Ila 1912, considered inappropriate, ips drafted a bill and submitted to govt, in 1950, took 28 yrs to present in loksabhawhiccan act to indian parliament another 28 yrs to present in loksabha.which was referred to JPC, various committees did not consult IPS at any junctre, though 10 psychiatrists invted for oral evidences., after 8 more yrs, bil adopted, as Mental health bill, in1986 (rajya ) loksabha 87. bill recivedpresident;sasent on may 1987, 6 yrs more for implementing the act.
Positive aspects of MHA_ 1987- upholding the dignity of mentally ill persons, No one wants to be callled a lunatic,
2- the license to be renewed every 5 yrs.that results in improving standards of mental health care.2- licensing authorities do not have doctor who may be in better position to asess the facilities and services of these centres,there should be budgetary positions in the law, General hospitals are not mentioned,prohibited,no consent from 2 visitors is required as well,no written request requird. Minor admitted with consent of gaurdian.notthre in ILA , under special circumstances for invol pts,
Specila centres for drug addicts, under 16, mentally ill prisoners.
With facilities for out patient treatment and registered,with appropriate licensing authorities, admitting to a general nursing home –offencemedical officer- acc to law, it could bee even ayurvedic, homeopathic medical officer govt service- should be qualified psychiatrist.
Last- detention in a psychiatric hospital , jail or other places of safe custody.Mentally ill-def does not specify types of mental lllness to be included.misuse of the term,attached with stigma for person labelled mentally ill, a person with schizophrenia, panic disorder, anxiety,grief all under same category.MR subjects excluded,need separate services in form of rehab,prevention, etc,they too should have access to psych hosp.,Mentally ill personer ordered for detention in psychiatric hospital, jail or other places of custody
Minor admiited with consent of guardian,notthre in ILA.
Terminologies of indian lunacy act..,new chapters added on management of property and protection of human rights.. to provide check on licensing , guardians for maintaining property and person of mentally illdetention-
Good for theoretical aspects,its just like a window dressing,change should be implemented in practice and not on paper.2- extra burden on health budget.3, rather, they are prohibited.theyshoul be taken along.4-provisions for home rx.
Whether govt will provide expenses.2- doesnt it violate human rights?
UN- convention fon the roigghts of persons with disabilities, -2008- should be in compliance with UNCRPD.
3-environment to be conducive to facilitate recovery , rehab and full participation in society.
UNCRPD united nations convention on rights of persons with disabilities of 2008broad description of definition of mental illness, The Convention on the Rights of Persons with Disabilities is an international human rights treaty of the United Nations intended to protect the rights and dignity of persons with disabilities. Parties to the Convention are required to promote, protect, and ensure the full enjoyment of human rightsby persons with disabilities and ensure that they enjoy full equality under the law
Enabling provison- reaffirms every person’s right and capacity to decide what rx he/she must be subjected to. Consent- info about risks , benefits, alternatives in and understandable language, or with consent of state authoritym if person is not capable of giving consent.
Exceptions to this? – if not registered, the mental health review commission decides the validity. Section 5 read
The individual named as the nominated representative in an advanced directive, or a relative, care-giver, or someone appointed by MHRC state board.No NR, rep of registered organizations working with pers with mental illness temp perform duties NR, pending appt of NR. Written application to the doctor, temp NR, MINORS- legal guardians will be NR,unless state MHRC says otherwise,not acting in best interest of minor.unsuitable.
1requests the medical officer to admit as independent pt.
Mental illness with high support needs
After 30 days, if he no longer meets the criteria for admission, the pt should be no longer kept in the establishment.if he may clause for admission more than 30 days.
a) Already admitted under previous clause., both psychiatrists after taking into acct the adv directive, issue a certificate for admission., if not approved, dishcarge,
30 days, does not return after expiry of duration,
When Mental health prof is of opinion- person unable to understand the nature and purpose of his./her decisions.andrequre high support from NR,either- recent threatened or attempted or is threatening to cause bodily harm to himself, behaving violently or causing fear bodily harm , inability to care for oneself to a degree that places the individual at risk of harm to self or others.
only in exceptional circumstances, Ideally by nominated representative, upon receiving application, They should independently examine the minor on the day of admission or in the preceding 7 days- in the best interest of minor,mental health needs will not be met unless admitted,andaccomodated separately from adults.
Rights were never the focus of MHA 1987, as per req under UNCRPD,
Insufficient awareness, advocacy and sensitization about mental illness was a serious pitfall of MHA
Ipc1860, code of criminal procedure1973,2- 25 % increase over the last decade acc to National crime records bearue 2012
Unless necessary as an emergency measure to save a minor’s life.
1- would be responsible for registration and oversight of mental health establishments by laying down minimum standards and monitorin mechanism to ensure statutory compliance, MHRC. MHRB- first level of interaction with any mentally ill person, with the mental health care system for violation of his/her rights. MHA- gave power to Magistrate now its a forum for protection of their rights.
