MENTAL HEALTH ACT 1987

1. Mental health act 1987
Introduction Indian mental health act (MHA) was drafted by the parliament in 1987,
but it came into effect in all the states and union territories of India in April 1993. This
act replaces the Indian lunacy Act of 1912.
HISTORY:
 Mental health act was drafted by parliament in 1987
 Came into effect in all the states and union territories of India in April 1993
 Replaces the Indian lunacy act of 1912
 Which had earlier replaced the Indian lunatic asylum act of 1858
Definition of the Act
“An act to consolidate and amend the law relating to the treatment and care of
mentally ill persons, to make better provision with respect to their property and affairs
and for matters connected therewith or incidental there to”
SALIENT FEATURES OF THE ACT
Mental health act is divided into 10 chapters

2. consisting of 98 sections
 Chapter I: Deals with preliminaries of the act
 Chapter II: Deals with establishment of mental health authorities at central and
state levels
 Chapter III: Deals with establishment and maintenance of psychiatric hospitals
and nursing homes [Advance Directive]
 Chapter IV: Deals with the procedures of admission and detention of mentally
ill in psychiatric hospitals [Nominated represenative]
 Chapter V: It deals with the inspection, discharge, leaves of absence and
removal of mentally ill persons [Rights of Persons with Mental Illeness]
 Chapter VI: It deals with the judicial inquisition regarding allegedmentally ill
persons possessing property and its management. [Duties Appropriate to
government]
 Chapter VII: It deals with the maintenance of mentally ill persons in a
psychiatric hospital or psychiatric nursing homes [Central Mental Health
Authority]
 Chapter VIII: It deals with the protection of human rights of mentally ill
persons [State Mental Health Authority]
 Chapter IX: It deals with the penalties and procedures for infringement of
guidelines of the act
 Chapter X: It deals with miscellaneous matters not covered in other chapters of
the act [Mental Health Establishment]
Need
 To change the attitude of the society towards the mentally ill & considerably
realized that no stigma should be attached to such illness.
 Every mentally ill individual has the right to be treated like others sick people.

3.  To modify the act according to the rapid advancement of medical science and
the understanding.
Objectives of the Mental Health Act
 To regulate the power of the government for establishing, licensing and
controlling psychiatric hospital / nursing homes.
 To provide legal aid mentally ill persons at state expense in certain cases.
 To protect citizens from being detained in psychiatric hospital / nursing
homes without sufficient cases
 Central and state authorities for mental health services.
 To regulate maintenance charges of psychiatric hospitals/nursing homes
 To establish central and state authorities for licensing and supervising the
psychiatric hospitals
 To establish such psychiatric hospitals and nursing homes
 To provide a check on working of these hospitals
 To provide for the custody of mentally ill persons who are unable to look after
themselves and are dangerous for themselves and or, others
 To protect the society from dangerous manifestations of mentally ill
 6. To regulate procedure of admission and discharge of mentally ill persons
 To safeguard the rights of these detained individuals
 To protect citizens from being detained unnecessarily
 To provide the maintenance charges of mentally ill
 To provide legal aid to poor mentally ill criminals at state expenses
 To change offensive terminologies of Indian Lunacy act to new soother ones

4. CHAPTER I - PRELIMINARY
TERMS USED
DISTRICT COURT:a city Civil Court, the principal Civil Court of original jurisdiction, or
any other Civil Court competent to deal with all or any of the matters specified in this
Act
INSPECTING OFFICER: means a person authorized by the State Government or by
the licensing authority to inspect any psychiatric hospital or psychiatric nursing home
LICENSE: means a license granted under Sec.8
• means the holder of a licence
MAGISTRATE: - Metropolitan Magistrate; the Chief Judicial Magistrate, Sub-Divisional
Judicial Magistrate or such other Judicial Magistrate of the first class
MEDICAL OFFICER: means a gazetted medical officer in the service of Government
MENTALLY ILL PERSON:means a person who is in need of treatment by person of
any mental disorder other than mental retardation
MINOR:person who has not completed the age of 18 years
MENTALLY ILL PRISONER: Is a mentally ill person, ordered for detention in a
psychiatric hospital, jail or other places of safe custody
PSYCHIATRIC HOSPITAL / NURSING HOME: hospital or nursing home established or
maintained by the Government or any other person for the treatment and care of
mentally ill

