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Hindustan Times
21-05-2025
- Health
- Hindustan Times
Rethinking law and care for psychosocial disabilities in India
May is Mental Health Awareness Month and Borderline Personality Disorder (BPD) Awareness Month. BPD remains one of the least discussed, least understood mental health conditions in India. When I came out of my psychiatrist's office with a diagnosis of BPD, my mother seemed relieved. 'Borderline means it's not serious, right?' she asked. But nothing about how my world had been unravelling felt 'not serious.' In common parlance, the term borderline often implies ambiguity, something not quite there. But in psychiatric terms, BPD is one of the most severe and complex personality disorders, marked by chronic emotional pain, an abundance of trigger points, a fractured sense of self, a debilitating fear of abandonment, and in some cases, self-injury. The daily struggles of people living with BPD — navigating work, housing, and relationships are largely invisible in domestic, legal, clinical, and social discourse. While its symptoms vary, the core features include emotional instability, impulsivity, unstable relationships, and chronic feelings of emptiness. People with BPD have a higher suicide rate (5.9%) compared to those with other personality disorders (1.4%), with over 75% having attempted suicide in one study. BPD is also linked to various medical issues like obesity, diabetes, heart disease, chronic pain, and STDs. It often co-occurs with other personality, mood, attention, and eating disorders, as well as PTSD and substance use. Individuals with BPD tend to have shorter life expectancies and face challenges navigating the healthcare system. Yet, BPD remains poorly understood and heavily stigmatised, often weaponised in narratives that label people as toxic, dramatic, or too much. The Indian mental health discourse rarely makes space for personality disorders. Depression and anxiety dominate conversations, campaigns, and corporate wellness modules, while personality disorders like BPD remain in the shadows. Nowhere is this lack of understanding more visible than in the way Indian law approaches mental illness. Despite two relatively progressive laws — the Mental Healthcare Act, 2017 (MHCA) and the Rights of Persons with Disabilities Act, 2016 (RPWDA), the legal recognition of invisible disabilities like BPD remains patchy. The MHCA provides the right to community-based care, protection from inhuman treatment, and access to legal aid (Sections 18–28). It also emphasises capacity-based treatment and the autonomy of people with mental illness, a significant shift from paternalistic models. Similarly, the RPWDA includes mental illness under the definition of disability and affirms rights to non-discrimination, education, legal capacity, and community living. Yet, in practice, these rights remain aspirational. Both Acts lack an implementation framework for chronic, episodic, or invisible disabilities like BPD. While the RPWD Act recognises mental illness within its list of disabilities, it offers no concrete mechanism for invisible and chronic conditions like BPD to gain reasonable accommodations at work, in education, or legal settings. The revised guidelines under the RPWD Act require mental illnesses to persist for at least two years before a permanent disability certificate is issued. However, this delay can hinder early intervention, often crucial in preventing further decline in the individual's mental and social functioning. India's current system relies heavily on medical impairment rather than assessing functional limitations, which can obscure the real-life challenges individuals face. A shift toward functional assessments, in line with global standards, is needed. Notably, an expert committee of the Indian Psychiatric Society recommended a shorter, three-month treatment period before certification, to better reflect persistent disability after adequate care. First, trauma-informed care should become foundational in both clinical and legal spaces. Personality disorders like BPD are closely linked with early trauma, especially abandonment, sexual abuse, or emotional neglect. Responding with coercion or moral judgment only deepens harm. India urgently requires a substantial expansion of its mental health service infrastructure. This means increasing the number of mental health professionals and facilities, particularly in rural regions, to guarantee that everyone has access to the care they need. Second, we need legal reform. The RPWD Act must include clearer implementation pathways for those with psychosocial disabilities. Certification and access to benefits, accommodations, or legal support cannot remain a bureaucratic labyrinth. The MHCA must also ensure that its rights-based framework is meaningfully enforceable for people with invisible, non-psychotic conditions. Third, national mental health programmes must include BPD in awareness campaigns, resource allocation, and therapist training. Dialectical Behaviour Therapy, the leading treatment for BPD, is scarcely available in India and largely unaffordable. BPD is not a halfway house between sanity and madness; it is a serious, treatable condition demanding reasonable accommodation, empathy, and rights. When we narrow our vision of disability to what's visible—wheelchairs, sign language, or acute psychosis we leave many sufferers stranded in silence. Without an informed and reliable support system, it becomes a cycle of pain, shame, and further isolation. We need systems that understand us, policies that protect us, and a culture that refuses to cast us away as difficult, broken, or dangerous. This article is authored by Shailee Basu, lawyer and research fellow, Vidhi Centre for Legal Policy, New Delhi.