Mental health acts India -Dr.Samin Sameed
Mental Health Acts in India
• Mental health care acts in india was covered in two phases- pre-
independence and post independence.
1858- Indian Lunatic assylum act of 1858
1912- Indian Lunacy act of 1912
• Post Independence
1947- Indian Psychiatric Society established
1987-Mental health Act of 1987
• Mental health care bill (Proposed)
• Mental health act was drafted
in 1987 but it came into effect
in all the states and union
territories of India in April
• This act replaces the Indian
Lunacy act of 1912, which had
earlier replaced the Indian
Lunatic Asylum act of1858.
Consolidate and amend law relating to
treatment and care of mentally ill
For better provision with respect to
property and affairs of mentally ill
Features of MHA
Change of offensive terminologies used in Indian
Lunacy act of 1912
OUTDATED TERMS NEW TERMS
Nursing Home/Assylum Psychiatric Hospital
Lunatic Mentally ill person
Criminal Lunatic Mentally ill prisoner
• Establishment of Mental health authorities at
central and state levels.
• Establishment and maintenance of psychiatric
hospitals and nursing homes
• Procedures of admission and detention of
mentally ill .
• Inspection, discharge, leaves of absence and
removal of mentally ill persons.
• Judicial Inquisition Property of mentally ill
persons and its management.
• Maintenance of mentally ill persons in
a psychiatric hospital.
• Protection of human rights of
mentally ill persons.
• Penalties and procedures for
infringement of guidelines of the act
• To protect the society from dangerous
manifestations of mentally ill.
• Reception Order
Order for admission and detention of a mentally
ill person by a psychiatric hospital.
• Psychiatric Hospital-
Hospital for mentally ill persons maintained by
govt or private party .
• Medical Officer- A registered medical practitioner.
• Medical Officer in-
Medical officer in-charge
of a psychiatric hospital
or nursing home
• Mentally ill person
person suffering from
than Mental Retardation
• Mentally ill prisoner
mentally ill person
ordered for detention.
• To protect citizens from detained
• Maintenance charges of
mentally ill persons undergoing
• To provide legal aid to poor
mentally ill criminals at state
• Provision for separate places for
children, addicts, and convicted
Positive aspects of the act
• Upholding the dignity of mentally ill persons
by replacement of offensive terminologies.
• Establishment of licensing authorities.
• Provision for new hospitals
• Provision for outpatient care thus avoiding
• Appointment of guardians
Summary- MHA 87
• An Act to regulate and set standard for
restrictive psychiatric treatment facilities
• To establish procedure for Guardianship for
mentally ill who need it
• To protect Human Rights of mentally ill
• To set up authorities for development ,
regulation and coordination of mental health
Criticisms of the MHA-1987
• The change in terminologies –will it be
practically helpful in removing social stigma ?
• Establishing new hospitals in a developing
country – a costly affair.
• No mention of incorporating General
Hospitals and centers in the act.
• Stress laid on hospital admission and
• Simpler discharge provisions, but no
provisions for after discharge rehab
• If a relative comes forward to discharge of pt,
how long will that person be detained in the
hospital,and expenses after discharge.
• Research on Pts, by consent of guardian.-
• Unnecessary detention of a person- No Provision
for punishing relatives and officers who request
for the same.
• Society- Provisions to educate the society
regarding the misconceptions regarding mentally
• Provisions to start Community Mental health
Mental Health care bill 2013
• 16 chapters and 137 clauses.
• Mentally ill subjected to discrimination in society.
• Families bear the financial, physical, mental
emotional and social burden of treating and care
Mental Health care bill 2013
• Mentally ill to be treated like other persons
with health problems .
• MHA-1987 has not been able to adequately
protect the rights of persons with mental
illness and promote access to the mental
health care in the country.
Mental Health Care Bill 2013
• Definition of mental illness
• Right to access of mental health
• Advance Directive
• Central and state mental health
• Change of terminology from Psychiatric
hospital to mental health
• Mental health review commission and
• Decriminalizing suicide
• Prohibiting ECT without use of Anasthesia and
• Protection of rights of persons with mental
Definition of mental illness
• Definition of mental illness
“disorder of mood, thought, perception,orientation and
memory which causes significant distress to a person or
impairs that person’s ability to meet the demands of daily
life and includes mental conditions associated with the
abuse of alcohol and other drugs, but does not include
• Right to make an
to decide how a
pt should or
should not be
treated for a
mental illness in
Contd. Advance Directive
• Every person who is not a
minor has the right to
make an advance directive
specifying any of the
a) the way a person wishes
to be cared for and treated
for a mental illness
b)the way he wishes not to
be so cared for and treated
for a mental illness
• lays down
when they could
• All treatments and
to be conducted
only after free and
• A part of advance
directive where in a
person can appoint
individuals in order of
precedence to be
considered as his or
Who is my
Nominated Representative Rights and
• Duty to support the
person with mental
illness in making
• Information on diagnosis
• Right for discharge
• Right to give consent for
• Right to appoint a
Admission, Treatment and Discharge
• INDEPENDENT ADMISSION
Any person who considers himself to have mental
illness and desires admission, who is not a minor.
