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mhca 2017 1 (1).pptx
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- 3. PREAMBLE An Act • Toprovide mental health care and services for persons with mental illness • To protect, promote and fulfil the rights of such persons during delivery of mental health care services • And for matters connected therewith or incidental thereto
- 4. OVERVIEW • MHCA emphasison care and treatment rather than on custodial care. • It provided detailed procedures for hospital admission • Human rights, guardianship and the management of the property of people with a mental illness.
- 5. MENTAL HEALTHCARE ACT2017 • ❑ 16 Chapters, Contains 126 clauses • ❑ Chapters include • Definitions, • Advance Directives, • Nominated Representatives, • Rights of Patients , • Mental health authorities (Central/State), • Duties of appropriate governments, • Mental Health Review Boards, • Mental Health Establishment, • Admission, Treatment & Discharge • Penalties etc
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- 7. WHO IS THEPERSON WITH MENTAL ILLNESS AS PER MHCA ? ■ Person with Mental illness • ❑ Substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life • ❑ Includes Substance use disorders, • ❑ Excludes Mental Retardation
- 8. OBLIGATIONS •To register asMental Health Professional under SMHA •Intimation to the concerned MHRB within 72 hrs for women and children admission •Intimation to the concerned MHRB within 7 days for adult male •Ensuring and adhere to Rights of persons with mental illness in MHE •Ensuring MINIMUM STANDARDS at MHE •Informing Board about Restraint practice
- 9. HOW THIS MHCAGOING TO IMPLEMENTED IN INDIA ? • It is through Implementation Authorities • ❑ Central mental health authority (Ch-7, Sec 33-44) • ❑ State mental health authority (Ch-8, Sec 45-56) • ❑ Mental Health Board (District) (Ch-11, Sec 73-84)
- 10. CENTRAL MENTAL HEALTHAUTHORITY • (a) Secretary or Additional Secretary, MoHFW, GoI • (b) Joint Secretary, MoHFW, GoI • (c) Joint Secretary, Ayush, GOI. • (d) Director General of Health Services • (e) Joint Secretary, Department of Disability Affairs of the Ministry of Social Justice and Empowerment • (f) Joint Secretary, Ministry of Women and Child Development • (g) Directors of the Central Institutions for Mental Health • (h) Central Government Ministries or Departments • (i) One psychiatrist • (j) One psychiatric social worker • (k) One clinical psychologist • (l) One mental health nurse • (m) Two persons representing persons who have or have had mental illness • (n) Two persons representing care-givers or organisations representing care-givers, • (o) Two persons representing non-governmental organisations two persons representing areas relevant to mental health
- 11. CENTRAL MENTAL HEALTHAUTHORITY (a) Register, supervise and maintain a register of all mental health establishments (b) Develop quality and service provision norms for such establishments (c) Maintain a register of mental health professionals (d) Train law enforcement officials and mental health professionals on the provisions of the Act (e) Receive complaints about deficiencies in provision of services, and (f) Advise the government on matters relating to mental
- 12. STATE MENTAL HEALTHAUTHORITY • (a) Secretary or Principal Secretary in the Department of Health of State Government • (b) Joint Secretary in the Department of Health of the State Government, in charge of • mental health • (c) Director of Health Services or Medical Education • (d) Joint Secretary in the Department of Social Welfare of the State Government • (e) Head of any of the Mental Hospitals in the State or Head of Department of Psychiatry at any Government Medical College • (f) One psychiatrist from the State not in Government service
- 13. STATE MENTAL HEALTHAUTHORITY • (g) One mental health professional • (h) One psychiatric social worker • (i) One clinical psychologist • (j) One mental health nurse • (k) Two persons representing persons • (l) Two persons representing care-givers of persons • (m) Two persons representing non-governmental organisations
- 14. FUNCTION OF SMHA •(a) Register, supervise and maintain a register of all mental health establishments. • (b) Develop quality and service provision norms for such establishments, • (c) Maintain a register of mental health professionals, • (d) Train law enforcement officials and mental health professionals on the provisions of the Act, • (e) Receive complaints about deficiencies in provision of services, and • (f) Advise the government on matters relating to mental health.
- 15. MENTAL HEALTH REVIEWBOARD • The board consists of ❑ Judge (Chair-person) ❑ Representative of the District Collector ❑ Two members One Psychiatrist One Medical Practitioner ❑ Two more members from among Patients Relatives Caregivers NGOs
- 16. MENTAL HEALTH REVIEWBOARD • Powers/Functions ❑ Register, review, alter, modify or cancel an advance directive ❑ To appoint nominated representative ❑ To receive and decide application against the decision of the MO/MHP ❑ To receive and decide: Non-disclosure of information ❑ To adjudicate complaints regarding deficiencies in care and services ❑ Visit to MHE
- 17. MENTAL HEALTH REVIEWBOARD • ❑ Equal representation for patients, caregivers and NGO like that of Mental Health Professionals and Government Agencies in MHRB, SMHA & CMHA. • ❑ It ensure multi stakeholder perspective in different of MHRB, SMHA, CMHA
- 18. WHAT ARE THEOBLIGATION ON HOSPITAL BY MHCA ?
