Patiala: The Punjab govt restricted access to state-run de-addiction and rehabilitation services to patients holding a valid Punjab domicile certificate, a move that sparked concern among doctors and mental health experts who viewed it as being in contravention of the Mental Healthcare Act, 2017 (MHCA), which emphasises access to rights-based treatment for mental health conditions, including substance addiction. However, certain exceptions were provided.
Under the decision, individuals from other states suffering from substance abuse will no longer be able to seek treatment at govt facilities in Punjab, even though many earlier relied on the state's extensive drug treatment network.
The order, issued by the Directorate of Health and Family Welfare, Punjab (Mental Health Branch) on March 9, directed all govt de-addiction centres, govt rehabilitation centres and govt Out-Patient Opioid Assisted Treatment (OOAT) clinics across the state to stop providing services to patients who could not prove Punjab residency.
The directive followed a high-level meeting chaired by the Principal Secretary (Health) last month and imposed a major restriction on Punjab's public de-addiction infrastructure, which was developed over the past 2 decades to address the state's drug crisis. Earlier, during a meeting held in December last year with govt and private doctors, officials reiterated that the DDRP portal is strictly applicable to Punjab residents and that patients from other states would not be covered under it.
The March 9 circular mandated strict domicile verification before admission and also applied to patients already registered on the state's PDDRC and DDRP portals, requiring compliance with all prescribed procedural and statutory requirements.
Three exceptions allowed
The order provided 3 exceptions under which non-domicile patients may still receive treatment. These included cases where a patient is brought in by the police, where admission is directed through a specific court order, and for jail inmates in Punjab who require treatment as part of custodial care or rehabilitation, subject to inter-state coordination protocols. The instructions were shared with all Deputy Commissioners-cum-chairmen of district panchayati committees and all civil surgeons across Punjab.
Concerns raised by experts
The move drew objections from mental health professionals, who said linking access to treatment with domicile could raise legal and ethical questions.
Experts pointed out that the Mental Healthcare Act, 2017 guarantees individuals the right to access mental health treatment, and substance addiction is recognised as a mental health condition under the Act.
A psychiatrist at a private hospital in Patiala said denying treatment to patients already registered for de-addiction therapy could have serious consequences. "Many non-domiciled patients working in Punjab were receiving treatment from govt or private centres. With this order, they may no longer receive medicines or services," the doctor said. He added that patients living near interstate borders also accessed treatment in Punjab due to the lack of facilities in their own areas, and the new restriction could leave such individuals without support.
A private psychiatrist in Ropar echoed similar concerns, saying that doctors at OOAT clinics and de-addiction centres often deal with patients in acute withdrawal or crisis situations. Turning away non-residents in such conditions could create ethical and legal complications.
Govt says decision meant to streamline system
Responding to the concerns, Programme Officer (De-addiction and Mental Health) Dr Sandeep Bhola said the domicile rule applies to both govt-run and private centres covered under the state programme.
He said about 13 lakh patients are currently registered on the portal, while surveys indicate that the number of substance abuse patients in Punjab is around 8 to 9 lakh. According to him, some patients from neighbouring states were receiving treatment and medicines from Punjab facilities, which made follow-up monitoring difficult.
"They were being counted as Punjab patients even though they belonged to other states. The step was taken to streamline the system," he said, adding that the govt does not have precise data on how many non-domiciled patients were availing services.
Bhola said the govt was open to reviewing the decision if necessary. "No one is being discriminated against. We are open to amendments, improvements or changes in the decision if required," he said.
Implementation under review
Even as the circular was issued, officials indicated that the matter is being reconsidered. A senior health department official, speaking on condition of anonymity, said the issue was discussed in a meeting with govt and private doctors on Thursday and the decision may undergo further review.
Punjab shares borders with Haryana, Himachal Pradesh, Jammu and Kashmir, and Rajasthan, and patients from these states historically sought treatment at the state's govt and private de-addiction centres. With the new restriction and possible reconsideration under discussion, uncertainty remains for many patients from outside Punjab who depend on the state's treatment facilities.
Start a Conversation
Post comment