India’s Mental Healthcare Act, 2017: Building Laws, Protecting Rights

Acknowledgements
Contents
Introduction
	Abstract
	Introduction
	References
About the Authors
Abbreviations
List of Tables
Part I Mental Health Law and the Role of International Standards
1 Background to Mental Health Law
	1.1 The Pre-history of Mental Health Law
	1.2 A Timeline of Mental Health Law
		1.2.1 Poor Laws and the Protection of Property
		1.2.2 Early Residential Care
		1.2.3 The Asylum Era
		1.2.4 Deinstitutionalization
		1.2.5 Rights-Based Mental Health Law
	1.3 Political and Ideologically Driven Legislation Relating to Mental Illness
		1.3.1 Military Psychiatry
		1.3.2 Eugenics
		1.3.3 Key Events and the Protection of Society
		1.3.4 Legislation Relating to Suicide
		1.3.5 Forensic Psychiatry
		1.3.6 Marriage Laws
	1.4 Summary
		1.4.1 India’s Mental Healthcare Act, 2017
	References
2 The United Nations and Mental Health Law
	2.1 The United Nations and Human Rights
	2.2 The United Nations’ Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (1991)
	2.3 The United Nations’ Convention on the Rights of Persons with Disabilities (2006)
		2.3.1 Innovations of the Convention on the Rights of Persons with Disabilities
		2.3.2 Criticism of the Convention on the Rights of Persons with Disabilities’ Impact on People with Mental Illness
	2.4 The United Nations’ Human Rights Council
	References
3 The World Health Organization and Mental Health Law
	3.1 The World Health Organization and the International Classification of Diseases
	3.2 The World Health Organization’s Mental Health Care Law: Ten Basic Principles (1996)
	3.3 World Mental Health Atlas (2001–2017)
	3.4 The World Health Report (2001)
	3.5 The World Health Organization Resource Book on Mental Health, Human Rights and Legislation (2005)
	3.6 Mental Health and Development (2010)
	3.7 World Health Organization Mental Health Action Plan 2013–2020 (2013)
	3.8 World Health Organization QualityRights Initiative (2012)
	References
Part II Mental Health Legislation in India
4 History of Mental Health Legislation in India
	4.1 Early Mental Healthcare in India
	4.2 Early Mental Health Legislation in India
	4.3 Indian Lunacy Act, 1912
	4.4 Constitution of India, 1949 and Representation of the People Act, 1950
	4.5 India’s Mental Health Act, 1987
	4.6 Modern Indian Legislation
	References
5 India’s Rights of Persons with Disabilities Act, 2016
	5.1 Background to India’s Rights of Persons with Disabilities Act, 2016
	5.2 Provisions of the Rights of Persons with Disabilities Act, 2016
		5.2.1 ‘Preliminary’ Matters and Definitions
		5.2.2 ‘Rights and Entitlements’
		5.2.3 ‘Education’
		5.2.4 ‘Skill Development and Employment’
		5.2.5 ‘Social Security, Health, Rehabilitation and Recreation’
		5.2.6 ‘Special Provisions for Persons with Benchmark Disabilities’
		5.2.7 ‘Special Provisions for Persons with Disabilities with High Support Needs’
		5.2.8 ‘Duties and Responsibilities of Appropriate Governments’
		5.2.9 ‘Registration of Institutions for Persons with Disabilities and Grants to Such Institutions’
		5.2.10 ‘Certification of Specified Disabilities’
		5.2.11 ‘Central and State Advisory Boards on Disability and District Level Committee’
		5.2.12 ‘Chief Commissioner and State Commissioner for Persons with Disabilities’
		5.2.13 ‘Special Court’
		5.2.14 ‘National Fund for Persons with Disabilities’
		5.2.15 ‘State Fund for Persons with Disabilities’
		5.2.16 ‘Offences and Penalties’
		5.2.17 ‘Miscellaneous’
	5.3 Rights, Needs and Opportunities
	References
6 India’s Mental Healthcare Act, 2017
	6.1 Background to India’s Mental Healthcare Act 2017
	6.2 Provisions of the Mental Healthcare Act 2017
		6.2.1 ‘Preliminary’ Matters and Definitions
		6.2.2 ‘Mental Illness and Capacity to Make Mental Healthcare and Treatment Decisions’
		6.2.3 ‘Advance Directive’
		6.2.4 ‘Nominated Representative’
		6.2.5 ‘Rights of Persons with Mental Illness’
		6.2.6 ‘Duties of Appropriate Government’
		6.2.7 ‘Central Mental Health Authority’
		6.2.8 ‘State Mental Health Authority’
		6.2.9 ‘Finance, Accounts and Audit’
		6.2.10 ‘Mental Health Establishments’
		6.2.11 ‘Mental Health Review Boards’
		6.2.12 ‘Admission, Treatment and Discharge’
		6.2.13 ‘Responsibilities of Other Agencies’
		6.2.14 ‘Restriction to Discharge Functions by Professionals Not Covered by Profession’
		6.2.15 ‘Offences and Penalties’
		6.2.16 ‘Miscellaneous’
