The WHO’s 2025 rights-based guidelines call for dignity and inclusion in mental health care, but India’s system traps reform in rhetoric, not reality.

There is no health without mental health – the World Health Organisation’s (WHO) enduring reminder takes on renewed urgency today. Globally, an epidemic is unfolding, claiming lives at an alarming pace. Over 1 billion individuals across the globe are lost to suicide or continue to live with severe mental health conditions without access to adequate care. These numbers are often dismissed as statistics, but what remains unseen are the lives behind them and the structural factors that lead to such devastating outcomes. Despite this, responses remain grossly inadequate.

Every year, October 10 is observed as World Mental Health Day by the WHO, serving as yet another reminder of the urgent need for awareness and destigmatisation. The 2025 theme highlighted mental health for those at the forefront of “natural disasters, conflicts and public health emergencies.” In an era marked by war, environmental crises and public health disasters, a central question persists: can mental health be prioritised when survival itself is at stake? This raises a deeper concern – do governments treat mental health as a right or as a privilege accessible to only a few?

In India, conversations around mental health are frequently silenced or ridiculed, often equated with weakness, incapacity or madness. Such attitudes prevent meaningful public dialogue. The lack of political will is evident in parliament itself. During a debate on the Mental Healthcare Bill, 2016 (now the Mental Healthcare Act, 2017), Dr Shashi Tharoor remarked, “This is an issue of national challenge, and not something that is to be discussed on a Friday afternoon,” referring to the near-empty house – a pointed critique of the neglect shown by lawmakers.

This lack of prioritisation prompts an important question: can international directives provide the impetus for reform? It is against this backdrop that the WHO has sought to reframe mental health globally as a fundamental right and not a privilege.

WHO guidelines, 2025: mental health as a right

In March 2025, the WHO released new guidelines aligned with international human rights standards, including the Convention on the Rights of Persons with Disabilities (CRPD) and the WHO Comprehensive Mental Health Action Plan, 2013-2020, which already include proposed actions for member states and national and international partners. These guidelines call for a rights-based, person-centred and recovery-oriented approach, emphasising dignity, lived experience, non-coercive practices and community inclusion.

They also highlight the social determinants of mental health – poverty, housing, unemployment and discrimination. Divided into five modules, the guidelines address reform areas, policy processes, country-specific scenarios and strategic actions. Among these, Module 4 is particularly significant, as it underscores that localised strategies must not dilute international standards, particularly those of CRPD. Instead, they should adapt reforms to local circumstances while upholding commitments to dignity, autonomy and inclusion.

Also read: Financing Gaps, Poor Implementation Mar India’s Programmes to Tackle Mental Illness

To make this framework concrete, the WHO illustrates three case scenarios: a low-income country at the early stages of building community systems with minimal resources, a high-income country developing regional strategies centered on deinstitutionalisation and independent monitoring and a middle-income country focusing on child and adolescent mental health through cross-sectoral coordination. These examples demonstrate that while approaches differ, all converge on the principle of embedding dignity, autonomy and participation at the core of policy reform.

India’s reality within Module 4

When applied to India, these principles find partial resonance in the Mental Healthcare Act 2017 (MHCA 2017). Hailed as progressive upon its enactment, the Act recognised the right to access mental healthcare, decriminalised suicide and imposed obligations on the state to provide affordable services. It aligned itself, at least in spirit, with the CRPD by emphasising autonomy, informed consent and community-based rehabilitation.

However, the gap between legislative ambition and lived reality is striking. Eight years later, the Act functions more as rhetoric than as an enforceable law. Budgetary allocations for mental health continue to hover around 1% of the total health budget, most of which supports psychiatric institutions rather than community-based initiatives. Awareness of the Act and its rights-based guarantees is abysmally low, even among health professionals and law enforcement officials. Without adequate training and sensitisation, the Act risks becoming symbolic rather than transformative.

Structural and cultural deficits

This gap is most visible in India’s continued reliance on institutional care. Psychiatric hospitals remain the dominant providers, with negligible progress toward deinstitutionalisation or community-centred services. Severe shortage of psychiatrists, psychologists, nurses and social workers compounds the problem, with training rarely emphasising rights-based or recovery-oriented approaches.

Critically, the MHCA 2017 fails to recognise counsellors and therapists, reinforcing a psychiatrist-led biomedical model. By contrast, countries such as Australia and the UK have integrated non-medical professionals and peer-support specialists into community care, broadening access and reducing dependence on hospitals.

India also struggles with entrenched stigma. Conversations around mental health remain taboo and public awareness campaigns are sporadic and urban-centric. Rural and marginalised groups remain underserved. In contrast, Canada’s “Opening Minds” campaign demonstrates how sustained, nationwide literacy initiatives can effectively dismantle stigma across schools, workplaces, and communities.