Time of India
19-05-2025
- Health
- Time of India
Punjab battles drug crisis, Mental Healthcare Act yet to be fully enforced
Chandigarh: Even as Punjab has waged a high-decibel war on drugs through its flagship 'Yudh Nasheyan De Virudh' campaign, the state govt has fallen short on a crucial front — the full implementation of the Mental Healthcare Act, 2017 (MHCA), which experts say is essential for effective, rights-based treatment of drug addiction. While the state made progress in expanding treatment access, with over 10 lakh individuals currently undergoing treatment at 529 govt-run outpatient opioid assisted treatment (OOAT) centres and 180 private centres, experts have flagged critical gaps in aligning de-addiction services with the provisions of the MHCA. Punjab initiated steps toward implementing the Act by establishing the State Mental Health Authority (SMHA) in 2018 and notifying the Punjab State Mental Healthcare (Standards of Care) Rules in 2019. However, full enforcement remains elusive. The Punjab and Haryana high court earlier this year had directed the state to comply with all the mandatory provisions of the MHCA, pointing to the gaps in execution. The Act, once fully implemented, ensures that drug addiction is treated as a mental health issue — not a criminal one. It promotes care over punishment, dignity over stigma, and sustainable recovery over temporary detox, while safeguarding patient rights and ensuring standardised, ethical treatment practices. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like No dark spots, 10 years younger! Just take this from Guardian URUHIME MOMOKO Learn More Undo The Indian Psychiatric Society (IPS) wrote to Punjab health minister Dr Balbir Singh, urging the govt to expedite the MHCA implementation across the state. The IPS lauded the intent behind 'Yudh Nasheyan De Virudh', calling it a timely and sensitive response to Punjab's worsening substance abuse crisis. The society also welcomed the inclusion of private sector psychiatrists in the campaign, labelling it a much-needed step toward inclusive public health reform. The Indian Psychiatric Society members, however, expressed concern over the current treatment protocols in the state, calling these "flawed and a hindrance" in treatment. They stressed that all matters regarding the treatment of addiction had to be monitored under the provision of the MHCA and not under the Narcotic Drugs and Psychotropic Substances (NDPS) Act. They also called for the routine use of evidence-based medications such as buprenorphine, in line with international standards, to ensure effective outcomes. The IPS recommended that during inspections of de-addiction centres or psychiatric facilities, any concerns involving psychiatrists should be referred to the district or state mental health review boards constituted under the MHCA. Disciplinary action, they said, should follow only after recommendations from these statutory bodies. A senior health department official said efforts were underway to implement the Mental Healthcare Act, 2017 in its entirety, and the enforcement process was expected to be completed soon. Despite repeated attempts, health minister Dr Balbir Singh could not be reached for comments. Health Department Working On Modalities (BOX) Punjab health minister Dr Balbir Singh has announced that private psychiatrists would be permitted to dispense buprenorphine and naloxone to patients undergoing treatment for substance abuse. The department has started working on the modalities. MSID:: 121271378 413 |
Mint
05-05-2025
- Health
- Mint
Not many claim mental healthcare insurance. Here's why
Mental health, after years of being overlooked in India's healthcare discourse, is finally beginning to receive the attention it needs. A major milestone in this shift was the introduction of the Mental Healthcare Act (MHCA), 2017, which came into force on 7 July 2018, replacing the outdated Mental Health Act of 1987. This Act redefined the rights of individuals with mental illnesses and made it mandatory for health insurance policies to include mental health coverage. In individual policies, psychiatric ailments are covered by default as all policies need to be compliant with relevant regulations. However, despite this legislation, a significant gap remains between policy and its implementation. Many employees are still hesitant to use mental health support at work because they are afraid of being judged or looked down upon. While some insurers impose a sub-limit on psychiatric ailments depending on the chosen plan, there are policies that cover these conditions up to the full sum insured. This contrasts with