• Century-old law leaves doctors operating in legal grey zones
• Patients admitted outside legal provisions amid system constraints
• New bill aims to bridge disconnect between law, practice
• Stakeholders push for stronger human rights alignment
• HRCSL preparing further recommendations

The importance of mental health has become more critical than ever in the current era, driven by a range of complex and evolving factors. 

In an increasingly interconnected and technologically advanced world marked by the rapid development of artificial intelligence, growing human rights concerns, economic crises, cyberbullying, increasing substance abuse, conflict, and trauma, protecting mental well-being has emerged as a pressing priority.

In Sri Lanka, however, despite gradual progress in public attitudes, mental health continues to be shaped by persistent stigma and deeply rooted misconceptions. Efforts to strengthen mental health care have long been constrained by outdated, colonial-era legislation, which no longer reflects contemporary medical, social, or rights-based approaches.

Attempts to reform this legal framework have been ongoing for nearly two decades. Renewed momentum is now evident, however, with moves underway to repeal Sri Lanka’s colonial-era mental health law. A concept paper outlining a draft bill to replace the Mental Diseases Ordinance of 1873 has been presented to the Cabinet.

As part of the legislative process, public consultations have commenced. A recent consultation was held at the Human Rights Commission of Sri Lanka (HRCSL), with a further session scheduled for Thursday (2 April).

Attempts to repeal current law and challenges

Mental health professionals have long warned that Sri Lanka’s reliance on a law dating back over a century poses serious risks to the country’s mental health system, with experts – particularly the Sri Lanka College of Psychiatrists – describing the move to repeal the Mental Diseases Ordinance of 1873 as long overdue.

Following the introduction of the ordinance, it was updated periodically, with the last revision made in 1943. A more formal Mental Diseases Act was introduced in 1956. However, no substantive amendments have been made since then. Attempts to update the law in the 1980s and 1990s were unsuccessful.

In 2022, the Sri Lanka College of Psychiatrists handed over a draft bill to the Ministry of Health; however, it did not progress beyond that stage. The college resubmitted an updated draft to Health Ministry Secretary Dr. Anil Jasinghe in 2025, and the current process is a result of that.

National Institute of Mental Health (NIMH) Senior Consultant Psychiatrist and former President of the Sri Lanka College of Psychiatrists Dr. Kapila Ranasinghe said there was an urgent need for legal reform, noting that Sri Lanka’s current mental health framework remained rooted in colonial-era legislation that no longer reflected present-day realities.

“The law we are using was enacted during British colonial times, and although there were amendments in the 1950s, those changes have not been sufficient to address the current mental health needs of the country. Today, the system does not provide a safe or user-friendly framework, nor does it adequately protect the dignity and rights of patients,” he said.

He pointed out that the existing law was increasingly misaligned with modern constitutional and human rights standards, making several of its provisions open to legal challenge. “There is a clear mismatch between this outdated law and current human rights frameworks. In some instances, individuals can be brought in by force and treated with limited transparency, which is not consistent with modern medical ethics or international norms,” he noted.

Dr. Ranasinghe also highlighted the practical challenges faced by authorities under the current system, stating that the lack of updated legal guidance placed both healthcare workers and law enforcement in difficult positions.

He further explained that under the existing legislation, treatment could only be provided during an active phase of illness, and inpatient care was legally restricted to the NIMH in Angoda. “All patients across the country who require inpatient care must, in principle, be referred to Angoda. This includes those from distant areas such as Jaffna,” he noted.

Dr. Ranasinghe added that the law imposed strict criteria for admission, requiring that the individual must have a mental illness, be likely to benefit from temporary treatment, and lack the capacity to decide whether treatment is necessary. “Only patients who fulfil all three conditions can be admitted under the current legal framework,” he said.

However, Dr. Ranasinghe pointed out that the situation differed significantly in practice. “At present, inpatient care is being provided at psychiatric units in Government hospitals across the country. Patients are admitted with the consent of relatives, and where there are no relatives, they are produced before court through the Police and admitted under a judicial order. This, however, is not fully in line with the existing law,” he said, warning that such inconsistencies had led to legal challenges in some cases.

