This document provides an overview and critical review of India's Mental Health Act of 1987. It discusses the history and objectives of mental health legislation in India. The positives of the 1987 Act include more humane terminology and provisions for patient rights and property management. However, it is still criticized for prioritizing legal over medical considerations and not removing the criminal element for involuntary patients. The 10 chapters of the Act are also analyzed, identifying inadequacies around definitions, oversight, and emphasis on hospitalization over community care. Improvements are suggested regarding admission criteria and independent review of involuntary treatment.

1. PRESENTER: -
DR. GURU S
SENIOR RESIDENT
NIMHANS, BANGALORE
MENTAL HEALTH ACT
A CRTICAL REVIEW

2. Overview
 Brief history of the mental health act.
 Objectives of the act.
 Importance of the act.
 Positive changes in the MHA.
 Critical aspects of MHA 1987.
 The 10 chapters of MHA, short details, inadequacies
and suggested improvements.
 Changes to the Mental Health Act 2007
 Conclusions

3. HISTORY OF MENTAL HEALTH LEGISLATION
IN INDIA
 Aug 2 1858- Govt of India act, -
- Guideline for establishment of mental asylum
- Admission procedure
- Safe custody of pt
 Indian Lunacy Act (ILA), 1912 was governing the mental health in India.
- mental asylum- mental hospital.
- role of psychiatrist.
- inspector of central prison – directorate of health services.
 In 1947, when Indian Psychiatric Society came into existence,
 In 1949 IPS Reviewed that, ILA-1912 was considered insufficient to
safeguard the rights of mentally ill patients.

4. HISTORY OF MENTAL HEALTH LEGISLATION
IN INDIA
 Adhoc committee- 3 psychiatrist appointed
 IPS drafted a mental health bill and submitted it to govt. of
India in 1950.
 It took another 28 years for govt. to present it in the Lok
Sabha.
 After a gap of another 8 years the bill was adopted as Mental
Health Bill by Rajya Sabha in 1986 and the Lok Sabha in 1987
 This bill received President’s assent in May, 1987 but finally
came into force after 6 years in April 1993

5. Changes in ILA-1912
- Directorate of health services.
-Role of psychiatrist.
-Appointment of full time medical officer.
-Critique
- No guidelines for admission , safety ,
- Detention, treatment, discharge,

6. OBJECTIVES OF THE ACT –(MHA-1987)
 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.

7. OBJECTIVES OF THE ACT (CONTD….)
 To regulate procedure of admission and discharge of
mentally ill persons to the psychiatric hospitals or
nursing homes either on voluntary basis or on request
 To safeguard the rights of these detained individuals
 To protect citizens from being detained unnecessarily

8. OBJECTIVES OF THE ACT (CONTD….)
 To provide for the maintenance charges of mentally ill
persons undergoing treatment in such hospitals
 To provide legal aid to poor mentally ill criminals at
state expenses
 To change offensive terminologies of Indian Lunacy act
to new soother ones

9. IMPORTANCE OF THE ACT
 The fact that even four decades after India received its
independence, we were continuing with an outdated and
anarchic law speaks volumes about the importance of this act
 However, whatever fallacies that have come to the fore ever
since this law was enforced are due to following facts:
 At the time of conception of law, private psychiatry was still in infancy and
the growth and development of private psychiatry was neither foreseen nor
predicted. That might be the reason the law in its current form seems to be
biased against private psychiatry
 The field of psychiatry itself has grown by leaps and bounds and the scope of
this branch has widened beyond the horizons predicted before. Hence so
many changes have crept into this field that the law after two decades
already seems outdated

10. Positive changes in the MHA
 More humane approach to problems of mentally ill persons by
changing the terminology and new chapters on management of
their property and protection of human rights have been
included
 Creation of Central and State Mental Health Authorities- a
welcome step to safeguard the interests of the mentally ill person
under one authority
 Procedure for admission and discharge of voluntary patients
have been simplified and liberalized
 Minor can be admitted with the consent of a guardian under this
act. This provision is not there in the Indian Lunacy Act, 1912
 Separate provision for admission of involuntary patients under category
“Admissions Under Special Circumstances”

11. CONTD….
 Special centres for special population like drug addicts, under
16 years, mentally ill prisoners etc.
 Establishment and maintenance of psychiatric hospitals and
psychiatric nursing homes in private sector which was not in
the earlier law
 Discharge procedure have been made easy and more simplified
 There are new additions in this law like protection of human
rights of mentally ill persons, penalties, cost of maintenance and
management of properties of mentally ill persons
 Prohibition on any research on subjects without proper consent

12. CRITICAL ASPECTS OF MHA 1987 AS A WHOLE
 Legal considerations have been given more
weightage in comparison to medical ones
 Failed to remove the criminal flavour by keeping the
power of criminal court to exert its control over
admissions and discharge of non criminal mentally
ill persons
 There are no provisions for punishing the relatives
and officers requesting unnecessary detention of a
person to such hospitals.