group policies, which are tailored specifically to the needs of the group. The coverage and sub-limits for group plans are determined by various factors, including budgetary provisions for health insurance, making them more flexible yet potentially less comprehensive than individual plans. With the usual age of onset of mental ailments being around 18 years, the incidence peaks at around 40 years, thereby affecting the most productive years of human life. In India, the incidence rate of common mental disorders like depressive disorders has been around 2.7 %, with a treatment gap rate of close to 85 %. This highlights the huge burden of the disease and the fact that only a very small percentage of the affected seek medical advice or have access to quality health care. Interestingly, even though mental illness-related claims for corporate employees account for less than 1% of total claims, there has been a notable 20% increase compared to last year. The most commonly reported mental health conditions include autistic disorder, conversion disorder with seizures or convulsions, unspecified anxiety disorder, phobic anxiety disorders, and depressive episodes are notable conditions. Remarkably, the top three disorders have experienced a 100% increase, which can be attributed to enhanced corporate insurance coverage and a growing willingness among employees to seek help. Although the Mental Health Act of 2017 has made it compulsory to make provisions for mental illnesses in health insurance policies, several factors continue to limit the benefits. Taboo still surrounds mental illnesses, deterring people from openly discussing or addressing their issues. Lack of awareness about early symptoms further prevents timely intervention. Even when policies do provide coverage, many come with sub-limits as low as ₹ 30,000, which makes treatment unaffordable in many cases. Also, several policies do not offer OPD cover—which is mostly the primary mode of treatment for conditions such as stress, anxiety, and depression. We have seen some progress over the years though. In 2023, the number of organisations covering psychiatric inpatient care (IPD) increased by 5%. However, psychiatric OPD coverage remains limited to just 7% of employers. Industries such as IT/ITES, manufacturing, and BFSI are leading the way, offering up to 50% of the sum insured for inpatient care and up to ₹ 25,000 for outpatient care. Another important step has been recognising substance abuse and alcohol addiction as mental health issues, so they get the proper care they need. Also, the new law (Bharatiya Nyaya Sanhita) has now fully put into effect the rule that decriminalises attempted suicide, which is another big move forward. Given the impact of mental well-being on workplace productivity and employee health, it is crucial that organisations treat mental health as a priority. Employees should be encouraged to talk about their struggles rather than suffer in silence, and access to professional help must be made seamless. Employers can play a pivotal role by organising mental health awareness sessions, investing in comprehensive insurance policies that cover both OPD and hospitalisation, and ensuring the confidentiality of employees seeking support. Expert-led training programmes, webinars, and seminars play a key role in addressing mental health challenges and breaking the stigma of mental illnesses at workplace. Additionally, with internal communication modes at firms to share mental health resources available, awareness drives, and most importantly, employee success stories can help in building a more informed and supportive workplace culture. Not only corporates, insurance brokers, too, have a significant part to play when it comes to mental health. With their knowledge of industry trends and available options, brokers are positioned in a unique way to help employers design customised and budget-friendly policies that provide sufficient mental health coverage. With their expertise, they can identify and address the disconnect between available solutions and employees' real requirements. The conversation around mental health in the workplace has begun—but it's time to turn awareness into action. By addressing stigma, increasing access to treatment, and providing better insurance support, Indian workplaces can build a culture where mental health is valued as much as physical health. The road ahead demands collective effort—from employers, policymakers, and employees—to create a supportive ecosystem for mental health at work. (Surinder Bhagat is head – employee benefits, vice president, large account practice, Prudent Insurance Brokers)
