The National Mental Healthcare Act-2017 and its implication to current psychiatric care practice in India. A webinar on the topic at Parul University, Vadodara, Gujrat India

1. Mental Healthcare Act-2017
&
Implications to Psychiatric Care Practice
Bivin J. B. (MSc. PN, DCMH)
Psychiatric Nurse & Research Scholar
Forensic Psychiatric Division
Government Mental Health Center,
Thiruvananthapuram, Keralam

2. • Ratification of UN Convention on the
person with disabilities, UNCRPD in Oct.
2007
• India had to harmonize all existing laws
with UNCRPD
• March 2017: Loksabha passes the bill
• 7th April 2017: MHCA signed by president
• May 2018: MHCA came into force

3. • To protect the rights o the person with
mental illness (PMI)
• To address the stigma associated with
mental illnesses
• To provide quality care to PMIs

4. • Basic human right- liberty, equality &
dignity
• Autonomy: Individual capacity to make
decisions
• Will & preferences Vs. Best interest

5. • Indian Lunacy Act, 1912 (Custodial Care)
• Mental Health Act, 1987 (Treatment to
PMI)
• Person with Disability Act, 1995 (Social
model of disability care)
• Mental Healthcare Act, 2017 (Human
rights in psychiatric treatment)

6. • An act
– To provide mental healthcare and services for
Persons with mental illness, PMI
– To protect, promote and fulfill the rights of PMI
during delivery of mental health care services
– And of matters connected therewith or
incidental thereto.

7. • 126 sections arranged under 16 chapters
• Chapter I : Preliminary
• Chapter II : Mental Illness and capacity to make
mental healthcare and treatment decisions
• Chapter III : Advance directive (AD)
• Chapter IV : Nominated representative (NR)
• Chapter V : Rights of the PMI
• Chapter VI Duties of appropriate government
• Cont.

8. – Chapter VII : Central Mental Health Authority
– Chapter VIII : State Mental Health Authority
– Chapter IX : Finance, accounts and audit
– Chapter X : Mental health establishments
– Chapter XI : Mental Health review boards
– Chapter XII : Admission, treatment and discharge
– Chapter XIII : Responsibilities of other agencies
– Chapter XIV : restriction to discharge function by
professionals not covered by profession
– Chapter XV : Offenses and penalties
– Chapter XVI : Miscellaneous

9. • Chapter I Preliminary
• Definitions
– Mental Illness:
• Included substance use disorders
• Mental retardation is excluded
• Determined based on international standards, ICD
– Includes PG AYUSH practitioners as medical
professionals to determine the treatment need of
PMI
– Mental Health Establishments, MHEs.

10. • Chapter II : Mental Illness and capacity
to make mental healthcare and
treatment decisions
– Sec-3: Determination of mental illness
» Guidance document for capacity
assessment
– Sec-4: Capacity to make mental healthcare
and treatment decisions
» Understand information
» Appreciate the value
» Communication of choice/preferences

11. • Chapter II : Advance Directive, (AD)
• (Sec. 5)
– Every PMI except minor has the right to have
an AD by writing
– Empowers the PMI to choose their treatment
and appoint a representative to tae decision
on behalf of them
– In case minor, the parents or caregiver will
act as the representative
– Not applicable at the time of emergency

12. • Chapter IV : Nominated representative
(NR)
– Every person except minor have the right to
appoint a NR
– NR shall not be a minor, be competent to
discharge duties and functions assigned to
him under this act
– In case of no responsible persons available to
be NR, the Board shall appoint the Director,
Dept. of Social Welfare or his designated
representative of the person

13. • Sec-17: Duties of NR
– Consider the current & past wishes, the life history,
values, cultural background and the best interest of
the PMI
– Provide support in making treatment decisions
– Right to see information on diagnoses and treatment
of PMI
– Access to family or home based rehabilitation
services
– Involved in discharge planning
– Apply mental health establishment for admission &
discharge
– Right to give consent or withhold consent for
research

14. • Chapter V : Rights of the persons with Mental
illness
– Right to access mental healthcare (Sec.18)
– Right to community living (Sec.19)
– Right to protection from cruel, inhuman and degrading
treatment (Sec.20)
• Right to refuse compulsory tonsuring
• Right to live with dignity
• To live in safe and hygienic environment
• Have adequate sanitary conditions
• Facilities for leisure, recreation, education and
religious practice
• Right for privacy

15. – Not be forced to work and to receive appropriate
remuneration
– To wear own clothes
– Protected from every form of potential abuse
• Sec 21: Right to equality and non-discrimination
– Medical insurance (Sec. 21, (4)
• Sec. 22: Right to information
• Sec. 23-24: Right to confidentiality
• Sec. 25: Right to access medical records
• Sec. 26: Right to personal contacts & Communication
• Sec. 27: Right to legal aid
• Sec. 28: Right to make complaints about deficiencies in
provision of services- Interim Grievance redress
mechanism

16. • Chapter VI Duties of appropriate government
» Sec. 29-32
– Promotion of mental health & preventive
programs.
– Creating awareness about mental health &
illness and reducing stigma associated with
mental illness.
– Appropriate Government to take measures as
regard to human resource development &
training, etc.
– Co-ordination within appropriate Government