13. CRITICAL ASPECTS OF MHA 1987 AS A WHOLE
(CONTD….)
 No importance to family and community psychiatry.
 Once a person is admitted to mental hospital he is termed
insane or mad by the society. There should be provisions in
the act to educate the society against these misconceptions
 Much stress is laid on hospital admission and treatment. This
again increases the cost of health care. No provisions are
made for home treatment/ CTO(community treatment order)
 The act has no provision for transportation of an unwilling
patient except by police,
 No importance to Individual autonomy of patient .

14. THE TEN CHAPTERS OF MENTAL
HEALTH ACT, THEIR SHORT DETAILS,
INADEQUACIES & SUGGESTED
IMPROVEMENTS

15. CHAPTER I
 Deals with preliminaries of the act, definitions and provides
for change of offensive terminologies used in Indian Lunacy
act 1912
 Medical officer: “A registered medical practitioner.”
According to law can be even an Ayurvedic or
homeopathic medical officer in Government service
whereas – Should be a qualified psychiatrist
 Mentally ill person: “person who is in need of treatment by
reason of any mental disorder other than mental
retardation” The definition does not specify the types of
mental illness to be included

16.  Licensed psychiatric hospital or licensed psychiatric nursing home:
“ means a psychiatric hospital or psychiatric nursing
home as the case may be licensed, or deemed to be
licensed, under the Act” Definitions of psychiatric
hospitals and psychiatric nursing homes” (Section2q)
excludes government hospitals, and is
discriminatory. In this case a uniform policy should
be adopted.
CHAPTER I (CONTD….)

17. CHAPTER II
 Deals with the procedures for establishment of
mental health authorities at central and state
levels
 Suggested changes: Licensing authorities do not
have a doctor who may be in a better position to
assess the facilities and services of these centers,

18. CHAPTER III
 It lays down the guidelines for establishment and
maintenance of psychiatric hospitals and nursing homes
 There is a provision for licensing authorities to process
applications for license which have to be renewed every
five years
 Suggested changes: should include general hospitals
which may provide better health care. Licensing
process should be made simpler. Procedures to check
the working of licensing authorities and powers
vested in them

19. CHAPTER IV
 It deals with the procedures of admission and detention of
mentally ill in psychiatric hospitals
Suggested changes:
 Emergency situations: To be an emergency, it must be demonstrated
that the time required to follow substantive procedures would cause
sufficient delay and lead to harm the concerned person or others,
 Involuntary admission and treatment only on the assessment and
advice of a qualified mental health/medical practitioner.
 Emergency treatment should not include: Depot injection, ECT,
Sterilization Psychosurgery and other irreversible treatment

20. CHAPTER IV (CONTD….)
 Emergency treatment must be time limited (say within one week)
and substantive procedures for involuntary admission and
treatment if necessary must be initiated as soon as possible and
completed within this period
 Admission under special circumstances (involuntary patients)
(Section 19). There should be set Criteria for involuntary
admission.
 Two accredited medical practitioner, of which one should be a
psychiatrist, to certify mental disorder.
 Provision for regular time bound review of involuntary
admissions by review body.
 Discharge procedures to be flexible and easy, to prevent
unnecessary detention

21. CHAPTER IV (CONTD….)
 Establishment of independent and impartial court like body with a
judicial function (Mental Health Tribunal). This body to assess each
involuntary admission and treatment
 Review Body should review the cases at periodic intervals and should
have the power to discharge the patients if withheld unnecessarily
 This body could authorize or prohibit intrusive and irreversible
treatment for example psychosurgery, sterilization

22. CHAPTER IV (CONTD….)
 In developing countries like ours with limited resources
the review body mentioned previously can perform the
following functions
 Regular inspection of mental health facilities
 Regular monitoring of patients welfare and well being
 Providing guidance for minimizing intrusive
treatment
 Keeping records and statistics
 To make recommendations to concerned authorities

23. CHAPTER V
 It deals with the inspection, discharge, leaves of absence
and removal of mentally ill persons
 Although the act provides for a simpler discharge
procedure but no provisions made for after discharge
care and rehabilitation. Much stress laid on hospital
admission and treatment. This again increases cost of
health care. No provisions made for home
treatment

24. CHAPTER VI
 It deals with the judicial inquisition regarding alleged
mentally ill persons possessing property and its
management
 Legal determination of capacity to assume full
control of one’s property or to control one’s
inherited assets does not require the opinion of a
medical professional
 Thus increasing the possibility that subjective bias
could prevent individuals recovered from mental
illness from controlling their own assets.

