State-level barriers to implementing the Mental Healthcare Act, 2017: Insights from Punjab, India

ABSTRACT Background: The Mental Healthcare Act (MHCA), 2017, represents a landmark legal framework aimed at safeguarding the rights of persons with mental illness in India. Despite its progressive provisions, implementation at the state level remains inconsistent, with several barriers limiting effective enforcement. Punjab, a state with significant mental health challenges, offers a critical context to explore these obstacles. Methodology: A cross-sectional and descriptive study was conducted from July 2024 to January 2025 across the urban and rural settings in Punjab. A purposive sample of 300 stakeholders – including mental health professionals, policymakers, law enforcement officials, and caregivers – was interviewed using a semi-structured questionnaire. Quantitative data were analyzed using the descriptive statistics, and qualitative data underwent thematic content analysis. The key indicators included awareness, resource availability, infrastructure, and systemic challenges to the MHCA implementation. Results: The majority of respondents (68%) reported inadequate infrastructure and insufficient trained personnel as major barriers. Over 72% indicated low awareness of MHCA provisions among frontline healthcare workers and law enforcement. Financial constraints and delays in state-level policy adoption were cited by 65% and 58% of participants, respectively. Furthermore, 55% highlighted sociocultural stigma and lack of community engagement as significant impediments. Logistic regression revealed that stakeholders from rural areas had significantly lower awareness levels compared to urban counterparts (adjusted odds ratio = 0.45; 95% confidence interval: 0.30–0.67; P < 0.001). Conclusion: Multiple systemic, infrastructural, and socio-cultural barriers hinder the effective implementation of the MHCA, 2017 in Punjab. Strengthening awareness campaigns, increasing resource allocation, and promoting community participation are vital to bridging the implementation gap. Policymakers must prioritize operationalizing the Act to ensure mental health rights are upheld.