Medico-legal responsibilities of mentally ill persons and recent amendments in Mental Health Act 2017, Procedures of restraint or admission of mentally ill person to psychiatric hospital.

1. Forensic Psychiatry
Dr Ashutosh B. Potdar,
Head of Department,
Dept of Forensic Medicine,
D. Y. Patil Medical College, Kolhapur

2. Forensic Psychiatry
Definition:
Application of knowledge of psychiatry in
the administration of justice.

3. McNaughton British PM

4. McNaughton’s Rule
• Daniel McNaughten, a 29 year Scotsman, labouring
under delusion, shot dead Edward Drummond, the
secretary to the British Prime Minister Sir Robert Peel.
• McNaughten was paranoid schizophrenic and had
delusion that Sir Robert Peel was conspiring against
him.
• He had intended to kill Sir Robert Peel but mistakenly
killed Drummond.

5. McNaughton’s Rule
• The Jury, after hearing medical evidence of 9
physicians, found McNaughten not guilty by reasons
of unsoundness of mind.
• The Queen Victoria, Sir Robert Peel and other well-
known persons were outraged by the verdict.
• They invited 15 eminent judges to the House of Lords
who were requested to respond to series of questions
on criminal responsibility of insane.

6. McNaughton’s Rule
• The answers given by the learned judges were
immortalized in the history and have come to be
known as ‘McNaughten rule’ or ‘the legal test’ or
“Right - wrong test”.

7. Symptoms of Mental Illness
•Delusion
•Illusion
•Hallucination
•Impulse
•Obsession
• Phobia

8. Delusion
• Disturbance of Thought
• It is a false belief in some thing which is not a fact,
and which persists even after its falsity has been
clearly demonstrated
• Often is a reflection of the patient’s mood

9. Types of Delusion
1. Delusion of Grandeur or Exaltation: Here the person feels
that he is rich or famous but actually he may be poor.

10. Types of Delusion
2. Delusion of poverty:
• Person thinks he or she is poor/pauper, though he or she
is rich.
3. Delusion of persecution:
• Here the person thinks that some persons are persecuting
against him. Nearest and dearest relatives are trying to
poison or kill him or her.

11. Types of Delusion
4. Delusion of reference:
• Imagines that others are referring him in a special way e.g.
people are talking about him, newspaper are writing
about him etc.
5. Delusion of influence (or control):
• Here the person feels that his thoughts are being controlled
by some external force.
6. Nihilistic delusion:
Here the person feels that nothing exists around him or
that there is no world.

12. 7. Delusion of infidelity:
Person imagines or thinks that his wife is unfaithful to him. It is also called
as “Othello Syndrome” or conjugal paranoia.

13. Types of Delusion
8. Delusion of influence (control):
• Feels that he is controlled by an outside power, agency,
radio, hypnotized telepathy, etc.
9. Hypochondrial delusions:
• He is ill or is convinced that something is wrong with his
body. Actually the person is healthy.
10. Delusional dysmorphophobia:
Thinks that he is ugly.

14. Types of Delusion
11. Erotomania (Clerambault syndrome):
• Common among females
• she feels that a particular individual, especially her
superior officer or her employer, etc is in love with her.

15. Medicolegal Importance of Delusion
1. Delusional ideas or thoughts may affect the conduct
of a person.
2. When labouring under delusional ideas, a person
may commit suicide or homicide or other crime.
3. A person doing the unlawful act under delusional
thought cannot be held responsible for the act.

16. Illusion
• Disorder of perception
• It is a false interpretation of an
object or stimulus which has a
real existence
• Such falsity in interpretation can
be removed from mind
• A person may mistake rope as a
snake or tree as ghost or self-
shadow as ghost.