5. Chapter II - Mental Health Authorities
Deals with the procedures for establishment of mental health authorities at central
and state levels
It deals with establishment of central & state authorities for regulation and co-
ordination of mental health services.
CENTRALAUTHORITY
o Shall be subject to the superintendence, direction and control of the central
government
o Shall be in charge of regulation, development, direction and co-ordination
with respect to mental health services under the central government
o Supervise the psychiatric hospitals and psychiatric nursing homes and other
mental health service agencies under the control of the central government
o Advise the central government on all matters relating to mental health
STATE AUTHORITY
o Shall be subject to the superintendence, direction and control of the state
government
o Shall be in charge of regulation, development, direction and co-ordination
with respect to mental health services under the state government
o Supervise the psychiatric hospitals and psychiatric nursing homes and other
mental health service agencies under the control of the state government
o Advise the state government on all matters relating to mental health
CHAPTER III - PSYCHIATRIC HOSPITALS AND PSYCHIATRIC NURSING HOMES
It lays down the guidelines for
 Establishment and maintenance of psychiatric hospitals and nursing
homes

6.  Provision for licensing authorities to process applications for license
 The Central Government may established or maintain psychiatric
hospitals or psychiatric nursing homes for:
 the admission and care of mentally ill persons Separate
psychiatric hospitals and psychiatric nursing homes may be
established or maintained for:
 those who are under the age of sixteen years
 those who are addicted to alcohol or other drugs which lead to
behavioral changes in a persons
 hose who have been convicted of any offence
LICENCE
 no person shall established or maintain a psychiatric hospital or psychiatric
nursing home
 unless he holds a valid licence granted to him
 by Central Government or State Government
Application for licence
 A person, who intends to establish or maintain a psychiatric hospital or
psychiatric nursing home, shall, unless the said person already holds a valid
licence, make an application to the licence authority for the grant of a licence
 Duration and renewal of licence
 A licence shall not be transferable or heritable
 Every licence shall, unless revoked earlier, be valid for a period of five years
from the date on which it is granted
CHAPTER IV : ADMISSION AND DETENTION IN PSYCHIATRIC HOSPITAL
 ADMISION ON VOLUNTARY BASIS
 ADMISSION UNDER SPECIAL CIRCUMSTANCES

7.  RECEPTION ORDERS
 ADMISION ON VOLUNTARY BASIS
ADMISION ON VOLUNTARY BASIS
 Request by major for admission as voluntary patient
 Request by guardian for admission of a ward

8. Regulation with respect to, voluntary patient:
 On receipt of a request, the medical officer-incharge shall make an inquiry
within a period of 24 hours and if satisfied, he may admit such application as a
voluntary patient
 Every voluntary patient admitted shall be bound to abide by regulations as
may be made by the medical officer
DISCHARGE OF VOLUNTARY PATIENTS
 The medical officer-in-charge on a request made in that behalf :
 by any voluntary patient
 by the guardian, if he is a minor
 Discharge the patient within 24 hours of the receipt of such request
 If medical officer-incharge is satisfied that the discharge will not be in the
interest of the patient, he shall:
 within 72 hours of a request constitute a Board consisting of two medical
officers and seek its opinion
 if the Board is of the opinion that patient needs further treatment
 medical officer should continue his treatment for a period not exceeding
ninety days at a time
ADMISSION UNDER SPECIAL CIRCUMSTANCES:
 Any mentally ill persons who does not, or is unable to, express his willingness
for admission
 may be admitted and kept as an in-patient in a psychiatric hospital
 on an application made in that behalf by a relative or a friend of the mentally ill
persons

9.  if the medical officers-in-charge is satisfied that in the interest of the mentally
ill persons it is necessary so to do
RECEPTION ORDERS
Application for reception order:
 An application for a reception order may be made by
 the medical officer-in-charge
 the spouse or other relative of the mentally ill

10. Where a medical officer-in-charge is satisfied that :
 the treatment in the psychiatric hospital is required to be continued for more
than six months
 It is in the interests of the health & safety of the mentally ill person or for the
protection of others

