Is the Mental Healthcare Act 2017 fully implementable in India, or does it require amendments?

Abstract

BACKGROUND: The Mental Healthcare Act, 2017 (MHCA) was enacted in India to protect the rights of individuals with mental illnesses and improve their access to mental healthcare services. However, despite its progressive nature, the implementation of the MHCA has faced numerous challenges. This manuscript aims to discuss the difficulties encountered in implementing the MHCA in its current form and propose potential amendments to enhance its acceptability and effectiveness. CHALLENGES: The authors have tried to evaluate MHCA from an Indian perspective by examining its impact on mental healthcare in the country. It raises pertinent questions regarding the effectiveness of the MHCA, the invocation of key provisions such as Advance Directives and Nominated Representatives, the facilitation of care delivery, adequacy of national resources and infrastructure, public awareness of provisions, and police handling of individuals with mental illness. In addition, the manuscript highlights multifaceted challenges in implementing the MHCA, including the failure to acknowledge the role of family members in providing care, lack of clear procedures and guidelines for treatment implementation, insufficient funding, limited resources and mental health professionals in rural areas, persistent stigma attached to mental illness, inadequate community-based care services, and a limited focus on prevention and early intervention. RECOMMENDATIONS AND CONCLUSION: Based on the identified challenges, the authors propose several amendments to the MHCA. These recommendations include provisions for capacity building and manpower training, phased implementation according to economic and infrastructure readiness, involvement of existing institutional bodies in scrutiny, operational definition of capacity to consent, encouragement of community participation, establishment of continued treatment and care in the community for chronic mentally ill patients, clarification of provisions for different mental illnesses, protection for well-meaning clinical decisions, and addressing stigma through strengthened anti-discriminatory measures and public awareness.