Author: Dev Singla, Student at the Geeta Institute of Law
To the Point
Mental health, a cornerstone of human well-being, has long been overlooked in India’s legal and healthcare systems. Although the Mental Healthcare Act, 2017 was a progressive step in recognising the right to mental healthcare as a legal entitlement, deep systemic issues continue to hinder its effective implementation. From outdated social perceptions to a severe lack of infrastructure and awareness, the gap between legal rights and lived realities remains wide. This article critically evaluates the Indian legal framework on mental health, highlights the challenges in enforcement, explores the intersection of mental illness with the criminal justice system, and proposes reforms to make mental healthcare accessible, affordable, and just
Use of Legal Jargon
Advance Directive – A legally binding written statement made by a person specifying how they wish to be cared for during future episodes of mental illness, as recognised under Section 5 of the Mental Healthcare Act, 2017.
Informed Consent – A legal requirement ensuring that individuals voluntarily agree to medical treatment with full knowledge of the risks, benefits, and alternatives. Under MHCA 2017, treatment without informed consent is generally prohibited.
Legal Insanity – A defence under Section 84 of the Indian Penal Code (IPC), where a person cannot be held criminally liable if, due to unsoundness of mind, they were incapable of knowing the nature or wrongfulness of their act.
Non-Discrimination Clause – A provision under Section 21 of MHCA, which ensures mental health services are provided without discrimination on the basis of gender, religion, caste, class, disability, or sexual orientation.
Decriminalisation of Suicide – As per Section 115 of the MHCA, individuals who attempt suicide are presumed to be under severe stress and are entitled to treatment, thereby overriding Section 309 IPC, which had previously criminalised suicide attempts.
Mental Health Review Board (MHRB) – A quasi-judicial body established under MHCA to protect the rights of persons with mental illness, resolve disputes, and review the legality of involuntary admissions and treatments.
Legal Capacity – The right of persons with mental illness to make decisions about their treatment, finances, and personal matters, unless declared otherwise by a competent authority.
Criminal Procedure Protections – Sections 328–339 of the Criminal Procedure Code (CrPC) lay out procedures when an accused is suspected to be of unsound mind, ensuring fair trial standards and medical evaluation.
The Proof
Despite legal recognition, the condition of mental healthcare in India is far from adequate. According to the National Mental Health Survey (NMHS) 2016, nearly 150 million Indians require mental health interventions, but only about 10% of them receive it. The treatment gap is staggering — 83% for mental disorders and 90% for substance use disorders. The WHO Mental Health Atlas 2020 shows that India has only 0.3 psychiatrists per 1 lakh population, as opposed to the desirable 3 per lakh.
The Mental Healthcare Act, 2017, enacted after India’s ratification of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), guarantees the right to mental healthcare, prohibits inhuman treatment, ensures the right to live in the community, and promotes rehabilitation. But State Mental Health Authorities (SMHAs) and Mental Health Review Boards (MHRBs), mandated by the Act to monitor care and handle grievances, are barely functional in most states.
The decriminalisation of suicide under Section 115 of the MHCA was hailed as a progressive move. However, it has not significantly changed police procedures or public attitudes. Most suicide survivors still face stigma, harassment, or are wrongly booked under Section 309 IPC by unaware law enforcement officers.
Abstract
Mental health is an integral part of human dignity and the right to life under the Indian Constitution. Despite this, mental illness has historically been treated with stigma, neglect, and legal invisibility. The enactment of the Mental Healthcare Act, 2017 (MHCA) marked a major shift toward a rights-based framework, recognising mental healthcare as a justiciable right and decriminalising suicide. However, implementation remains poor due to inadequate infrastructure, lack of awareness, insufficient budget allocation, and weak enforcement mechanisms. This article critically examines the legal provisions of MHCA, the intersection of mental health with the criminal justice system, and relevant judicial precedents. It also draws comparisons with international legal standards to highlight how India can improve access, protection, and justice for individuals with mental illness. Bridging the gap between law and lived experience requires a comprehensive reform strategy that includes awareness, institutional accountability, and respect for individual autonomy.
Discussion
1. Historical Context and the Need for Reform
India’s earlier legislation, the Mental Health Act, 1987, was a custodial approach, focusing more on institutionalization than rehabilitation. It was widely criticized for being outdated, paternalistic, and violating personal liberty. Following the ratification of the UNCRPD, there was a constitutional and international mandate to shift to a rights-based approach, which led to the enactment of the Mental Healthcare Act, 2017.
