Stigma, inclusion and India’s Mental Healthcare Act 2017
| Pages | 199-205 |
| Date | 05 September 2019 |
| DOI | https://doi.org/10.1108/JPMH-02-2019-0021 |
| Published date | 05 September 2019 |
| Author | Richard M. Duffy,Gautam Gulati,Niket Kasar,Vasudeo Paralikar,Choudhary Laxmi Narayan,Avinash Desousa,Nishant Goyal,Brendan D. Kelly |
| Subject Matter | Health & social care |
Stigma, inclusion and India’s Mental
Healthcare Act 2017
Richard M. Duffy, Gautam Gulati, Niket Kasar, Vasudeo Paralikar, Choudhary Laxmi Narayan,
Avinash Desousa, Nishant Goyal and Brendan D. Kelly
Abstract
Purpose –India’s Mental Healthcare Act 2017 provides a right to mental healthcare, revises admission and
review procedures, effectively decriminalises suicide and has strong non-discrimination measures, among
other provisions. The purpose of this paper is to examine Indian mental health professionals’views of these
changes as they relate to stigma and inclusion of the mentally ill.
Design/methodology/approach –The authors held nine focus groups in three Indian states, involving 61
mental health professionals including 56 psychiatrists.
Findings –Several themes relating to stigma and inclusion emerged: stigma is ubiquitous and results in
social exclusion; stigma might be increased rather than remedied by certain regulations in the 2017 Act;
stigma is not adequately dealt with in the legislation; stigma might discourage people from making “advance
directives”; and there is a crucial relationship between stigma and education.
Practical implications –Implementation of India’s 2017 Act needs to be accompanied by adequate service
resourcing and extensive education, including public education. This has commenced but needs substantial
resources in order to fulfil the Act’s potential.
Social implications –India’s mental health legislation governs the mental healthcare of 1.3bn people, one
sixth of the planet’s population; seeking to use law to diminish stigma and enhance inclusion in such a large
country sets a strong example for other nations.
Originality/value –This is the first study of stigma and inclusion since India’s 2017 Act was commenced
and it highlights both the potential and the challenges of such ambitious rights-based legislation.
Keywords Stigma, Inclusion, India, Human rights, Psychiatry, Mental health legislation
Paper type Research paper
Introduction
People with mental disorders commonly experience loss of liberty, social exclusion, stigma and
denial of human rights (Kelly, 2016). As a result, the role of legislation in relation to the mentally ill
requires careful and ongoing attention to ensure that it facilitates treatment, maximises liberty,
minimises suffering, and is equitable, proportionate and fair.
This issue came into new focus in 2006 following the United Nations’Convention on the Rights of
enjoyment of all human rights and fundamental freedoms by all persons with disabilities”,
including “those who have long-term physical, mental, intellectual or sensory impairments which
in interaction with various barriers may hinder their full and effective participation in society on an
equal basis with others”(United Nations, 2006). In 2017, the World Health Organisation
emphasised the “vital role”of law in “advancing the right to health”(World Health Organisation,
2017), further underlining the need for countries to ensure that their mental health legislation is
up-to-date, effective and focussed on human rights, including the right to treatment.
Against this background, the commencement of India’s Mental Healthcare Act 2017 in
May 2018 is a powerful, if complex,example of potentially positive change (Narayan and Shekhar,
2015; Kalmegh et al., 2018; Mishra and Galhotra, 2018; Duffy and Kelly, 2017a,b, c, 2019a).
Received 7 February 2019
Revised 7 February 2019
Accepted 12 March 2019
Conflicts of interest: there are no
potential conflicts of interest.
Research funding: no funding was
received for this project.
Richard M. Duffy is based at
Trinity College Dublin, Dublin,
Ireland.
Gautam Gulati is based at the
University of Limerick,
Limerick, Ireland.
Niket Kasar and Vasudeo
Paralikar are both based at KEM
Hospital Research Centre,
Pune, India.
Choudhary Laxmi Narayan is
based at AN Magadh Medical
College, Gaya, India.
Avinash Desousa is based at
Lokmanya Tilak Municipal
General Hospital and Medical
College, Mumbai, India.
Nishant Goyal is based at
Central Institute of Psychiatry,
Ranchi, India.
Brendan D. Kelly is based at
Trinity College Dublin,
Dublin, Ireland.
DOI 10.1108/JPMH-02-2019-0021 VOL. 18 NO. 3 2019, pp. 199-205, © Emerald Publishing Limited, ISSN 1746-5729
j
JOURNAL OF PUBLIC MENTALHEALTH
j
PAG E 19 9
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