	6.3 A Vision for Change?
	References
Part III India’s Mental Healthcare Act, 2017 and International Human Rights Standards
7 India’s Mental Healthcare Act, 2017 and the World Health Organization’s Checklist on Mental Health Legislation
	7.1 Introduction
	7.2 Areas of Concordance
	7.3 Areas of Non-concordance, Omissions and Deviations
		7.3.1 Key Areas of Non-concordance
		7.3.2 Key Omissions in Areas of Generally Good Concordance
		7.3.3 Well-Justified, Progressive Deviations
	7.4 Overall Assessment
		7.4.1 Strengths and Limitations of This Analysis
		7.4.2 Summary and Conclusions
	References
8 Incorporation of the United Nations’ Convention on the Rights of Persons with Disabilities into Indian Law Through the Rights of Persons with Disabilities Act, 2016 and the Mental Healthcare Act, 2017
	8.1 Introduction
	8.2 Concordance with the United Nations’ Convention on the Rights of Persons with Disabilities
		8.2.1 Article 5: Equality and Non-discrimination
		8.2.2 Article 6: Women with Disabilities
		8.2.3 Article 7: Children with Disabilities
		8.2.4 Article 8: Awareness-Raising
		8.2.5 Article 9: Accessibility
		8.2.6 Article 10: Right to Life
		8.2.7 Article 11: Situations of Risk and Humanitarian Emergencies
		8.2.8 Article 12: Equal Recognition Before the Law
		8.2.9 Article 13: Access to Justice
		8.2.10 Article 14: Liberty and Security of Person
		8.2.11 Article 15: Freedom from Torture or Cruel, Inhuman or Degrading Treatment or Punishment
		8.2.12 Article 16: Freedom from Exploitation, Violence and Abuse
		8.2.13 Article 17: Protecting the Integrity of the Person
		8.2.14 Article 18: Liberty of Movement and Nationality
		8.2.15 Article 19: Living Independently and Being Included in the Community
		8.2.16 Article 20: Personal Mobility
		8.2.17 Article 21: Freedom of Expression and Opinion, and Access to Information
		8.2.18 Article 22: Respect for Privacy
		8.2.19 Article 23: Respect for Home and the Family
		8.2.20 Article 24: Education
		8.2.21 Article 25: Health
		8.2.22 Article 26: Habilitation and Rehabilitation
		8.2.23 Article 27: Work and Employment
		8.2.24 Article 28: Adequate Standard of Living and Social Protection
		8.2.25 Article 29: Participation in Political and Public Life
		8.2.26 Article 30: Participation in Cultural Life, Recreation, Leisure and Sport
	8.3 Overall Assessment
	References
9 Compliance of India’s Mental Healthcare Act, 2017 with the United Nations’ Convention on the Rights of Persons with Disabilities
	9.1 Introduction
	9.2 Capacity
		9.2.1 Advance Directives
		9.2.2 Nominated Representative
		9.2.3 Supported Decision-Making and Individual Will and Preference
	9.3 Involuntary Treatment
		9.3.1 Supported Admissions
		9.3.2 Treatment During a ‘Supported Admission’
		9.3.3 Emergency Treatment
		9.3.4 Restraint and Seclusion
	9.4 Other Areas of Non-concordance with the CRPD
		9.4.1 Research
		9.4.2 Privacy and Confidentiality
		9.4.3 Electroconvulsive Therapy
	9.5 Conclusions
	References
10 Adhering to Conventions: Intentional Grey Areas or Shirking Responsibility?
	10.1 Introduction
	10.2 The Role of International Bodies in Reforming Mental Health Law
	10.3 An Ethical Analysis of India’s Mental Healthcare Act, 2017’s Deviations from the World Health Organization’s Resource Book on Mental Health, Human Rights and Legislation
		10.3.1 Medical Ethics in Resource-Scarce Environments
		10.3.2 Beneficence and Definitions
		10.3.3 Autonomy and Capacity
		10.3.4 Ethics and the Evidence Base
	10.4 An Ethical Analysis of India’s Mental Healthcare Act, 2017’s Deviations from the United Nations Convention on the Rights of Persons with Disabilities
		10.4.1 Capacity and Limited Guardianship
		10.4.2 Coercive Treatments
		10.4.3 Migration, Citizenship and Nationality
	10.5 Balancing Idealism with Pragmatism
		10.5.1 Autonomy in Tension with Dignity
		10.5.2 Restriction in Tension with Ineffectual Treatment
		10.5.3 Universal in Tension with Personalized Treatment Options
		10.5.4 Ideal Treatment in Tension with Pragmatic Treatment
		10.5.5 The Individual in Tension with Society
		10.5.6 Involvement in Tension with Privacy
	10.6 Conclusions
	10.7 Directions for Future Research
		10.7.1 Understanding Coercion
		10.7.2 Reducing Coercion
	References
Part IV Where Now?—Contribution by Dr Soumitra Pathare and Arjun Kapoor
11 Implementation Update on Mental Healthcare Act, 2017
	11.1 Introduction
	11.2 Progress Under the Mental Healthcare Act, 2017
	11.3 Judiciary
	11.4 Other Developments
		11.4.1 Resistance of Mental Health Professionals
		11.4.2 Bureaucracy
		11.4.3 Political Will
		11.4.4 Human Resources
	11.5 Reflections and Conclusions
	References
Index