Introduction:
The Kerala High Court has expressed serious concern over the continuing conditions in the State’s Mental Health Centres and indicated that it is considering a comprehensive social audit of such institutions to ensure transparency, accountability and protection of the fundamental rights of persons undergoing treatment or institutional care.
The observations were made by a Division Bench comprising Justice Devan Ramachandran and Justice Basant Balaji while hearing The High Court Legal Aid Committee v. The State of Kerala and Others, W.P.(C) No. 16603 of 2026. The proceedings form part of an ongoing public interest litigation concerning the conditions prevailing in mental health institutions in Kerala.
The PIL traces its origins to 1996 and was initiated pursuant to directions issued by the Supreme Court in Sheela Barse v. Union of India, a landmark proceeding concerning the rights and treatment of persons confined in custodial and institutional settings. The long-running proceedings before the Kerala High Court have continued to focus attention on the conditions in mental health establishments and the State’s responsibility towards persons who are among the most vulnerable sections of society.
The latest hearing assumed particular significance because the Division Bench had itself visited three Mental Health Centres located at Thiruvananthapuram, Thrissur and Kozhikode. The visits were undertaken to ascertain the actual conditions prevailing within the institutions rather than relying solely upon reports or submissions placed before the Court.
Following those inspections, the Court had issued directions intended to secure urgent improvements. However, at the hearing on September 1, 2026, the Bench expressed dismay that its earlier directions appeared not to have produced any meaningful change on the ground.
The Court described the situation observed during its visits as deeply disturbing and expressed the view that the human rights concerns within the centres were sufficiently serious to require immediate State intervention.
The Bench also questioned whether the secrecy surrounding the functioning of these institutions had contributed to the lack of accountability. According to the Court, members of the public and even the press had little or no access to what was occurring inside the centres. The Bench indicated that such a situation could allow violations of rights, whether intentional or otherwise, to continue without adequate scrutiny.
It was in this context that the suggestion of conducting a social audit of all Mental Health Centres in Kerala came before the Court.
The suggestion was made by the learned amici curiae assisting the Court. It contemplated allowing carefully regulated or supervised access to the centres, including restricted access for members of the press. The purpose would not be to compromise the privacy or dignity of patients, but to introduce an additional layer of independent scrutiny into institutions that ordinarily operate away from public view.
The Court indicated that it would keep the proposal under consideration and potentially act upon it at a later stage.
The issue presents a delicate balance. Persons receiving mental healthcare are entitled to privacy, dignity and protection from public exposure. At the same time, privacy cannot be transformed into complete institutional secrecy, particularly where allegations or judicial observations suggest that human rights may be at risk.
The Bench’s remarks reflected precisely this tension. It questioned whether the invocation of privacy and confidentiality had been used to such an extent that there was virtually no external accountability.
The Court’s concern was not directed merely at physical infrastructure. Its observations encompassed the broader manner in which patients were being treated and the extent to which their basic human rights were being respected.
The Bench went so far as to remark orally that the centres, as they presently functioned, could not meaningfully be described as health centres if the conditions observed during the judicial inspections continued to exist.
At the same time, the Court acknowledged the efforts of doctors and nurses working within the institutions. The Bench recognised that healthcare personnel had themselves been working under extremely difficult conditions and commended their efforts to sustain the system despite its deficiencies.
The Court nevertheless made it clear that the dedication of individual medical professionals cannot absolve the State of its institutional responsibilities.
The constitutional obligation to protect human dignity extends to persons with mental illness just as it does to every other citizen. Institutionalisation cannot result in the suspension of fundamental rights. Persons receiving mental healthcare remain entitled to humane treatment, bodily integrity, dignity and conditions compatible with their basic human existence.
The proceedings therefore raise important questions concerning the relationship between mental healthcare, institutional accountability and constitutional rights.
The Court has also requested the Advocate General to represent the State in the matter, indicating the seriousness with which it is treating the issue and the need for an effective response from the highest level of the State’s legal representation.
The development follows another significant intervention by the Court in the preceding month, when it sought the State’s response to a suggestion that the expression “Mental Health Centres” itself be reconsidered. The proposal was aimed at addressing the stigma that may be associated with the terminology and exploring whether a more dignified nomenclature would better reflect the nature of modern mental healthcare.
The latest observations consequently form part of a broader judicial effort to examine not only the physical conditions of these institutions but also the manner in which persons receiving mental healthcare are perceived, treated and protected.
Arguments of the Parties:
The proceedings before the Kerala High Court are in the nature of continuing public interest litigation, and the Court has been assisted by learned amici curiae in examining the conditions of the Mental Health Centres. The concerns placed before the Court have centred on the need to improve institutional conditions, protect patients’ rights and ensure that State authorities comply with the directions issued by the Court following its inspections.