He further highlighted the lack of mechanisms for long-term care. “Patients with severe mental illness who are treated and discharged often do not receive sustained medication. Without continuous treatment, there is a high risk of relapse,” he said, noting that many countries had established systems to ensure long-term treatment, including regulated compulsory care where necessary.

Dr. Ranasinghe added that the proposed draft mental health bill sought to address these gaps by enabling inpatient treatment at psychiatric units in Government hospitals across the country and introducing a legal framework better aligned with current treatment practices.

“In practice, there are no clear, updated legal guidelines on how to intervene without risking violations of individual rights. At the same time, treatment methods, hospital systems, and regulatory frameworks have evolved significantly, but the law has not kept pace with these changes,” he said.

He stressed that the effective implementation of Sri Lanka’s mental health policy depended on a robust legal foundation. “To properly implement a national mental health policy, we need a strong legal framework and a clearly defined service structure. That is something Sri Lanka has not yet fully established. This is why reforming the mental health law is not just necessary, but long overdue,” he added.

Differences between ordinance, draft bill

The draft mental health bill marks a significant legislative shift from the colonial-era Mental Diseases Ordinance (Chapter 559), introducing a modern, rights-based framework that redefines how mental health care is delivered, regulated, and overseen.

At its core, the draft law departs from the ordinance’s long-standing emphasis on the “care and custody” of persons deemed to be of “unsound mind,” instead prioritising human dignity, autonomy, and participation in treatment decisions. The proposed act adopts a ‘least restrictive’ approach, seeking to ensure that individuals with mental disorders are supported within community settings wherever possible, rather than being institutionalised.

This philosophical shift is reinforced through updated terminology that aligns with contemporary medical and human rights standards. Terms such as ‘person of unsound mind’ and ‘mental hospital’ are replaced with ‘person with a mental disorder’ and ‘authorised mental health facility,’ reflecting a move away from stigmatising language towards person-centred care.

A key structural change lies in the transfer of decision-making authority from the Judiciary to the medical profession. Under the existing ordinance, district courts play a central role in determining whether an individual is of sound or unsound mind and in authorising detention. In contrast, the draft act empowers psychiatrists and medical officers to make treatment decisions based on clearly defined clinical criteria, including risk of harm, lack of consent capacity, and likelihood of deterioration. Judicial oversight is replaced with specialised mental health review boards, which are mandated to review prolonged admissions and hear patient appeals.

The draft law also introduces Supported Outpatient Treatment (SOT), a notable departure from the ordinance’s institutional focus, allowing individuals who meet strict clinical and social criteria to receive mandatory treatment within the community rather than in hospital settings. Eligibility requires both a diagnosis of mental disorder and demonstrable risks such as harm to self or others, or severe neglect alongside additional safeguards – including a structured treatment plan and review by a provincial review board.

Emergency procedures are similarly redefined. While the ordinance permits a justice of the peace to order the immediate removal of individuals to observation facilities, the draft bill places this authority in the hands of medical officers, enabling faster, clinically driven interventions.

The proposed legislation establishes a multi-tiered oversight framework, including a national mental health advisory council and provincial committees, aimed at strengthening governance and accountability. These bodies are complemented by review boards with quasi-judicial powers to assess long-term treatment decisions, including extended hospitalisation and the administration of specific interventions such as Electroconvulsive Therapy (ECT).

Importantly, the act introduces explicit patient rights and safeguards that are largely absent in the existing ordinance. These include protections against discrimination, equal access to insurance, and the right to transport for treatment. It also sets out stricter protocols for the use of restraints and ECT, including requirements for second medical opinions and formal monitoring mechanisms such as seclusion registers.

The treatment of minors is addressed in significantly greater detail, with the draft law introducing age-specific provisions and mandating specialised child and adolescent psychiatric care, including dedicated facilities. It also raises the age threshold for voluntary admission, requiring individuals to be over 18 to consent independently to treatment.

Provisions relating to prisoners with mental disorders are also updated, shifting authority from the Minister of Justice to medical professionals and introducing the concept of secure forensic units for high-risk cases.

Overall, the draft represents a comprehensive overhaul of Sri Lanka’s mental health legal framework, aligning it more closely with international human rights standards while attempting to balance clinical necessity with individual freedoms.