11.  The application is to be made to magistrate within the local limits of
jurisdiction of the psychiatric hospital
Every application shall be:
 Signed and verified in the prescribed manner
 Shall be accompanied by two medical certificates
 From two medical practitioners of whom one shall in the service of
government
Duties of police officers in respect of certain mentally ill persons:
Every officer in charge of a police station –
o May take into protection any person found wandering within the limits of his
station whom he believes to be mentally ill & incapable of taking care of
himself, and dangerous by reason of mental illness
o No person shall be detained without being informed, his relatives or friends, if
any

12. o Every person shall be produced before the nearest Magistrate within a period
of twenty-four hours
Admission after Inquisition:
 If any district court holding an inquisition regarding any person who is found to
be mentally ill
 By order such person shall be admitted and kept as an in- patient in a
psychiatric hospital
Admission and detention of mentally ill prisoner:

13.  An order under Sec. 30 of the Prisoners Act, Sec. 330 or Sec. 335 of the Code
of Criminal Procedure 1973
 directing the reception of a mentally ill
 shall be sufficient authority for the admission of such person into any
psychiatric hospital
CHAPTER V - INSPECTION, DISCHARGE, LEAVE OF ABSENCE AND REMOVAL OF
MENTALLY ILL PERSONS
INSPECTION:
 Not less than three visitors shall at least once in every month
 Make a joint inspection of every part of the psychiatric hospital
 Shall enter in a book kept for that purpose such remarks as they deem
appropriate in regard to the management and condition
 The visitors shall not be entitled to inspect any personal records of an in-
patient of confidential nature
DISCHARGE:
 Discharge by medical officer
 Discharge on application

14.  Discharge on request
 Discharge of person subsequently found on inquisition to be of sound mind
Discharge by medical officer:
o On the recommendation of two medical practitioners one of whom shall
preferably be a psychiatrist
o By order in writing, the medical officer shall direct the discharge of any person
from the psychiatric hospital
o Other than a voluntary patient
Discharge on application
o Any person detained in a psychiatric hospital under an order and in pursuance
of an application
o shall be discharged on an application made in that behalf to the medical
officer in charge
o Provided that no person shall be discharged if the medical officer in charge
certifies in writing that the person is dangerous and unfit to be at large
Discharge on request
o Any person (not being a mentally ill prisoner) detained in pursuance of an
order ,who feels that he has recovered from his mental illness, may make an
application to the Magistrate, for his discharge from the psychiatric hospital

15. o The application made shall be supported by a certificate either from the
medical officer in charge or from a psychiatrist
o The Magistrate may, after making such inquiry as he may deem fit, pass an
order discharging the person or dismissing the application.
Discharge of person subsequently found on inquisition to be of sound
mind
o If any person detained in a psychiatric hospital in pursuance of a reception
order is subsequently found
o on an inquisition to be of sound mind or
o capable of taking care of himself and
o managing his affairs

16. o The medical officer-in-charge shall discharge such person from such hospital
or nursing home
LEAVE OF ABSENCE
An application for leave of absence may be made to the medical officer-incharge:-
 by the husband or wife of the mentally ill
 relative of the mentally ill person duly authorized by the husband or wife or
 by the person on whose application the mentally ill person was admitted
 Every application shall be accompanied by a bond undertaking :-
 To take proper care of the mentally ill person
 To prevent the mentally ill person from causing injury to himself or to
others, and
 To bring back the mentally ill person to the psychiatric hospital on the
expiry of leave
 The medical officers-incharge may grant leave of absence for such period as
deemed necessary
 The total number of days shall not exceed sixty days
REMOVAL
 Any mentally ill person other than a voluntary patient subject to any general or
special order of the state government
 Be removed from any psychiatric hospital or psychiatric nursing home to any
other psychiatric hospital or psychiatric nursing home
 Within the state, or to any other state with the consent of the government of
that other state
Chapter VI Judicial Inquisition Regarding Alleged Mentally Ill Persons
Possessing Property, Custody of His Person & Management of his
Property

