THE PLIGHT OF MENTALLY ILL PRISONERS: LEGAL AND SYSTEMIC GAPS

The Mental Healthcare Act, 2017, recognises the right to mental health, yet implementation remains uneven across India’s prison system. Mentally ill prisoners face systemic neglect, prolonged incarceration, and inadequate rehabilitation, highlighting the urgent need for judicial and governmental action to translate statutory rights into real-world care.

Introduction 

The Hon’ble Supreme Court of India recently recognised the right to mental health as an integral component of the right to life under Article 21 of the Constitution in Sukdeb Saha v. State of Andhra Pradesh, 2025 INSC 893. While it was in the context of a student who had been preparing for competitive exams, judicial recognition of mental health and illness becomes even more relevant in the case of mentally ill inmates, whose rights are curtailed both by incarceration and by systemic neglect. 

Statutory Framework:

The Mental Healthcare Act, 2017 (MHA) defines “mental illness” in Section 2(s) as a “substantial disorder of thinking, mood, perception, orientation, or memory that grossly impairs judgment, behaviour, capacity to recognise reality, or ability to meet the ordinary demands of life.” 

Section 3 vests the competent court with the authority to determine whether a person is of unsound mind, thereby linking the functioning of prisons and courts directly with the machinery of the MHA. Section 103 of the Act specifically directs that prisoners with mental illness be admitted into psychiatric wards in prison medical wings or transferred to a mental health establishment (MHE) with the approval of the Mental Health Review Board. 

Reality Check

On paper, the Act ensures access to treatment, protection from discrimination, and pathways for rehabilitation. But the reality, as always, is a different story. Although enacted in 2017, the basic framework of the Mental Healthcare Act remained unimplemented, or improperly implemented partially, for the next few years in most states. Recently, the Punjab and Haryana High Court came down heavily on the Punjab and Haryana governments for their failure to notify rules under the MHA ,which is key for the Act to achieve its objectives. 

There was a slew of observations by various High Courts between 2021-22, with the Kerala High Court, Patna High Court,  Delhi High Court, and Bombay High Court noting that the State Mental Health Authorities were either not established, or if established, remained largely non-functional without following the mandated annual meetings and other compliances under the MHA. The Hon’ble Supreme Court in the case of Kush Kalra v. Union of India And Ors., WP(C) No. 701/2022 issued a notice in a plea that sought for proper establishment of MHE in prisons nation-wide, along with an imparting of awareness and training to the prison staff and enforcement authorities. This plea contained stats from a RTI application that revealed that none of the 56 prisons in the 7 states which responded had an MHE. Alongside its February 2025 order directing the Union Government to file a detailed affidavit on the establishment and functioning of the Central and State Mental Health Authorities and Mental Health Review Boards under the MHA, the Supreme Court should have ideally also sought for the updated data on the number and functioning of MHEs in prisons specifically.

Baby Steps in the Form of Judicial Cognisance

Prisoners who are mentally ill face double marginalisation in the form of incarceration and being mentally ill. While even non-prisoner mental illness patients languish in mental hospitals due to a refusal of family acceptance to take them back, the situation for prisoners is understandably doubly worse as their challenges are magnified by systemic neglect. So far, it is only the Don Quixote-quoting Kerala High Court which has taken actionable steps for mentally ill prisoners on a suo motu basis, where it highlighted the peculiar troubles that mentally ill prisoners face, such as having to continue in prison or a mental health facility until they are taken in by relatives or friends voluntarily even if they may have been found eligible for discharge, bail, or acquittal. The status of undertrial prisoners was deemed to perhaps be ‘even worse’ as they might have to continue under remand until they are able to make their defence, which the Court acknowledged, never happens in some cases. The Kerala state government framed a scheme for their rehabilitation post-acquittal and sanctioned an amount of Rs. 39,660/- annually for their rehab centres. 

As noted by Kush Kalra in the 2022 petition, the mental health evaluation of prisoners at the time of admission isn’t included as a part of their medical examination. In a judicial system which claims to be reformative but has yet to fully strive toward it, the mental health aspect of prisoners should not be neglected if the end goal is their assimilation back into the society. 

Conclusion 

The Mental Healthcare Act, 2017, provides a robust framework for the treatment and rehabilitation of persons with mental illness, including prisoners, who have a higher need for mental health facilities given their social isolation. Yet, systemic gaps, right from a lack of Mental Health Establishments in prisons to lack of awareness among prison staff, leave prisoners vulnerable and impede reintegration into society. Judicial recognition, such as in Kush Kalra, marks progress, but it is high time that courts and governments stepped further from merely toe-dipping to committing both feet to the tide of reforms by ensuring their directives are realised in practice. Full implementation of statutory directives, proactive establishment of MHEs, and attention to prisoners’ broader rights are essential to transform India’s vision of reformative justice into lived reality.