1922, the term ‘mental hospital’ replaced ‘lunatic asylum’
(Somasundaram 1987).
INDIA’S MENTAL HEALTH ACT, 1987

India gained independence in 1947, but continued to use the Indian Lunacy Act, 1912 until it was
replaced by the Mental Health Act, 1987. The Act of 1987 introduced many positive changes to
mental healthcare in India. It adopted a more human rights-based approach to care, replaced much
of the stigmatizing terminology, created the Central and State Mental Health Authorities, simplified
admission and discharge policies, and facilitated proxy consent for involuntary admission and the
admission of minors (Rastogi 2005; Nambi et al. 2016). It was also the first of India’s mental health
acts to consider outpatient treatment and thus helped shift the focus of psychiatric care from the
psychiatric hospitals to the community, at least in theory. The Act also introduced-separate inpatient
services for people with addiction-based problems and provided children with separate mental
health services.

Despite these advances, the 1987 Act was heavily criticized for a number of reasons. First, it failed
to align with government policy, India’s Mental Health Pro- gramme or many World Health
Organization guidelines. Second, the new legislation approached mental illness from a legal
perspective rather than a clinical one and consequently placed arguably excessive power in the
hands of judges rather than clinicians. Third, the Act did little to address stigma or the inappropriate
use of men- tal health legislation or to educate society as a whole about mental illness. Fourth, little
consideration was given to psychiatry outside of admission to mental hospitals. Finally, the police
were often the only means of transporting involuntary patients to hospital, which added to stigma,
rather than reducing it (Nambi et al. 2016).A major injustice occurred where no relatives came
forward to support a person in hospital, as such people could then, in theory, be detained
indefinitely.

Overall, some of the innovations of the 1987 Act were steps in the rights direction, but they still fell
short of the legislative standards of the time. For example, the Act simplified the admission and
discharge processes (Rastogi 2005), but made no men- tion of rehabilitation or care after discharge.
The 1987 Act also gave consideration to research (which was not present in the 1912 Act) and
prohibited research without valid consent, but allowed relatives to provide consent on the patient’s
behalf.

REHABILITATION COUNCIL OF INDIA ACT 1992 (18)

The Rehabilitation Council of India Act, 1992 is an Act of Parliament in India that established the
Rehabilitation Council of India (RCI).

Key provisions of the Act:

◦ Establishment of the Rehabilitation Council of India (RCI) as a statutory body responsible

for regulating and standardizing training programs and services in the field of rehabilitation
for persons with disabilities.
◦ Composition of the Council: The Act outlines the composition of the Rehabilitation Council
of India, which includes a Chairperson, Vice-Chairperson, Secretary, and other members
appointed by the central government. The members represent various stakeholders, including
persons with disabilities, experts in rehabilitation, and representatives from relevant
ministries and organizations.
 ◦ Functions of the Council: The Act delineates the functions of the Rehabilitation Council of
India, which include:
◦ Accrediting institutions that offer courses in rehabilitation-related fields.
◦ Setting guidelines and standards for curriculum, infrastructure, and faculty
qualifications.
◦ Conducting inspections and assessments of educational and training programs.
◦ Promoting research and development in the field of rehabilitation.
◦ Granting recognition and certification to professionals in the rehabilitation sector.
◦ Powers of the Council: The Act empowers the Rehabilitation Council of India to take
necessary measures to fulfill its objectives, including the power to make regulations, levy
fees, and issue guidelines for the implementation of the Act.
◦ Recognition of Qualifications: The Act provides for the recognition of qualifications in the
field of rehabilitation conferred by institutions approved by the Rehabilitation Council of
India.
◦ Offenses and Penalties: The Act specifies offenses and penalties for contravening its
provisions, including fines and imprisonment for individuals or institutions found guilty of
unauthorized use of the term "rehabilitation professional" or other related offenses.
◦ Advisory Committees: The Act allows the Rehabilitation Council of India to constitute
advisory committees to assist in the performance of its functions and duties.

THE PERSONS WITH DISABILITIES(PWD) ACT, 1995 and RPWD Act,

2016(19)

After India signed and ratified the UNCRPD in 2007, the process of enacting a new legislation in
place of the Persons with Disabilities Act, 1995 (PWD Act, 1995) began in 2010 to make it
compliant with the UNCRPD. After series of consultation meetings and drafting process, the Rights
of PWD Act, 2016 (RPWD Act, 2016) was passed by both the houses of the Parliament. The Act
lays stress on nondiscrimination, full and effective participation and inclusion in society, respect for
difference and acceptance of disabilities The principle reflects a paradigm shift in thinking about
disability from a social welfare concern to a human rights issue.

The PWD (Equal Opportunities, Protection of Rights, and Full Participations) Act, 1995 was
enacted to give an effect to the “Proclamation on the Full Participation and Equality of the People
with Disabilities in the Asian and Pacific Region.”[2] The Act listed seven conditions of disabilities,
which were blindness, low vision, leprosy cured, hearing impairment, locomotor disability, mental
retardation, and mental illness. The Act adopted an approach of social welfare in respect of PWD
and the main focus was on prevention and early detection of disabilities, education and employment
of the PWD. The Act also provided 3% reservation in Government jobs and educational institutions.
It stressed on making the barrier-free situations as a measure of nondiscrimination.

In the RPWD Act, 2016, the list has been expanded from 7 to 21 conditions and it now also includes
cerebral palsy, dwarfism, muscular dystrophy, acid attack victims, hard of hearing, speech and
language disability, specific learning disabilities, autism spectrum disorders, chronic neurological
disorders such as multiple sclerosis and Parkinson's disease, blood disorders such as haemophilia,
thalassemia, and sickle cell anaemia, and multiple disabilities. The nomenclature mental retardation
is replaced by intellectual disability and also provides an elaborate definition of mental
illness.Persons with benchmark disabilities are defined as those with at least 40% of any of the
above disability. PWD having high support needs are those who are certified as such under section
58(2) of the Act.

The RPWD Act, 2016 provides that “the appropriate Government shall ensure that the PWD enjoy
the right to equality, life with dignity, and respect for his or her own integrity equally with others.”
The Government is to take steps to utilize the capacity of the PWD by providing appropriate
environment. Living in the community for PWD is to be ensured and steps are to be taken by the
Government to ensure reasonable accommodation for them. Special measures are to be taken to
ensure women and children with disabilities enjoy rights equally with others. Measures are to be
taken to protect the PWD from being subjected to cruelty, inhuman, and degrading treatments and
from all forms of abuse, violence, and exploitation. For conducting any research, free and informed
consent from the PWD as well as a prior permission from a Committee for Research on Disability
to be constituted in the prescribed manner.Under section 7(2) of the Act, any person or registered
organization, who or which has reason to believe that an act of abuse, violence, or exploitation has
been, is being or likely to be committed against any PWD, may give information to the local
Executive Magistrate who shall take immediate steps to stop or prevent its occurrence and pass
appropriate order to protect the PWD. Police officers, who receive a complaint or otherwise come
to know of violence, abuse, or exploitation, shall inform the aggrieved PWD of his right to
approach the Executive Magistrate. The police officer shall also inform about particulars of nearest
organization working for the rehabilitation of the PWD, right to free legal aid, and right to file
complaint under the provisions of this Act or any other law dealing with such offence.

