Introduction
On 29th September 2025, the world observed the International Day of the Deaf, a day meant to empower the deaf community and advocate for their rights. Yet, in India, the silence remains heavy, especially in mental healthcare. In one empirical effort to document this, Mishra and Kulshrestha in 2022 conducted a study, which used a bilingual online questionnaire translated into Indian Sign Language to assess 52 deaf and 52 hearing participants using Beck’s Depression Inventory, Beck’s Anxiety Inventory, and the WHO Quality of Life questionnaire. It shows that deaf participants reported significantly higher levels of depression and quality of life (psychological health and environmental health component) compared to the hearing population.
In this blog, the authors argue that the exemption of a mental health institution registered under the Mental Healthcare Act (“MH Act”) from seeking registration under Section 50 of the Rights of Persons With Disabilities Act (“RPWD Act”) leads to several exemptions from compliances. This legal loophole results in the absence of several disability-specific requirements that would otherwise be mandatory if institutions were required to register under both legislations. Thus, persons with disabilities are unable to access appropriate mental healthcare because of the lack of essential compliances. For the 70 lakh deaf and mute people in India, access to healthcare, education, and mental health, continues to be elusive. This blog draws on psychological studies on mental health among the deaf, analyses of the RPWD and MH Acts, comparative research on sign language lexicons, and judicial interpretations of accessibility and reasonable accommodation.
The Legal Loophole
The RPWD Act prohibits anyone from establishing or maintaining an institution for people with disabilities unless registered and certified by a competent authority. However, an institute for the care of mentally ill persons with a valid license under the MH Act is exempt from this requirement of registration.
At first glance, this may appear as an attempt at demarcation and harmonisation. However, in practice, it creates a serious loophole. For registration under the RPWD Act, the competent authority must be satisfied that the institute has fulfilled all requirements under the Act. State governments are empowered to frame rules with respect to the registration of establishments under the RPWD Act. These rules require institutions to meet certain disability-friendly benchmarks, such as the institution to be working in the field of rehabilitation for disabled persons for a minimum of three years and to have ‘teaching and learning material for people with disabilities.’
On the other hand, registration under the MH Act imposes no such obligations. For example, the Central Rules and the Karnataka State Rules make no mention of any disability-friendly benchmarks as a prerequisite to registration. There is no rule that requires psychologists trained in Indian Sign Language (“ISL”) or the availability of assistive infrastructure. Furthermore, there are rarely any mental health practitioners equipped to communicate with the deaf community beyond informal counselling or mentoring.
Rule 15 of the RPWD Rules, 2017 lists seventeen documents comprising “accessibility rules” that mandate every establishment to comply with standards of physical accessibility, transport, and Information and Communication Technology, such as compliance with the Harmonised Guidelines and Standards for Universal Accessibility in India, as issued by the Ministry of Housing and Urban Affairs. However, in 2024, the Supreme Court, in Rajive Raturi v. Union of India, struck down Rule 15(1) as ultra vires the RPWD Act. The Court observed that the documents referred to under the Rule were merely “guidelines or aspirational principles” and the same could not be enforced as binding norms. Moreover, since these documents contained multiple, and sometimes inconsistent, benchmarks for the same accessibility requirements, they failed to establish non-negotiable, uniform standards as envisaged under the RPWD Act.
The Court directed the Government to delineate mandatory rules under Section 40 of the RPWD Act within three months. However, as of October 2025, these remain in draft form and under public consultation. Consequently, even the limited scope for disability-friendly accommodation in mental health institutions remains unimplemented.
The RPWD Act guarantees ‘reasonable accommodation’ for persons with disabilities and ‘community support services’ which should ideally include mental health services. The Supreme Court has also emphasised that the principle of reasonable accommodation is the instrumentality to enable the disabled to enjoy Article 14 and Article 21. The term has been interpreted widely to include the right to have a scribe in examinations, additional compensatory time to write during examinations, and reasonable accommodation in employment for disabilities that are specified, and not specified in the RPWD Act.
However, despite the spirit of the Act, gaps persist. The Act mandates the government to take steps to facilitate inclusive education, such as training and employing teachers and other professional staff, but it does not mandate the training of doctors and medical professionals in sign language. In principle, the Act provides for ‘barrier-free access’ for the disabled in medical institutions, but provides absolutely no enforcing mechanism as to how this principle will be carried out into reality. In theory, a deaf or mute person can demand accessible services as a right under the RPWD Act. However, in the absence of mandatory registration and compliance in mental health establishments, these directives remain aspirational at best.
Practical Implications
Consider the case of a deaf and mute person seeking therapy. They approach a general mental health facility, only to find that the staff cannot communicate with them. They then try a disability-centred institution, only to discover that there are no licensed psychiatrists there. Thus, they are pushed into a cycle of exclusion merely because the law doesn’t require mental health institutions to accommodate their disability.
Mental healthcare fundamentally relies on communication and emotional reflection. However, very few psychologists are trained in ISL, and interpreter availability in psychiatric settings is scarce to non-existent. Even when interpreters are present, they often lack the mental health training required to accurately convey complex psychological terms. As a result, symptoms of deaf individuals are misunderstood, misdiagnoses are rampant, and basic human experiences of grief, trauma, anxiety are either misinterpreted or completely lost in translation. Group therapy becomes difficult to participate in, and confidentiality is also at risk when family members have to interpret during sessions. Due to influence from the family, patients may withhold sensitive information, leading to miscommunication. In order to ensure accurate care, neutral interpreters and confidentiality rules are necessary. In some instances, deaf patients are even institutionalised involuntarily, not because they’re a danger, but because they simply couldn’t communicate.
