A presentation on mental health acts in India with focus on the current Mental health care bill awaiting approval.

1. Mental Health Acts in India
Presenter-Dr.SaminSameed
Chairperson-Dr.Anil Kakunje

2. • Mental health care acts in india was covered in two phases- pre-
independence and post independence.
• Pre-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)

3. History
• Mental health act was drafted
by 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, which had
earlier replaced the Indian
Lunatic Asylum act of1858.

4. MHA- 1987
• Purpose
Consolidate and amend law relating to
treatment and care of mentally ill
persons.
For better provision with respect to
property and affairs of mentally ill
persons.

5. 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OUTDATED TERMS NEW TERMS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

6. • 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.

7. • 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.

8. Important Terminologies
• 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.

9. • Medical Officer in-
charge
Medical officer in-charge
of a psychiatric hospital
or nursing home
• Mentally ill person
person suffering from
mental disorder,other
than Mental Retardation
• Mentally ill prisoner
mentally ill person
ordered for detention.

10. • To protect citizens from detained
unnecessarily.
• Maintenance charges of
mentally ill persons undergoing
treatment
• To provide legal aid to poor
mentally ill criminals at state
expenses.
• Provision for separate places for
children, addicts, and convicted
persons.

11. 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
unnecessary detention
• Appointment of guardians

12. 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
services

13. 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
treatment.

14. • 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.-
Human rights?

15. • 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
ill persons.
• Provisions to start Community Mental health
centres

16. Mental Health care bill 2013
• WHY?
• UNCRPD
• 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

17. 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.

18. Mental Health Care Bill 2013
• Definition of mental illness
• Right to access of mental health
• Advance Directive
• Central and state mental health
authority
• Change of terminology from Psychiatric
hospital to mental health
establishment.
• Mental health review commission and
board

19. • Decriminalizing suicide
• Prohibiting ECT without use of Anasthesia and
muscle relaxants.
• Protection of rights of persons with mental
illness.

20. 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
mental retardation”

21. Legal Capacity
• Right to make an
Advanced
directive –right
to decide how a
pt should or
should not be
cared and
treated for a
mental illness in
the future.

22. Contd. Advance Directive
• Every person who is not a
minor has the right to
make an advance directive
specifying any of the
following
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
c)nominated
representative.

24. • lays down
elaborate
procedure for
registration and
revocation of
advance directives,
and situation
when they could
be overridden.
• All treatments and
medical research
to be conducted
only after free and
informed consent.

25. Nominated Representative
• A part of advance
directive where in a
person can appoint
individual or
individuals in order of
precedence to be
considered as his or
her nominated
representative

26. Nominated
Representative
Care-giver
Advance
Directive
Relative
Appointed
by MHRC

27. For Minors??
Who is my
Nominated
Representative

28. Nominated Representative Rights and
Duties
• Duty to support the
person with mental
illness in making
treatment decisions.
• Information on diagnosis
and treatment.
• Right for discharge
planning
• Right to give consent for
treatment modalities.
• Right to appoint a
suitable attender.

29. 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
treatment

30. • 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
establishment.

31. Discharge of Independent Pts
• On request
• Minor becoming
major under in-
patient care, can
decide as independent
pt,

32. Admission and Treatment for pts with
high support needs, upto 30 days
• When and how?
Upon application by Nominated
Representative,
2 mental health professionals, including
a Psychiatrist, after independent
examination ,
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

33. • c) recently shown
inability to care oneself
to a degree that places
at risk of harm to oneself
• Limited to a period of 30
days.
• To be informed to MHRC
within 7 days of
admission.

34. Admission and treatment for pts with
High support needs for more than 30
days
• 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.

35. • Visit by
Representative of
the mental health
review commission
may visit anytime
during the hospital
to review the
treatment given to
the person with
mental illness.

36. Leave of absence
• Granted by - Medical officer or Psychiatrist.
• After securing consent of Nominated
Representative.
• 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.

37. • 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
establishment.

38. Absence without leave
• Without discharge, absents
one-self
• Taken into protection by
Police Officer at the request
of the Psychiatrist in charge
and brought back.

39. Emergency Treatment
• Who can treat ?By any
Registered Medical
Practitioner, subject to
informed consent from the
Nominated Representative.
• when ?
when its necessary to
prevent
a)death or irreversble harm
to health of the person,or,
b)person inficting serious
harm to himself/others
c)person causing damage to
property
No, i can keep
u here for 72 h

40. Contd.
• ECT is not permitted as an emergency
procedure
• Emergency treatment limited to 72 hrs or till
the person is assessed at a mental health
establishment.
Disasters/emergencies, it may extend to 7 days.

41. • Power with the mental health professional to
prevent discharge of person for a period of 24
hrs to allow assessment if necessary?
Recent suicide
attempt/threatening Violence
towards others
Inability to
care for
oneself

42. Admission of Minors
2 Psychiatrists 1 Psychiatrist & 1 mental
health professional
1 Psychiatrist & 1 medical
practitioner
Minor

43. • Nominated
Representative to be
with the minor for the
entire duration of
admission
• Treatment for the minor
with informed consent
of Nominated
Representative.

44. Protection of Rights of Persons with
mental illness.
• Rights- based
• Right to access mental health
care, services including
shelter homes, supported
accomodation, community
based rehab
• Right to live with dignity, right
to confidentiality
• Right to information, access
to medical records,
• Right to personal
communication, right to
community living
• Right to equality and non-
discrimination

45. Duties of the Government
• Planning, designing,
implementing programs for
promotion of health
• Prevention of mental illness
• Creating awareness about
mental illnesses

46. • Reducing stigma
• Sensitizing govt officials
including police officers
• Implementing public
health programs to
reduce suicides

47. 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
investigation or
prosecution.”
• The numbers –
2011- 135,585 people
committed suicide

48. Provisions related to Electro
Convulsive Therapy and other
procedures
• Prohibition on ECT for minors

49. • Prohibition on sterilization of men or women
as mode of treatment for mental illness
• Prohibition on any form of chaining of
persons.

50. • Psychosurgery as
treatment only with
patient’s informed
consent and MHRB’s
approval.

51. • The bill permits
ECT for adults with
use of muscle
relaxants and
anaesthesia

52. Systematic changes in the mental
health care system
• Establishment of Central and state mental
health authorities
• Mental Health Review Commission (MHRC)
and state-wise Mental Health Review
Boards(MHRB).

53. • 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
1987.

54. 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
some amendments
• 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
the Parliament.

55. •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
Psychiatry,51:11-19
• 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