Rajvi Mariwala, Director, Mariwala Health Initiative (MHI) informs that mental health which has long been neglected in political manifestos, for the first time gets mentioned by few political parties
Mental health sees a landmark in 2019, with finding clear mention and provision in the Indian National Congress and the Communist Party of India (Marxist) manifestos. This is the first time mental health has been found in a political manifesto. Looking at all national party manifestos as far back as 1991 – we see that mentions and provisions for persons with disabilities and women see clear provisions but mental health has been neglected, despite facing stigma and oppression, just like vulnerable communities such as persons with disability, women and the LGBTQ community. For example, progressive steps for the LGBTQ community saw a mention for the first time in 2014, when CPI (M) included queer rights in its manifesto for 2014, followed by the Aam Aadmi Party (AAP), the Congress and the Communist Party of India (CPI). It required a coalition of campaigners with information, videos and a public petition to engage with political parties to put mental health on the map in 2019. The Bridge The Care Gap coalition had reached out to multiple parties and engaged with them over months to enable this milestone – but other major parties are still silent on mental health – an issue that affects over 150 million Indians as well as suicide being the leading cause of death among youngsters aged 10-24 in the country.
However, mental health content in both the Congress (I) and CPM manifestos signal a few significant shifts both in terms of actionable commitments and ideological content. Importantly, both commit to rights-based work on mental health with the intent to implement the Mental Healthcare Act 2017 (MHCA). The CPI(M) manifesto also vows to implement the Rights of Persons with Disabilities Act (RPD) as well as compliance with United Nations Convention on Rights of Persons with Disabilities (UNCRPD). Mental health institutions and practise has seen grave human rights violations, be the restraints of chemical and physical nature to familial violence. Such an ideological focus and paradigm shift on informed consent, patient rights, and right to community life possibly has not been seen in the overall health/ medical sector. Additionally, by promising the enforcement of the Mental Healthcare Act (MHCA), 2017 both parties signal that universal mental healthcare is a justiciable right. This means that not only is mental health a right for each individual, but also recognising that responsibility for this will be incumbent on a variety of stakeholders including the judiciary as well as law enforcement officials.
While these ideological shifts are critical, progressive and rooted in social justice— what about the actionability of these ideological premises? Crucially, both parties have promised adequate budgetary allocations for the implementation of the MHCA. According to the National Mental Health Survey (NHMS) of India, 2016, India spends less than one per cent of its entire health budget on mental health. Without this promise, the commitment by these two parties would remain on paper. Some important provisions of MHCA 2017 that are easy assess, include integrating mental health at primary, secondary and tertiary healthcare levels— which would remain a pipe dream without requisite budgetary allocations.
Secondly, the MHCA asks for constituting and functioning Central Mental Health Authority (CMHA) and state mental health authorities and mental health review boards which must oversee social audits and day-to-day implementation of the MHCA which would include complaints about human rights violations and gaps in services. Thus, the promises in the manifestos themselves have road maps as well as measures to ascertain how these campaign promises have been fulfilled. This accountability is a key premise for further progress on rights based mental health and is cause for cheer. This has been a historic year as we finally see political will to work on mental health, but, the push must remain to hold the political apparatus accountable to implement the MHCA, law of the land, in both letter and spirit.