For B.Sc Nursing students

1. ADMISSION AND
DISCHARGE OF A
MENTALLY ILL PATIENT
R. RUPPAMERCY
M.SC. NURSING II YEAR

2. INTRODUCTION
Mental & behavior disorders are understood as clinically significant conditions
characterized by alterations in thinking, mood (emotions) or behavior associated
with personal distress or impaired functioning.(WHO)People are admitted to a
hospital when they are affected with less serious or life – threatening problem to
get adequate care on time to time

3. DEFINITION
Admission:
Admission is defined as allowing a patient to stay in hospital for
observation, investigation, treatment and care.
Discharge:
Discharge of patient from the hospital means, relieving a person from
hospital setting, who admitted as an inpatient in that hospital.

4. TYPES OF ADMISSION

5. VOLUNTARY & INVOLUNTARY
IF THE PATIENT IS WILLING, REQUEST MADE BY A MAJOR/GUARDIAN
OF THE MINOR FOR ADMISSION TO MEDICAL OFFICER
MEDICAL OFFICER MAKES ENQUIRES FOR 24 HRS
IF THE MO IS SATISFIED FOR ADMISSION AND
PROVIDES REQUIREMENT FOR TREATMENT
VOLUNTARY ADMISSION IS MADE
IF THE PATIENT IS UNWILLING OR UNABLE TO MAKE A REQUEST
FOR ADMISSION, A RELATIVE OR A FRIEND MAKES THE
APPLICATION ON BEHALF OF PATIENT
INVOLUNTARY ADMISSION IS MADE –
ADMISSION UNDER SPECIAL CIRCUMSTANCES

6. WHO CAN MAKE THE APPLICATION
An application for the involuntary admission of an adult may be made to a
registered medical practitioner by a spouse, civil partner or relative, an
authorised officer or any other person.
An authorised officer is an officer of the Health Service Executive (HSE) who is
designated by the Chief Executive Officer of the HSE for the purposes of making
such applications.
This does not include a separated spouse or civil partner or one against whom an
application or order under the Domestic Violence Act has been made.
The person applying must have seen the person whose admission is sought within
the 48 hours before making the application.

7. UNDER AUTHORITY OF ORDER
RELEASE
PETITION
EXAMINATION
DETERMINANTS
MEDICAL ADMINISTRATION
HOSPITALIZATION -
EMERGENCY,SHORT
TERM,LONG TERM

8. RECEPTION ORDER
• ON APPLICATION - Only a relative or friend makes application to magistrate. Application
should be supported by two medical certificates, Magistrate obtains consent from the
medical officer in-charge of mental hospital. Admission under reception order is made.
• ON PRODUCTION BEFORE MAGISTRATE - Mentally Ill patient exhibiting violent
behavior detained by police officer. Production in the court within 24 hours of detention.
Application is supported by two medical certificates. Magistrate issues reception order.
• AFTER INQUEST - A district court holding an inquisition regarding any person who is
found to be mentally ill, in the interest of such person, may, by order direct for admission.
Every such order may be varied from time to time.
• ADMISSION OF A MENTALLY ILL PRISONER - A mentally ill prisoner may be admitted
into a mental hospital on order of the presiding officer or a court.

9. ON APPLICATION
Application is made by a relative/friend makes to magistrate.
Application should be supported by two medical certificates
Magistrate obtains consent from the medical officer in-charge of mental
hospital.
Admission under reception order is made.

10. ON PRODUCTION BEFORE
MAGISTRATE
Mentally Ill patient exhibiting violent behavior detained by police officer.
Production in the court within 24 hours of detention.
Application is supported by two medical certificates.
Magistrate issues reception order.

11. AFTER INQUEST
Inquest of a mentally ill patient by district court
In the interest of such person district court directs for admission
Admission is made

12. MISCELLANEOUS
• A mentally ill patient can be admitted either on humanitarian grounds (e.g.
wanderers) or for observation purpose. Social workers can obtain an order
from the magistrate pending report from medical officer.

