New Delhi: In September 2023, news broke that over 1,022 women and men considered fit to be discharged were confined in mental health establishments (MHEs) across Maharashtra, with more than 300 of them institutionalised for over a decade.
Another news story suggested that 15 out of 37 individuals at the Regional Mental Hospital (RMH) in Yerawada, Maharashtra, who had recovered could not be discharged because their families refused to accept them. They had nowhere to go.
A petition filed by psychiatrist Harish Shetty, with the Bombay High Court revealed that over 350 individuals remained confined in MHEs despite being declared fit for discharge, as their applications had not been reviewed by the Mental Health Review Boards.
The National Human Rights Commission (NHRC), during visits in 2022 and 2023, discovered that over 2,000 women and men who had recovered from mental illness were still confined in various hospitals.
These included around 900 individuals across four hospitals in West Bengal.
In January 2023, the NHRC issued notices to state governments about the illegal detention of people deemed “fit to be discharged” calling the condition of these establishments “pathetic” and “inhuman”.
It expressed serious concerns over the failures of state governments to guarantee a “right to community living unfettered, unchallenged and/or without any hindrance” to those with mental illnesses, as outlined in the Mental Healthcare Act, 2017.
The Act mandates the establishment of community facilities, such as halfway homes, group homes, sheltered accommodation, and supported living arrangements.
In October 2023, the NHRC issued an advisory, directing the Centre, states and union territories to “expeditiously provide the halfway homes system” and “coordinate rehabilitation with multiple departments”.
Yet, the failure of the state and union governments to provide for these homes has led to over 1,500 women and men remaining in mental health institutions nationwide, when they should have been discharged.
On 1 September 2024, the NHRC ordered Maharashtra to submit reports on 93 individuals at the Regional Mental Hospital, Thane. They had recovered but were not rehabilitated.
Earlier this year, high courts issued notices to Punjab and Maharashtra regarding the establishment of group homes and halfway homes.
The Bombay High Court found that the individuals were not transferred to halfway homes due to lack of coordination between the State Mental Health Authority (SMHA) and the government departments.
The Court directed the SMHA to submit a comprehensive plan for rehabilitation but significant delays in responses continued.
This points to a deeper, systemic problem.
The Legal Right To Community Living
The 2017 Mental Healthcare Act guarantees the right to community living, with considerable emphasis being placed on this right during parliamentary discussions before it was passed.
There was widespread advocacy for a deinstitutionalised model, with a call to end seclusion and custodial treatment.
Politicians criticised the predecessor Mental Health Act, 1987, for its focus on institutional-based treatment and welcomed the new Act for its commitment to community-based care.
They proposed the establishment of halfway homes and other community-based alternatives, describing long-term hospitalisation as a last-resort, applicable only in extreme cases.
The 2017 Act states that a person can be discharged immediately upon request (unless opposed by a medical officer) or when deemed ‘fit for discharge’ by a mental health professional, in cases of independent patients, those who have the capacity to make healthcare and treatment decisions or require minimal support in making decisions.
For individuals with high support needs, applications for discharge are to be reviewed by a Mental Health Review Board.
The Act requires the state to then work to reunite them with their families. If the families cannot be found or refuse to accept them, they are to be transferred to halfway homes and other community rehabilitation facilities.
According to professionals, this is because individuals deemed ‘fit for discharge’ do not need hospital-based medical care but social support to avoid destitution and homelessness as they reintegrate into society.
The Act explicitly mentions that individuals cannot be confined in an MHE solely because they lack family support or due to the absence of community-based facilities as they have the right to live in society and cannot be segregated.
Yet many individuals with mental illness continue to be confined in institutions, even after being declared ‘fit for discharge’.
Cursory Compliance & Delays
The judiciary and human rights bodies have stepped in, but have not been able to change the broken system.
In 2017, Gaurav Kumar Bansal, a lawyer and activist, filed a petition in the Supreme Court about 55 women and 15 men in a hospital in Bareilly, Uttar Pradesh, who were deemed “fit to be discharged” but remained confined.
The Court directed all states to implement the guidelines framed by the department of empowerment of persons with disabilities (DEPwD) within a year and submit status reports by August 1, 2018.
The union government then framed three sets of guidelines named “Guidelines for discharge of ‘mentally cured’ or ‘fit for discharge’ patients from mental health institutions”, “Guidelines for the State Government for setting up of Rehabilitation homes” and “Deendayal Disabled Rehabilitation Scheme, Revised Guidelines”.
Bansal, in 2018, filed a contempt petition accusing various state governments of non-compliance.
During the proceedings, many states did not submit any data or status reports demonstrating compliance with the Supreme Court’s 2017 order. It was only when the Court threatened to summon officials that the governments responded.
On 23 July 2021, on directions from the Court, the ministry of social justice and empowerment (MSJE) directed state governments to establish halfway homes within six months.
To demonstrate compliance with the order, Maharashtra re-designated 75 beggar and old-age homes as halfway homes.
The Supreme Court criticised this as “lip-service” and ordered the proper establishment of halfway and rehabilitation homes, directing Maharashtra to stop the practice of transferring individuals with mental illnesses to beggar or old-age homes, as it violated the Act.
