Mental Healthcare Act, 2017

The Mental Healthcare Act, 2017 makes access to mental healthcare a legal entitlement and treats persons with mental illness as rights holders. Its rights-based framework protects autonomy, dignity and non-discrimination while regulating treatment, mental health establishments and review mechanisms. It also approaches attempted suicide primarily through care and rehabilitation rather than punishment.

Autonomy and rights during care

The Act combines supported decision-making with enforceable rights concerning access, treatment and participation in decisions.

• Section 4 presumes decision-making capacity when a person can understand relevant information, appreciate reasonably foreseeable consequences and communicate a decision.
• Under Sections 5 and 14, an adult may issue an advance directive and appoint a nominated representative.
• Sections 18-28 protect access to affordable, good-quality and geographically accessible government mental healthcare, community living, dignity, privacy, information, medical records, confidentiality and free legal services.
• Under Section 21, persons with mental illness must receive healthcare without discrimination; insurers must provide medical insurance on the same basis as for physical illness.

Treatment safeguards and accountability

Admission and treatment must satisfy statutory criteria, professional assessment and review requirements, particularly when a person needs substantial decision-making support.

• Sections 89-90 regulate supported admission through assessment, time limits and oversight by the Mental Health Review Board.
• Section 95 prohibits chaining, unmodified electroconvulsive therapy and sterilisation as treatment for mental illness. Electroconvulsive therapy for minors requires guardian consent and prior Board permission.
• Sections 96-97 require informed consent and Board approval for psychosurgery, prohibit seclusion and restrict physical restraint to statutorily permitted circumstances.
• The Central and State Mental Health Authorities register and regulate mental health establishments and specified professionals, while Review Boards deal with advance directives, nominated representatives, certain admissions and rights complaints.

Treatment of attempted suicide under Section 115

Section 115 creates a rebuttable presumption that a person who attempts suicide was under severe stress, unless the contrary is proved. Consequently, the person shall not be tried and punished under Section 309 of the Indian Penal Code for that attempt.

• As enacted, Section 115 operated notwithstanding Section 309 of the Indian Penal Code; it did not formally repeal that offence but restricted its operation through the statutory presumption.
• The presumption is rebuttable, so the protection applies unless it is proved that the person was not under severe stress.
• The provision marked a shift from treating attempted suicide primarily as criminal conduct to treating the person as requiring care and support.
• The appropriate government must provide care, treatment and rehabilitation to reduce the risk of recurrence.