The court said that the ultimate task is of rehabilitation cannot not be subserved by merely relocating the persons with mental illness who no longer need to be institutionalised.

Supreme court of IndiaPTI
Health Mental health Thursday, September 02, 2021 - 18:12

The Supreme Court on Wednesday expressed serious concern over the alleged violations of human rights of women in mental health institutions like tonsuring of their head and lack of privacy and asked the Centre to immediately take up the issue with the States and Union Territories (UTs) to alleviate these problems. The top court also directed all the States and UTs to ensure time bound COVID-19 vaccination of all inmates lodged in mental health institutions along with healthcare workers and others.

A bench of Justices DY Chandrachud, Vikram Nath and Hima Kohli noted that based on certain research studies conducted in 2016 by NIMHANS and National Commission for Women in 2020, it has been highlighted that the women who are institutionalised in government run mental health establishments across the country face several indignities and violation of human rights.

The issues which have been flagged in the interlocutory application are of serious concern. We direct that the Ministry of Social Justice and Empowerment shall strictly raise each of the concerns which have been expressed in the research studies and has been formulated with the States/UTs in the course of monthly monitoring that has been directed, the bench said.

The top court directed that necessary directions be issued for taking steps to ensure that the problems which have been highlighted in the study are alleviated by the state governments and UTs by taking necessary measures.

The bench took note of submission of advocate Gaurav Bansal, who has filed an interlocutory application, saying that three research studies conducted by an NGO Human Rights Watch in 2014, National Institute of Mental Health and Neuro Sciences in 2016 and National Commission for Women in 2020 have highlighted that women institutionalized in government run mental health establishments are facing several problems. He said that they are facing problems like lack of sanitary napkins, lack of privacy, tonsuring of head, lack of issuance of identity cards (like Aadhar card), lack of issuance of disability certificates and lack of issuance of disability pension. Bansal pointed out that women institutionalized in Mental Health Establishments (for treatment or rehabilitation purpose) are not allowed to keep their children with them as there is no separate mother child ward in many of the government run mental health establishments.

The top court also noted that the Union Ministry of Health and Family Welfare has requested to all the States and UTs in pursuance of the orders of the court to ensure vaccination of mentally ill persons, who are lodged in mental health establishments against COVID-19 on a priority basis.

In order to ensure, that these directions are complied with by all the States/UTs, we direct to lay down a time bound schedule for facilitating vaccination of all persons who are lodged in mental health care institutions, no later than within a period of one month from the date of receipt of this order, the bench said. It said that a progress report shall be filed by every States/UTs with the department of social justice and empowerment of the union ministry on or before October 15, 2021 explaining the steps taken, the number of persons who are vaccinated against COVID-19 in the mental health care institutions.

The bench said, the vaccination of residents must also be coupled with vaccination of all the service providers as well as healthcare professionals, and other staff associated with these institutions. It added that the progress shall be monitored by the Union government and details shall be submitted to this court, when a status report is next filed, in pursuance of the directions given in this order.

On July 6, the top court had directed the Centre to ensure that people living in mental health establishments are tested for COVID-19 and fully vaccinated at the earliest.

It had taken serious note of Maharashtra government's shifting patients lodged in mental health institutes to homes for beggars and asked it to discontinue the practice immediately saying it is counter-productive and runs against the provisions of Mental Health Act. It had noted the Union government’s assurance that vaccination of inmates would be taken up with utmost priority.

Bansal in his plea has said that around 10,000 people who are fit to be discharged are forced to live in different mental hospitals across the country due to social stigma.

Proactively set up ‘halfway homes’ for rehabilitation

In the same case, the Supreme Court also deprecated the practice by states of re-designating old-age homes and other custodial institutions as ‘halfway homes’ for people with mental illness who no longer need institutionalisation but need to be moved to another facility to be rehabilitated. The court said that re-designating existing facilities like old age homes will not “subserve the purpose of rehabilitation.” The bench said that halfway homes and rehabilitation of these people must take place proactively across the country by the states/UTs.

The top court noted that Maharashtra has decided to issue 186 persons who were overstaying in mental health care institutions to beggars' homes or other custodial institutions. It said that after the issue was highlighted by the court in its previous order, a letter was written on July 21 by the chief secretary to expedite the process of shifting these persons from homes for beggars or old age homes to halfway homes.

The bench said that a note filed by the state government indicated there were a total of 415 patients who have over stayed in mental health institutions who are now considered ‘cured’, of whom 186 were temporarily shifted to old age homes, homes for women and homes for beggars, until the establishment of halfway homes and their rehabilitation takes place.

It said the note states that on July 23, 2021, a decision was taken by Maharashtra to relocate persons who have been ‘cured’ of mental illness within three months after identifying and contacting NGOs working in the sector of mental health services. It added that until the above exercise is completed, the public health department has taken the responsibility of providing requisite facilities both in terms of medical care, counselling and other requirements.

The bench said that Maharashtra has stated that the exercise of establishing halfway homes and rehabilitation homes will be completed within six months. The modalities which have been said by the state of Maharashtra are simply pushing the patients who no longer need institutionalisation at mental health care institutions to beggar homes and old age homes. This could not amount to compliance with earlier directions of this court, the bench said.

“Now that the state has woken up to its responsibilities and has taken action, we direct the process be taken to its logical conclusion by assuring that on or before November 30, such persons are duly placed with the institutions, which are capable of meeting with their requirements of no longer needing to be in mental health institutions but needing to be placed in halfway homes, so that their rehabilitation and care can be pursued,” it said.

It directed that Maharashtra government should take steps to abide by the undertaking of setting up halfway homes, and rehabilitation homes within a period of six months. Dealing with Uttar Pradesh, the bench said that the status report filed by Union government indicates that the state government has simply followed a pattern of re-designating the old age homes in each of 75 districts, as halfway homes.

Again, this does not mark a valid discharge of its duties and obligations by the state government of complying with the direction of this court as well as provisions of the mental health care act, the bench said. It said, merely re-designating the existing homes in all the 75 districts as halfway home will only do lip service to the need of having actual halfway homes where requirements of rehabilitation are duly observed.

Set up a dashboard to track availability of institutions

The court said that the ultimate task of rehabilitation cannot not be subserved by merely relocating the persons with mental illness who no longer need to be institutionalised. “In this context the guidelines which have been issued by the Centre provide a detailed blueprint for setting up the homes and for following a social care model of rehabilitation,” it added. “We do not find any genuine progress has been made in that context though different state governments have indicated varying timelines for setting up the halfway homes.”

The court said it would be appropriate if the Union government monitors the progress and apprises the court periodically, so that it is not required to take up the case of each state individually for assessing the progress which has been made. It said the Ministry of Social Welfare and Empowerment must hold meetings every month to monitor the progress of setting up of halfway homes and for the rehabilitation of persons who no longer need to remain in mental health institutions.

The court said the Union government may set up a dashboard in which states can upload the information on a real time basis about the facilities at halfway homes, availability of institutions, capacity, occupancy and region wise distribution of halfway homes. It adjourned the matter for further hearing to the last week of December and asked the Union government to file a status report with all the details from the states and progress made in setting up of halfway homes.

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