Mental Healthcare, Disability Rights And Public Health

Abstract

Mental healthcare, disability rights, and the law of public health represent a very crucial, yet under-researched area of the law and policy structure in India. The Mental Healthcare Act, 2017 (MHCA), and the Rights of Persons with Disabilities Act, 2016 (RPwD), are markers of the shift towards the rights-orientated paradigm of the organisation of mental health and disability governance. The current paper is a qualitative research of the ways in which these statutes conceptualise and operationalise the rights to health, autonomy, and inclusion, and how the way they have been implemented is interacting with the changing forms of government of public health in India. It also clarifies the issues linked to integrating mental health into the larger public health systems and disability models, especially because of the limited resources available in India and existing social stigma. The paper contends that more institutions should be coordinated to bring about facilitated implementation of the right to mental healthcare under the regime of the Indian public-health law.

Introduction

Mental health and disability rights have long been marginalised within India’s broader health policy, despite their deep social and economic consequences. According to the World Health Organization, nearly one in seven Indians suffers from a mental disorder, yet access to quality mental health services remains uneven and stigmatised (Lakshminarayanan, 2011). The legal framework governing this area has undergone significant change in the past two decades, coming to a head in the Mental Healthcare Act, 2017 (MHCA) and the Rights of Persons with Disabilities Act, 2016 (RPwD), two important pieces of legislation that align India’s domestic laws with international obligations under the UN Convention on the Rights of Persons with Disabilities (UNCRPD). Together, they demonstrate a shift from a medical to a human-rights model of mental health and disability, emphasising autonomy, informed consent, and state responsibility (Math, 2019; Balakrishnan, 2019).

The MHCA 2017 guarantees the right to access mental healthcare services, decriminalises suicide, and establishes mental health review boards for oversight (Math, 2019). Meanwhile, the RPwD Act 2016 expands the definition of disability to include mental illness, ensuring entitlements in education, employment, and social protection (Prakash, 2024). However, despite their progressive orientation, the implementation of these acts has been filled with institutional, financial, and bureaucratic challenges. Surveys of practitioners and psychiatrists reveal that many state governments have not constituted review boards or allocated sufficient resources for community-based services (Malhotra, 2024). Similarly, procedural complexities in disability certification and poor interdepartmental coordination continue to hinder realisation of the Acts’ goals (Prakash, 2024; Math, 2019).

At the same time, India’s public health laws—notably the Epidemic Diseases Act, 1897, and the Disaster Management Act, 2005—largely focus on infectious diseases and emergency responses, leaving chronic and mental health conditions inadequately addressed (Sahoo, 2018; National Health Systems Resource Centre [NHSRC], 2023). The lack of a consolidated Public Health Act and fragmented governance between central and state authorities have further complicated the integration of mental health into public health planning (Lakshminarayanan, 2011; Sahoo, 2018).

This paper therefore seeks to explore how India’s mental-health and disability legislations interact with its public-health law regime and what this reveals about the country’s evolving understanding of the right to health. The study aims to:

1. Examine the conceptual overlaps and gaps between MHCA 2017, RPwD 2016, and public-health law;
2. Identify challenges in their implementation;
3. Propose strategies for stronger integration and community-based governance.

By situating the Indian experience alongside foreign frameworks, such as the United Kingdom’s Mental Health Act 1983 and the United States’ Americans with Disabilities Act 1990, the paper highlights comparative lessons for balancing public health imperatives with individual rights (see JPH, 2024). The ultimate goal is to advance a nuanced understanding of how law can serve as a vehicle for inclusive, equitable, and effective mental healthcare in India.

Evolution of Mental Health and Disability Legislation in India

India’s approach to mental health and disability law has undergone major transformation over the past century, reflecting evolving social attitudes, medical understanding, and human rights norms. The Indian Lunacy Act of 1912 regulated asylums rather than promoting treatment or rehabilitation (Math, 2019). This colonial framework viewed people with mental illness as subjects of confinement rather than individuals with autonomy. Post-independence, the Mental Health Act of 1987 (MHA 1987) sought reform but continued treating people with mental illness as passive recipients of care instead of rights-bearing citizens (Balakrishnan, 2019).

Parallelly, the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 (PWD Act) marked progress by recognising disability as a social issue. Nevertheless, it narrowly focused on physical and sensory impairments, excluding psychosocial and intellectual disabilities, and suffered weak implementation (Math, 2019).

