Mental Healthcare Act,2017: A Framework for Ensuring Psychosocial Interventions

The National Mental Health Survey (NMHS) of India reported a lifetime prevalence of mental morbidity at 13.7%, with a current prevalence of 10.6% across the population. ¹ To address this substantial public health burden, the Government of India enacted an aspirational and rights-based legislation, the Mental Healthcare Act, 2017 (MHCA 2017). ² The preamble of this legislation lays the foundational principles for a paradigm shift in the country’s approach to mental health. It unequivocally establishes two important rights-based objectives: (a) to provide mental healthcare and services for persons with mental illness, and (b) to protect, promote, and fulfill the rights of such persons during the delivery of mental healthcare and services. ² This editorial, therefore, narrows its focus to psychosocial interventions and will examine the critical legal compliances that healthcare providers, institutions, and policymakers must navigate to ensure these interventions are not only accessible, practical, and effective but also fully respect the legal rights enshrined in the MHCA 2017.

Discussion

To Provide Mental Healthcare and Services for Persons with Mental Illness

Including the Preamble and Section 18 of the MHCA 2017 articulates a legally enforceable Right to Access Mental Healthcare (3), stating that “every person shall have a right to access mental healthcare and treatment from mental health services run or funded by the appropriate Government.” This right is not confined to pharmacological or biomedical care but extends to holistic, evidence-based, person-centered, multidisciplinary treatment approaches. Critically, this includes access to psychosocial interventions as an integral component of mental healthcare. Psychosocial interventions such as psychotherapy, family therapy, cognitive remediation, psychosocial rehabilitation, vocational training, and social skills enhancement are central to recovery-oriented and rights-based care principles. These interventions promote functional recovery and community integration and reduce the long-term disability associated with mental illness.

Despite their importance, the availability of trained mental health professionals capable of delivering these services, particularly clinical psychologists, psychiatric social workers, and psychiatric nurses, remains alarmingly scarce within the public sector in India. ³ This deficit significantly hampers the operationalization of Section 18 and undermines both the quantity and quality of service delivery under the National Mental Health Program. The situation in the private sector is equally concerning, where psychosocial services are disproportionately concentrated in urban centers.^2,3 High out-of-pocket expenses, lack of insurance reimbursement for non-pharmacological interventions, and absence of regulatory standards further restrict access. Adding to this, in India, psychiatric nurses, psychiatric social workers, and psychologists at times encounter professional resistance from specific segments of the mental health professional’s community that they are not authorized to deliver therapeutic interventions independently. Consequently, India faces a substantial treatment gap for psychosocial care, contributing to prolonged disability, delayed recovery, and an intensified burden on caregivers.

Allied and Healthcare Professions

To uphold the constitutional and statutory mandate of MHCA 2017, urgent health systems reforms are needed, including workforce augmentation, task-shifting, task-sharing, inclusion of psychosocial care in insurance schemes, and robust regulation of service standards across sectors. This can be achieved through the National Commission for Allied and Healthcare Professions Act, 2021 (NCAHP 2021), ⁴ which offers a transformative opportunity to address the psychosocial intervention gap in India by formalizing and regulating key mental health-related professions such as psychologists, clinical social workers, medical social workers, psychiatric social workers, behavioral analysts, and mental health support workers. The NCAHP 2021 standardizes education, qualifications, competencies, and ethical practices. ⁴ This creates a uniform benchmark for training and ensures quality psychosocial care across both public and private sectors, aligning with the multidisciplinary approach mandated under Section 18 of the MHC 2017. However, to ensure the efficacy and accountability of this workforce, all allied and healthcare professionals must undergo rigorous training, certification, and registration through the Allied and Healthcare Professionals Enrolment Portal. This digital platform maintains an updated national registry, facilitates licensure, and supports health system planning. The NCAHP 2021 standardizes and legitimizes the training and practice of psychosocial professionals. It supports better workforce planning and integration into national mental health services. This approach must be further strengthened through task shifting and task sharing, alongside formalizing health insurance coverage for psychosocial interventions, as part of a comprehensive strategy to expand access and uphold the right to mental health care for underserved and hard-to-reach populations. ⁵ This helps reduce the psychosocial treatment gap, especially in underserved areas. Strategic alignment with MHCA 2017, NCAHP 2021, and national programs is essential for full impact.