- 19. MENTAL HEALTH ESTABLISHMENT •2 (1) (p) “mental health establishment” means any health establishment, including Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy establishment, by whatever name called, either wholly or partly, meant for the care of persons with mental illness, established, owned, controlled or maintained by the appropriate Government, local authority, trust, whether private or public, corporation, co- operative society, organisation or any other entity or person, where persons with mental illness are admitted and reside at, or kept in, for care, treatment, convalescence and rehabilitation, either temporarily or otherwise; and includes any general hospital or general nursing home established or maintained by the appropriate Government, local authority, trust, whether private or public, corporation, co-operative society, organisation or any other entity or person; but does not include a family residential place where a person with mental illness resides with his relatives or friends
- 20. MENTAL HEALTH ESTABLISHMENT •The definition of ‘Mental health establishment’ (MHE) is mainly for registration only. • Hospital provide inpatients care to person with mental illness need to be registered as ‘Mental health establishment’ (MHE) under SMHA. • OPD basis treatment and day care services are exempted from registration under SMHA. • OPD is not considered as the MHE.
- 21. MINIMUM STANDARDS FORMHE • Premises to be well maintained • Comfortable living conditions • Hygiene, cleanliness and sanitation • Wholesome, sumptuous and nutritive food and potable drinking water • Cultural, leisure and recreational activities • Adequate human resources • Adequate floor spaces • Maintenance of privacy, safety, dignity and security
- 22. ADMISSION & DISCHARGEPROCEDURE UNDER MHCA 2017 • Articulation is clear and almost similar to MHA 1987 • Clinician look into Capacity, Advance Directive and NR related issue... • Only reporting to board is added
- 24. SUPPORTED ADMISSION ■ Justifications •Recent threatening/attempt of self-harm Violence towards others • Inability to care for himself to a degree that places the individual at risk of himself ■ Information to the Board Within 3 days in case of women or minors
- 25. EMERGENCY TREATMENT (SEC94) • Any medical treatment may be provided subject to • ❑ Informed consent of the nominated representative, • ❑ If it is immediately necessary to prevent – • Danger to self or • Danger to others or • Person causing serious damage to property belonging to self or to others • The treatment referred shall be limited to 72 hours only.
- 26. PROHIBITIONS AND RESTRICTIONS •a) Psychosurgery, only after consent & Board clearance • b) Restraint • a) If it is the only way to prevent imminent and immediate harm to self or others • b) Authorized by the psychiatrist in-charge • c) As less a time as is permissible • c) Unmodified electro-convulsive therapy - totally prohibited • d) Sterilization- Totally prohibited • e) Chaining/seclusion/solitary confinement - prohibited • f) ECT is prohibited in minors (except with prior clearance from the board)
- 27. DE-CRIMINALIZING SUICIDE • Section115 of the act provides for decriminalizing suicidal attempts (Sec 309 IPC). • A person who attempts suicide shall be presumed to be suffering from mental illness (stress) at that time and will not be punished under the Indian Penal Code
- 28. LEAVE OF ABSENCE(SEC 91) • The medical officer or psychiatrist in charge of the hospital may grant leave to an inpatient to be absent from the establishment subject to such conditions, if any, and for such duration as such medical officer or psychiatrist may consider necessary • Consent from nominated representative In writing
- 29. RIGHTS OF PERSONSWITH MENTAL ILLNESS • Right to access mental health care ❑ All type of services (IP/OP/Rehabilitation) ❑ Affordable cost, quality & quantity ❑ Compensatory ❑ Free treatment for BPL/Destitute ❑ Long term care also included
- 30. RIGHT TO PROTECTIONFROM CRUEL, INHUMAN AND DEGRADING TREATMENT (a) Safe and hygienic environment (b) Adequate sanitary conditions (c) Leisure, recreation, education and religious practices; (d) Privacy, Clothing (e) Not to be forced to undertake work in a mental health establishment and to receive appropriate remuneration for work when undertaken (f) Adequate provision for preparing for living in the community
- 31. RIGHT TO PROTECTIONFROM CRUEL, INHUMAN AND DEGRADING TREATMENT (g) Wholesome food, articles of personal hygiene, in particular, women’s personal hygiene (h) No compulsory tonsuring (shaving of head hair) (j) To wear own personal clothes; if so wished and to not be forced to wear uniforms provided by the establishment; and (h) To be protected from all forms of physical, verbal, emotional and sexual abuse.