It is to be ensured that all PWD enjoy legal capacity on an equal basis with others in all aspects of
life and has the right to equal recognition everywhere as any other person before the law and have
the right, equally with others, to own and inherit movable and immovable property as well as
control their financial affairs (Sec 13).

The Bill provides for the access to inclusive education, vocational training, and self-employment of
disabled persons without discrimination and buildings, campuses, and various facilities are to be
made accessible to the PWD and their special needs are to be addressed. ……………………
Appropriate healthcare measures, insurance schemes, and rehabilitation programs for the PWD are
to be undertaken by the Government. All Government institutions of higher education and those
getting aid from the Government are required to reserve at least 5% of seats for persons with
benchmark disabilities. Four percent reservation for persons with benchmark disabilities is to be
provided in posts of all Government establishments with differential quotas for different forms of
disabilities. Incentives to employer in private sector are to be given who provide 5% reservation for
persons with benchmark disability. Special employment exchanges for the PWD are to be set up.
Awareness and sensitization programs are to be conducted and promoted regarding the PWD.
Standards of accessibility in physical environment, different modes of transports, public building
and areas are to be laid down which are to be observed mandatorily and a 5-year time limit is
provided to make existing public building accessible. Access to information and communication
technology is to be ensured. The Central and State Advisory Boards on disability are to be
constituted to perform various functions assigned under the Act. District level Committees are also
to be constituted by the State Government. Chief Commissioner and two Commissioners for PWD
are to be appointed by the Central Government at the central level for the purposes of the Act.
Similarly, State Commissioners for PWD are to be appointed by the State Governments. National
Funds for PWD and State Funds for PWD are to be constituted at the central and state levels
respectively by the appropriate Governments. Contraventions of the provisions of the Act have been
made punishable by a fine of an amount up to ten thousand for first contravention and fifty
thousand extendable up to five lakhs for subsequent contraventions. Atrocities on PWD have been
made punishable with imprisonment of 6 months extendable to 5 years and with fine. Fraudulently
availing of the benefits meant for PWD has also been made punishable.

THE NATIONAL TRUST FOR WELFARE OF PERSONS WITH AUTISM, CEREBRAL

PALSY, MENTAL RETARDATION AND MULTIPLE DISABILITIES ACT, 1999 (20)

Objectives of the Act

This Act provides for the constitution of a national body for the Welfare of Persons with Autism,
Cerebral Palsy, Mental Retardation and Multiple Disabilities. Such a national body will be a trust
whose objects shall be as under:

(a) to enable and empower persons with disability to live as independently and as fully as possible
within and as close to the community to which they belong;

(b) to strengthen facilities to provide support to persons with disability to live within their own
families;

(c) to extend support to registered organisation to provide need based services during the period of
crisis in the family of persons with disability;

(d) to deal with problems of persons with disability who do not have family support;

(e) to promote measures for the care and protection of persons with disability in the event of death
of their parent or guardian;

(f) to evolve procedure for the appointment of guardians and trustees for persons with disability
requiring such protection;

(g) to facilitate the realization of equal opportunities, protection of rights and full participation of
persons with disability; and

(h) to do any other act which is incidental to the aforesaid objects. The Act received the assent of
the President on 30th December, 1999 and extends to the whole of India.
PROTECTION OF WOMEN FROM DOMESTIC VIOLENCE ACT, 2005
(21)
The Act ensures woman’s right to reside in her matrimonial home. This Act has a special feature
with specific provisions under law which provides protection to a woman to live in violence free
home. Though this Act has civil and criminal provisions, a woman victim can get immediate civil
remedies within 60 days. Aggrieved women can file cases under this Act against any male adult
perpetrator who is in domestic relationship with her. They can also include other relatives of the
husband and male partner as respondents to seek remedies in their case.

Salient features of the Act:

▪ Ensures Right to Residence under sec 17.

▪ Ensures economic relief by recognising economic violence.
▪ Recognises verbal and emotional violence.
▪ Provides temporary custody of child.
▪ Multiple Judgements in a single case.
▪ Both petitioner and respondent can prefer Appeal.

PROTECTION OFFICERS

Under the Domestic Violence Act, 2005, Protection Officers have been appointed by the
Government to help the aggrieved woman in filing the case against her husband or against any male
adult person who has committed domestic violence and who is in domestic relationship with the
petitioner. The Protection Officer facilitates the women to approach the court by providing legal aid
and get appropriate relief from the courts concerned. Further, they execute the orders of the Court
wherever necessary with the help of police. Options are also available to the aggrieved person to
file the petition before the Judicial Magistrate Court or with the service provider or in the nearby
police station.

SERVICE PROVIDERS

Under the Protection of Women from Domestic Violence Act, 2005, service Providers are the
members from notified Non Governmental Organizations They co-ordinate with all the stakeholders
in getting justice and relief to the victims of domestic violence. The Service Providers help the
aggrieved women in filing the Domestic Incident Report, provide accommodation in the short stay
homes along with their children, counsel them and help the aggrieved to get medical treatment if
necessary. They also impart them with vocational training to help them secure employment and
sustainable income.

Mental healthcare bill 2011 and 2013

Mental healthcare bill 2011 (22)
India, as a signatory to the UNCRPD, is obligated to bring its existing laws into
congruence with the basic principle of the UNCRPD which views persons with
disabilities as ‘subjects with rights’, not ‘objects of charity’. Hence, the Government
of India (GOI) initiated the process of developing the National Health Bill,
revision of the existing Mental Health Act of 1987, and amending the Persons
with Disabilities Act. The draft of -
‘ The Mental Health Care Bill, 2011, has undergone several modifications through
consultative processes. It is felt that the new legislation should facilitate and strengthen a
mental health policy which provides acceptable, accessible and equitable mental health
care (7). The importance of ethical issues in public health policy is being increasingly
recognised worldwide. A law becomes meaningful when it is realistic, implementable and
ethical in its provisions. The US National Commission for the Protection of Human
Subjects of Biomedical and Behavioural Research published the Belmont Report in
1979 (8). This report is an articulation of the key ethical principles for research and
clinical care involving human subjects. The key ethical principles according to the
Belmont Report are respect for persons, beneficence and non-malfeasance, and
justice. Respect for persons involves honouring the autonomy of an individual to
deliberate upon and act according to his/her goals and protecting the autonomy of
each individual. Beneficence involves acting to ‘‘do good’’ for participants or to act for
their well-being while also taking steps to avoid and minimise harm (i.e., non-
malfeasance). These concepts of beneficence and non-malfeasance are commonly
understood as expressed in the Hippocratic Oath and, thus, extend from the typical
doctor–patient relationship to the context of clinical research. Justice involves
fairness in the distribution, care, and service to equals in equal manner.Hence, it is of
paramount importance to look critically at the bill from an ethical perspective, with
reference to respect and confidentiality, along with the core principles of autonomy,
beneficence, non-malfeasance and justice (9).