2. Highlights of the Mental Healthcare Act, 2017
Right to Mental Healthcare (Section 18): Every person has the right to access affordable and quality treatment without discrimination.
Advance Directive (Section 5): Individuals can specify how they want to be treated in the future.
Mental Health Review Boards (Section 73): To resolve disputes and protect patient rights.
Decriminalisation of Suicide (Section 115): Presumes that the person attempting suicide is under severe stress.
Free Treatment for BPL Persons (Section 18(4)): Mandates that the government provide free treatment for those below the poverty line.
3. Challenges in Implementation
Poor Infrastructure: India’s mental health infrastructure is severely lacking — fewer than 50 mental hospitals serve a population of 1.4 billion.
Workforce Shortage: There are only around 1,700 psychiatrists, 898 clinical psychologists, and 380 social workers for the entire country.
Budget Allocation: India spends only 1.3% of its health budget on mental health, far below the WHO recommendation of 5%.
Stigma and Discrimination: Social stigma remains a significant barrier. Families often conceal mental illness due to shame, leading to delayed treatment.
Lack of Awareness: Even among medical professionals and law enforcement officers, there is poor understanding of the Act and mental illness itself.
4. Mental Health and the Criminal Justice System
Section 84 IPC provides the defence of legal insanity: the accused is not liable if they were incapable of knowing the nature of the act due to mental unsoundness.
Sections 328–339 CrPC deal with procedures for trial of persons of unsound mind. Often, the accused is held in custody for long periods without trial, violating Article 21.
Mentally ill prisoners are often denied treatment. In Reena Banerjee v. GNCT Delhi (2022), the Delhi HC held that jails are not substitutes for mental hospitals.
Supreme Court in Shatrughan Chauhan v. Union of India (2014) recognised that executing mentally ill death row convicts violates Article 21.
5. International Practices
UK: Mental Health Act, 1983 (as amended in 2007) allows involuntary admission but under strict safeguards and periodic review.
USA: ADA (Americans with Disabilities Act) prohibits discrimination based on mental illness; HIPAA ensures confidentiality of treatment.
Australia: National Mental Health Strategy provides community-based support and includes mental health in primary healthcare.
India’s MHCA is theoretically more progressive, but lags far behind in practical execution.
Case Laws
Reena Banerjee v. GNCT Delhi (2022) – Delhi HC ordered the shifting of mentally ill prisoners to mental health institutions.
Shatrughan Chauhan v. Union of India (2014) – SC ruled mentally ill convicts cannot be executed; acknowledged the psychological trauma in death row prisoners.
Shikha Nischal v. NLU Delhi (2023) – HC held that mental illness is a valid ground for exam deferment, recognising psychological health as essential.
Union of India v. Lalu Prasad Yadav (2022) – Accused sought bail citing mental illness; the court insisted on a medical board certification to prevent misuse.
Navtej Singh Johar v. UOI (2018) – Emphasised individual identity and mental well-being in the broader context of dignity and Article 21.
Conclusion
The Mental Healthcare Act, 2017, has the potential to revolutionise mental health rights in India, but the journey from law to lived reality is incomplete. The law promises dignity, equality, non-discrimination, and community-based treatment, but fails in implementation. The criminal justice system must be trained and sensitised; prisons cannot remain holding centres for the mentally ill. Mental health is not just a medical issue; it is a legal, constitutional, and human rights issue. A comprehensive approach involving legal reform, awareness, resource allocation, and judicial oversight is urgently needed. Only then can India truly claim to honour the dignity of all its citizens, including those suffering silently in the shadows of mental illness.
FAQS
Q1: Is mental illness a valid defence in criminal law?
Yes. Under Section 84 IPC, a person is not liable for an act if they were incapable of knowing its nature or that it was wrong due to unsoundness of mind.
Q2: Is attempted suicide still a crime in India?
No. Section 115 of MHCA, 2017, decriminalises attempted suicide and mandates care and treatment instead of punishment.
Q3: What is an Advance Directive in mental health law?
It is a legal document where an individual specifies their preferences for treatment during future mental health crises.
Q4: Are mental health services free in India?
Yes, under Section 18(4) of MHCA, persons below the poverty line are entitled to free mental healthcare from government institutions.
Q5: Are police and judges trained on mental health laws?
Not adequately. Lack of awareness and training remains a serious gap in law enforcement and the judiciary.