17. • Chapter VII : Central Mental Health Authority,
CMHA
• Sec.34- Composition of CMHA
• Sec. 43- Functions of CMHA
1. Registration of all mental health establishments
2. Development of service provision norms
3. Supervision of mental health establishments
4. Maintenance of national register for mental health
professionals
5. Training on MHCA
6. Advise central government on all matters relating
to MH care and services

18. • Chapter VII : State Mental Health Authority,
SMHA
• Sec.34- Composition of SMHA
• Sec. 43- Functions of SMHA
1. Registration of all mental health establishments
of the concerned state
2. Development of service provision norms
3. Supervision of mental health establishments
4. Maintenance of state-register for mental health
professionals
5. Training on MHCA at state-level
6. Advise state government on all matters relating
to MH care and services

19. • Chapter IX : Finance, accounts and audit
• Sec.57-64 grants, fund and auditing
• Chapter X : Mental health establishments,
MHE
• Sec. 65-72: Registration, review & Inspection of
MHE

20. • Chapter XI : Mental Health review boards,
MHRB
• Sec.73, 74: Constitution of MHRB
• Sec.82: Functions of MHRB
• Register, review and alter an advance directive
• To appoint a nominated representative
• Receive application from a PMI on a nominated
representative
• To adjudicate complaints regarding deficiencies in
MH services s
• To visit & inspect prison & seek clarifications from
MO in charge

21. • Chapter XII : Admission, treatment and
discharge
– Sec.85: Admission o PMI as independent patient
– Sec. 87: Admission of a Minor
– Sec. 89: Supported admission < 30 days
• The nominated representative should apply to
the psychiatrist
– Sec. 90: Continuous supported admission
(90/120/180 days)
– Sec.91: Leave or absence
– Sec. 94: Emergency treatment
• A period of <72 Hours
• During disasters or emergencies up to 7 days

22. –Sec. 95: Prohibited procedures
• Direct ECT
• ECT for minors
– Obtain informed consent from legal guardian
• Sterilization for men/women
• Chaining
• Physical restraints without consent of a
psychiatrist
• Psycho surgery only after permission from
MHRB

23. • Chapter XII : Admission, treatment and
discharge
• Cont…
– Sec.96: Psychosurgery
– Sec. 97: Restraints & Seclusions
• Only when absolutely needed & Least
restrictive mode
• Immediately record the procedure
• To be informed to the nominated
representative
• Monthly report to the MHRB

24. • Chapter XIII : Responsibilities of other
agencies
– Sec. 100: Duties of Police
• PMI should not be put into jail
• Inform the PMI, the need for custody &
treatment
• Taken to nearest health establishment within
24 Hrs. for assessment & treatment
• Wandering PMI’s FIR to be lodged and
necessary steps to trace the relatives to be
made
• Ill treatment to PMI to be reported to the
magistrate

25. –Sec. 102: Conveying admission to MHE
by magistrate
• Authorize admission for 10 days
–Sec. 103: Prisoners with MI

26. – Chapter XIV : restriction to discharge function by
professionals not covered by profession
• Sec.106: MHPs cannot discharge duties which MHCA does not
authorize
– Chapter XV : Offenses and penalties
– Non-registration of MHE is liable to a penalty of Rs. 5000-
5000 first time and up to 5 lakh subsequently
– A non-registered MHP who serves in a MHE will be liable
to a penalty of Rs. 25000.
– Chapter XVI : Miscellaneous
• Sec.115: Decriminalization of suicide, i.e. Dissolution of IPC-Sec.
309)

27. Key differences
MHA-1987 & MHCA-2017
MHA-1987 MHCA-2017
Terminology Mentally ill PMI, MHE, MHP
Focus Law Rights of PMI
Authorities State & Central Govt. CMHA, SMHA, MHRB
Newer Provisions Advanced Directive,
Nominated
Representative,
Decriminalization of
suicide
Emergency treatment

28. • Chapter-5 (rights of PMI)- Heart and soul of
the law
• Safeguard PMI’s right to access quality care
& compensation by state
• Free treatment for BPL patients, destitute and
homeless
• Newer options like AD, NR etc. giving
autonomy to PMIs
• Insurance coverage for mental illnesses

29. • Exclusion of mental retardation from mental illness & no
clarity towards including Personality disorders and minor
mental ailments
• An array of new bodies like CMHA, SMHA, MHRB need
huge funding for its functioning
• Over inclusion of traditional system practitioners into the
definition of MHP
• Need to report to MHRB may cause delay in patient care
related decisions making
• Heavily influenced by western legislation
• Ignored the presence of NMHP & no remarks to
strengthen the same.

30. 1. Mental Healthcare Act, 2017.
Available;http://www.prsindia.org/uploads/media/M
ental%20Health/Mental%20Healthcare%20Act,%2
02017.pdf.
2. Math SB, Basavaraju V, Harihara SN, Gowda GS,
Manjunatha N, Kumar CN, et al. Mental Healthcare
act-2017- Aspiration to action. Ind J. Psychiatry.
2019; 61: S660-6.
• Acknowledgement:
– Special thanks to Dr. Suresh Badamath, Head,
Department of Forensic Psychiatry & Telemedicine,
NIMHANS, Bengaluru & his video lectures in YouTube
channel

31. Thank You