The mental health bill has several new provisions under its fold. The prejudicial term
“mentally ill” gets replaced with “person with mental illness” in order to separate the
person from the illness. This avoids branding an individual and helps in reducing the
stigma. New provisions like “nominated representative,” “consent”, “supported
admission”, and “advance directives” have been introduced for persons with mental
illness.

Nominated representative
Any person who is 18 years of age, and above, and is competent can appoint a
person who is above 18 years age as a “nominated representative (NR)”. The
representative helps the patient to interact with the mental health system and also acts
as a legal guardian for the patient.

Consent
The Bill gives great importance to free and fully informed consent. The autonomy of the
individual takes precedence over the ‘best interest principle’, with the exception of certain
clinical situations. Unilateral decision making by the clinician citing the ‘best interest
principle’ has been discouraged.In situations where there is lack of full capacity to give
consent, the new draft allows a nominated representative, whose bona fides and
credentials are clear to the service provider, to be part of the supported decision making.
This gives greater autonomy to the patient. The draft Bill makes it mandatory for the
health service provider to proactively empower the patient to either accept or refuse
treatment. However, during emergency medical interventions, the principle of
beneficence, i.e. ‘doing good’, takes precedence over autonomy. In such situations,
 the consent may be presumed unless there is a previous declaration to the contrary.
The thorough assessment of evolving capacity and intellectual maturity and
documentation involves the investment of a significant amount of time by the
clinician. Though this is in keeping with the ethical tenet of autonomy, we feel that
this might amount to additional workload, involving a considerable amount of time
for the clinician.
Moreover, clinicians need to be trained to assess the above; in the absence of
adequate training and standardised instruments, the objective may not be achieved.
Given the inadequacy of infrastructure and resources in our country, this needs to be
examined from a pragmatic angle

Con dence
The bill emphasises the confidentiality of patient-related information in both the virtual
and real spaces.

Standard of care
The Central Mental Health Authority has prescribed minimum standards for facilities,
personnel training, and services. This should help to bring equal treatment into care
and also ensure that every patient receives a basic minimum standard of care, thus
fulfilling the principle of justice.

Legal capacity

According to the Bill, all patients with mental illness have legal capacity and may/ may
not require support to exercise their legal capacity. The level of safeguards provided
is based on the level of support needed. There is provision for a review at the end of a
prescribed period to check for the ability to make independent decisions and for
further need of a high level of support. These provisions emphasise the autonomy of
patients.

Supported admissions

This measure was earlier known as “admission under special circumstances” under
which a patient could be admitted for up to 90 days under a single admission
process. Under the Bill, this period has been reduced to 30 days, and may be
extended up to 90 days. Further admission beyond this period of 90 days can be
extended up to 180 days subject to certain conditions. This has been done to
ensure the safety of the person. Treatment shall only be provided after taking into
account any existing advance directive or with the support of the nominated
representative. This covers the important ethical principle of non-malfeasance.
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Prohibited treatment
The Bill makes a provision for prohibition of certain treatments. The policy seems
to have been derived from the principle of non-malfeasance. There is a prohibition on
electro-convulsive therapy (ECT) without the use of muscle relaxants and
anaesthesia (unmodified ECT). However, the practical implications of this prohibition
need consideration. In routine clinical practice, there are often situations like life-
threatening catatonia wherein a patient may need urgent electroconvulsive therapy.
Moreover, modified ECT is expensive and requires the specialised services of an
anaesthetist. Given the manpower and financial constraints in our country, a
complete ban on unmodified ECT may result in failure to provide this e ective and
life-saving treatment to all those who need it. This goes against the ethical
principle of beneficence. Serious adverse e ects are a rarity with unmodified ECT,
and it should be allowed under rare circumstances.The draft disallows the
administration of ECTs in any form to minors. Severe mental disorders such as
schizophrenia and bipolar illness often set in during adolescence and can present as
catatonia which can be life threatening. It is well known, and a scientifically established
fact, that catatonia responds very well to treatment with ECT.
A blanket ban on ECT in minors can be potentially dangerous to the life of the
patient. Hence, provision should be made to allow administration of ECTs in minors
only during exceptional clinical circumstances.The Bill puts significant restrictions on
psychosurgery by making it mandatory to acquire approval from the State Mental
Health Authority (SMHA). Psychosurgery is rare and is still an unexplored area. It is
a complicated decision which should be taken by a well informed clinical team
comprising of experienced neurosurgeons, anaesthetists and psychiatrists. Elaborate
procedures are likely to discourage a clinician from o ering a potentially beneficial
clinical procedure to a patient. We agree that safeguards need to be in place to avoid the
exploitation of patients. To ensure the same, we feel that the decision should be at the
discretion of the local institutional ethics committee. Moreover, the field of neurosurgery
has advanced with the application of newer techniques with greater accuracy and
fewer complications. We feel that the process of making it mandatory to obtain
permission from the SMHA could impair the progress of research in psychosurgery and
also may cause delay in the treatment for certain patients.

Discharge planning

To ensure continuity of care with a proper referral and briefing of the caregiver/family
member of the patient.
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Advance directives

One new feature of the Bill, which needs to be evaluated in greater detail, is the
inclusion of the provision of “advance directives”. Advance statements documenting
mental health service consumers’ preferences for treatment during a future mental
health crisis or period of incapacity have gained salience in recent years in the
United States and some European countries, including the United Kingdom. The
new provision of “advance directives” is in keeping with the principle of autonomy.
Every person, irrespective of their mental health status has a right to make a
written statement known as an ‘advance directive’. The ‘advance directive’ is a legal
document which provides the individual with the autonomy to decide the manner in
which he/she wishes to be cared for during a future period of illness. A patient can
appoint a person in the order of precedence as nominated representative during his
period of illness.In the present draft, the advance directive needs to be certified by a
medical practitioner regarding the competence of the individual. However, this might
give rise to a dilemma for the clinician as certification of advance directive may
potentially lead to legal entanglement. The draft allows the provision of amending,
cancelling or revoking the advance directive to the individual at any point of time. This
substantially strengthens the principle of autonomy. However, keeping to the
principle of beneficence, a blanket refusal of all kinds of treatment in the advance
directive is considered invalid unless approved by the district panel of the Mental
Health Review Commission (MHRC).Advance directives give a greater degree of
autonomy to the patient; but they could come into conflict with the “best interest”
principle. The treating doctor may hesitate to treat the patient in a crisis situation
where the choice of treatment is contrary to the directive, unless an appeal is made
before the MHRC for overruling of the same.

