Four years on, Mental Healthcare Act yet to see light in Maharashtra

Currently, there are four major regional mental hospitals in Maharashtra including Thane Mental Hospital. File pic

Call it apathy or lack of bureaucratic willingness which has led to non-implementation of the Mental Healthcare Act, 2017 in Maharashtra, even four years after it was passed.

The Mental Healthcare Act, 2017, was introduced by the Centre to provide free mental healthcare and services. States such as Tamilnadu, Kerala, Karnataka, Sikkim, Rajasthan and Chhattisgarh have not only implemented the Act but have also formulated their own rules and adhered to the provisions like formation of mental health review boards.

Unfortunately, Maharashtra has not taken any step towards implementation of the Act in the past four years; leaving mental health professionals worried as stress, anxiety, depression, insomnia, emotional distress are some mental illnesses that are visibly seen in adults, the elderly and even children and have increased multiple folds amid the COVID-19 pandemic.

Dr Soumitra Pathare, a consultant psychiatrist and director of the Centre for Mental Health Law and Policy, Indian Law Society (ILS), Pune who had provided technical assistance to the Ministry of Health and Family Welfare in drafting the Act, says, "It is the need of the hour that all stakeholders, especially families and people with living experience of mental illness get together and push the authorities to implement the Mental Healthcare Act. Unless aggressive collective voices of the community are heard by those in corridors of power, the Act will never be implemented in Maharashtra."

Dr Pathare added, "Maharashtra has four major regional mental hospitals - in Thane, Pune, Nagpur and Ratnagiri, but nothing has been done at the ground level on implementation of the said Act, which is due to sheer lack of bureaucratic willingness and concern for mental health issues... The public health system in Maharashtra, especially when it comes to mental healthcare, has been a serious area of concern."

The four regional mental hospitals in the state have a bed capacity of approximately 4,000-5,000.

When told that lack of finance was being cited as one of the reasons for delay in implementing the Act, Dr Pathare contested the claim saying, "This is not entirely true. First, we must understand that health and mental health is a state subject, and thus states are primarily responsible. The Centre's fund can be a top up. In addition, the Central government has allocated funds for implementation of the Act, but many states returned these funds. If funds were an issue, then why did the state not use the money allotted by the Centre to set up the required infrastructure?"

Another psychiatrist requesting anonymity said, "Making a law is easier, but ensuring its implementation is a challenge; and unfortunately this is the truth in Maharashtra with regards to the Mental Healthcare Act. Moreover, when it comes to mental health issues, the government and bureaucrats are least interested."

The doctor added, "I am of the view that this Act will die a natural death without seeing the light of the day, as implementation of the suggestions under the said Act require funds, which the state may not be keen to spend amid the fear of a third wave of COVID-19."

Dr Sanjay Kumavat, senior consulting psychiatrist and former deputy director of Mental Health Services, Maharashtra, said, "The pandemic and subsequent lockdowns triggered a bigger challenge concerning mental health issues amid children, adults and senior citizens alike, which should not be ignored. It is not only mental health patients, but even their caregivers who are screaming for help in isolation, and the state should provide helping hands."

"The government should make budget provisions to ensure that District Mental Health Review Boards (DMHRB) are formed in all districts for proper implementation of the Act. Provisions also need to be made for setting up community-based rehabilitation homes, half-way homes and workshops, for reintegration of people with mental health issues back into the society with dignity," explained Kumavat.

2017
Year when the Mental Healthcare Act was passed