In order to ensure proper and speedier rehabilitation of cured patients from mental health hospitals, the Bombay High Court has passed 25 directions to make the State Mental Health Authority (SMHA) fully functional and set up six additional halfway homes / rehabilitation centres in four months. The court has also directed to prepare a comprehensive protocol that’s reasonably flexible to adapt to individual needs. The plan is to be prepared within six months.
SMHA and 'Halfway Homes'
The SMHA is a nodal authority which ensures effective implementation of the Mental Healthcare Act in the state. Without an active and functional State Mental Health Authority, the Act will remain on paper. "Even after two years, the essential data is still lacking, and there is no clear road map for the rehabilitation of recovered patients," a bench of Justices Nitin Jamdar and Milind Sathaye said on Friday.
The Mental Healthcare Act provides for "Halfway Homes" for persons who no longer require treatment in more restrictive mental health establishments and they have not been accepted by their families. At present there are six halfway homes, and the state has been asked to set up additional six halfway homes to ensure the patients can exercise their right to community living. The bench has emphasised it is imperative for the State Government to fulfil its obligations concerning rehabilitation and funding for the SMHA.
The court has asked the authority to invite inputs from mental health professionals and NGOs in the field.
Till the time the plan is finalised, the HC has asked the authority to use the draft submitted earlier and make an attempt to release 50-70 patients either to families or half-way homes.
Details of petition
The court was hearing a petition by psychiatrist Dr Harish Shetty, through his advocate Pranati Mehra, highlighting the plight of patients languishing in mental hospitals despite being cured or even when they are not seriously mentally ill. The plea highlighted the case of a woman who languished in a state mental health institute for 12 years, even after being cured, as her family refused to accept her. The woman was admitted to a home in 2009 and he sought divorce in 2012. Her family abandoned her and refused to take her back. Only in 2022, the family was convinced that she was cured and she re-settled with the family.
In a detailed 94-page judgement, the HC noted: “X's (woman’s) incarceration and abandonment raised grave issues regarding apathy to the problem of mental health in the society and inefficiency of the institutional framework.”
It was only after the high court passed a series of orders in February 2022, the SMHA was made functional. It noted that at the time, even the basic framework of the socio-beneficial Mental healthcare Act of 2017 was not in place in Maharashtra.
Last December, the SMHA informed the HC that 42 patients from Pune Mental Health Hospital have been rehabilitated in Halfway Homes. Also, six patients from the Thane Mental Hospital were discharged, of these, three were reunited with their families, but the other three had to be returned to the institution as there was resistance from their families.
The judges noted that a disturbing scenario has emerged from the narration and the data presented by the authorities concerned about the various crucial issues regarding the functioning of the Act regarding rehabilitation of cured patients in the State.
Protocol for people with mental illness
The court has also dealt with aspects of rights of prisoners with mental illness and the involvement of Maharashtra State Legal Services Authority (MSLSA) and the Mental Health Review Boards. As per the Act, MSLSA has to coordinate with SMHA for jail inmates.
The HC has directed to devise a collaboration protocol and asked MSLSA to bring out an action plan for the right to legal aid of persons with mental illness. The judges have said that advisories are in place, but the same needs to be strictly implemented. “Given the large number of prisoners in Maharashtra, in principle, the proposal to sanction seven additional posts of psychologists and 6 posts of psychiatrists is approved, a timeline for issuing the final orders is required,” the court added.
Additionally, SMHA has been directed to create a website in four months which will have a feedback mechanism and protect confidentiality of individuals. SMHA will upload the final annual reports, keeping in mind the rights to confidentiality and restrictions on release of information regarding mental illness and such other sensitive data.
The state has been directed to ensure that the SMHA can function at its fullest capacity and its activities are not hampered by a lack of funds. The state government shall in future ensure that the vacancies in the State Mental Health Authority are also filled up in time, the court emphasised.
SMHA to develop protocol to train concerned persons
SMHA to develop a protocol for training all concerned persons, that is, law enforcement officials, mental health professionals and other health professionals, about the provisions and implementation of the Act.
SMHA to regularly conduct workshops and seminars to sensitise stakeholders, such as the Police Department, Child Welfare Committees, non-governmental organisations working in mental health, jail authorities, elaborated the court.
State to issue necessary directions to establish a common portal for unknown patients and all mental health establishments to upload the photos and information of unknown patients to accelerate the process of reuniting with families located anywhere in the country. This portal be made accessible only to mental health establishments, police officials and concerned government agencies.
State to examine the recommendations in the advisory issued by the National Human Rights Commission last year for implementing recommendations regarding minimum standards for mental healthcare in prisons.
All Police Authorities, the Commissioner of Disabilities Welfare, and other departments concerned and governmental and non-governmental organisations, within the ambit of their duties and functions, to cooperate with the SMHA to perform its duty under the Act and for compliance of these directions.