17. Hallucination
• Disorder of perception
• It is a false sensory perception without any external
object or stimulus to produce it
• They are purely imaginary and may affect any or all the
special senses
• Causes:-
• Schizophrenia, Affective disorders, Organic mental disorders, High
fever, Drug addiction or in Head injuries

18. Types of Hallucination
1. Auditory
2. Visual
3. Olfactory
4. Gustatory
5. Tactile – Cocaine bugs

19. 1. Auditory hallucinations
• Most common type
• Hearing of noises or voices without any stimulus.
• Auditory hallucinations may be of following types:
a)Elementary type: Person hear only noises
b)Partly organized: Person hears music
c)Completely organized: Person hears hallucinatory voices

20. 2. Visual hallucinations
• Seeing images, flash of light, etc.
• Visual hallucinations may be of:
a)Elementary type: Person sees only flashes of light
b)Partly organized: Person sees as patterns or unformed
images
c) Completely organized: Person sees as images, figures or
image of people, animal or objects.

21. 3. Olfactory hallucinations:
• Person perceives nonexistent smell/odour.
4. Gustatory hallucinations:
• Patient perceives good or bad taste without eating actual
food.
5. Tactile hallucinations:
• Person senses abnormal touch.
• E.g. person may feel that bugs or insects are crawling over
his skin (Formication).

22. Cocaine bugs

23. Impulse
Sudden and irresistible desire or force,
compelling to
commit conscious performance of some action
without motive or fore thought

24. Types of impulse
1. Kleptomania: –
irresistible desire or impulse
to steal objects or articles of
small value.

25. Types of impulse
2. Pyromania:
irresistible desire or
impulse to set fire or objects
on fire.

26. Types of impulse
3. Trichtillomania: irresistible
desire or impulse to pull out
one’s own hair.

27. Types of impulse
4. Dipsomania: irresistible desire or
impulse to drink alcohol.
5. Mutilo-mania: irresistible desire
or impulse to maim or hurt or
torture animals.

28. Obsession
An idea or impulse or emotion that intrudes
into conscious awareness repeatedly
The person in spite of all his efforts, cannot
drive it out of his mind, though he knows or
realizes it to be wrong or unnecessary

29. Phobia
It is irrational, excessive, out of proportion
fear about a particular object or situation
A. Claustrophobia – closed spaces
B. Agoraphobia – open spaces
C. Acrophobia – height
D. Nyctophobia – darkness
E. Mysophobia – dirtiness or uncleanness
F. Hydrophobia – water

30. Mental Health Care Act 2017
• Replaces the earlier Mental Health Act 1987
• Divided into 10 chapters
• Decriminalizing the “attempt to commit suicide” (S. 309 IPC)
• S. 309 IPC: Whoever attempts to commit suicide and does
any act towards the commission of such offence, shall be
punished with simple imprisonment for a term which may
extend to one year or with fine, or with both
• Instead individual should be offered rehabilitation from Govt
authorities

31. Mental Health Care Act 2017
• Safeguard the rights of people with mental illness
• Health insurance is must for mental illness also
• Restricted usage of ECT (electro-convulsive therapy)
only in cases of emergency and prohibited to be used
for minors
• Provisions for the registration of mental health related
institutions

32. Mental Health Care Act 2017
• Chapter I: deals various with various definitions
• ‘Mentally ill person’ instead of ‘Lunatic’
• ‘psychiatric hospital’ instead of ‘mental hospital’
• Mentally ill person: a person who is in need of treatment by
reason of any mental disorder other than mental
retardation.
• Chapter II: Establishment of Mental Health Authorities at
State & Centre levels

33. Mental Health Care Act 2017
• Chapter III: Guidelines for establishment &
maintenance of psychiatric hospitals
• Chapter IV: Admission and detention in psychiatric
hospitals
• Chapter V: Inspection, discharge, removal of mentally
ill person
• Chapter VI: mentally ill person’s property
management

34. Mental Health Care Act 2017
• Chapter VII: Cost of mentally ill person’s management
• Chapter VIII: Protection of human rights of mentally ill
person
• Chapter IX: Penalties for infringement
• Chapter VIII: Miscellaneous matters

35. Procedure of Admission and Detention
(Restraint of the Insane)
1. Voluntary or direct restraint
2. Reception order on petition
3. Reception order other than on petition
4. Reception after judicial inquisition
5. Reception of mentally ill criminal
6. Reception of the escaped mentally ill.