The amici curiae suggested that a social audit could provide an effective mechanism for assessing the functioning of Mental Health Centres from a perspective broader than routine governmental inspection. The suggestion included the possibility of allowing persons from civil society and members of the press to obtain restricted or supervised access to the institutions.
The underlying rationale was that independent observation could help bring greater transparency to institutions where patients may be unable to independently advocate for themselves. A social audit could potentially examine the actual conditions of accommodation, sanitation, treatment, staffing, patient care and respect for basic rights.
The suggestion for media access was not necessarily presented as unrestricted entry into patient areas. The proposal contemplated restricted or supervised access, thereby allowing the concerns of transparency and privacy to be balanced.
The amici’s suggestion also arose against the background of the Court’s own inspections. Having personally witnessed the conditions inside the centres, the Bench was in a position to assess whether the State’s assurances and reports corresponded with the realities observed on the ground.
The Court’s own observations indicated that it believed substantial deficiencies remained.
The State, meanwhile, was expected to respond to the directions previously issued by the Court and to explain the steps taken to improve the conditions in the three centres inspected by the Bench. The Court’s remarks make clear that it was dissatisfied with the apparent lack of implementation.
The State’s position was particularly significant because the Court had already provided time for corrective action following its inspections. The Bench noted that its visit to the first centre had taken place more than a month earlier, yet it did not see corresponding improvement at ground level.
The Court therefore expressed concern that its earlier directions were not being taken with the seriousness expected of a State administration responding to judicial findings concerning human rights.
The State also had to address the broader question of institutional secrecy. Mental healthcare necessarily involves confidentiality, and information concerning patients’ medical conditions cannot simply be made publicly available. However, the existence of legitimate confidentiality requirements does not necessarily mean that the institutions themselves should be immune from independent scrutiny.
The proceedings therefore involve a balancing exercise between two competing considerations: protecting the privacy and dignity of persons receiving treatment and ensuring sufficient transparency to prevent abuse and neglect.
The Court’s observations suggest that it considered the existing level of secrecy to have gone beyond what was justified. The Bench questioned the practical benefits of keeping the institutions entirely inaccessible to external observers when such secrecy had apparently not resulted in improved conditions for patients or other persons present at the centres.
The Court also recognised that healthcare professionals working within the centres should not themselves be unfairly blamed for systemic shortcomings. The Bench specifically acknowledged that the doctors and nurses had made significant efforts despite the difficult circumstances.
This distinction is important. Institutional deficiencies can arise from inadequate infrastructure, staffing, resources, administrative supervision and policy failures, rather than from the conduct of individual healthcare workers.
The constitutional responsibility, however, rests ultimately with the State to ensure that institutions under its control operate in a manner consistent with fundamental rights.
The Court’s concern was therefore directed towards systemic conditions rather than merely individual acts.
The petition itself represents the larger public interest in ensuring that persons with mental illness are not forgotten or treated as invisible members of society. Institutional care can create a significant power imbalance because patients may have limited ability to communicate their grievances, approach courts or demand improvements in their living conditions.
This makes independent monitoring particularly important.
The Court’s consideration of a social audit can accordingly be understood as an attempt to introduce an additional accountability mechanism where conventional inspection and administrative oversight may not have produced sufficient results.
The involvement of the press was similarly considered as a possible means of breaking institutional isolation. The Court did not indicate that journalists should have unrestricted access to patients or confidential medical information. Rather, the observations concerned restricted or supervised access capable of allowing independent observers to see the conditions prevailing within the institutions.
The State would therefore have to reconcile the proposed transparency measures with its statutory and constitutional duties concerning patient privacy.
Another issue emerging from the proceedings is the language used to describe institutions providing mental healthcare. The Court had previously sought the State’s response to a proposal to rename Mental Health Centres to remove the stigma associated with the terminology.
This indicates that the Court’s approach is not limited to physical infrastructure. It is also concerned with dignity, social perception and the manner in which institutional mental healthcare is conceptualised.
The Court’s continuing supervision has thus brought together questions of human rights, healthcare administration, privacy, institutional accountability and social stigma.
Court’s Judgment:
The Division Bench of the Kerala High Court, comprising Justice Devan Ramachandran and Justice Basant Balaji, expressed grave concern over the conditions prevailing in the State’s Mental Health Centres and indicated that it was considering a social audit of all such centres.
The Court recorded the suggestion made by the learned amici curiae that a social audit should be conducted, with even members of the press being granted restricted or supervised access to the institutions.
The Bench stated that it would keep the proposal in mind and act upon it in due course. The Court’s reasoning was rooted in its concern that the existing approach of maintaining secrecy had not produced tangible benefits for patients or other persons within the centres.
The Court’s observations were particularly strong because they followed direct judicial inspections.