The Mental Health Care Bill, 2013(23)

It was introduced in the Rajya Sabha on August 19, 2013. The Bill repeals the Mental Health Act,
1987.

The Statements of Objects and Reasons to the Bill, state the government ratified the United Nations
Convention on the Rights of Persons with Disabilities in 2007. The Convention requires the laws of
the country to align with the Convention. The new Bill was introduced as the existing Act does not
adequately protect the rights of persons with mental illness nor promote their access to mental
health care. The key features of the Bill are:

• Rights of persons with mental illness: Every person shall have the right to access mental
health care and treatment from services run or funded by the government. The right to access
mental health care includes affordable, good quality of and easy access to services. Persons
with mental illness also have the right to equality of treatment, protection from inhuman and
degrading treatment, free legal services, access to their medical records, and complain
regarding deficiencies in provision of mental health care.
• Advance Directive: A mentally-ill person shall have the right to make an advance directive
that states how he wants to be treated for the illness during a mental health situation and who
his nominated representative shall be. The advance directive has to be certified by a medical
 practitioner or registered with the Mental Health Board. If a mental health professional/
relative/care-giver does not wish to follow the directive while treating the person, he can
make an application to the Mental Health Board to review/alter/cancel the advance directive.
• Central and State Mental Health Authority: These are administrative bodies are required
to (a) register, supervise and maintain a register of all mental health establishments,(b)
develop quality and service provision norms for such establishments, (c) maintain a register
of mental health professionals, (d) train law enforcement officials and mental health
professionals on the provisions of the Act, (e) receive complaints about deficiencies in
provision of services, and (f) advise the government on matters relating to mental health.
• Mental Health Establishments: Every mental health establishment has to be registered with
the relevant Central or State Mental Health Authority. In order to be registered, the
establishment has to fulfill various criteria prescribed in the Bill.
• The Bill also specifies the process and procedure to be followed for admission, treatment
and discharge of mentally ill individuals. A decision to be admitted in a mental health
establishment shall, as far as possible, be made by the person with the mental illness except
when he is unable to make an independent decision or conditions exist to make a supported
admission unavoidable.
• Mental Health Review Commission and Board: The Mental Health Review Commission
will be a quasi-judicial body that will periodically review the use of and the procedure for
making advance directives and advise the government on protection of the rights of mentally
ill persons. The Commission shall with the concurrence of the state governments, constitute
Mental Health Review Boards in the districts of a state. The Board will have the power to (a)
register, review/alter/cancel an advance directive, (b) appoint a nominated representative, (c)
adjudicate complaints regarding deficiencies in care and services, (d) receive and decide
application from a person with mental illness/his nominated representative/any other
interested person against the decision of medical officer or psychiatrists in charge of a mental
health establishment.
• Decriminalising suicide and prohibiting electro-convulsive therapy: A person who
attempts suicide shall be presumed to be suffering from mental illness at that time and will
not be punished under the Indian Penal Code. Electro-convulsive therapy is allowed only
with the use of muscle relaxants and anaesthesia. The therapy is prohibited for minors.
POCSO (Protection of Children from Sexual Offences) Act, 2012 (24)
The POCSO Act was enacted to protect children aged less than 18 from sexual assault sexual abuse,
sexual harassment, and pornography.

Key provisions

• POCSO states a sexual assault is to be considered aggravated if –

◦ The abused child is mentally ill or,
◦ When the abuse is committed by-
1. A member of the armed forces or Security forces
2. A public servant
3. A person in a position of trust or authority of the child, like a family member, police officer,
teacher, or doctor or a person-management or staff of a hospital, whether Government or
private.
• It prescribes rigorous imprisonment for a term which shall not be less than ten years but which
may extend to imprisonment for life and also fine as punishment for aggravated penetrative
sexual assault.
• It also makes provisions for avoiding the re-victimization of the child at the hands of the
judicial system.
• The Act also makes it mandatory to report such cases. It makes it the legal duty of a person
aware of the offence to report the sexual abuse. In case he fails to do so, the person can be
punished with six months imprisonment or a fine.
• The act was amended in 2019 to increase the minimum punishment from seven years to ten
years. It further adds that if a person commits penetrative sexual assault on a child below the
age of 16 years, he will be punishable with imprisonment between 20 years to life, with a fine.
• Aggravated penetrative sexual assault under POCSO Act, 2012 is the equivalent provision for
aggravated rape.
• A person can be charged with this offence in certain aggravating circumstances, such as if the
rape occurs within a relationship of trust or authority, or if it leads to pregnancy, among
others.
• Under POCSO, the consent of a person under the age of 18 is irrelevant, regardless of the
nature and circumstance of the sexual interaction, or the particulars of the person with whom
it takes place. This means that any sex with a minor is rape.
 THE JUVENILE JUSTICE ACT 2015 (25)

In 2015, a new law was enacted, which replaced the 2000 Act. The Juvenile Justice Act of
2015 was necessitated partly due to a mass hysteria created after the Delhi gang rape of
2012, as one of the members of the group that raped the woman in a moving bus was a
juvenile who was aged a few months short of 18 years, and he was tried as a juvenile and
sent to a reformation home for three years and released in December 2015, while other
accused who were adults were awarded death penalty. Without understanding the
philosophy behind the juvenile justice system, public outcry led to the demand for
lowering the age of juveniles
under the Act, particularly when they committed heinous o ences, so that such juveniles
can be prosecuted and sentenced in adult courts.

Salient Features of the 2015 Act:

While a juvenile was de ned as a child below the age of 18 years, children in the age
group of 16-18 can be prosecuted as adults if they commit a heinous crime;
Further, a child of 16-18 years who commits a less serious o ence, may be prosecuted
as an adult if he / she is apprehended after the age of 21 years;
O ences perpetrated by juveniles are classi ed into three categories - A heinous crime is
any o ence which prescribes a minimum of seven years imprisonment; a serious o ence
attracts 3-7 years of imprisonment, and a petty o ence prescribes three or less years of
imprisonment.
The law provides for establishment of Juvenile Justice Boards (JJBs) in each district with
a metropolitan magistrate and two social workers, including a woman. The JJBs
will conduct a preliminary inquiry of an o ence committed by a juvenile within a speci ed
time period and determine if the juvenile should be sent to the rehabilitation centre or to a
children's court to be tried as an adult. The Board can take the help of
psychologists and psycho-social workers and other experts to take the decision.
The law also mandates establishment of Child Welfare Committees (CWCs) in each
district with a chairperson and four other members who have experience in dealing
with children. One of the four members must be a woman. The committee decides
whether an abandoned child should be sent to an institution or put up for adoption or
foster care.
The 2015 Act introduced foster care in India for the rst time through S. 44. Families
could register with the government and volunteer to foster children in need of care
and protection, or children in con ict with the law. Such families will receive aid
from the concerned government.