36. 1. Voluntary or direct restraint
• Any major person, who considers himself to be a
mentally ill
• Desires to be admitted to any psychiatric hospitals for
treatment
• Request the medical officer-in-charge of that hospital
for voluntary admission as a voluntary patient

37. 2. Reception Order on Petition
• Relative or a friend,(taking care of the patient for a period of
more than 14 days prior to date of petition writing)
• Application to the magistrate
• A medical certificate from registered Medical practitioner
stating that patient needs hospitalization for treatment
• Magistrate’s order of reception: Magistrate shall issue the
order of reception and if there is a need he or she may
personally come and examine the patient. This order holds
good for 30 days.

38. 3.Reception order other than on petition
Wandering and dangerous lunatic
• Police officer can arrest such patient  produce before a
magistrate.
• Magistrate issues reception order directly
• Or Sends the patient for medical examination and then, issue
reception order if the patient is certified medically as mentally ill
and dangerous.
Lunatic not cared for properly:
• Police officer can produce a mentally ill person who is not properly
cared for or cruelly treated by the relatives to the magistrate and a
reception order can be sanctioned.

39. 4. Reception after judicial inquisition
If a person possessing huge property turns mentally ill
• Highcourt or District court may pass an order of inquisition
and arrange:
• Reception of the patient to a psychiatric hospital
• Proper care of his or her property
• Recovering necessary fees from the profits or income from
property of the patient under court care

40. 5. Reception of Mentally Ill Criminal
•It is one who is mentally ill and has committed a crime
or become mentally ill after being imprisoned.
•Presiding officer of the court issues order for restraint.
6. Reception of the Escaped Mentally Ill
•Such a patient can be readmitted to psychiatric
hospital by a police officer or any officer or servant of
the hospital

41. Discharge of Mentally Ill from Psychiatric
Hospital
• Voluntary patients: discharged within 24 hours of the receipt
of request for discharge made by patient or if minor, made
by the guardian.
• On application by Relatives or friends: may apply to the
Magistrate for his discharge. Magistrate can pass order if the
relatives executes a bond to take proper care of such
mentally ill person.
• Medical officer-in-charge of psychiatric hospital can order
the discharge of any patient, on recommendation of two
medical practitioners one of whom should be a psychiatrist.

42. Criminal responsibility of mentally ill
S. 84 of Indian Penal Code
“nothing is an offense which is done by a person
who, at the time of doing it, is, by reason of
unsoundness of mind, incapable of knowing the
nature of the act, or that he is doing what is
either wrong or contrary to law”

43. Feigned Insanity
• Defined as a condition wherein a person is pretending
to be insane.
Purpose
• To escape capital punishment by a criminal (criminal
death sentences)
• To avoid business transactions or deeds
• To quit service in military jobs.

44. Feigned Insanity
Medicolegal Importance
• It is a most responsible duty of the doctor to detect
and report feigned insanity
• Observation is a must for a minimum of 10 days (may
be extended with permission of magistrate).

45. Feigned Insanity vs True Insanity
Feigned Insanity True Insanity
On set Abrupt Gradual
Motive Present Absent
Predisposing factor Absent Present
Facial appearance Exaggerated Vacant
Frequent examination Resents Doesn’t mind
Sleep Cant withstand lack of
sleep
Insomnia

46. Civil Responsibilities of Mentally ILL
1. Testamentary capacity
•Ability of a person to make valid will or testament
•Valid will: Testator must be a major, in compos
mentis, fully conscious. Document written and
signed by the testator, authenticated by witnesses.
2. Management of property
•Court appoints a manager/guardian for mentally ill

47. Civil Responsibilities of Mentally ILL
3. Consent
•Not valid unless in lucid interval
4. Contract
•Not valid unless in lucid interval
5. Marriage
6. Competence as a witness
•Incapable to give evidence unless in lucid interval

48. Lucid Interval
• It is the period of normalcy with normal mental
activities
• During this period symptoms of mental illness may be
completely absent
• All civil rights - make valid will, give evidence, make
contract.
• Person can judge his acts hence, criminally
responsible for unlawful acts

49. Thank you