mental health care act 2017

1. MENTAL HEALTHCARE ACT,
2017

3. PREAMBLE
An Act
• To provide mental health care and services for
persons with mental illness
• To protect, promote and fulfil the rights of such
persons during delivery of mental health care services
• And for matters connected therewith or incidental
thereto

4. OVERVIEW
• MHCA emphasis on care and treatment rather than on
custodial care.
• It provided detailed procedures for hospital admission
• Human rights, guardianship and the management of
the property of people with a mental illness.

5. MENTAL HEALTHCARE ACT 2017
• ❑ 16 Chapters, Contains 126 clauses
• ❑ Chapters include
• Definitions,
• Advance Directives,
• Nominated Representatives,
• Rights of Patients ,
• Mental health authorities
(Central/State),
• Duties of appropriate governments,
• Mental Health Review Boards,
• Mental Health Establishment,
• Admission, Treatment & Discharge
• Penalties etc

6. PARADIGM SHIFTS

7. WHO IS THE PERSON WITH MENTAL
ILLNESS AS PER MHCA ?
■ Person with Mental illness
• ❑ Substantial disorder of thinking, mood, perception,
orientation or memory that grossly impairs judgment,
behavior, capacity to recognize reality or ability to
meet the ordinary demands of life
• ❑ Includes Substance use disorders,
• ❑ Excludes Mental Retardation

8. OBLIGATIONS
•To register as Mental Health Professional under SMHA
•Intimation to the concerned MHRB within 72 hrs for
women and children admission
•Intimation to the concerned MHRB within 7 days for
adult male
•Ensuring and adhere to Rights of persons with mental
illness in MHE
•Ensuring MINIMUM STANDARDS at MHE
•Informing Board about Restraint practice

9. HOW THIS MHCA GOING TO
IMPLEMENTED IN INDIA ? • It is through Implementation
Authorities
• ❑ Central mental health
authority (Ch-7, Sec 33-44)
• ❑ State mental health authority
(Ch-8, Sec 45-56)
• ❑ Mental Health Board
(District) (Ch-11, Sec 73-84)

10. CENTRAL MENTAL HEALTH AUTHORITY
• (a) Secretary or Additional Secretary, MoHFW, GoI
• (b) Joint Secretary, MoHFW, GoI
• (c) Joint Secretary, Ayush, GOI.
• (d) Director General of Health Services
• (e) Joint Secretary, Department of Disability Affairs of the Ministry of Social Justice and Empowerment
• (f) Joint Secretary, Ministry of Women and Child Development
• (g) Directors of the Central Institutions for Mental Health
• (h) Central Government Ministries or Departments
• (i) One psychiatrist
• (j) One psychiatric social worker
• (k) One clinical psychologist
• (l) One mental health nurse
• (m) Two persons representing persons who have or have had mental illness
• (n) Two persons representing care-givers or organisations representing care-givers,
• (o) Two persons representing non-governmental organisations two persons representing areas relevant to mental health

11. CENTRAL MENTAL HEALTH AUTHORITY
(a) Register, supervise and maintain a register of all mental
health establishments
(b) Develop quality and service provision norms for such
establishments
(c) Maintain a register of mental health professionals
(d) Train law enforcement officials and mental health
professionals on the provisions of the Act
(e) Receive complaints about deficiencies in provision of
services, and
(f) Advise the government on matters relating to mental

12. STATE MENTAL HEALTH AUTHORITY
• (a) Secretary or Principal Secretary in the Department of Health of State Government
• (b) Joint Secretary in the Department of Health of the State Government, in charge of
• mental health
• (c) Director of Health Services or Medical Education
• (d) Joint Secretary in the Department of Social Welfare of the State Government
• (e) Head of any of the Mental Hospitals in the State or Head of Department of
Psychiatry at any Government Medical College
• (f) One psychiatrist from the State not in Government service

13. STATE MENTAL HEALTH AUTHORITY
• (g) One mental health professional
• (h) One psychiatric social worker
• (i) One clinical psychologist
• (j) One mental health nurse
• (k) Two persons representing persons
• (l) Two persons representing care-givers of persons
• (m) Two persons representing non-governmental
organisations

14. FUNCTION OF SMHA
• (a) Register, supervise and maintain a register of all mental health
establishments.
• (b) Develop quality and service provision norms for such
establishments,
• (c) Maintain a register of mental health professionals,
• (d) Train law enforcement officials and mental health professionals on
the provisions of the Act,
• (e) Receive complaints about deficiencies in provision of services, and
• (f) Advise the government on matters relating to mental health.

