What the government owes you when someone at home has a mental illness
What the government owes you when someone at home has a mental illness
There is a particular way families stand outside a government hospital OPD.
Shoulders folded slightly inward. The file held flat against the chest. Whoever has been chosen to do the talking has rehearsed one sentence in the auto on the way and is now waiting for a gap in which to say it.
I have watched this for close to a decade, and the thing that stays with me is not the waiting. Everyone waits. It is the posture. People come asking for mental healthcare the way you would ask a favour from a distant relative who once helped with a wedding. Apologetically. Half-prepared to be turned away.
They should not have to. Under Indian law, what that family is queueing for is not a favour anybody is doing them. It is theirs.
Almost nobody has told them this. That is most of the problem, and it is the part this page is trying to fix.
The short answer
The Mental Healthcare Act, 2017 makes mental healthcare a right, not charity. The government is legally required to provide it — close enough to reach, affordable, and of reasonable quality.
If the family is below the poverty line, destitute, or homeless, treatment at government establishments is free of charge. With or without a BPL card.
Medicines on the essential list are to be free at government establishments.
Insurers must cover mental illness the way they cover physical illness.
Much of the machinery to deliver this now exists. Some of it is still being built. This page covers both — what you can ask for today, and where you are likely to meet a wall.
What the law actually says
The Mental Healthcare Act came into force in 2018 and replaced a law from 1987 that was written around custody rather than care. The new one is built the other way round: it starts from the person and works outward to the state’s duties.
Section 18 is the one that matters most to an ordinary family. Stripped of the legal grammar, it says this:
- Every person has a right to mental healthcare from services run or funded by the government. Not “may apply for”. Has a right to.
- That right is defined properly. It means services that are affordable, of good quality, available in sufficient quantity, reachable geographically, and delivered without discrimination on grounds of caste, class, gender, sexual orientation, religion, disability or anything else.
- People living below the poverty line, and people who are destitute or homeless, are entitled to treatment free of any charge at government establishments — explicitly whether or not they hold a BPL card. That clause about the card was deliberate. It exists because the people who need it most are usually the people whose paperwork has gone missing.
- Medicines on the Essential Drug List are to be made available free of cost at government establishments.
- If the minimum services are not available in the district where the person lives, they are entitled to access services elsewhere, and the cost is to be borne by the government.
That last one is worth reading twice. The law anticipated its own shortfall and put the cost of the shortfall on the state rather than on the family. In practice this clause is very rarely invoked, mostly because almost nobody knows it is there.
Two other provisions are worth knowing.
Section 21 requires every insurer to make provision for insurance for the treatment of mental illness on the same basis as for physical illness. Parity, in one sentence.
Section 115 changed the position on attempted suicide. A person who attempts suicide is presumed, unless proved otherwise, to be under severe stress, and is not to be prosecuted. Families should know this plainly, because the fear of a police case is one of the commonest reasons a person is not taken to hospital in time. Taking someone for medical help after an attempt is not an act that invites punishment. It is the correct thing to do.
What has actually been built
It would be easy, and lazy, to write the next part as a list of failures. The honest picture is more interesting than that, because a good deal has in fact been constructed, and most families have no idea it exists.
The District Mental Health Programme. Running since 1996, now sanctioned across roughly 767 districts, which is the overwhelming majority of the country. The design is sound: a team at the district hospital — psychiatrist, clinical psychologist, psychiatric social worker, psychiatric nurse — running outpatient services, counselling, follow-up for severe illness, and a small inpatient unit at district level, with outreach to community and primary health centres.
Tele-MANAS. Launched in October 2022. Fifty-three cells across thirty-six states and union territories, twenty languages, free, round the clock. It has handled somewhere above thirty-four lakh calls. Video consultation has since been added, and there is an app available in twelve languages, Marathi among them. Whatever else one says about Indian mental health policy, this is a genuinely serious piece of public infrastructure and it did not exist four years ago.
Government hospitals and medical colleges. Forty-seven government mental hospitals, twenty-five institutions funded as centres of excellence, psychiatry departments at government medical colleges and at AIIMS institutions. For a complicated case, a government medical college psychiatry OPD is frequently the deepest expertise available anywhere in the region, private or public.
Insurance cover under public schemes. Mental health admissions are covered under Ayushman Bharat PM-JAY, and in Maharashtra under the state scheme. Between 2021-22 and 2023-24, over a lakh mental health admissions were authorised under PM-JAY. Families routinely assume psychiatric admission is excluded. It is not.