13. TYPES OF DISCHARGE

14. CONTD…
DISCHARGE OF A PATIENT ADMITTED ON VOLUNTARY BASIS.
MO of hospital on recommendation from two medical practitioners can issue
direction for discharge of patient.
DISCHARGE OF A PATIENT ADMITTED UNDER SPECIAL
CIRCUMSTANCES
A relative or a friend makes an application to the medical officer for care and
custody of the patient. The relatives are required to furnish a bond, along with an
undertaking that the mentally ill person shall be prevented from causing injury to self
and others.
DISCHARGE OF A PATIENT ADMITTED ON RECEPTION OF ORDER.
An application is made. A certificate from medical officer-in-charge of psychiatric
hospital is obtained. A magistrate issues an order if patient is fit for discharge.

15. CONTD…
DISCHARGE OF A MENTALLY ILL PRISONER
The hospital authorities have to report every 6 months about the persons state of mind
to the authority, which had ordered detention. As soon as they find that the person is
fit to stand the trial, they have to inform about the same to the authority concerned.
The person is then handed over to the prison officer for further legal action.
LEAVE OF ABSENCE (SECTION 45)
Leave of absence means, when mentally ill patients are detained in a hospital, they
may be given time limited leave, to leave the hospital with permission to visit family
members. It is a step towards community treatment.

16. Contd..
DISCHARGE OF A PATIENT ADMITTED BY POLICE
In cases where the police detain the mentally ill individual in hospital,
he may be discharged after the family members agree in writing to take
proper care, and the medical officer-in-charge opines that he is fit to be
discharged.

17. ROLES AND RESPONSIBILITIES OF A
NURSE
DURING ADMISSION PROCEDURE
• Setting the Setting the patient in the ward
• Welcoming to the ward
• Introducing to other staff members
• If any patient having suicidal ideas, he should have located in a place where the
patient can be closely observed.
• The patient should be shown various facilities like bathroom, recreation etc.
• Acquaint the patient with some of ward rules.
• Provide appropriate information.
• History, MSE, and head to toe observation to be done.
• Write nurses notes; enter in admission register.

18. ROLES AND RESPONSIBILITIES OF A
NURSE
• DURING DISCHARGE
• Nurse must ensure that the patient leaves the unit with all belongings and personal
effects, has the appropriate medications with him, and appointment for follow up.
• All necessary instructions, especially regarding his medication regimen, side-
effects, etc. must be clearly given to the patient and his family members.
• Any paper work, signing of documents should be completed. The hospital file
along with all charts and notes should be sent to the medical records section.
• The nurse should ascertain his travel plan and offer assistance if necessary.
• The nurse must bear in mind that the patient may have mixed feelings about
leaving the hospital and going back to his home environment.

19. LEGAL RESPONSIBILITIES OF A NURSE
• Patient’s rights.
• Criminal and civil responsibilities of mentally ill patients.
• Legal documentation
• Nursing malpractice: Malpractice involves the failure of professionals to provide
proper and competent care that is given by the members of their profession,
resulting in harm to the patient.
• Confidentiality: Confidentiality refers to the non- disclosure of private
information related to one individual to another, such as from patient to nurse.
• Informed consent: The informed consent is a patient’s authorization or agreement
to a specific medical intervention.

20. CONTD…
• Substitute Consent: It refers to the situation where a patient is not capable of
giving their own consent to the proposed treatment. In such cases authorization
is given by another individual, being a guardian appointed by the court or the
kith and kin on behalf of the patient. Before getting the consent of the patient or
his legal guardian, a full explanation is necessary in regard to the risks involved
in the investigation, treatment and procedures administered to the patient.
• Record Keeping:
• Nursing notes and progress records constitute legal documents and hence
should be maintained carefully.
• They should be non-judgmental and the statements made should be objective in
nature.

21. SUMMARIZE……………………

22. CONCLUSION
To practice psychiatric-mental health nursing, nurses must understand the basic
legal aspects of caring for psychiatric clients. Each state has laws attempt to
balance protection of the mentally ill. Such laws attempt to balance protection
of the mentally ill client’s civil rights with the preservation of public safety.

23. THANK YOU……