India’s ratification of the UN Convention on the Rights of Persons with Disabilities (UNCRPD) in 2007 catalysed legal modernisation, demanding alignment with global standards emphasising autonomy, equality, and inclusion (Balakrishnan, 2019). This led to two landmark reforms—the Rights of Persons with Disabilities Act, 2016 (RPwD) and the Mental Healthcare Act, 2017 (MHCA).

The RPwD Act, 2016, expanded disability categories from seven to twenty-one, explicitly including mental illness, autism, and learning disabilities (Prakash, 2024). It promoted equality, accessibility, and inclusion, linking mental illness with broader disability rights (Math, 2019). However, certification hurdles still restrict access for those with invisible or fluctuating conditions (Prakash, 2024).

The MHCA 2017 replaced the 1987 Act, declaring mental healthcare a legal right enforceable against the state (Math, 2019). It introduced advance directives, the right to nominate representatives, and decriminalised suicide—a major step toward destigmatisation (Malhotra, 2024). The Act also required Mental Health Review Boards to protect patient rights and ensure accountability, reframing mental health as a legal and ethical duty (Math, 2019; Gupta, 2022).

Despite progress, implementation remains uneven. Many states have yet to establish review boards or allocate funds for community-based care (Malhotra, 2024). The RPwD Act’s benefits are also hindered by inconsistent certification and limited awareness (Prakash, 2024). Mental health continues to be treated as a niche within public health rather than its core element (Lakshminarayanan, 2011; Sahoo, 2018).

In summary, India’s shift from custodial control to rights-based governance mirrors global trends. Yet, realising these rights demands systemic investment, intersectoral coordination, and sustained public awareness.

The Mental Healthcare Act, 2017 — Rights-Based Reform

The Mental Healthcare Act, 2017 (MHCA), represents a decisive shift in India’s mental-health law from a custodial to a rights-based framework. Replacing the outdated Mental Health Act, 1987, the MHCA enshrines the right to access mental healthcare services as a justiciable legal entitlement, thereby transforming mental well-being from a matter of policy discretion to a state obligation (Math, 2019). This transition reflects India’s effort to align domestic law with international human rights commitments under the UN Convention on the Rights of Persons with Disabilities (UNCRPD), emphasising autonomy, informed consent, and equality before the law (Balakrishnan, 2019).

Key Provisions and Objectives

The MHCA’s most significant contribution lies in its recognition of mental healthcare as a right. Section 18 mandates that every person shall have access to affordable, good-quality mental-health services, regardless of socioeconomic status or geographic location. It requires the central and state governments to establish mental-health facilities, rehabilitation centres, and community-based services to ensure parity with physical healthcare. Equally transformative is the decriminalisation of suicide under Section 115, which presumes that any person attempting suicide is under severe stress and requires care rather than punishment (Math, 2019). This provision overturns the colonial legacy of criminalisation under Section 309 of the Indian Penal Code, marking a vital step in destigmatising mental distress.

The Act also empowers individuals through mechanisms of autonomy and self-determination. The right to issue an advance directive allows a person to specify treatment preferences or refuse particular interventions in the event of future incapacity (Gupta, 2022). Similarly, the right to nominate a representative ensures participatory decision-making and safeguards against coercive institutionalisation (Malhotra, 2024). The creation of Mental Health Review Boards (MHRBs) as quasi-judicial bodies further strengthens accountability, providing avenues for appeal and redressal in cases of rights violations or involuntary admissions (Gupta, 2022).

Implementation Challenges

Despite its progressive orientation, the MHCA faces formidable challenges in practice. Studies indicate that many states have yet to establish functional MHRBs, undermining the Act’s enforcement mechanisms (Malhotra, 2024). Budgetary allocations for mental-health infrastructure remain minimal—less than 1% of the total health budget—resulting in inadequate staffing, limited rural outreach, and overburdened psychiatric facilities (Math, 2019). Furthermore, bureaucratic complexity and lack of training among healthcare professionals impede awareness and compliance with the Act’s provisions.

From a qualitative perspective, service users continue to report stigma, poor accessibility, and paternalistic treatment approaches that contradict the Act’s rights-based ethos (Malhotra, 2024). Scholars argue that, in the absence of strong institutional monitoring and community-level programmes, the MHCA’s rights framework risks remaining largely aspirational (see JPH, 2024). This “implementation gap” illustrates how legal reforms alone cannot transform entrenched systemic and cultural barriers.