Concerns raised at consultation session

At the first public consultation on the draft mental health bill in early March, stakeholders raised a series of concerns, warning that while the proposed legislation marked progress beyond the colonial-era framework, it fell short of delivering a fully rights-based approach aligned with international standards.

Participants noted that the draft continued to be heavily anchored in a clinical and risk-management model, with psychiatrists and medical decision-making placed at the centre of the law. This, they cautioned, risked undermining the autonomy of individuals and perpetuating a system where treatment decisions could override personal choice.

A key concern centred on the draft’s limited alignment with Sri Lanka’s obligations under the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which the country ratified in 2016. Stakeholders emphasised that modern mental health legislation should move beyond regulating involuntary treatment and instead prioritise dignity, equality before the law, and social inclusion. They urged lawmakers to restructure the bill as a rights-enabling framework that protected individuals from coercion, discrimination, and violations of autonomy.

Concerns were also raised over the continued use of medicalised and potentially stigmatising terminology, including references to ‘mental disorders’ and ‘patients’. Advocacy groups argued that such language reinforced outdated, paternalistic models and failed to recognise individuals as rights holders. They called for the adoption of person-centred terminology, such as ‘persons with psychosocial disabilities’ or ‘persons with mental health conditions’.

Another major point of contention was the draft’s approach to legal capacity and decision-making. The bill relies on assessments of treatment consent capacity, allowing clinicians to override an individual’s decisions in certain circumstances. Stakeholders argued that this effectively preserved a substitute decision-making model, contrary to international standards, and recommended the introduction of supported decision-making mechanisms and advance directives to safeguard individual choice.

Participants further highlighted concerns over the retention of coercive treatment provisions, including involuntary admission, community treatment orders, restraint, and non-consensual ECT. While acknowledging the inclusion of procedural safeguards, they argued that the continued reliance on such measures reflected an emphasis on enforcing compliance rather than empowering recovery, and called for a shift towards voluntary, community-based, and trauma-informed care models.

Governance and oversight structures proposed under the draft law also came under scrutiny. Although the establishment of bodies such as the national mental health advisory council and provincial review boards were viewed as an improvement, stakeholders questioned their independence and inclusivity. In particular, concerns were raised over the limited representation of individuals with lived experience, with calls for greater participation in policy-making and oversight processes to ensure meaningful accountability.

The stakeholders acknowledged that the draft bill represented a step away from Sri Lanka’s outdated custodial framework. However, they stressed that without a more decisive shift towards a rights-based model centred on autonomy, dignity, and community inclusion, the legislation risked retaining elements of the very system it sought to replace.

Progress of draft mental health bill under review

The HRCSL also raised concerns on several occasions regarding the current mental health legal framework, emphasising the need for reforms aligned with international human rights standards.

In 2023, the HRCSL issued directives to the Ministry of Health, calling for the enactment of a mental health act consistent with international medical standards and the State’s human rights obligations. Given the urgency, the commission recommended that the draft legislation be finalised within the first quarter of 2024. It further stressed that the proposed law should mandatorily provide for the establishment of a mental health monitoring board, vested with powers to ensure the effective implementation of the act.

Providing an update on the commission’s ongoing engagement with the draft legislation, HRCSL Acting Director – International Affairs Kapilan Villavarajan noted that discussions with the drafting committee were expected as the next step in the process.

“We have discussed the current status [of the draft bill] and the next step is to engage with the drafting committee. Given the many legal aspects involved, we also need to carry out a comparative study and examine the human rights approach more closely. We expect to submit our observations after receiving their input,” he said.

He said that initial reviews had indicated gaps in the draft that required further consideration, noting: “When we examined the draft, we observed that additional elements needed to be included. As a first step, we intend to engage with the drafting committee from a human rights perspective. Although a meeting was scheduled, it has been delayed due to the elections in the past years.”

Villavarajan added that the commission had already prepared an interim report containing its preliminary observations, including the recommendation that the law must be amended. “We have finalised an interim report and submitted our observations, but the full report has not yet been released. We are looking at the possibility of making it public soon,” he said.

Noting that the commission was still in the early stages of its review of the draft, he said: “At this stage, we are focusing on ensuring that the drafting committee considers the human rights dimension more comprehensively. The process is still ongoing and final observations have not yet been issued.”