17.  If a mentally ill person is possessed of property
 An application for holding an inquisition, to the District Court within the local
limits, into the mental condition of such person may be made either :
 by any of his relatives, or
 by a public curator or
 by the Advocate-General of the State or
 by the Collector ‘where the property is land’
 The duty of the Court is to determine judicially whether the person alleged is
incapable of managing himself or his affairs & is really mentally ill in this sense
 If so, the District Court or the Collector of the District may appoint any suitable
person to be his guardian
 the District Court or the Collector shall appoint any suitable person to be the
manager of property possessed by the mentally ill
The act says :- “No person, who is the legal heir of a mentally ill person shall be
appointed under Sec. 53, 54 or 55 to be the guardian of such mentally ill person or
the manager of his property unless the District Court or the Collector considers that
such appointment is for the benefit of the mentally ill person”
The guardian of a mentally ill person or the manager of the property or both
appointed under this Act shall be paid, from out of the property of the mentally ill
person, such allowance as the appointing authority may determine
Duties of guardian and manager :
 the care of the mentally ill person or his property or of both
 the maintenance of the mentally ill person and of such members of his family
as are dependent on him
 If the person appointed as guardian is different from the person appointed as
the manager, the manager of his property shall pay to the guardian allowance
as fixed by the authority

18.  A manager is empowered to exercise the same powers in the management of
the property of the mentally ill person as the mentally ill person would have
exercised as owner of the property had he not been ill
 The manager shall, however, not mortgage, create any charge on, or, transfer
by sale, gift etc. any immoveable property without the prior permission of the
District Court
 Manager has to furnish inventory and annual accounts in respect of the
property of the mentally ill person to the appointing authority 16
Chapter VII Liability To Meet Cost of Maintenance of Mentally Ill Persons
Detained in Psychiatric Hospital Or Nursing Home [Maintenance of Mentally
ill person ]
 The cost of maintenance of a mentally ill person detained as an in-patient in
any psychiatric hospital or psychiatric nursing home shall, unless otherwise
provided for by any law, be borne by the Government of the State
 When a mentally ill person has an estate or any person legally bound to
maintain such person, an application may be made to the District Court for
payment of cost of maintenance of mentally ill person
Chapter VIII Protection of Human Rights of Mentally III Persons
 No mentally ill person shall be subjected during treatment to any indignity
(whether physical or mental) or cruelty
 No mentally ill person under treatment shall be used for purposes of research,
unless
 such research is of direct benefit to him for purposes of diagnosis or
treatment, or .
 such person, being a voluntary patient, has given his consent in writing
or the guardian on his behalf, has given his consent in writing

19.  No letters or other communications sent by or to a mentally ill persons under
treatment shall be intercepted, detained or destroyed
Chapter IX Penalties & Procedure
Penalty in contravention of Chapter III
 Any person who establishes or maintains a psychiatric hospital or nursing
home in contravention of the Chapter III shall be punishable with :
 imprisonment for a term which may extend to three months, or
 with fine which may extend to two hundred rupees, or
 with both
 In the case of a second or subsequent offence:
 with imprisonment for a term which may extend to six months, or
 with fine which may extend to one thousand rupees, or
 with both
Penalty for improper reception of mentally ill person
 Any person who receives or detains or keeps a mentally ill person in a
psychiatric hospital or nursing home otherwise than in accordance with the
provision of this Act, shall be punishable with
 imprisonment for a term which may extend to two years or
 with fine which may extend to one thousand rupees, or
 with both.
Penalty for contravention by a manager
 Any manager who contravenes the provisions shall, be punishable with :
 fine which may extend to two thousand rupees and
 may be detained in a civil prison till he complies with the said
provisions

20. General provision for punishment of other offences
 Any person who contravenes any of the provisions of this Act be punishable
with
 imprisonment for a term which may extend to six months, or
 with fine which may extend to five hundred rupees, or
 with both 24
Chapter X Miscellaneous
Report by medical officer
 the medical officer should make a report about the mental and physical
condition of the discharged person to the authority under whose orders the
mentally ill person was detained in the psychiatric hospital
Pension, etc. of mentally ill payable by Government
 The pay, pension, gratuity or any allowance is payable by any Government, the
officer in charge may pay
 to the person having charge of the mentally ill person so much of the
said sum as he thinks fit
 the cost of maintenance to any person dependent on him for
maintenance
Bill of rights of mentally ill patients
Title V, section 501 of Mental Health Systems Act 42 U.S.C defines a Bill of Rights for
Mentally Ill Patients.
1. Right to treatment and services under conditions that support the person’s
personal liberty.