15. MENTAL HEALTH REVIEW BOARD
• The board consists of
❑ Judge (Chair-person)
❑ Representative of the District
Collector
❑ Two members
One Psychiatrist
One Medical Practitioner
❑ Two more members from
among
Patients
Relatives
Caregivers
NGOs

16. MENTAL HEALTH REVIEW BOARD
• Powers/Functions
❑ Register, review, alter, modify or cancel an advance
directive
❑ To appoint nominated representative
❑ To receive and decide application against the decision of
the MO/MHP
❑ To receive and decide: Non-disclosure of information
❑ To adjudicate complaints regarding deficiencies in care
and services
❑ Visit to MHE

17. MENTAL HEALTH REVIEW BOARD
• ❑ Equal representation for patients, caregivers and
NGO like that of Mental Health Professionals and
Government Agencies in MHRB, SMHA & CMHA.
• ❑ It ensure multi stakeholder perspective in different
of MHRB, SMHA, CMHA

18. WHAT ARE THE OBLIGATION ON
HOSPITAL BY MHCA ?

19. MENTAL HEALTH ESTABLISHMENT
• 2 (1) (p) “mental health establishment” means any health establishment, including
Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy establishment, by
whatever name called, either wholly or partly, meant for the care of persons with
mental illness, established, owned, controlled or maintained by the appropriate
Government, local authority, trust, whether private or public, corporation, co-
operative society, organisation or any other entity or person, where persons with
mental illness are admitted and reside at, or kept in, for care, treatment,
convalescence and rehabilitation, either temporarily or otherwise; and includes any
general hospital or general nursing home established or maintained by the
appropriate Government, local authority, trust, whether private or public, corporation,
co-operative society, organisation or any other entity or person; but does not
include a family residential place where a person with mental illness resides
with his relatives or friends

20. MENTAL HEALTH ESTABLISHMENT
• The definition of ‘Mental health establishment’ (MHE)
is mainly for registration only.
• Hospital provide inpatients care to person with
mental illness need to be registered as ‘Mental
health establishment’ (MHE) under SMHA.
• OPD basis treatment and day care services are
exempted from registration under SMHA.
• OPD is not considered as the MHE.

21. MINIMUM STANDARDS FOR MHE
• Premises to be well maintained
• Comfortable living conditions
• Hygiene, cleanliness and sanitation
• Wholesome, sumptuous and nutritive food and potable
drinking water
• Cultural, leisure and recreational activities
• Adequate human resources
• Adequate floor spaces
• Maintenance of privacy, safety, dignity and security

22. ADMISSION & DISCHARGE PROCEDURE
UNDER MHCA 2017
• Articulation is clear and almost similar to MHA 1987
• Clinician look into Capacity, Advance Directive and NR
related issue...
• Only reporting to board is added

24. SUPPORTED ADMISSION
■ Justifications
• Recent threatening/attempt of self-harm Violence
towards others
• Inability to care for himself to a degree that places the
individual at risk of himself
■ Information to the Board
Within 3 days in case of women or minors

25. EMERGENCY TREATMENT (SEC 94)
• Any medical treatment may be provided subject to
• ❑ Informed consent of the nominated representative,
• ❑ If it is immediately necessary to prevent –
• Danger to self or
• Danger to others or
• Person causing serious damage to property belonging to self
or to others
• The treatment referred shall be limited to 72 hours only.

26. PROHIBITIONS AND RESTRICTIONS
• a) Psychosurgery, only after consent & Board clearance
• b) Restraint
• a) If it is the only way to prevent imminent and immediate harm to self or others
• b) Authorized by the psychiatrist in-charge
• c) As less a time as is permissible
• c) Unmodified electro-convulsive therapy - totally prohibited
• d) Sterilization- Totally prohibited
• e) Chaining/seclusion/solitary confinement - prohibited
• f) ECT is prohibited in minors (except with prior clearance from the board)

27. DE-CRIMINALIZING SUICIDE
• Section 115 of the act provides for decriminalizing
suicidal attempts (Sec 309 IPC).
• A person who attempts suicide shall be presumed to
be suffering from mental illness (stress) at that time
and will not be punished under the Indian Penal Code

28. LEAVE OF ABSENCE (SEC 91)
• The medical officer or psychiatrist in charge of the
hospital may grant leave to an inpatient to be absent
from the establishment subject to such conditions, if
any, and for such duration as such medical officer or
psychiatrist may consider necessary
• Consent from nominated representative In writing

29. RIGHTS OF PERSONS WITH MENTAL
ILLNESS
• Right to access mental health care
❑ All type of services (IP/OP/Rehabilitation)
❑ Affordable cost, quality & quantity
❑ Compensatory
❑ Free treatment for BPL/Destitute
❑ Long term care also included

30. RIGHT TO PROTECTION FROM CRUEL,
INHUMAN AND DEGRADING TREATMENT
(a) Safe and hygienic environment
(b) Adequate sanitary conditions
(c) Leisure, recreation, education and religious practices;
(d) Privacy, Clothing
(e) Not to be forced to undertake work in a mental health
establishment and to receive appropriate remuneration for
work when undertaken
(f) Adequate provision for preparing for living in the
community

31. RIGHT TO PROTECTION FROM CRUEL,
INHUMAN AND DEGRADING TREATMENT
(g) Wholesome food, articles of personal hygiene, in
particular, women’s personal hygiene
(h) No compulsory tonsuring (shaving of head hair)
(j) To wear own personal clothes; if so wished and to
not be forced to wear uniforms provided by the
establishment; and
(h) To be protected from all forms of physical, verbal,
emotional and sexual abuse.

