1. Introduction and applicability
In India, mental health professionals (MHPs) and advocates are guided by a range of legislation, including the Indian Constitution, human rights-related parliamentary laws, the Mental Health Care Act (MHCA) of 2017, and international conventions and codes of ethics. These laws and conventions aim to ensure that mental health advocacy follows ethical standards and upholds the highest ideals of psychology.
However, there is currently no statutory “Code of Practice” (CoP) to complement the MHCA and clarify legal terms and provisions for stakeholders involved in addressing mental health issues in India. To address this gap, wmh.care is working to systematically define the rights and responsibilities of stakeholders and develop a code of ethics that outlines guidelines and best practices for integrity and professionalism in psychology and psychiatry.
In India, mental health professionals and advocates are guided by various legislation, including the Indian Constitution, human rights-related laws, and the Mental Health Care Act (MHCA) of 2017. However, there is no statutory “Code of Practice” (CoP) to complement the MHCA and clarify legal terms and provisions for stakeholders.
Wmh.care aims to address this gap by defining the rights and responsibilities of stakeholders and developing a code of ethics for psychology and psychiatry. This ethical code covers activities related to mental health rights, care, and treatment across various contexts, including clinical practice, research, education, and administration.
While the prescribed ethics code aims to establish higher standards of conduct, it does not form the basis of civil liability. It serves to protect the autonomy and rights of patients and guide mental health practitioners in their duties. Violations of these standards may lead to charges of unethical professional conduct.
2. Who is authorized to offer mental health services?
In India, the framework for mental health rights and treatment involves numerous stakeholders operating under the Constitution, parliamentary laws, and government directives. Mental Health Professionals (MHPs) administer diagnosis and treatment under the oversight of policymakers, central and state mental health authorities, courts, medical officers, and licensed mental health facilities.
As per the MHCA, the following Mental Health Professionals (MHPs) can provide mental health care services in India:
- Psychiatrists with a valid license
- Clinical psychologists with a valid license
- Psychiatric social workers with a valid license
- Human rights workers with a valid license
- Mental health nurses with a valid license
- Medical professionals registered in the central or state medical register
- Mental health professionals registered in the central or state medical register
- Mental health establishments with a valid license
- Medical or non-governmental or non-profit establishments with a valid license
3. Duties of mental health professionals
Desai, in his editorial essay, “Responsibility of Psychiatrists: Need for Pragmatic Idealism,” discusses the fundamental principles outlined in the landmark code of ethics for mental health professionals. He emphasizes the etymological basis of “responsibility” as the “ability to respond.” These principles include:
- Competence: The need for mental health professionals to master their tasks.
- Ethical behavior: The requirement to uphold ethical standards within the medical field.
- Accountability: The obligation to be accountable to the public.
- Advocacy: The responsibility to advocate for the mentally ill.
While various codes of ethics exist globally, they are generally based on universal medical ethics with minor adjustments to fit specific legal requirements. However, it is suggested that mental health professionals should tailor their duties and responsibilities to suit the specific needs of their environment. As mental health gains recognition as a fundamental right and a scientific discipline for alleviating psychological distress, the responsibilities of mental health professionals become increasingly crucial.
The duties of mental health professionals fall into professional, legal, ethical, and social categories. These are detailed below:
I. Professional responsibilities
The primary professional duty in mental health, as in any field, is competence. Mental health professionals must possess the necessary academic qualifications and skills to assist individuals with mental health conditions. They should adhere to professional protocols, avoid conflicts of interest, and prioritize the welfare of clients over personal gain. Additionally, they must continually enhance their professional expertise to meet the evolving needs of mental health care. However, psychiatry and mental health as disciplines are often characterized by ambiguity in their approaches and practices, including:
A. “Pseudoscientific” Profession
Misconceptions and misinformation often label the fields of psychiatry and psychology as unscientific or lacking empirical rigor. These misconceptions stem from perceptions of the professions as soft-skilled or experimental, and from a perceived lack of strict penalties for unprofessional behavior. In regions where mental health awareness is still developing, such as many developing countries, barriers to professionalism include a lack of standardized mental health disorder classification, a lower prioritization of mental health, and the imposition of Western-oriented mental health systems on different cultural contexts. This can lead to unscientific treatment practices, including misdiagnoses, stigma, unsafe treatment methods, and overuse of pharmaceuticals.
B. Practice without Prescription
Research, treatment, and services in the field of mental health are relatively new, leading to a lack of adequate frameworks in many developing and developed countries. The rapid advancements in theory and practice, coupled with technological progress and interdisciplinary interactions, make navigating a career path and achieving professional growth challenging. There is a scarcity of channels and tools for individuals aspiring to become mental health professionals, as well as a lack of uniform standards for qualifications and a dearth of monitoring mechanisms for maintaining standards. This situation is exacerbated by the absence of a comprehensive research agenda, insufficient data on treatment outcomes, and a shortage of skilled professionals and mental health infrastructure.
Furthermore, there is a lack of clear guidelines for implementing sustainable community health care programs, with existing programs often being based on Western models. Many mental health professionals in these programs are imported from Western countries and may be unfamiliar with the values, language, and culture of the communities they serve. Additionally, mental health treatment is often expensive in economically disadvantaged nations, making it inaccessible to many. This can widen the treatment gap and contribute to unscientific and misdiagnosed practices.