The Mental Health Care Act (MHCA), 2017(26)

With the promulgation of the MHCA 2017, India reformed its mental health laws making it fully
aligned with the UN Convention on the Rights of Persons with Disabilities (UNCRPD), focusing on
the promotion of the rights to community inclusion, dignity, autonomy, empowerment, and recovery
for all people with mental illness.
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The preamble of the Act has two parts:

1. Provide for mental health care and services for persons with mental illness; and
2. To protect, promote, and fulfill the rights of such persons during the delivery of mental health
care and services.

Chapter 5 of the Act refers to the “Rights of persons with mental illness.” The Act makes access to
mental health care and treatment from mental health services funded or run by the government, a
right of every individual. It also makes it obligatory on the government to make sufficient provision
to set up a range of services required by PMI (Chapter 5, clause 18[1]). In addition, it states that
“every person with mental illness shall be treated as equal to persons with physical illness in the
provision of health care…” (Chapter 5, Clause 21[1]; and the government shall integrate mental
health services into general healthcare services at all levels of health care including primary,
secondary, and tertiary health care (Chapter 5, Clause 5 a) MHCA Act in parenthesis.

It is a promising legislation and a welcome development. The aims and objectives of the Act are
laudable and in keeping with the need of the hour. Psychiatrists, mental health professionals,
persons with mental illness (PMI) and their families, and society in general welcome the Act.

However, even after five years of its existence, the Act appears to be a non-starter in most parts of
India. Constitution of State Mental Health Authorities, Mental Health Review Boards, and framing
of Rules and Regulations, as mandated in the Act, have not been done in many states (barring a few
exceptions) or are not fully functional. This poses a major hindrance in the delivery of services to
PMI.

The government has done little to fulfill its obligations given in the first part (point no 1) of the
preamble. Budget allocation for mental health remains abysmally low at < 1% of total health
budget. No efforts have been made post-MHCA to create, strengthen, or increase mental healthcare
service infrastructure in the country. Considering that the prevalence of mental disorders is about
10.6% (National Mental Health Survey 2015-16)[2] and number of psychiatrists is 0.3 per lac
population (World Mental Health Atlas 2014)[3] and that 80% of those in need of mental health
care do not get it in India (National Mental Health Survey 2015-16),[2] there is a massive need to
augment services and infrastructure on a priority basis.

Definition of mental illness as per the Act is “a substantial disorder of thinking, mood, perception,
orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or
ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol
and drugs, but does not include mental retardation….”. This definition includes mostly serious
mental illness of a severe degree who may need protection of law, and constitutes only a small
proportion (<20%) of all mental illness.

On point no 2 of the objectives, though the intent is laudable, the procedures prescribed to fulfill
this objective are far from satisfactory and even counter-productive. This is where the problems lie
specially in implementation of the Act. Unfortunately, many provisions are borrowed in toto from
laws in UK and Canada, which are inapplicable to the socio-cultural system prevailing in India.

For example:

1. There is a concept of Nominated Representative (NR) who has the authority and right to take
treatment decisions for the PMI in case the patient is unable to do so. This concept is alien to
Indian Society. NR is applicable in situations where there are no families as caretakers, as is
prevalent in western societies, or if the PMI is homeless or abandoned. In India, family
members are the caretakers of PMI in majority and absence of family is an exception rather
than a rule. Sometimes patients suffering from major mental illness during severe phase, turn
against family members, and this negativity disappears as the patient improves with treatment.
Thinking that someone other than the close family members would act in the best interest of
the PMI is a far-fetched argument. There is also a risk of vested interests getting designated as
NR. Thus, denying the first right to family to take decisions about the treatment of PMI
alienates the family and creates distrust, distress, and disruption, weakening the social fabric.
Families feel helpless and distraught. It is ironical that the family and caregivers are
mentioned in discharge planning (Section 98) but not in the admission process (Section 89) in
the Act. Assigning all treatment decisions to NR also alienates psychiatrists who act in good
faith in favor of the well fare and well-being of patients.
2. Similarly, the concept of Advance Directive (AD) is not in keeping with the socio-cultural
realities of India. Provision of AD requires the PMI to have sufficient knowledge of treatments
available for mental illness and make informed decisions that will be beneficial to him/her. In
reality, it is only presumptive and most patients in India may not have such level of
knowledge. Many times patients with mental illness refuse treatment due to impaired insight
and poor judgment temporarily or may be unaware of the consequences of various treatment
choices. They have to be explained and advised about various treatment options and its
relative benefits. AD made at a stage of illness where patients have impaired insight or loss of
personal and social judgment that has a potential to improve with treatment, may not be in
their best interest. It is also impossible to establish retrospectively that the AD was made when
the patient had the capacity to do so.
Pre-eminence of these provisions (AD and NR) in admission and treatment procedures hinder
and delay the treatment and convey an erroneous notion to people about the necessity of AD
and NR as essential prerequisites for accessing treatment.
3. In the Act, mental illness is equated with dangerousness and very severe levels of disturbance
for the purpose of supported/involuntary admission (Section 89, 1a,

• (i) has recently threatened or attempted or is threatening or attempting to cause bodily

harm to himself; or
• (ii) has recently behaved or is behaving violently toward another person or has caused
or is causing another person to fear bodily harm from him; or
• (iii) has recently shown or is showing an inability to care for himself to a degree that
places the individual at risk of harm to himself”).
This describes the extreme end of the severity of mental illness. Most PMIs are not
dangerous and may need supported inpatient treatment early on in the course of illness
before they become dangerous. Allowing them to reach such a level of severity that
they become harmful to self or society before they can be admitted in MHE is a bad
 strategy and also unethical practice. Many times involuntary treatment is needed much
before such a degree of severity is reached when the patient may have lost insight or
judgment. Prolonging the duration of untreated mental illness reduces the potential for
recovery. Admission criteria as per Section 89, 1a, hinders early treatment and is
detrimental to the interest of the patient and family, and needs to be changed.
4. Procedures laid down for admission and treatment of PMI with high support needs are highly
bureaucratic, impractical, and tardy, leading to delay and denial. Conventionally, advice for
hospitalization is the prerogative of the treating doctor in all medical/surgical specialties and
patient is asked to give written consent for the same, whereas, in MHCA, it is the patient or
the NR who seeks admission by filing a formal application on a specified form to the medical
officer in-charge of the MHE. This seems an unnecessary step. The admission should be
possible on the recommendation of the psychiatrist with the written consent of the patient or
NR as the case may be. Patients and families in need of immediate treatment in such a severe
situation feel harassed, and unsupported. The necessity of invoking AD, NR as a prerequisite
before any treatment can be instituted even in acute situation, needs to be reviewed and
simplified. Treatment should not be allowed to be delayed waiting for completion of these
formalities which in reality take at least a few days to weeks.
5. There is unwelcome judicial and bureaucratic over reach. Judicial officials are tasked with
decisions about treatment, admission, and discharge of patients in mental health establishment
(MHE), which is illogical and unnecessary. These are clinical (medical) decisions best left to a
psychiatrist. This also slows the system down making it inefficient.
6. Under the Act, only government officials are protected from legal proceedings for actions
taken in good faith, excluding the family, care givers, and mental health professionals,
whereas family, care givers, and mental health professionals also act in good faith for the care
of the PMI and should also be similarly protected.
7. Police, judiciary, insurance companies, and all others who are involved in the mental health
care of PMI are not sensitized or on board to take up the responsibilities and duties as
specified in the Act. Nothing has been done to achieve that.