The Bench had personally visited the Mental Health Centres at Thiruvananthapuram, Thrissur and Kozhikode. Such inspections enabled the judges to see the conditions prevailing inside the institutions firsthand.
After those visits, the Court had issued directions requiring urgent improvement. However, when the matter returned for consideration, the Bench observed that its earlier directions appeared not to have been complied with adequately.
The Court described the apparent non-compliance as an “abject shame” if the conditions remained as observed. It emphasised that the situation witnessed during the inspections was sufficiently disturbing that the Bench had initially restrained itself in the expectation that the Government would respond appropriately after being given some time.
The Court noted, however, that more than a month had passed since its first inspection without sufficient visible improvement.
This led the Bench to question whether its directions were being taken seriously.
The Court also connected the lack of progress with the institutional secrecy surrounding Mental Health Centres. According to the Bench, the absence of access for external observers, including the press, could create an environment in which violations of human rights remain hidden.
The Court was particularly concerned that such violations might occur even unintentionally or unwittingly. Regardless of intent, however, the State remains responsible for ensuring that persons under its institutional care are treated with dignity and that their rights are protected.
The Court’s observations demonstrate the constitutional dimension of the proceedings. The Bench made it clear that a constitutional court cannot simply turn away from serious allegations or findings of human rights violations within State-controlled institutions.
The constitutional guarantee of life and personal liberty under Article 21 has long been understood as encompassing the right to live with dignity. Persons suffering from mental illness do not lose that entitlement merely because they require institutional treatment or are unable to live independently.
The Court’s intervention is therefore grounded in the principle that institutional care must remain compatible with human dignity.
The Bench’s oral observations were particularly forceful in describing the conditions witnessed during its visits. It questioned whether the institutions could genuinely be regarded as health centres if patients continued to experience conditions inconsistent with basic human rights.
The Court also observed that the conditions could not be ignored merely because the persons affected were among the most vulnerable members of society.
The remarks concerning transparency were equally important. The Court questioned the use of privacy as a justification for preventing all external scrutiny. Privacy is undoubtedly an essential component of the dignity of persons receiving mental healthcare. Medical information, personal histories and treatment details require confidentiality.
However, the Court’s observations indicate that privacy cannot be used as a blanket justification for preventing independent oversight of institutional conditions.
There is a fundamental distinction between protecting a patient’s confidential information and concealing the functioning of an institution from legitimate scrutiny.
The proposed social audit seeks to address precisely that distinction.
A carefully structured social audit could allow independent persons to assess institutional conditions while maintaining safeguards around individual patients’ privacy. Similarly, supervised access for the press could provide transparency without permitting unrestricted exposure of vulnerable persons.
The Court’s consideration of this mechanism therefore represents an attempt to reconcile accountability with confidentiality.
The Bench also acknowledged the efforts of doctors and nurses working within the centres. It recognised that their contribution was significant and that they had continued working despite the difficult circumstances.
This recognition underscores that the Court’s criticism was directed primarily towards the systemic conditions and administrative response rather than being a blanket condemnation of healthcare personnel.
The State, in the Court’s view, must provide healthcare workers with the infrastructure, staffing, resources and institutional support necessary to deliver humane mental healthcare.
The Court’s decision to request the Advocate General to represent the State also reflects the seriousness of the proceedings. The matter involves questions extending beyond routine administrative deficiencies and into the constitutional obligations of the State towards persons under its care.
The Court has consequently sought a response at the highest level of the State’s legal representation.
The continuing nature of the proceedings is also significant. Rather than treating the matter as an ordinary petition to be disposed of after a single hearing, the Court is exercising continuing judicial supervision over the implementation of directions concerning the Mental Health Centres.
This form of monitoring enables the Court to examine whether its directions are actually producing changes on the ground.
The Court’s approach is particularly relevant in public interest litigation involving vulnerable groups. A judicial declaration alone may have limited practical value if the concerned authorities do not implement it effectively. Continuing supervision can ensure that institutional reforms are not confined to assurances filed before the Court.
The proposed social audit could further strengthen this monitoring process by introducing an independent perspective.
The suggestion to involve “right thinking citizens” and members of the press, as reflected in the Court’s oral observations, indicates the Bench’s desire to move beyond purely internal governmental inspection.
Independent observation can help identify deficiencies that may otherwise remain hidden from public view.
At the same time, any such mechanism would necessarily have to be carefully structured. Patients of Mental Health Centres are entitled to privacy and dignity, and media access cannot become a source of further harm or exploitation. The Court’s reference to restricted or supervised access recognises this need for balance.
The social audit, if ultimately implemented, would therefore have to operate within appropriate safeguards concerning patient identity, medical confidentiality, informed consent where applicable and protection against sensaionalisation.
The Court’s observations should consequently not be understood as adv