• Admitted if the Medical officer or Psychiatrist
is satisfied that
a)mental illness of severity requiring admission
b)pt should benefit from admission and
• c)request made is under
free will and not under
duress or undue influence
and has capacity to make
mental health care decisions
d) informed consent
e e) bound to rules and
regulations of the
Discharge of Independent Pts
• On request
• Minor becoming
major under in-
patient care, can
decide as independent
Admission and Treatment for pts with
high support needs, upto 30 days
• When and how?
Upon application by Nominated
2 mental health professionals, including
a Psychiatrist, after independent
feels that the person has a mental
illness of such severity that the person,
a) recently threatened or attempted to
cause bodily harm
b)recently behaving violently towards
another person, or causing another
person to fear bodily harm
• c) recently shown
inability to care oneself
to a degree that places
at risk of harm to oneself
• Limited to a period of 30
• To be informed to MHRC
within 7 days of
Admission and treatment for pts with
High support needs for more than 30
• Continue admission in the establishment,
• Same procedures as the previous clause,
where a re-examination will be done, but 2
psychiatrists examine the Pt
• Consistent inability to take care of oneself.
• To be informed to MHRC, to be approved
within 21 days.
• Limited to 90 days. Renewal to 120-180 days.
• Visit by
the mental health
may visit anytime
during the hospital
to review the
treatment given to
the person with
Leave of absence
• Granted by - Medical officer or Psychiatrist.
• After securing consent of Nominated
• Power with the practitioner to terminate
when appropriate to do so.
• If the Pt does not return, contact the person
on leave, or Nominated Representative.
• If pt requires in-pt care and NR also feels
so,the MO may contact the local Police Officer
to convey the person back to the
Absence without leave
• Without discharge, absents
• Taken into protection by
Police Officer at the request
of the Psychiatrist in charge
and brought back.
• Who can treat ?By any
Practitioner, subject to
informed consent from the
• when ?
when its necessary to
a)death or irreversble harm
to health of the person,or,
b)person inficting serious
harm to himself/others
c)person causing damage to
No, i can keep
u here for 72 h
• ECT is not permitted as an emergency
• Emergency treatment limited to 72 hrs or till
the person is assessed at a mental health
Disasters/emergencies, it may extend to 7 days.
• Power with the mental health professional to
prevent discharge of person for a period of 24
hrs to allow assessment if necessary?
Admission of Minors
2 Psychiatrists 1 Psychiatrist & 1 mental
1 Psychiatrist & 1 medical
Representative to be
with the minor for the
entire duration of
• Treatment for the minor
with informed consent
Protection of Rights of Persons with
• Rights- based
• Right to access mental health
care, services including
shelter homes, supported
• Right to live with dignity, right
• Right to information, access
to medical records,
• Right to personal
communication, right to
• Right to equality and non-
Duties of the Government
• Planning, designing,
implementing programs for
promotion of health
• Prevention of mental illness
• Creating awareness about
• Reducing stigma
• Sensitizing govt officials
including police officers
• Implementing public
health programs to
Decriminalization of Suicides
• “ A person who attempts
to commit suicide will be
presumed to have a
mental illness and will
not be subjected to any
• The numbers –
2011- 135,585 people
Provisions related to Electro
Convulsive Therapy and other
• Prohibition on ECT for minors
• Prohibition on sterilization of men or women
as mode of treatment for mental illness
• Prohibition on any form of chaining of
• Psychosurgery as
treatment only with
consent and MHRB’s
• The bill permits
ECT for adults with
use of muscle
Systematic changes in the mental
health care system
• Establishment of Central and state mental
• Mental Health Review Commission (MHRC)
and state-wise Mental Health Review
• Significant strides over the MHA in bringing
about protection of rights and empowerment
of persons with mental illness.
• Its effectiveness could be augmented if a
National Mental health Policy and Plan is
implemented , as per the WHO.
• Biggest task is to ensure that the bill gets
passed and to replace the outdated MHA
Current status of the Bill
• The Bill was introduced in Rajya
Sabha in August 2013 and was
sent to a Parliamentary standing
committee, which recommended
• The union cabinet has approved
the amendments on Jan 30, 2014,
• It is reported that the bill will be
passed in the current session of
•Antony, James T(2000): “A decade with the mental Health Act,1987, Indian
Journal of Psychiatry,42(4):347-355.
• Trivedi,Dr.JK(2009): “Mental Health Act:Salient Features,
• Objectives,Critique and Future Directions”, Indian Journal Of
• Kothari,Jayna: Chatur,Dharmendra :”Moving towards autonomy and
equality: an analysis of the mental health care bill 2012”
• The Mental Health Care Bill,2013, PRS legislative research.
• Rastogi,Dr.Prateek:Mental Health Act,1987, An Analysis.
• The Mental Health Care Bill,2012, Ministry of Health and family welfare,
Government of India, New Delhi