Integration with Public Health

The MHCA also reveals deeper structural tensions between mental-health governance and public-health administration. While the Act mandates coordination with general health services, mental health continues to function as a siloed sub-sector within India’s health bureaucracy (Sahoo, 2018). There remains limited linkage between the MHCA and broader public-health laws such as the Epidemic Diseases Act, 1897, or the National Health Mission. Consequently, preventive and community-based care models—essential for realising the Act’s vision—are underdeveloped (Lakshminarayanan, 2011).

In short, the Mental Healthcare Act, 2017, marks an important rights-based milestone that redefines state responsibility and individual autonomy. Yet, its effectiveness depends on sustained political will, financial investment, and structural integration into India’s public-health system. Without these, the promise of the MHCA risks remaining a symbolic victory rather than a transformative reform.

The Rights of Persons with Disabilities Act, 2016 — Inclusion and Accessibility

The Rights of Persons with Disabilities Act, 2016 (RPwD), complements the MHCA 2017 by situating mental illness within the broader disability-rights framework. Replacing the 1995 PWD Act, the RPwD expanded the recognised categories of disability from seven to twenty-one, explicitly including mental illness, autism spectrum disorders, and specific learning disabilities (Prakash, 2024). This marked a conceptual shift from welfare-based policy to a legal framework grounded in equality and non-discrimination, consistent with the UN Convention on the Rights of Persons with Disabilities (UNCRPD) (Balakrishnan, 2019).

A core feature of the Act is its emphasis on social inclusion and accessibility. It mandates reservations in education and public employment, protection from discrimination, and the right to appropriate government support for participation in community life. For individuals with psychosocial disabilities, the RPwD creates an important legal bridge to the MHCA by recognising mental illness as a disability that entitles one to benefits, rehabilitation, and protection from exploitation (Math, 2019).

Yet implementation remains limited. Certification procedures are often inconsistent, and many persons with fluctuating or invisible mental conditions struggle to qualify for official recognition (Prakash, 2024). The lack of coordination between health and social-welfare departments further delays access to entitlements and community-based care (Malhotra, 2024). Scholars argue that without harmonising the MHCA and RPwD through clear administrative guidelines and adequate funding, India risks maintaining two parallel systems—one focused on clinical treatment and another on social protection—without effective integration (Math, 2019; SeeJPH, 2024).

Overall, the RPwD Act strengthens India’s rights-based legal foundation but requires sustained institutional alignment with the MHCA and broader public-health governance to achieve genuine inclusion for persons with psychosocial disabilities.

Conclusion and Policy Recommendations

In conclusion, India’s legislative advances have laid a strong normative foundation for the protection and empowerment of persons with mental illness and disabilities. However, the true realisation of these rights depends on effective governance, sustained political commitment, and the recognition that mental health is integral to public health and human dignity.

Despite progressive intent, India’s implementation gap remains wide. Empirical analyses reveal persistent underfunding, lack of community-based infrastructure, and inadequate awareness among healthcare providers and local administrators (Goel, 2022; Gopikumar et al., 2021). Moreover, the disjointed application of MHCA and RPwD provisions leads to overlapping jurisdictions and confusion regarding certification, benefits, and rights enforcement. This institutional fragmentation undermines the Acts’ collective potential to deliver holistic, accessible care (see JPH, 2024).

Another enduring challenge is the stigma surrounding mental illness, which restricts disclosure, help-seeking, and community acceptance. Comparative experience from countries like the UK and Australia shows that successful reform depends not only on legal rights but also on social investment—through public education, workplace inclusion policies, and peer-led support systems (Thornicroft, 2011; Prakash, 2024).

To consolidate progress, a set of targeted policy actions is essential:

1. Inter-ministerial Coordination: Establish a unified oversight body linking the Ministry of Health and the Ministry of Social Justice to streamline MHCA and RPwD implementation, data collection, and funding.
   
   
2. Community-Based Care Networks: Develop decentralised, district-level rehabilitation centres in collaboration with NGOs and community health workers, ensuring access in rural and low-resource regions.
   
   
3. Awareness and Anti-Stigma Campaigns: Integrate mental health literacy modules into schools and workplaces to normalise mental health discourse and reduce discrimination.
   
   
4. Training and Accountability: Mandate continuous training for police, judiciary, and healthcare professionals on MHCA and RPwD rights, ensuring procedural sensitivity and legal compliance.
   
   
5. Research and Evaluation: Fund longitudinal studies to assess the socio-economic outcomes of the Acts, informing adaptive policy design and public investment priorities.
   

References

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