To say-Mental illness is not a monolith. Mental illnesses present with a wide spectrum of conditions and disorders
that require highly individualized treatment plans instituted in different settings and a range of services. All patients
with mental illnesses and services do not need special regulation and protection under law. There is a small minority
of patients who by virtue of its severity or nature, having lost insight or capacity, loss of sound judgment or those
who are abandoned, wandering, or homeless, etc., need the highest protection of law.

It is also mandated in the Act that mental health care is to be integrated with general health care at
all levels (Section 18, 5 (a)); however, there is no mechanism outlined in the Act to achieve this
objective. Definition of mental illness as per the Act completely excludes a large majority patient of
common mental disorders and less severe serious mental disorders being treated in outpatient
clinics of general hospital psychiatry or psychiatric hospitals and nursing homes, from the ambit of
the law, whereas, for inpatient care for all such patients, such facility will require registration as
mental health establishment as defined in the Act.
To say,Many patients with mental illness transition from one level of severity to another during the course of their
illness and may shift from a state of preserved capacity at one time to losing it temporarily at another. Management
of such dynamic clinical states should be possible without the hassle of having to shift patients from one service to
another or of bureaucratic procedures. It would be helpful if inpatient care during acute phase of illness, for a short
period of time (e.g., <6-8 weeks) is freely accessible at par with that for physical illness without invoking legal
procedures. This would provide convenience to patient and their families and also help in de-stigmatizing mental
illness in a major way. In other words, the Act should facilitate treatment in a most conducive environment.

Most patients of common mental illnesses and those with associated medical comorbidities seek
treatment in general healthcare settings. A large proportion (30-80%) of medically ill persons
treated in in-inpatient facility of general healthcare settings also suffer from associated psychiatric
illnesses (such as depression, anxiety, delirium, dementia, psychosis, and addiction) and are being
treated there. Going by the definition of the mental health establishment given in the Act, all general
healthcare facilities will qualify to be labeled as mental health establishments and will come under
the purview of the Act. This is another fallacy in the Act. The Act fails to acknowledge and provide
for co-occurrence of physical and mental illness.

INDIAN MENTAL HEALTH PROGRAMS, POLICIES, AND PLANS(27)

National Health Policy of India (NHP, 2017)
The Government of India (GoI) launched NHP in 2017, aiming to inform, clarify, strengthen, and
prioritize the role of the government in shaping health systems in all its dimensions. 15 NHP (2017)
made certain provisions that support NMHPolicy: (a) to increase the creation of specialists through
public financing, (b) to create a network of community members to provide psychosocial support to
strengthen MH services at primary level facilities, and (c) to leverage digital technology in a context
where access to qualified psychiatrists is difficult. 16

National Mental Health Plan-365 (2013)

The launch of the NMHPolicy co-occurred with the release of the MHAP-365 to succinctly describe
the roles and responsibilities of each stakeholder for a particular action. The major stakeholders of
the MHAP-365 are the union GoI, the governments of states/union territories, local bodies
including municipalities and Panchayati raj institutions, civil society organizations, PWMI, medical
and health-care providers, medical colleges, academic and research institutes, schools, and colleges,
private corporate sectors, and finally, media. MHAP-365 pointed out that although the complete
attainment of the complex objectives may not be feasible in the short or medium term, it is
nevertheless necessary to have directed and coordinated action plans.17, 18

The National Mental Health Programme (NMHP)(28)

It was launched by the Government of India in 1982 to address the high burden of mental disorders
and the shortage of qualified professionals in the mental health field. Later, in 1996, the district
Mental Health Program was added to the NMHP Programme.
NMHP aims to provide accessible and affordable mental healthcare services to all individuals. The
programme focuses on preventing, promoting, and treating mental health disorders. NMHP works
towards reducing the treatment gap and improving mental health literacy in the country.

◦ It emphasizes community-based care and strengthening mental health infrastructure.

◦ The programme offers various interventions, including awareness campaigns, training for
healthcare professionals, and establishment of mental health clinics and facilities.
◦ NMHP also supports integrating mental health services into the primary healthcare system.
◦ The World Bank and WHO have been contacted for assistance with different National Mental
Health Programme components.
◦ The Government of India funds state governments/UTs and nodal institutes under the
National Mental Health Programme to cover expenses for staff, equipment, vehicles,
stationary, contingencies, medicine, training, etc.

Aim of NMHP

◦ It prevents and treats mental and neurological disorders and their associated disabilities.
◦ Use of mental health technology to improve general health services.
◦ Application of mental health principles in total national development to improve quality of
life.

Objectives of NMHP

Here are the objectives of the National Mental Health Programme:

◦ The National Mental Health Programme (NMHP) aims to provide minimum mental
healthcare for all, particularly focusing on disadvantaged and vulnerable groups.
◦ It promotes applying mental health knowledge in general healthcare and social development.
◦ The programme emphasizes community participation in developing mental health services
and encourages self-help.
◦ NMHP also works towards improving human resource capacity in mental health sub-
specialties.

Components

The three components of this National Mental Health Programme are:

◦ Treatment of Mentally ill

◦ Rehabilitation and
◦ Prevention and promotion of positive mental health.
District Mental Health Programme (DMHP)

District Mental Health Program was launched in 1996 in four districts under National Mental
Health Programme based on the “Bellary model,” it was expanded to 27 districts across the country
by the end of the IXth Five Year Plan period. Currently, the DMHP is being implemented in 704
districts across the country.

◦ District Mental Health Programme’s (DMHP) primary goal is to deliver community mental
health services and integrate mental health with general health services by decentralising
treatment from specialised mental hospital-based care to primary health care services.

National Mental Health Policy (NMHP)

The Indian government launched its National Mental Health Policy on October 10, 2014.

Vision

◦ The vision of the policy is to ensure the socioeconomic inclusion of people affected by
mental illness by promoting mental health, preventing mental illness, facilitating recovery
from mental illness, promoting destigmatization and desegregation, and enabling recovery
from mental illness.
◦ Providing all people with accessible, affordable, high-quality health and social care within a
rights-based framework.

