21-05-2025
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.