Mental Health Review Boards. These are the quasi-judicial bodies the Act created so that a person with mental illness, or their nominated representative, has somewhere to go if their rights are violated — a wrongful admission, an advance directive ignored, conditions in an establishment. They are chaired by a district judge or an officer of equivalent standing. Twenty-six states and union territories have constituted them. Maharashtra has, and Nashik is among the locations where a board sits.
And where it is still being built
None of what follows is a scandal. I want to be careful here, because it is fashionable to write about Indian mental health as though somebody in an office decided that people should suffer, and that is not what happened.
What happened is more ordinary and, in some ways, harder to solve. A very good law was written faster than the people to staff it could be trained and paid. That is a lag, not a betrayal. But families are living inside the lag right now, and pretending otherwise helps nobody.
Here is where the gap sits.
People. India has roughly nine thousand psychiatrists — something in the region of 0.75 for every lakh of population, against international reference figures several times that. The shortfall in clinical psychologists and psychiatric social workers is proportionally worse. You cannot legislate a psychiatrist into existence. From the day a student enters medical college to the day they can sit alone in an OPD is the better part of a decade. Even if every seat were filled tomorrow, the arithmetic takes years to move.
Where those people are. Most of them are in cities. A district may have a sanctioned DMHP post and no one sitting in it — a sanctioned post and a filled post are very different objects, and the difference is invisible from a policy document and extremely visible from a waiting room.
Rules and machinery. Only a handful of states have notified their state mental healthcare rules. Roughly a third have notified the rules governing their state authority. The fund that is meant to pay for the authority’s work exists in about a fifth of states and union territories. A board that exists on paper and a board that sits regularly, with members appointed and honoraria paid, are not the same thing.
Awareness, including ours. In one survey of Indian psychiatrists, only around a quarter of respondents knew whether the review board in their own area was actually functioning. I am not going to pretend that is somebody else’s failing. If doctors do not know, families certainly will not.
Insurance in practice. Parity has been the legal position since 2018 and was reiterated by the regulator in 2022. Compliance remains patchy. A review of over two hundred policies published in 2024 found that only about a third genuinely covered mental illness, and roughly half had no cover at all. Outpatient psychiatric care — which is where most treatment actually happens — is rarely covered by anybody.
Money. Mental health accounts for around one per cent of the health budget. And in some places allocated DMHP funds have gone unspent, which is worth sitting with for a moment, because it is not always what people assume it is.
The result of all of this is a treatment gap that the National Mental Health Survey put at somewhere above eighty per cent. Fewer than one person in five who needs care receives it.
I do not find that figure useful as a headline. It is too large to feel. What it looks like from a consulting room is much simpler: people arrive late. Not a few weeks late. Two years, five years, sometimes the better part of a decade late.
Why arriving late matters more in psychiatry than people think
In most of medicine, waiting means suffering for longer. That is bad enough.
In psychiatry, waiting often changes the shape of the problem itself.
An episode that goes untreated does not simply pause and resume. Things happen during it. Work is lost. Education stops, sometimes permanently. A marriage takes damage that outlasts the illness. The person’s own confidence in themselves erodes, and that erosion is its own clinical problem afterwards.
There is a second thing, less discussed. A family’s energy is finite. By the time many families reach a psychiatrist, they have already spent two years, most of their savings, and nearly all of their hope on other doors — a temple, a healer, a general physician who did what he could, a private hospital that took the money and did not have the expertise. They arrive at the right place exhausted, and exhausted families find it harder to sustain the follow-up that treatment actually requires.
I am not going to attach a number to how much earlier treatment helps, because the honest answer is that it varies enormously between people and between illnesses. But the direction is not in dispute among anyone who does this work. The delay is not neutral. It is part of the clinical picture.
Which is why a gap in the system is not merely an administrative matter. It writes itself into people.
A fictional composite, not a real patient
The following is invented. It is assembled from patterns I see repeatedly, and does not describe any individual.
A family from a taluka a couple of hours from Nashik. Their son is twenty-four. He stopped going to work, then stopped leaving the room, then stopped bathing. He talks, at length, to people who are not there.
Over two years they tried a temple, then a healer who was recommended warmly by a neighbour, then a general physician who gave something to help him sleep and, to his credit, said he was out of his depth. Then a private hospital in the city, where they spent an amount that meant selling the buffalo.
Nobody, in two years, mentioned that the district hospital had a psychiatrist sitting there on fixed days. Nobody mentioned that the medicines would cost them nothing. They eventually learned it from a cousin of a neighbour.
He is in treatment now. That part is fine. But the two years took his job and the family’s savings, and neither of those comes back because a diagnosis was finally made. That is the cost of the information gap, and it is paid by people who did nothing wrong.
What to do with what exists today
Government options first, because they are the ones people are least often told about and because for a great many families they are the only realistic ones.
