This month on Patient Safety Day, the internet was flooded with checklists for hospitals: structural improvements, infection control, and capable workforces. These are vital steps for physically ill patients. Yet, as a professional in the allied healthcare sector, I have to ask: Where is the safety plan for the mind?

The lack of practical, measurable safety standards for mental health services especially in Out-Patient settings is glaring. It’s a painful reminder of how far behind we lag in valuing mental well-being. For too long, the prevailing societal ‘safety measure’ was to lock away the problem. It took a full century to move from the punitive 1912 Lunacy Act to the transformative Mental Healthcare Act of 2017 (MHCA).

The 2017 Act was a sunrise, finally granting individuals with mental health conditions basic human rights and, crucially, autonomy. It gave them the power to make an Advance Directive, even appointing a Nominated Representative (NR) to speak for them if they become unable to. This shift from institutional control to personal choice is monumental.

But here’s the brutal truth: a progressive law on paper means little when culture and infrastructure stand in the way.

We are forced to ask difficult questions. What is the real-world definition of “capacity to consent” in a society where mental illness is still steeped in stigma? How can we ensure a patient’s right to self-determination when the deeply embedded familial and social influence pressures them to conform or stay silent? The law grants autonomy, but does our culture even recognize it?

Now, let's talk about the situation in my home state, Punjab. The MHCA 2017 mandates the creation of Mental Health Review Boards (MHRBs) in every district, the very mechanism designed to uphold patients' rights, review institutional detentions, and prevent abuse. Despite repeated reprimands from the High Court and allocated funds, Punjab has zero functional MHRBs. The state’s Mental Health Authority, established in 2018, exists only as a name on a few documents.

This systemic failure leaves us, the allied healthcare professionals, standing on very shaky ground.

We lack a fully qualified and sufficient workforce. Our dedicated institutes are often poorly maintained and under-resourced. Crucially, we are constantly blocked by a failure of governance—a lack of serious officials willing to implement and enforce these life-changing policies.

So, on this Patient Safety Day, I am left to wonder: What do we actually have?

We have the law, yes, but its vital organs are missing. We are surviving on the sheer grit and dedication of frontline workers, the compassion of a few good doctors, and the incredible, often-unseen resilience of our patients.

Our assurance to our patients cannot be a lie about perfect systems. Instead, it must be a solemn promise born of urgency:

We assure you, our patients, that we will not give up the fight. We will demand the functional Review Boards that are your right. We will speak out against the neglect that treats mental health as a secondary, disposable problem. Your chance to recover and flourish lies not just within you, but in our collective refusal to accept the status quo. We are building the safety net with every small victory, every successful session, and every loud demand for the rights the law already granted. We are here, and that, for now, is our only true safety standard.