32. RIGHT TO EQUALITY AND
NONDISCRIMINATION
• Equality to persons with physical illness in the
provision of all health care
• Obligation of the State to provide emergency facilities
and emergency services for mental illness such as
ambulance, adequate and appropriate living
conditions similar to physical illness.
• Insurance for those with mental illness
❑ Insurers make provisions for medical insurance for
treatment of mental illness on the same basis as is
available for treatment of physical illness .

33. RIGHT TO INFORMATION
• As per the Act, person with mental illness and his
nominated representative shall have the rights to the
following information
a) Reason for admission,
b) To ask for a review of admission procedure: to the
board,
c) Treatment procedure
d) Language

34. RIGHT TO CONFIDENTIALITY
• Duty to keep information confidential, Exceptions
a) Nominated representative
b) Other mental health professionals and other health
professionals to enable them to provide care and
treatment
c) Dangerous to self or others
d) Medical emergencies
e) In the interest of public safety and security
f) Judicial proceedings

35. RIGHTS OF PWMI
•Right to Community Living
•Right to Legal Aid
•Right to access medical records
❑ OP / IP Basic Medical Records
•Right to restriction on release of information in respect
of mental illness
•Right to personal contacts and communication
•Right to make complaints about deficiencies in
provision of services

36. WHO IS CARE-GIVER / FAMILY /
RELATIVE ?
• Care-giver - Means a person who resides with a
person with mental illness and is responsible for
providing care to that person and includes a relative
or any other person who performs this function,
either free or with remuneration
• Family - Means a group of persons related by blood,
adoption or marriage
• Relative - Means any person related to the person
with mental illness by blood, marriage or adoption;

37. RESPONSIBILITIES OF OTHER AGENCIES
• Police officer –
❑ Wandering HMI
❑ Absconding patients
❑ Ill treated / neglected
• Section 111 - order by magistrate, only for 10 days –
for assessment and treatment.
• After 10 days submit report – discharge or admit him
as per the provisions of the act

38. ADVANCE DIRECTIVE
• Every person, who is not a minor
❑ The way the person wishes to be treated for
❑ The way NOT to be treated for
❑ The individuals he/she wants to appoint as his
nominated representative
❑ Comes into play only during ‘LOSS OF CAPACITY’
❑ Not applicable in cases of ‘Emergency Treatment’
❑ MHPs/Relative/Caregiver can approach the board

39. WHO CAN BE A N R ?

40. NOMINATED REPRESENTATIVE
• Individual appointed under AD
❑ Relative / Family
• By marriage
• By blood
• By adoption
❑ Care-giver
❑ Suitable person appointed by the board
❑ State (Social Welfare department)

41. NOMINATED REPRESENTATIVE
• To provide support to the person with mental illness
in making treatment decisions under section 89 or
section 90
• Has the right to seek information on diagnosis and
treatment
• Discharge planning
• Apply to the board on behalf of PWMI
• Right to give consent for research

42. RANGE OF SERVICE ADVOCATED AT
DISTRICT LEVEL UNDER MHCA 17
• (a) Acute mental healthcare services
• (b) Outpatient and inpatient services
• (c) Half-way homes, sheltered accommodation, supported
accommodation
• (d) mental health services to support family of person with
mental illness or home based rehabilitation
• (e) Hospital and community based rehabilitation
establishments and services
• (f) Child mental health services and old age mental health
services.

43. CHAPTER XV TITLED OFFENCES AND
PENALTIES
• Penalties for hospitals:
❑ 5000 to 50000 for first time,
❑ 50000 to 2 lakhs second time and
❑ 2-5 lakhs for 3rd time
• Breaking any other rules:
❑ 6 months to 2 years imprisonment with or without
fine

44. PROS OF NEW LEGISLATION
• This act is a long anticipated act based on United Nations Convention on
Rights of Persons with Disability(UNCRPD).
• MHCA legislation is concordant with higher proportion of WHO’s human right
standard.
1. Increased focus on human rights
2. Increased patient autonomy.
3. Decriminalization of suicide
4. Regulation and licensing of general hospital
5. Review boards consists of representation from allied sciences and
representation of parent party might be helpful in complete view/perspect in
taking decision.

45. CONS OF NEW LEGISLATION
• After passing of the act, there has been large debate regarding whether the
inspection of these facility would discourage opening of General Hospital
Psychiatric Units.
• Especially , private practitioners added onus of responsibilities on them.
• Burden of providing health care on shoulder of government.
• Possibility of underrepresentation of psychiatrists as place made for allied
sciences.
• Banning unmodified ECTs in resource poor setting, which might be lifesaving
option.
• Issues regarding the resources
• Autonomy might limit ability to treat patients.

46. THANK YOU