Values and Principles

Fundamental values and principles representing the ethos of the National Mental Health Policy are
discussed below:

Equity
◦ In India, mental health services should be sensitive to diverse social and cultural situations
and groups and the needs of remote and rural areas.
◦ The burden of mental health problems and mental illness should be reflected in an equitable
share of the national health budget.
◦ People with mental health problems and mental illness should have equal access to
education, employment, housing, and social welfare.
Justice
◦ It is essential to consider the needs of the community’s most vulnerable and excluded
members.
Integrated care
◦ To provide mental health services within the existing health care system, the Primary Health
Care approach should be used.
◦ In India, mental health services should uphold the values of equitable distribution,
community involvement, cross-sectoral coordination, and appropriate technology use.
 ◦ The availability and accessibility of mental health services should be ensured across India
within a given time frame.
◦ Mental health services in India should be comprehensive, addressing the needs of people
with mental illnesses, their carers, and health care professionals.
Quality
◦ Mental health services in India should meet international quality standards and be acceptable
to local users and carers.
Goals

◦ To reduce the effects of mental health issues on a person’s entire lifetime, including
disability, distress, exclusion morbidity, and premature mortality,
◦ To increase awareness of mental health issues in the country.
◦ To improve mental health leadership at the national, state, and district levels.
Objectives of the Policy

◦ To ensure that everyone has access to mental health care & services.
◦ To improve access to and utilisation of comprehensive mental health services by people
suffering from mental illnesses.
◦ To improve access to mental health care, particularly for vulnerable groups such as homeless
people, people living in remote areas, and those from disadvantaged educational, social, and
economic backgrounds.
◦ To minimise the prevalence and effects of the risk factors for mental health issues.
◦ To reduce the risk, occurrence, and rate/attempts of suicide.
◦ To ensure that people with mental health problems have their rights respected and are safe
from harm.
◦ To reduce the stigma associated with mental health issues.
◦ To improve the availability and equal distribution of skilled human resources for mental
health care.
◦ To increase financial allocation and improve mental health promotion and care utilization
over time.
◦ Recognising, addressing, and offering appropriate interventions for the social, biological, and
psychological determinants of mental health issues.

The National mental health policy aligns with the United Nations Convention on the Rights of
Persons with Disabilities (UNCRPD, 2007).It is also supported by laws like the Rights of Persons
with Disabilities Act (RPWD, 2016) and the Mental Healthcare Act (MHCA, 2017).

NATIONAL SCHEMES
Swavlamban Health Insurance Scheme to provide affordable Health
Insurance to the persons with disabilities (PwDs), 2015(29)

A Prestigious Health insurance Scheme for Persons with Disabilities (As Per PWD Act 1995)
launched by The New India Assurance Company limited, in Association with Ministry Of Social
Justice, Dept of Empowerment of Persons with Disabilities.
Mission

1. To Provide affordable Health Insurance to persons with Blindness, Low Vision, leprosy-Cured,
Hearing Impairment, Loco-Motor disability, Mental-Retardation and mental illness.
2. To Improve general Health condition & Quality of life of persons with Disabilities

KEY FEATURES:

1. Sum insured of Rs. 2 lacs on family floater for a period of 12 months.

2. Age band 0 – 65 years.
3. Family size up to 1+3. Primary member is Person with disabilities. In case of minor being
PWD, parent/legal guardian of such minor can also be covered under the scheme.
4. Available for persons with disabilities with family annual income of Rs. 3 lacs and below on
declaration basis in proposal form.
5. Persons with multiple disabilities, Cerebral Palsy & autism are not covered under this scheme.

The National Divyangjan Finance and Development Corporation

(NDFDC) (30)
It is a Company wholly owned by Government of India. It functions as an apex
institution for the benefit of Persons with Disabilities. Financial assistance is
extended by the Corporation at concessional interest rate for starting /augmenting any
activity contributing directly or indirectly in the income generation of Persons with
Disabilities, thus helping them in their overall process of empowerment. The
assistance is extended through the State Channelizing Agencies(SCAs) nominated by
the State Government(s)/selected Public Sector Banks (PSBs)/Regional Rural
Banks(RRBs) and other organisations with which MoA has been signed by NDFDC
for channelizing the funds.
Prominent schemes being implemented by NDFDC are as under:

1.Divyangjan Swavalamban Yojana :-

Financial assistance in terms of loan at concessional rate of interest is provided for
the benefit of Persons with Disabilities for starting /augmenting any activity
contributing directly or indirectly in the income generation and helping them in their
overall process of empowerment.

2.Vishesh Microfinance Yojana (VMY) :-

Under this scheme NDFDC provides prompt and need based finance for the target
group and activities at reasonable rate of interest through NBFC-MFI, Section-8-
MFI, and NGO-MFI, SHG Federations, state Government Missions and other state
level organizations to pursue small/micro business and development activities.
National Institute for Locomotor Disabilities (NILD)(31)

NILD was established to render comprehensive rehabilitation services to the persons with loco-
motor disabilities. The prime objectives of the institution include following:

• Human Resource Development-to develop manpower for providing services to the

Orthopaedically Handicapped population, namely training of Physiotherapist, Occupational
therapist, Orthotic and Prosthetic technicians, Employment and Placement Officers and
Vocational Counsellor etc.
• To provide services in the area of rehabilitation, restorative surgery, aids and appliances and
vocational training to the persons with disability.
• Manpower development to serve the orthopaedically handicapped population.
• To conduct and sponsor research in all aspects related to the rehabilitation of the
orthopaedically handicapped.
• To standardize aids and appliances and to promote their manufacture and distribution.
• To provide consultancy services to the State Government and voluntary agencies.
• To serve as an apex documentation and information centre in the area of disability and
rehabilitation.

The rehabilitation service of the institution include Disability Evaluation and Assessment,
Physiotherapy services, Occupational services, Prosthetic and Orthotic services, Socio-economic
services, Indoor Medical rehabilitation Services, Diagnostic Services, Facilitation and Outreach
services.

Indira Gandhi National Disability Scheme(32)

It was launched on February 2009 by the Ministry of Rural Development headed by the Central
Government to support the disabled people in our country. This scheme introduced under National
Social Assistance Program provides monthly pension to disabled people for the prosperity of their
lives. Any disabled person whose age is more than 18 years, and with disability 80% or more
belonging to the poverty line can apply for this scheme.A pension of Rs.300/- per month is provided
to Divyangjan between 18 years and 79 years. For persons who are 80 years and above the pension
of Rs.500/- per month will be provided.The eligibility criteria for a disabled person to avail the
benefits are as follows.

• The age of the applicant should range between 18-79 years.