To Protect, Promote, and Fulfill the Rights of Persons with Mental Illness During the Delivery of Psychosocial Intervention

Human Rights Violation

Rights violations during mental health interventions for persons with mental illness are a significant concern globally, including in India.^6,7 Unfortunately, they are often brushed under the carpet. These violations often stem from inadequate oversight, training, systemic power imbalances, and outdated or nonevidence-based practices. From the psychosocial perspective, some mental health professionals continue to practice conversion therapy, which is a pseudoscientific and unethical practice aimed at changing an individual’s sexual orientation, gender identity, or gender expression. ⁸ Conversion therapy is a gross violation of human rights, lacking any scientific basis and causing significant psychological harm. Similarly, another outdated intervention is aversion conditioning therapy. ⁹ Using mild electric shock is a controversial psychosocial intervention historically used to discourage maladaptive behaviors, including addictions, paraphilias, or other behavioral issues. Its effectiveness is scientifically questionable, and its use risks trauma and coercion. The MHCA 2017 protects individuals from such degrading treatment.

Boundary Violation

Another burning issue is that boundary violations in psychotherapy represent serious breaches of ethical conduct and are particularly harmful when dealing with persons with mental illness who are inherently more vulnerable. ¹⁰ These violations may include sexual exploitation, financial abuse, emotional manipulation, or dual relationships, where the therapist assumes an additional role outside the therapeutic context. ¹¹ Each of these compromises the integrity of the therapeutic relationship and can cause long-lasting psychological harm. For instance, sexual relationships with patients are considered among the most egregious ethical violations, often resulting in profound emotional trauma, loss of trust in mental health services, and legal consequences for the perpetrator. ¹¹ The therapeutic relationship is rooted in trust and respect. When mental health professionals exploit their position of power, it undermines both individual recovery and systemic credibility. ¹² From a policy and institutional standpoint, it is essential to have stringent mechanisms to prevent, detect, and respond to boundary violations. Critical safeguards include regular ethics training, licensing oversight, mandatory reporting mechanisms, and patient education.

What We Do Not Measure, We Miss: A Systemic Oversight

Psychotherapy is widely recognized as an effective and evidence-based treatment for various mental health disorders, including depression, anxiety, post-traumatic stress disorder, personality disorders, and more. However, while the benefits of psychotherapy are well established, the potential for adverse effects or “side effects” is rarely assessed in research, ¹³ or acknowledged in clinical practice.^14,15 The prevalence varies depending on the patients, treatments, settings, assessment methods, and the type of side effect researched. ¹⁶ The adverse effects of psychotherapy can be diverse. ¹⁷ Some patients may experience a worsening of symptoms, including increased anxiety, distress, depressive symptoms, lack of perceived control over participation in therapy, and dissatisfaction during the therapeutic process. ¹⁸ Others may develop a dependency on the therapist, face disruption in relationships, or experience emotional exhaustion. Poorly conducted therapy, lack of therapist competence, boundary violations, or the use of nonevidence-based techniques can also cause psychological harm rather than benefit.^15,19 Despite these risks, discussions around the side effects of psychotherapy are often absent in routine clinical practice and also during psychosocial interventional research. One of the possible reasons may be that “survivor bias” in psychotherapy research refers to a systematic error that occurs when conclusions about the effectiveness of therapy are based primarily on the data from individuals who complete the treatment, while those who drop out or do not engage are excluded or underrepresented.

Despite being unassessed, unacknowledged, unaddressed, and underreported, adverse effects in psychotherapy have not only remained neglected but are often actively resisted by psychotherapists in clinical and research discourse, ultimately impeding the accumulation of critical safety and risk-related data in the field. However, the MHCA 2017 mandates informed consent, and ethical practice standards require that patients be adequately informed about the nature, risks, and alternatives of any treatment, including psychotherapy. The failure to disclose potential adverse effects compromises patients’ autonomy and rights and weakens the therapeutic alliance and trust. ¹⁸

Conclusions

The MHCA 2017 enshrines the right to access mental healthcare, including psychosocial interventions such as psychotherapy, cognitive retraining, family-based care, rehabilitation, and vocational support. However, a critical shortage of trained professionals has hampered its implementation, particularly in public and rural sectors. The NCAHP 2021 addresses this gap by standardizing allied mental health professionals’ training, registration, and regulation. By recognizing the roles of various health professionals, the NCAHP Act strengthens the MHCA’s vision. Together, these laws provide a robust framework for expanding accessible, ethical, and skilled mental healthcare in India. However, there is an urgent need to expand access to clinical psychotherapy-related skills training through multimodal approaches such as online, in-person, hybrid, and supervised models, and by leveraging digital technologies to ensure nationwide capacity building.