Author: Astha Pathak

Introduction

John Stuart Mill once said, “the only freedom which deserves the name, is that of pursuing our own good in our own way.” On every Independence Day, as we celebrate India’s liberation from colonial rule, this question lingers: have we truly achieved freedom if millions of Indians still lack the ability to decide for themselves, especially in matters of mental health? Legal independence without mental independence is, in many ways, unfinished freedom.

A History of Control, Not Care

Mental health law in India has long carried the imprint of control rather than compassion. The Indian Lunacy Act, 1912, reduced individuals to “lunatics” and treated them as threats rather than rights-holders. The Mental Health Act, 1987, though an improvement, still leaned heavily on institutionalization. The Mental Healthcare Act, 2017 (MHCA), marked a radical shift by aligning with the UN Convention on the Rights of Persons with Disabilities (UNCRPD). It introduced Advance Directives and Nominated Representatives, empowering patients to chart their own treatment path. It also decriminalized suicide, acknowledging it as a health concern rather than a crime. Yet, law in text has not translated into law in action.

The Glaring Gaps Between Law and Life

Despite MHCA’s promise, ground realities remain dire. The National Mental Health Survey reports that 14% of Indians experience some form of mental disorder during their lifetime, but 83% receive no treatment due to stigma, lack of access, or systemic failure. This shows how we have failed to give importance to mental health even after 79 years of independence. India has only 0.29 psychiatrists per 100,000 people, far below the WHO recommendation of three per 100,000.

A 2023 study revealed that only 20% of patients knew they had the right to make an Advance Directive, and over 92% of psychiatrists expressed dissatisfaction with MHCA’s implementation, citing procedural delays and weak infrastructure. Even Mental Health Review Boards, designed as watchdogs of autonomy, remain absent or non-functional in most states. In 2021, the National Human Rights Commission released its Report on the Status of Mental Healthcare Institutions in India and found conditions in 46 mental hospitals “deplorable.” In simple terms, the very spaces meant to offer care and dignity often end up
stripping people of both. The mindset remains paternalistic: families or institutions often decide for patients, even
when the individual is capable of making decisions. This undermines autonomy and violates Article 21 of the Constitution, which guarantees dignity and liberty.

Intersection of Mental Health and Social Inequality

Autonomy is even more fragile when mental illness intersects with poverty, caste, and gender. For instance, Dalit women with trauma-related illnesses face triple invisibility caste bias, gender discrimination, and mental health stigma. A 2020 study in the Indian Journal of Psychiatry titled Mental Health Policy and Programmes: Addressing Gender and Caste Dimensions revealed that less than 10% of public mental health programmes address caste or gender vulnerability. In simpler terms, it means that the women who are already carrying the heaviest burdens are the very ones abandoned when they reach out for help. This silence is not just neglect, it is structural injustice. If democracy means dignity, equality, and freedom, then these communities are living on the margins of both mental health care and constitutional promise.

The Reality of Suicide in India

The tragedy of inaction is most visible in suicide data. In 2022, 1.7 lakh Indians died by suicide which is one every three minutes. Daily wage workers constituted 26% of these deaths, while students accounted for 7.6%. While MHCA decriminalized suicide, implementation has been lethargic. In Punjab, the High Court had to push the government into action five years after the Act was passed. Compounding this, India spends just 0.06–0.16% of its health budget on mental health. The National Mental Health Programme was allocated only ₹40 crore in 2018–19, a number that barely scratches the surface of India’s mental health crisis. Spending only 0.06–0.16% of the health budget and allocating just ₹40 crore in 2018–19 shows that mental health is treated as
a token concern rather than a real priority.

The Economic Cost of Neglect

Neglecting mental health is not only a rights violation but also an economic blunder. The Lancet Commission estimated that between 2011 and 2030, India could lose $1.03 trillion in economic productivity due to mental health issues if left unaddressed. Workplace stress, depression, and anxiety already reduce efficiency, yet most employers lack structured mental health policies. Investing in autonomy and support systems is not just ethical—it is economically prudent.

Emerging Youth Concerns and Education

The crisis among India’s youth is a ticking time bomb. With rising academic pressure, competitive exams, and unemployment, student mental health deserves urgent policy prioritisation. Unless the stigma around counselling is dismantled in schools and universities, India risks silencing the very generation that will carry its democratic values forward.

What Needs to Change?

To translate legal text into lived freedom, India must:

1. Raise awareness about MHCA rights through public campaigns, medical training, and legal aid.
2. Activate Review Boards in every district for genuine patient oversight. Increase funding: even 1% of the health budget towards mental health would be transformative.
3. Strengthen community-based care with peer-support and local counsellors.
4. Integrate mental health into education and workplace policies to normalise care and dismantle stigma.
5. Focus on vulnerable groups by tailoring policies for women, Dalits, Adivasis, and rural communities.
6. Leverage technology through tele-counselling platforms and AI-assisted diagnostics to bridge access gaps in underserved areas.

Comparative International Perspectives

Globally, the push for autonomy has taken stronger roots.
● Canada: Adopted “supported decision-making” models, ensuring people with psychosocial disabilities receive assistance without surrendering autonomy.
● UK: The Mental Capacity Act, 2005 provides structured mechanisms for respecting individual decisions, even when capacity is impaired.
● Australia: Community-based care and peer-support systems have significantly reduced reliance on long-term institutionalisation.
● New Zealand: The country’s “Like Minds, Like Mine” initiative integrates anti- stigma campaigns with mental health law, strengthening both legal and cultural change.
● Germany: In 2021, reforms mandated stronger patient consent protocols and independent ombudsman oversight in psychiatric treatment.

India’s MHCA draws inspiration from these models but remains trapped in underfunding, stigma, and lack of trained personnel.

Conclusion

As Mill argued, freedom means the ability to pursue our own good in our own way. Until individuals with mental health conditions are given that same autonomy, India’s independence remains incomplete. True democracy is not just about the freedom to vote but about the freedom to live with dignity, make decisions, and own one’s life. Mental independence is not a privilege, it is a right. Without it, India’s constitutional promise of liberty and dignity rings hollow.