Another challenge lies in informed consent and advance directives, progressive provisions introduced by the MHCA 2017. In practice, however, patriarchal norms and familial dominance often override individual autonomy. Women and marginalised groups may have their choices disregarded, with consent effectively exercised by male relatives. As a result, advance directives risk becoming symbolic rather than empowering. In contrast, operationalising such provisions through community education and procedural safeguards, ensuring that individual autonomy is protected against cultural and institutional pressures is proving to be a lot more effective.

Finally, weak accountability mechanisms undermine the Act’s intent. The MHCA 2017 envisioned Mental Health Review Boards as quasi-judicial bodies to protect rights. Yet many remain non-functional or under-resourced, leaving individuals with little recourse. By comparison, the United Kingdom’s Mental Health Tribunal system demonstrates how independent, well-resourced bodies can transform rights from paper promises into enforceable protections.

The failure to meet WHO’s rights-based standards arise from a combination of structural, socio-political, and cultural factors. Whilst progressive laws exist, their translation into funded and monitored programs is inconsistent. Although the MHCA 2017 was drafted with consultation, it remains unclear whether marginalised groups, persons with lived experiences, and grassroots organisations were meaningfully included.

Also read: ‘Only One Psychiatrist for 938 Inmates’: Delhi Govt Report on Deaths in Shelter Home

Mental health is further marginalised in the public health agenda, overshadowed by communicable diseases. Budgetary neglect reflects this hierarchy, and educational inequalities exacerbate this problem as low literacy translates into poor health awareness, reinforcing stigma, and deterring help-seeking. Cultural attitudes often conflate mental illness with weakness or dishonour, deepening exclusion. These structural and cultural barriers, combined with weak state capacity, create a system where progressive law exists in principle but fails in practice.

Way forward

For India, the lesson is clear: despite being a middle-income country, its mental health system has yet to prioritise youth-focused intervention, meaningful deinstitutionalisation, or independent oversight. On World Mental Health Day 2025, the Prime Minister called on people to “work collectively to create environments where conversations around mental health become more mainstream”. While the statement resonates, it is starkly at odds with India’s realities mentioned above. Sustainable change can occur only if reforms reach the grassroots, but what does this mean in a country still struggling to integrate mental health into primary health care?

For laws and policies to take effect, they must grow from the ground up through awareness and sensitisation. Grassroots literacy is the starting point. Campaigns in local languages tailored to different age groups – students, workers, caregivers – can normalise conversations and dismantle stigma. Peer and caregiver support groups offer solidarity and belonging, particularly in rural areas. Without such groundwork, even the most progressive law risks irrelevance.

Consider India’s student suicide crisis, which has nearly doubled in a span of ten years. Recently, IIT Kharagpur attempted to curb suicides by installing smaller fans in hostels – an ill-informed move that addresses the symptom and not the cause. The deeper solution lies in adapting the WHO’s middle-income scenario’s emphasis on school and community-based mental health services, including offering counselling services, safe spaces in schools and universities and crisis-referral mechanisms. Awareness must be paired with access; one without the other is ineffective.

India cannot rely solely on scarce specialists. The only scalable model is to embed mental health into primary care, as recommended by WHO. Training general practitioners and community health officers in brief, rights-based interventions can ensure earlier detection and treatment.

India must establish competency standards, ethical codes and accreditation systems to formally integrate counsellors, therapists and peer supporters within the legislation and public health system. Recognition tied to regulation will raise quality and accessibility while reducing the dominance of institutional psychiatry.

Also read: The Central Role India’s Courts Have Played to Protect People With Mental Illness

Reallocation of the budget is imperative: earmarking funds for local initiatives, publishing utilisation reports, and tying allocations to deliverables such as trained staff, community support groups, or response times. Without structural funding reform, digital programs like tele-MANAS risk widening rather than bridging the rural-urban divide.

Accountability is urgent. India must adopt measures such as pairing advance directives with community education and procedural safeguards, and activating Mental Health Review Boards in every district, with statutory timelines, public dashboards, and penalties for non-compliance. Enforcement should combine sanctions for repeated failures with technical support and commendations for compliant facilities, striking a balance between accountability and trust.

Finally, as activist Amba Salelkar observes, “There is no law that has all the answers.” Especially to address complex issues such as disability and mental health, governments must create multi-stakeholder councils at the state level, contract NGOs to run support networks and helplines and set shared indicators of success. Far from fragmenting services, such partnerships can ensure flexible, community-driven responses.

The way forward must bridge top-down policy with grassroots action, connecting the two in a rights-centric and community-anchored system. If India aligns law, funding and practice with rights, mental health will cease to be treated as a privilege and will become what it must be – a fundamental right realised in practice.

Surabhi Bhandari is an Assistant Professor of Law at Jindal Global Law School, O.P. Jindal Global University. Her teaching and research focus on mental health law and its intersections with caste, gender and migration. 

Tharika Sai S. Mohan is an advocate at the Madras High Court. Her passions include research and writing on gender justice, human rights and mental health law.

This article went live on October thirtieth, two thousand twenty five, at eight minutes past six in the evening.

The Wire is now on WhatsApp. Follow our channel for sharp analysis and opinions on the latest developments.