Mental Health Acts in India

Presenter-Dr.SaminSameedChairperson-Dr.Anil Kakunje

• 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 established1987-Mental health Act of 1987

• Mental health care bill (Proposed)

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.

MHA- 1987

• PurposeConsolidate 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.

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OUTDATED TERMS NEW TERMS Nursing Home/Assylum Psychiatric Hospital Lunatic Mentally ill personCriminal Lunatic Mentally ill prisoner

• 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.

• 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.

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.

• Medical Officer in-chargeMedical officer in-charge of a psychiatric hospital or nursing home

• Mentally ill personperson suffering from mental disorder,other than Mental Retardation

• Mentally ill prisonermentally ill person ordered for detention.

• 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.

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

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

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.

• 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?

• 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

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

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.

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

• Decriminalizing suicide

• Prohibiting ECT without use of Anasthesia and muscle relaxants.

• Protection of rights of persons with mental illness.

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”

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.

Contd. Advance Directive

• Every person who is not a minor has the right to make an advance directive specifying any of the followinga) the way a person wishes to be cared for and treated for a mental illnessb)the way he wishes not to be so cared for and treated for a mental illnessc)nominated representative.

• 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.

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

Nominated

Representative

Care-giver

Advance DirectiveRelativeAppointed by

MHRC

For Minors??Who is my Nominated Representative

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.

Admission, Treatment and Discharge

• INDEPENDENT ADMISSIONAny person who considers himself to have mental illness and desires admission, who is not a minor.

• Admitted if the Medical officer or Psychiatristis satisfied that a)mental illness of severity requiring admissionb)pt should benefit from admission and treatment

• 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 consente e) bound to rules and

regulations of the establishment.

Discharge of Independent Pts• On request• Minor becoming

major under in-patient care, can decide as independent pt,

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

• 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.

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.

• 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.

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.

• 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.

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.

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/othersc)person causing damage to property

No, i can keep u here for 72 h

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.

• 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

othersInability to care for oneself

Admission of Minors

2 Psychiatrists 1 Psychiatrist & 1 mental health professional

1 Psychiatrist & 1 medical practitioner

Minor

• Nominated Representative to be with the minor for the entire duration of admission

• Treatment for the minor with informed consent of Nominated Representative.

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

Duties of the Government

• Planning, designing, implementing programs for promotion of health

• Prevention of mental illness• Creating awareness about

mental illnesses

• Reducing stigma• Sensitizing govt officials

including police officers• Implementing public

health programs to reduce suicides

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

Provisions related to Electro Convulsive Therapy and other procedures

• Prohibition on ECT for minors

• Prohibition on sterilization of men or women as mode of treatment for mental illness

• Prohibition on any form of chaining of persons.

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

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

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).

• 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.

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.

•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

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