- 32. RIGHT TO EQUALITYAND NONDISCRIMINATION • Equality to persons with physical illness in the provision of all health care • Obligation of the State to provide emergency facilities and emergency services for mental illness such as ambulance, adequate and appropriate living conditions similar to physical illness. • Insurance for those with mental illness ❑ Insurers make provisions for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness .
- 33. RIGHT TO INFORMATION •As per the Act, person with mental illness and his nominated representative shall have the rights to the following information a) Reason for admission, b) To ask for a review of admission procedure: to the board, c) Treatment procedure d) Language
- 34. RIGHT TO CONFIDENTIALITY •Duty to keep information confidential, Exceptions a) Nominated representative b) Other mental health professionals and other health professionals to enable them to provide care and treatment c) Dangerous to self or others d) Medical emergencies e) In the interest of public safety and security f) Judicial proceedings
- 35. RIGHTS OF PWMI •Rightto Community Living •Right to Legal Aid •Right to access medical records ❑ OP / IP Basic Medical Records •Right to restriction on release of information in respect of mental illness •Right to personal contacts and communication •Right to make complaints about deficiencies in provision of services
- 36. WHO IS CARE-GIVER/ FAMILY / RELATIVE ? • Care-giver - Means a person who resides with a person with mental illness and is responsible for providing care to that person and includes a relative or any other person who performs this function, either free or with remuneration • Family - Means a group of persons related by blood, adoption or marriage • Relative - Means any person related to the person with mental illness by blood, marriage or adoption;
- 37. RESPONSIBILITIES OF OTHERAGENCIES • Police officer – ❑ Wandering HMI ❑ Absconding patients ❑ Ill treated / neglected • Section 111 - order by magistrate, only for 10 days – for assessment and treatment. • After 10 days submit report – discharge or admit him as per the provisions of the act
- 38. ADVANCE DIRECTIVE • Everyperson, who is not a minor ❑ The way the person wishes to be treated for ❑ The way NOT to be treated for ❑ The individuals he/she wants to appoint as his nominated representative ❑ Comes into play only during ‘LOSS OF CAPACITY’ ❑ Not applicable in cases of ‘Emergency Treatment’ ❑ MHPs/Relative/Caregiver can approach the board
- 39. WHO CAN BEA N R ?
- 40. NOMINATED REPRESENTATIVE • Individualappointed under AD ❑ Relative / Family • By marriage • By blood • By adoption ❑ Care-giver ❑ Suitable person appointed by the board ❑ State (Social Welfare department)
- 41. NOMINATED REPRESENTATIVE • Toprovide support to the person with mental illness in making treatment decisions under section 89 or section 90 • Has the right to seek information on diagnosis and treatment • Discharge planning • Apply to the board on behalf of PWMI • Right to give consent for research
- 42. RANGE OF SERVICEADVOCATED AT DISTRICT LEVEL UNDER MHCA 17 • (a) Acute mental healthcare services • (b) Outpatient and inpatient services • (c) Half-way homes, sheltered accommodation, supported accommodation • (d) mental health services to support family of person with mental illness or home based rehabilitation • (e) Hospital and community based rehabilitation establishments and services • (f) Child mental health services and old age mental health services.
- 43. CHAPTER XV TITLEDOFFENCES AND PENALTIES • Penalties for hospitals: ❑ 5000 to 50000 for first time, ❑ 50000 to 2 lakhs second time and ❑ 2-5 lakhs for 3rd time • Breaking any other rules: ❑ 6 months to 2 years imprisonment with or without fine
- 44. PROS OF NEWLEGISLATION • This act is a long anticipated act based on United Nations Convention on Rights of Persons with Disability(UNCRPD). • MHCA legislation is concordant with higher proportion of WHO’s human right standard. 1. Increased focus on human rights 2. Increased patient autonomy. 3. Decriminalization of suicide 4. Regulation and licensing of general hospital 5. Review boards consists of representation from allied sciences and representation of parent party might be helpful in complete view/perspect in taking decision.
- 45. CONS OF NEWLEGISLATION • After passing of the act, there has been large debate regarding whether the inspection of these facility would discourage opening of General Hospital Psychiatric Units. • Especially , private practitioners added onus of responsibilities on them. • Burden of providing health care on shoulder of government. • Possibility of underrepresentation of psychiatrists as place made for allied sciences. • Banning unmodified ECTs in resource poor setting, which might be lifesaving option. • Issues regarding the resources • Autonomy might limit ability to treat patients.
- 46.
Editor's Notes
- #3 28/5/18 implemented