The current changes to Indian mental healthcare policy warrant examination. Earlier this November, the Indian government categorized mental health illnesses as non-communicable diseases in the 12th Five Year Plan for Health. By including this group of illnesses into the official policy, the government hopes to organize action plans and targets for decreasing prevalence and increasing care. Moreover, by placing mental health alongside physical health services, legislation aims to remove the stigmatization of mental illness. This change resulted after the World Health Organization (WHO) classified mental health as a non-communicable disease in the Moscow Declaration earlier in April.
Moreover, the Mental Health Care Bill was passed by the Indian Law and Health Ministries. The new bill aims to treat patients in a more humane manner by protecting them from being placed in hospitals or asylums for more than six months and from receiving electrical shock therapy without consent. Moreover, the bill aims to restore respect and agency to the patients during the treatment process. One of the clauses in the Bill, Advance Directive, allows patients who are capable of deciding to select their course of action. By curbing the power of health professionals, the law aims to return the right to health and free will back to the patients.
After reading the bills and examining their contents, I felt optimistic that change may ensue. Ideally, through legal amendments, mental health agendas can be approached with political force and rigor. Since policy makers become bound by their words, in theory, laws have the power to create accountability, generate funds, and increase accessibility of services. But, while analyzing in-depth interviews in sites around India, I have had the opportunity to look at the broader perspectives of the Indian primary health care (PHC)-delivered mental health programs. I have noted how there is a discrepancy between the government’s expectations and the ground level situation at health centers in the past. For example, governmental rules state that there should be a certain number of trained mental health professionals in each site, but coordinators and practitioners have expressed concern about the short supply of qualified and trained individuals. Unmotivated by the government pay and incentives, trained individuals do not fill these posts. The law mandates strict stipulations, but whether they can be carried out by healthcare centers is another story.
I have begun to critically examine the extent of the influence of legislation in mental healthcare in India. What approaches must be used to translate policy to practice in low and middle income settings like India? Who will be the advocates that push to make these policies a reality? Although the government has raised mental health as a priority issue, the supporting structures and details have not been developed. As such, the legislation may not be effectively converted to policy. Future evaluations are crucial for understanding the nature of ground level transformations due to the creation of laws in mental healthcare. Only time will tell if the policy changes devised by government officials will lead to effective mental healthcare in India.