21. 2. Once disability is certified, the person can avail benefits of travel allowances in
Indian Railways, and an accompanying relative
3. Right to an individualized,written or service plan
4. Right to ongoing participation in the planning of services to be provided.
5. Provision for certain tax benefits for psychiatric patients
6. Right to be provided with a reasonable explanation of all aspects of one’s own
condition and treatment
7. Right to refuse treatment
8. Right to not to participate in experimentation in the absence of the patient’s
informed, written consent
9. Right to freedom from restraints and seclusions
10. Right to humane treatment environment that affords reasonable protection from
harm and appropriate privacy
11. Right to confidentiality of records
12. Right to access, upon request, one’s own mental health care records
13. Right to have jobs in the public sector
14. Right to have access to telephones and mails to converse with others privately
15. Right to assert grievances with respect to infringement of the bill of Rights
16. Right to referral as appropriate as appropriate to other providers
17. Right to wear own clothes
Nurse’s implications for protecting patient’s rights
 To protect the patient’s rights the nurse should be aware of these rights

22.  She should ensure that ward procedures and policies should not violate
patient’s rights
 Discussing these rights with the mental health team and including these rights
in the nursing care plan is important in protecting the patient’s rights
Roles and responsibility of nurses
 Approach the client with warm and accepting manner
 Should have adequate knowledge about admission and discharge procedure
of patient
 Take informed consent from patient or family members to perform various
procedures in the client
 Follow various guidelines giver regarding application of restraints and
seclusions
 She should protect the basic human right of patient Maintain confidentiality of
patient’s data
 Maintain privacy of patient while doing any procedures
 All records should be kept strictly confidential
 Inform concerned person if client escapes from unit
 Keep hazardous objects away from patients
 Make sure that hospital policy does not violate patient’s rights
 Watchful for mentally ill criminals.

25. Human rights of mentally ill
INTRODUCTION
All persons with a mental illness, or who are being treated as such persons, shall be
treated with humanity and respect for the inherent dignity of the human
person...There shall be no discrimination on the grounds of mental illness..."
All Human rights organizations set forth codes by which they align their
purposes and activities . The mental health declaration of human rights articulates the
guiding pricples of CCHR (citizen communication of human rights ) and the standard
aginst which human rights violations by psychaitry are relentlessly investigated and
exposed .
MENTAL HEALTH:-
Mental health is a state of well-being in which the individual realizes his or her own
abilities, can cope with the normal stresses of life, can work productively and fruitfully
and is able to make a contribution to his or her community
MENTAL ILLNESS:-
Mental illness is a recognized, medically diagnosable illness that results in the
significant impairment of an individual’s cognitive, affective or relational abilities.
Mental disorders result from biological, developmental and/or psychosocialfactors
and can be managed using approaches comparable to those applied to physical
disease (i.e., prevention, diagnosis, treatment and rehabilitation)
HUMAN RIGHTS :-
The simplest way defining human rights is that they are about balancing the
inalienable rights of all of us as human being within the community regardless

26. defferences in birth ,social origin,gender ,physcial defferences ,faith and belief
,ideology ,nationality and so on.
THE PSYCHIATRIC PATIENTS CURRENTLY HAVE THE FOLLOWING RIGHTS:-
 Right to communicate with people outside the hospital through
correspondence, telephone, and personal visits.
 Right to wear clothing and personal effects with them in the hospital
 Right to religious freedom
 Right to be employed if possible
 Right to manage and dispose of property
 Right to execute bills
 Right to education
 Right to habeas corpus
 Right to independent psychiatric examination
 Right to civil service status
 Right to retain licences, privileges, or permits established by law, such asa
driver’s or professional licence
 Right to sue or be sued
 Right to marry and divorce
 Right to make purchase
 Right to hygienic condition
 Right not to be subject to unnecessary mechanical restraints
 Right to periodic review of status
 Right to legal representation
 Right to privacy
 Right to informed consent
 Right to treatment
 Right to refuse treatment
 Right to treatment in the least restrictive setting

27. Some of these rights deserve a more thorough discussion:-
Right to Communicate With People Outside the Hospital:
This right allows patient to visit and hold telephone conversations in
privacy and send unopened letters to anyone of their choice, including judges,
lawyers, families, and staff. Although the patient has the right to communicate in
anuncensored manner, the staff may limit access to the telephone or visitors when it
could harm the patient or be a source of harassment for the staff. The hospital also
can limit the times when telephone calls are made and received and when visitors can
enter the facility.
Right to Keep Personal Effects:-
The patient may bring clothing and personal items to the hospital, taking into
consideration the amount of storage space available. The hospital is not responsible
for their safety, and valuable items should be left at home. If the patient brings
something of value to the hospital, the staff should place it in the hospital safe or
otherwise provide for maintaining a safe environment and should take dangerous
objects away from the patient if necessary.
Right To Enter Into Contractual Relationships:-
The court considers contracts valid if the person understands the circumstances of the
contract and its consequences. Once again, a psychiatric illness does not invalidate a
contract, although the nature of the contract and degree of judgement needed to
understand it are influencing factors.
Right to education:-