- Start at the district hospital. Ask specifically for the District Mental Health Programme OPD — many counter staff know it by the programme name rather than as “psychiatry”. Ask which days the psychiatrist sits. Write the days down. In much of Maharashtra, this is a fixed weekly schedule, not a daily one.
- Ask about free medicines. Essential-list medicines are meant to be provided free at government establishments. Ask directly. Do not assume you will be told.
- Use Tele-MANAS — 14416 or 1800-891-4416. Free, twenty-four hours, available in Marathi. It is not only for emergencies. “We do not know what this is or where to go” is a completely legitimate reason to call, and it is the question they are best at.
- For anything complicated, consider the psychiatry OPD at a government medical college. Long wait, deep expertise. For a case that has already confused several doctors, that trade is usually worth it.
- Before assuming an admission is not covered, check. If the family has PM-JAY or the Maharashtra state scheme, mental health admissions fall within scope. Ask the hospital’s scheme desk in as many words.
- If a private insurer refuses a mental illness claim, know that the legal position is parity, and that this has been the regulator’s stated requirement since 2018. Get the refusal in writing. The routes that exist from there are the insurer’s own grievance officer, then the regulator’s grievance channel, then the Insurance Ombudsman. I am a doctor and not a lawyer, and anything beyond that is properly a question for someone qualified to answer it.
- If someone’s rights are violated inside an establishment — admitted without proper process, an advance directive ignored, information refused to a nominated representative, conditions that are not acceptable — the Mental Health Review Board is the body built for exactly that. It is not a court and you do not need a lawyer to approach it. The State Mental Health Authority can tell you which board covers your district and where it sits.
The part that actually helps
When a public system is thin, the instinct of anyone who can afford it is to go around it. Those families come to people like me, and I am paid for that. I would be talking nonsense if I claimed to have no stake in what I am about to say.
But here is the thing that I think is genuinely true anyway.
When everyone with means routes entirely around the government system, the attendance numbers at those services stay low. And low utilisation is precisely the argument that gets a vacant post left vacant, and an allocated budget left unspent. Somewhere in a district office, unspent funds become evidence that the demand was never really there.
It was there. It was sitting in a temple courtyard, or in a private hospital that could not help, or at home for two years.
So use the thing. Walk into the district hospital and ask, even on a day when you could afford elsewhere. Ask when the psychiatrist sits. Ask why the post is vacant if it is vacant. Ask whether the review board meets. None of these are confrontations, and none of them require anger. They are the ordinary business of a public service, which improves in exactly one way: by being used, and by being watched while it is used.
And a word to my own profession, since it would be dishonest to write all of this and put the work entirely on families. Register properly. Sit on the boards when asked. Send trainees to district postings and treat those postings as real work rather than a punishment. The gap between the law and the ground is not only the state’s to close.
The last thing
I do not think anger is the answer here. Anger at a district hospital that is short of three staff does not staff it.
But I do not think patience is the answer either, if patience means silence.
The law already says what you are owed. It has said so since 2018. Most families have simply never been told, and so they queue apologetically for something that was written down as theirs.
That is the whole problem. It is also, oddly, the cheapest part of it to fix — because it costs nothing at all to tell a family that the door they are standing outside is one they are entitled to walk through.
Sources
- The Mental Healthcare Act, 2017 — Sections 18, 19, 21, 73, 74, 77 and 115. Government of India.
- Directorate General of Health Services, Ministry of Health and Family Welfare — National Mental Health Programme and District Mental Health Programme.
- Ministry of Health and Family Welfare — replies in Lok Sabha and Rajya Sabha on the National Tele Mental Health Programme, District Mental Health Programme coverage, and the constitution of State Mental Health Authorities and Mental Health Review Boards.
- Insurance Regulatory and Development Authority of India — circular on providing cover for mental illness under health insurance policies, October 2022.
- National Mental Health Survey of India, 2015-16 — National Institute of Mental Health and Neuro Sciences, Bengaluru.
- Zoya S, Jagannathan A, Sivakumar T, Padmavati R. Status of inclusion of mental illness under health insurance coverage in India — an exploratory study. Indian Journal of Psychiatry, 2025.
- Centre for Mental Health Law and Policy — tracker on implementation of the Mental Healthcare Act, 2017.
- Maharashtra State Mental Health Authority, Commissionerate of Health Services, Government of Maharashtra — notifications regarding Mental Health Review Boards.
If you need help right now
Tele-MANAS — 14416 or 1800-891-4416. Free, twenty-four hours a day, available in Marathi.
If there is immediate danger to life, go to the nearest hospital casualty department, or call 112.