Clinical evidence from India shows how excluding mental health establishments from accessibility rules under the RPWD Act can affect deaf patients. Psychiatrists from Dr. Ram Manohar Lohia Hospital and Safdarjung Hospital reported three such cases of prelingually deaf-mute patients whose diagnoses relied entirely on improvised communication due to the absence of trained interpreters. The first case involved a 39-year-old man diagnosed with Other Non-Organic Psychotic Disorder (F28). Since clinicians could not communicate with him directly, they had to rely solely on his behaviour to interpret his fears, which delayed proper diagnosis. The second patient, a 22-year-old woman with panic episodes, depended on her mother to describe her symptoms to doctors, which compromised her privacy and independence. The third, a 29-year-old woman with major depression and suicidal thoughts, could only use written notes to communicate, making it difficult to establish trust or express her emotions effectively. In all three cases, doctors could assess patients accurately only after creating improvised methods of communication. The study demonstrates that the lack of accessibility measures in psychiatric settings can lead to delayed or incorrect diagnoses, compromised confidentiality, and emotional distress.
Another one of the most pressing issues is the lack of a developed mental health vocabulary in ISL. Compare this with other jurisdictions: American Sign Language (“ASL”) includes hundreds of well-documented mental health terms, with specific signs for conditions such as depression, anxiety, etc, thanks to concerted efforts by deaf mental health professionals. Similarly, British Sign Language (“BSL”) encompasses signs for trauma, panic attacks, suicidal thoughts, and therapy. In Australia and New Zealand, national sign languages feature developed mental health vocabularies, supported by video dictionaries, mobile applications, and interpreter training modules.
In stark contrast, the ISL lacks widely recognised signs for terms like depression, anxiety, hallucination, self-harm, consent, trigger, trauma, and addiction. Without a mental health vocabulary, emotional literacy cannot develop and the absence of adequate linguistic infrastructure renders mental healthcare completely inaccessible for the deaf.
Proposed Regulatory and Implementation Framework
It is, therefore, proposed that every mental health hospital or clinic should have appropriate ISL facilities to enable deaf patients to communicate freely and receive equitable treatment. There should be at least one certified ISL interpreter (Level C or higher certification from the Indian Sign Language Research and Training Centre (“ISLRTC”) or an equivalent organisation), present at all times or on-call for outpatient services in each institution. For every 25 deaf patients receiving care, one certified interpreter should be employed.
In addition, all physicians, psychologists, and nurses must complete a minimum of 20 hours of annual training in basic ISL and deaf awareness, certified by the ISLRTC through courses designed and approved by the Rehabilitation Council of India (“RCI”). Funding for training can come from existing programs such as the National Mental Health Programme (NMHP) or the National Programme for the Welfare of Persons with Disabilities. To ensure accountability, each State Mental Health Authority should conduct yearly inspections, and any institution found non-compliant must face suspension of registration under the MH Act until corrective measures are implemented.
Most importantly, the exemption provided to mental health institutes in the RPWD Act must be eliminated, and it must be ensured that all mental health facilities follow the accessibility and inclusion requirements defined in the RPWD Act and rules. To avoid ambiguity, the MH Act must cross-reference the accessibility requirements in the RPWD Act.
Conclusion and Time-Bound Pilot Proposals
To move from principles to practical solutions, the following time-bound pilot proposals can be immediately implemented.
Firstly, state governments should maintain a registry of certified ISL interpreters and make them available to hospitals on-call or electronically within the next 6 months. This would be especially beneficial for smaller hospitals, which, by coordinating with the registry, can collaborate to share interpreter services or use secure video calling where in-person interpreters are unavailable. States may begin a 6-12 month trial phase to test the availability of interpreters within medical institutions and coordination between hospitals. They may thus evaluate outcomes in terms of access to mental healthcare for the disabled and refine the system before scaling it up.
The ISLRTC must immediately create a comprehensive mental health lexicon in ISL in collaboration with deaf users, professionals, and linguists. This lexicon should be widely disseminated through institutions and public health campaigns, with the initial rollout to be made available within 3 months.
Lastly, existing tele-mental health platforms, such as Tele-MANAS, should also integrate sign language options to provide deaf patients with remote access to mental health consultations. This can be done through appointments with ISL-trained professionals or by accessing real-time video interpreting services. A trial phase over the next year can assess patient satisfaction as well as efficiency of services.
India, as a signatory to the UN Convention on Rights of Persons with Disabilities, enacted the RPWD Act and the MH Act to reinforce dignity and accessibility. However, as argued above, a closer reading reveals that they fail to complement each other. Access to mental healthcare should never depend on whether someone can speak or hear. In a country that takes pride in its progressive, inclusive laws, it is time those laws truly speak to one another so that those who have long gone unheard can finally have a voice. To build a truly inclusive mental health ecosystem, India must recognise that accessibility is not a favour, but a fundamental right, especially for those who have been long marginalised by silence.
This blog is written by Ishita Bharadwaj and Medha, Student at Rajiv Gandhi National University of Law, Punjab