28. Many patient exercise the right to education on behalf of their emotionally ill or
mentally retarded children. The U.S. Constitution guarantees this right to everyone,
although many states have not provided adequate education to all citizens in the past
and are now required to do so.
Right to Habeas Corpus:-
Habeas corpus is an important constitutional right patients retain in all states even if
they have been involuntarily hospitalized. It provides for the speedy release of any
person who claims to be detained illegally. A committed patient may file a writ at any
time on the grounds of being sane and eligible for release. The hearing takes place in
court, where those who wish to restrain the patient must defend their actions. Patients
are discharged if they are judged to be sane.
Right to privacy :-
The right to privacy implies the person’s right to keep some personal information
completely secret or confidential. Confidentiality involves the nondisclosure of specific
information about a person to someone else unless authorized by that person. Every
psychiatric professionalis responsible is responsible for protecting a patient’s right
to confidentiality, including even the knowledge that a person is in treatment or in a
hospital. Revealing such information might result in damage to the patient. The
protection of the law applies to all patients.
Right to informed consent:-
The goal of informed consent is to help patients make better decisions. Informed
consent means that a clinician must give the patient a certain amount of information
about the proposed treatment and must attain the patient’s consent, which must be
informed ,competent and voluntary.

29. Information to be Disclose in Obtaining Informed Consent
Diagnosis : Description of the patient’s problem
Treatment: Nature and purpose of the proposed treatment
Consequences: Risks and benefits of the proposed treatment including physical and
psychologicaleffects, costs, and potential resulting problems
Alternatives: Viable alternatives to the proposed treatment and their risks and benefits
Prognosis : Expected outcomes with treatment, with alternative treatments, and
without treatment.
Right to treatment :- Early court cases extended the right to treatment to all
mentally ill and mentally retarded people who were involuntarily hospitalized. The
courts defined three criteria for adequate treatment :
1. A humane psychological and the physical environment
2. A qualified staff with a sufficient number of members to administer adequate
treatment
3. Individualized treatment plans
Right to Refuse Treatment :-
The relationship between right to treatment and right to refuse treatment is complex.
The right to refuse treatment includes the right to refuse involuntary hospitalization. It
has been called the right to left alone. The involuntary therapy conflicts with two basic
legal rights: freedom of thought and the right to control one’s life and actions as
long as they do not interfere with the rights of others.
Right to Treatment in the Least Restrictive Setting :-
The right to treatment in the least restrictive setting is closely related to the right to
adequate treatment. Its goal is evaluating the needs of each patient and maintaining

30. the greatest amount of personal freedom, autonomy, dignity, and integrity in
determining treatment.
This right applies to both hospital-basedand community programs. Another
consideration in the least restrictive alternative is that it applies not only to when a
person should be hospitalized but also to how a person is cared for.
It requires that a patient’s progress be carefully monitored so that treatment plans
are changed based on the patient’s current condition.
ROLE OF NURSE IN PATIENT’S RIGHTS:
The National League for Nursing (1977) issued a statement on the nurse’s role
inpatient’s rights. The league urged nurses to get involved in ensuring patient’s
human and legal rights .
The league identified many of the previously mentioned following rights :
 Right to health care that is accessibleand meets professional standards ,
regardless of the setting
 Right to courteous and individualized health care that is equitable, human , and
given without discrimination based on race, colour, creed, sex, national origin,
source of payment, or ethical or political beliefs
 Right to information about their diagnosis, prognosis, and treatment ,
including alternatives to care and risks involved
 Right to information about the qualifications, names, and titles of healthcare
personnel
 Right to refuse observation by those not directly involved in their care
 Right to coordination and continuity of health care
 Right to information on the charges for services, including the rights to
challenge these charges

31.  Above all, the right to be fully informed about all their rights in all health care
settings.