25. CHAPTER VII
 It deals with the cost of maintenance of mentally ill
persons in a psychiatric hospital or psychiatric nursing
homes
 Suggested changes: No provision for patients with no estate
and no relative.
 Mental health legislation should include integration with NMHP
and NGO’s to improve community and primary psychiatric
services.
 Legislation should ensure the introduction of mental health
interventions into primary health care. Integrated care reduces
stigma associated with mental illnesses and also promotes mental
health .

26. CHAPTER VIII
 It deals with the protection of human rights of mentally
ill persons
 Suggested changes: There should be provisions in the
act to educate the society against misconceptions.
 Indian common law provides a patient with a right to
informed consent and confidentiality of patient
records, although the Mental Health Act only requires
informed consent for experimental treatment.
 Indian law severely curtails the civil and political
rights of mentally ill individuals

27.  CHAPTER IX
- Penalties and procedure
 CHAPTER X
- Miscellaneous
No changes needed……

28. Other changes to be incorporated in to new law
 Protection of a human right of the mentally ill pt.
 Treatment of destitute.
 Integration of mentally ill pt to society after a
treatment.
 Individual autonomy.
 Advance directive…

29. The MH Amendments 2007 change the MHA 1983 by
• Making ‘Nine Key Changes’ to the existing MHA 1983
(most of the Act stays the same)
• These are accompanied by a revised Code of Practice
(CoP)
• Introducing ‘Five Guiding Principles’ which must inform
every decision made under the MHA..

30. How do the new amendments work?
 Mental Health Act – tells staff what to do
 Code of Practice – tells them how to do
 Guiding Principles – requirement to consider
individual circumstances

31. 9 Key changes - summary
1. Single definition of Mental Disorder
2. Appropriate Treatment Test
3. Two New Professional Roles
4. Right to Displace Nearest Relative
5. ECT safeguards
6. Supervised Community Treatment
7. Mental Health Review Tribunals
8. Right to Advocacy
9. Young People

32. 1. Single definition of ‘Mental Disorder’
– Mental disorder means:
– any disorder or disability of mind
– The 4 separate categories used previously
 ( Mental illness, Severe mental disorder and
Psychopathic disorder) are abolished

33. 2. Appropriate Treatment Test
– Treatment appropriate to the person’s mental disorder
and circumstances must be actually available
– ‘Medical treatment’ includes psychological treatment,
nursing, and rehabilitation

34. 3. Two new professional roles
 Approved Mental Health Professionals
 Approved Clinicians (allowing the above professionals as
well as doctors to take on the role of Responsible
Clinician)

35. 4. Nearest Relative
- People who are receiving compulsory treatment can
go to court to displace their nearest relative
- Civil partners now on equal terms with married
couples

36. ECT safeguards
– A person with capacity who does not want ECT cannot be
forced to have it
– A competent child or adolescent under 18 who refuses ECT
cannot be made to have it
– A child under 18 cannot receive ECT without the agreement
of an independent approved doctor.
– A person who lacks capacity who has made an advance
refusal cannot be given ECT except in an emergency.
-If a patient does not have the capacity to give consent, then
ECT can be given if it is also approved by a Second Opinion
Appointed Doctor (SOAD) from the Mental Health Act
Commission*. This is an independent psychiatrist.

37. - Replaces Supervised Discharge
- Known as Supervised Community Treatment (SCT)
- Only for people who have been on a treatment order.
- This is suspended when you are discharged
- The team list conditions to ensure the person receives
treatment, there is no harm to self or others and person
attends for examination.
- If the order is revoked you return to Hospital on
Section3
- There is then an automatic referral to the tribunal
6. COMMUNITY TREATMENT ORDER

38. 7. Referral to Mental Health Review Tribunals (MHRT)
– Automatic referral to tribunal after 6 months if no
hearing in that period
– Then every 3 years for adults and now EVERY year for
under 18 year olds

39. 8. Advocacy service (from April 2009)
– All patients who are subject to compulsion for longer
than 72 hours have the right of access to an Independent
Mental Health Advocate (IMHA)
– Advocates will help patients gain information and
understanding of their situation and treatment
– Advocates will have the right to interview patients and
professionals in private
– Advocates will have access to patient records where
patient gives permission