On 1 September 2021, the Court directed the MSJE to set up an online dashboard with the state-wise distribution of rehabilitation homes(RH) and halfway homes(HH), and their intake capacity and occupancy.
In January 2023, when telling the Court the dashboard had been “set up”, the MSJE attributed the delay to the state governments’ failure to provide the necessary information. The Court directed states to take up the matter with “utmost alacrity”.
Finally, in March 2023, the MSJE presented the Court with the completed dashboard.
Lack Of Data
The Court ordered the ministry to provide real-time updates on the dashboard. As of 23 October 2024, the homepage indicated that there were 415 rehabilitation and halfway homes in 34 states and union territories with a capacity of 25,981 (12,481 male and 13,500 female).
According to the dashboard, these institutions housed 20,289 individuals (9717 males and 10,572 females).
However, the main dashboard shows 589 entries for homes, many of which are duplicates. It does not provide state-wise numbers for homes and contains many discrepancies, despite several years of judicial scrutiny.
For example, most of the entries from Mizoram, Haryana and Punjab were listed multiple times, with the same halfway home name, address, intake, and occupancy.
The same issue was found in other states, such as Kerala and Tamil Nadu.
This dataset remains the only official source of information to track the establishment of halfway homes nationwide.
Limited Capacity & Low Occupancy
The MSJE’s dashboard shows that while some states, like Kerala and Tamil Nadu, have more than 100 halfway homes, several other states, such as Chhattisgarh, Jammu & Kashmir, Jharkhand, Karnataka and West Bengal, have two or less.
The homes in Kerala have a capacity of more than 10,000 and those in Tamil Nadu more than 5,000, but homes in Haryana, Jammu & Kashmir and Karnataka have the capacity to home less than 30. Homes in Andhra Pradesh and Jharkhand have a capacity of 90 each.
The data indicate that there are no halfway homes for men in Mizoram and Uttarakhand, and there are no halfway homes for women in Jammu & Kashmir.
The dashboard shows that all the homes in the Andaman & Nicobar Islands and Tripura are completely vacant.
A third of all the states and UTs have vacancy rates exceeding 50%.
Analysis of the raw data shows that multiple homes in Assam, Chhattisgarh and Rajasthan are fully vacant.
There are also homes in some states such as Bihar, Kerala, Rajasthan, Tamil Nadu and Uttarakhand, which are over-occupied, while other facilities in the state remain unoccupied.
Over 50 homes in the country don’t provide vocational training, as required by the Deendayal Guidelines.
Stuck In Institutions
The low number of homes, low capacity and low occupancy in some states suggest that either there are very few individuals in need of halfway homes or that other underlying issues exist.
The first explanation is unlikely as the dashboard shows a significant number of persons “languishing” in mental health establishments. These individuals have been deemed fit but have not been discharged or moved to halfway homes yet.
As of 23 October 2024, the homepage indicated that there are 1956 individuals with mental illnesses (1003 males and 953 females) “languishing” in MHEs.
This number, too, does not match the data on the same website.
The dashboard has 144 entries, the names of hospitals, their district names and the number of males and females “languishing” in MHEs, yet many of these are duplicates.
Additionally, some entries—specifically from Arunachal Pradesh, Delhi, Kerala, and Madhya Pradesh—contained data for halfway homes instead of MHEs.
Only 61 of the entries are of unique MHEs and show that 1643 individuals (830 male and 813 female) are “languishing” in MHEs across the country.
Despite repeated directions by the Supreme Court, the dashboard still does not contain data from MHEs in Maharashtra and Odisha.
Eight states and UTs—Andaman & Nicobar, Assam, Bihar, Chandigarh, Delhi, Nagaland, Puducherry and Tamil Nadu—reported none who need transfer.
The dashboard shows that as of 23 October, 2024, 796 persons with mental illnesses (377 males and 419 females) live in four MHEs in West Bengal, with over 200 in Kerala, 100 in Jharkhand and 70 in Madhya Pradesh.
According to officials at the DEPwD, the lack of halfway homes is a minor factor in this issue and true in only some districts.
They attribute “lags” as the main reason behind non-discharge which is why they have created the dashboard—to “monitor and reduce this time lag”.
These “lags” can vary anywhere from lack of family support, bureaucratic delays, absence of comprehensive rehabilitation plans and lack of coordination between different agencies.
Insufficient Capacity to Accommodate All
However, even if these “lags” and delays are resolved, at least eight states, Himachal Pradesh, Jharkhand, Karnataka, Madhya Pradesh, Punjab, Tripura, Uttarakhand and West Bengal, cannot accommodate all the individuals declared fit because they do not have enough homes.
As of 23 October, 2024, West Bengal has 796 people in MHEs but has space for only 88 more individuals in its halfway homes.
The homes in Uttarakhand are over-occupied with no capacity to admit men.
Tripura has only one halfway home with a capacity of 50 individuals, while it has 61 people currently “languishing” in MHEs.
This shows that not much has changed since the Supreme Court's last order in 2023.
What is needed to fix the system is genuine compliance rather than surface-level responses and for politicians to commit to providing the ‘right to community living’ under the 2017 Mental Healthcare Act.
(Ritika Goyal is a human rights lawyer and policy researcher.)
(I would like to thank Shubrojeet Nayak for his assistance with data analysis.)
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