• The applicant should be a resident of India.
• The applicant should be a physically or mentally disabled person.
• The applicant’s disability should be more than 80%.
• Dwarfs are also eligible for this scheme.
• The applicant should belong to Below Poverty Line.
WEST BENGAL STATE SCHEMES(33)
By Government of West Bengal -Department of Women and Child Development and Social Welfare
Directorate of Social Welfare

Scheme to Promote Voluntary Action for Persons with Disability

(01-04-2003)
1) Vocational Training Centers
2) Sheltered Workshop
3) Special schools for the persons with disabilities
4) Special schools for the mentally challenged
5) Special schools for the visually challenged
6) Project for the cerebral palsied children
7) Project for the Pre-school and early intervention and training
8) Home based Rehabilitation Programme / Home Management Programme
9) Project for the rehabilitation of the Leprosy cured children

Scheme for Assistance to Disabled Persons for Purchase/Fitting of

Aids and Appliances (ADIP)
The main objective of the scheme is to assist the needy disabled persons in procuring durable,
sophisticated and scientifically manufactured, standard aids and appliances that can promote their
physical, social and psychological rehabilitation by reducing the effects of disabilities and
enhancing their economic potential. The scheme is implemented through the implementing agencies
like voluntary organizations, National Institutes under the Ministry, ALIMCO, Zilla Panchayats,
DRDAs, etc. The implementing agencies are provided grant-in-aid for purchase, fabrication and
distribution of aids and appliances. The scheme also includes under its ambit medical / surgical
correction and intervention, which is essential prior to fitment of aids and appliances.

Quantum of Assistance in ADIP Scheme(34)-

(i) For aids /appliances costing up to Rs. 15,000: Full financial assistance under the scheme.

(ii) For aids /appliances costing between Rs. 15,001/- to Rs. 30000/-: Financial assistance up to Rs
15000/-

(iii) Further, all expensive items costing above Rs. 30,001/, except Cochlear Implant and Motorized
Tricycle, eligible for assistance under the scheme, subject to income ceiling, would be listed out.
The government of India shall bear 50% of the cost of these items thus listed by the Committee and
the remainder shall be contributed by either the State Govt. or the NGO or any other agency or by
the beneficiary concerned subject to prior approval of the Ministry on case to case basis; limited to
20% of the Budget under the Scheme.
Note: For providing modern assistive devices to all categories of PWDs, the items will be decided
by Expert Committees constituted in the Department of Empowerment of Persons with Disabilities.
The West Bengal Disability Pension Scheme 2010 (35)
It provides financial assistance to persons with disabilities who are unable to work and earn a living.
The scheme is implemented by the Department of Women and Child Development and Social
Welfare, Government of West Bengal.The eligibility criteria for a disabled person to avail the
benefits are as follows.

Applicant must be a disable person with 40% of disability.

The disabled person must be declared unsuitable for physical work by the respective Medical
officer with following disabilities :
• Deaf and Dumb.
• Blind.
• Orthopedically handicapped.
• Mentally retarded
• Permanently incapacitated.
The disabled person is declared unsuitable for physical work by the respective Medical officer.
His / Her family income, if any, must not exceed ₹ 1,000/- per month.
Residency Duration
• The applicant must be a citizen of India and a resident of West Bengal. (OR)
• The disabled person should have been a resident of the state of West Bengal for at least 10
years at the time of applying for the pension. (OR)
• For disabled persons below 10 years old, the period of residence will be limited to the time
span covered by the date of birth and the date of submission of the application.

—Recent Initiatives By The Government Of India—

Recognizing the potential impact of COVID-19 on people’s mental health, the Government of India
has launched several initiatives, including:

◦ A 24/7 toll-free helpline called “Kiran (1800-599-0019)” was launched by the Ministry of
Social Justice and Empowerment in 2020 to support people dealing with stress, depression,
anxiety, suicidal thoughts, and other mental health issues.
◦ Through the (iGOT)-Diksha platform, the Bengaluru-based National Institute of Mental
Health and Neurosciences (NIMHANS) is enhancing the ability of health professionals to
provide online psychosocial support and training.
◦ To support students’ mental health and well-being through psychosocial support, the HRD
Ministry (now the Ministry of Education) launched the MANODARPAN initiative in July
2021.
◦ It is a step toward the Prime Minister’s vision of Atma Nirbhar Bharat.
◦ The Ministry also launched a dedicated National Toll-free Helpline on the
MANODARPAN website.
 ◦ The Government of India launched the MANAS (Mental Health and Normalcy
Augmentation System) mobile app in 2021 to encourage mental health among various age
groups.
◦ In the Budget for 2022-23, the government announced a “National Tele Mental Health
Programme” to improve access to quality mental health counselling and care services in the
country.

ETHICAL AND FORENSIC ISSUES IN PRACTISING PSYCHOLOGY (36)

Soundness of mind is generally assumed in other branches of medicine, but in psychiatric research,
there are often individuals who lack full judgment capacity or decision-making capacity.[25] The
most common ethical dilemma in forensic psychiatry is between the two principles of (a)
beneficence or promotion of welfare and (b) respect for justice.[27] The forensic psychiatrist often
has to make a choice between well-being of the patient and well-being of the society as a whole. In
India, the psychiatrist practicing forensic psychiatry has the dual role of both carrying out forensic
assessments as well as providing medical treatment. In settings with well-established forensic
services, one way of overcoming this dilemma has been to have forensic psychiatrists carrying out
mental assessments of mentally ill offenders on behalf of the legal system, and treatment provision
by a different set of treating professionals.
The ultimate aim of the forensic psychiatrist should be revelation of truth as part of pursuit of
justice without affecting privacy and autonomy of the patient.[28]

Way Forward~

Since the right to health has been incorporated into the definition of the right to life in Article 21 of
the Indian Constitution, people with mental illnesses in India also have the right to avail
comprehensive mental health services. Therefore, the National Mental Health Programme was
established to address the heavy burden of mental illness on the community and to improve the
country’s mental health care infrastructure. However, the pandemic has exposed previously unseen
mental health issues, highlighting gaps in existing mental health infrastructure and laws/policies.

◦ In India, mental health concerns will require active policy interventions at multiple levels and
measures to train and sensitise the community or society.
◦ The government should support initiatives such as the Swachh Mansikta Abhiyan to
encourage people to learn about mental health.
◦ Government should also encourage easy and affordable access to primary mental health care
at every PHC level in India.
◦ Thus, eliminating chronic disorders and psychiatric illnesses in India would require more
funds to improve India’s medical infrastructure under the National Mental Health
Programme.
————————- end———————

Notes prepared by:

Akansha Chakraborty (M.Phil 1st Year,Trainee)
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26.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569318/ (Intext ref as per the paper)
27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9460016/ (Intext ref as per the paper)
28.https://testbook.com/ias-preparation/national-mental-health-programme
29.https://enabled.in/wp/swavlamban-health-insurance-scheme-persons-
disabilities/
30. https://depwd.gov.in/national-handicapped-finance-and-development-
corporation/
31.https://www.punarbhava.in/index.php/connect/publications/national-institutes-
publications/nioh
32. https://www.myscheme.gov.in/schemes/igndps#
33.https://punarbhava.in/index.php/legal-instruments/schemes-and-initiatives/states/state-wise-
schemes?layout=view&id=478
34.https://www.myscheme.gov.in/schemes/sadppfaa
35.https://www.myscheme.gov.in/schemes/dpwb
36.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282613/#ref12 (Intext ref as per the paper)