Punjab Implements Domicile-Based Access to State De-Addiction Services
The Punjab government has introduced a significant policy change, restricting access to state-run de-addiction and rehabilitation services exclusively to patients holding a valid Punjab domicile certificate. This decision, issued by the Directorate of Health and Family Welfare, Punjab (Mental Health Branch) on March 9, has ignited widespread concern among medical professionals and mental health experts. They argue that the move contravenes the Mental Healthcare Act, 2017 (MHCA), which guarantees rights-based treatment for mental health conditions, including substance addiction.
Details of the Directive and Its Implementation
The order directs all government de-addiction centres, rehabilitation facilities, and Out-Patient Opioid Assisted Treatment (OOAT) clinics across Punjab to cease providing services to patients who cannot prove Punjab residency. This follows a high-level meeting chaired by the Principal Secretary (Health) last month and represents a major shift in the state's public de-addiction infrastructure, developed over two decades to combat Punjab's drug crisis. Previously, during a December meeting with government and private doctors, officials emphasized that the DDRP portal is strictly for Punjab residents, excluding patients from other states.
The March 9 circular mandates strict domicile verification before admission and applies to patients already registered on the state's PDDRC and DDRP portals, requiring compliance with all procedural and statutory requirements. However, the order includes three exceptions: cases where a patient is brought in by the police, admissions directed through a specific court order, and jail inmates in Punjab requiring treatment as part of custodial care or rehabilitation, subject to inter-state coordination protocols.
Expert Concerns Over Legal and Ethical Implications
Mental health professionals have raised strong objections, stating that linking treatment access to domicile raises serious legal and ethical questions. Experts highlight that the Mental Healthcare Act, 2017 ensures individuals the right to access mental health treatment, with substance addiction recognized as a mental health condition under the Act. A psychiatrist at a private hospital in Patiala warned that denying treatment to registered non-domiciled patients could have severe consequences, as many from neighbouring states rely on Punjab's facilities due to lack of services in their own areas.
A private psychiatrist in Ropar echoed these concerns, noting that doctors at OOAT clinics and de-addiction centres often handle patients in acute withdrawal or crisis. Turning away non-residents in such situations could create ethical and legal complications, potentially endangering lives and undermining public health efforts.
Government Justification and Potential Revisions
In response, Programme Officer (De-addiction and Mental Health) Dr. Sandeep Bhola explained that the domicile rule applies to both government-run and private centres under the state programme. He cited that about 13 lakh patients are registered on the portal, while surveys estimate only 8 to 9 lakh substance abuse patients in Punjab. According to Bhola, some patients from neighbouring states were receiving treatment and medicines from Punjab facilities, complicating follow-up monitoring and inflating patient counts.
Bhola stated, "The step was taken to streamline the system," adding that the government lacks precise data on non-domiciled patients availing services. He emphasized openness to reviewing the decision, saying, "No one is being discriminated against. We are open to amendments, improvements or changes in the decision if required." Officials have indicated that the matter is under reconsideration, with a senior health department official noting that discussions in a recent meeting with government and private doctors may lead to further review.
Regional Impact and Ongoing Uncertainty
Punjab shares borders with Haryana, Himachal Pradesh, Jammu and Kashmir, and Rajasthan, and patients from these states have historically sought treatment at the state's de-addiction centres. With the new restriction and potential reconsideration under discussion, uncertainty persists for many non-domiciled patients dependent on Punjab's treatment facilities. This policy shift highlights broader challenges in balancing state resources with national mental health rights, as stakeholders await possible revisions to ensure equitable access to critical healthcare services.