40. 9. Young People
- 16 -17 year olds must be treated as adults when
considering admission e.g. they cannot be admitted if they
object even if parents think they should be admitted.(Jan
2008).
- must be admitted to an environment suitable to their needs
(2010)
- They can be admitted on to an adult ward if this is assessed
as being suitable for them

41. The Guiding Principles
1. Purpose principle
2. Least restriction principle
3. Respect principle
4. Participation principle
5. Effectiveness, efficiency and equity principle

42. • Designed to guide the professional to think
 – Who?
 – How?
 – Why?
• None of the principles carry any more weight,
Importance or significance than any other
• All 5 principles must inform every decision made under
the MHA

43. Principle 1
Purpose
- Staff must be able to explain why a certain decision has
been made
- Actions and decisions must be in the best interests of the
person who has been detained.

44. Principle 2
Least restrictive alternative
 Any decisions that are made without the person’s consent
must attempt to minimise the restrictions on their liberty

45. Principle 3
Respect
 Staff must have respect for a person’s:
- age, race, disability, religion, culture, gender, sexual
orientation.
- views, wishes and feelings whether expressed at the
time or in advance

46. Principle 4
Participation
- Where practicable people should be involved in
planning and developing their own care
- This involvement should also be extended to
encourage carers, family members and other people who
have a genuine interest for the person’s welfare

47. Principle 5
Effectiveness, Efficiency and Equity
 There needs to be efficient use of resources and
 effective and equal distribution of services .

48. CONCLUSIONS
 Undoubtedly, considerable changes have taken place in the
Indian MH legislation and policies over the last 2 decades.
 Contrary to these positive developments on paper, sufficient
research evidence exists to suggest that the provisions of the
MH Act are not implemented and that the current practice
pertaining to persons with MI does not adequately protect
their human rights.
 The Act is found lacking on the right to treatment and care
for both, simple as well as complex MI, does not exercise
equal control on treatment, discharge and quality of care
issues in government versus private institutes.

49. It is with this that the following measures are suggested
to improve the scope and effectiveness of the MH Act in
India:
 Of primary importance in addressing issues of MI in
India is educating the population.
 The MH Act provides for severe conditions and does not
take into account other vulnerable groups or different
ways of care provision. Along with children and
substance addicts, separate places are needed for elderly
persons, destitute and women with MI.

50.  There is also a need to re-evaluate the role of PHC in
providing community based MH care and further
provisions should be made to strengthen the PHC
system by investing in additional community based
rehabilitation centres.
 Provisions in the law for the after care of the mentally
ill after discharge from the hospital to ensure their full
integration back into the society.

51. OTHER LEGISLATIONS TO PROTECT THE RIGHTS OF
MENTALLY-ILL INDIVIDUALS
 Health is also a subject of State governments and, in many
areas, the state government legislations are applicable
 Besides enactment of the Mental Health Act, other legislations
have been introduced to protect and promote the rights and
needs of mentally-ill individuals

52. OTHER LEGISLATIONS TO PROTECT THE RIGHTS OF MENTALLY-
ILL INDIVIDUALS (CONTD…)
 The newly enacted acts are as follows:
 Persons with Disabilities (Equal Opportunities,
Protection of Rights and Full Participation) Rules, 1996
 State and central governments can provide mentally ill
individuals with housing , education, employment and social
security benefits
 Unsuccessful as legislation cannot identify individuals who
qualify
 Juvenile Justice Act (2000)
 A system of local welfare committees for at-risk children
 Often means involuntary admission of children

53. OTHER LEGISLATIONS TO PROTECT THE RIGHTS
OF MENTALLY-ILL INDIVIDUALS (CONTD…)
 Protection of Human Rights Act (1993)
 Establishes National Human Rights Commission
 Investigates human rights abuses of vulnerable persons, including
mentally-ill individuals
 Rehabilitation Council Act (2000)
 Establishes strict and exclusive licensing system of rehabilitation
professionals caring for mentally-ill individuals
 Excludes the NGOs, which provide majority of rehabilitative care

54. OTHER LEGISLATIONS TO PROTECT THE RIGHTS OF MENTALLY-
ILL INDIVIDUALS (CONTD…)
 National Trust for Welfare of Persons with Autism,
Cerebral Palsy, Mental Retardation and Multiple
Disabilities Rules (2000)
 Provides benefits to mentally ill individuals who are simultaneously
afflicted by a second physical or mental disability