MENTAL HEALTH NURSING
UNIT XIVLEGAL ISSUES IN MENTAL HEALTH
NURSING
TOPIC : MENTAL HEALTH CARE BILL AND RIGHTS OF MENTALLY ILL CLIENTS
Prepared By: Mrs Bemina JA
Assistant Professor
ESIC College of Nursing
Kalaburagi
REASONS TO THE BILL
The new Bill was introduced as the existing Act does not adequately protect the
rights of persons with mental illness nor promotes their access to mental
healthcare.
THE KEY FEATURES
Every person shall have the right to access mental health care and treatment
from services run or funded by govt.
A mentally ill person shall have the right to make an advance directive that
states how he wants to be treated for illness.
Every mental health establishment has to be registered with the relevant Central
or State Mental Health Authority, These authorities are in addition responsible
for supervising and maintaining a register of all mental health establishment.
A person who attempts suicide shall be presumed to be suffering from mental
illness at that time and will not be punished under the Indian Penal Code.
Electro-convulsive therapy is allowed only with the use of muscle relaxants and
anesthesia. The therapy is prohibited for minors.
The Mental Health Care Bill sets out:
• What is Mental Health?
• When and how people can be treated if they have a
mental disorder
• When people can be treated or taken into hospital
against their will?
• What people's rights are, and the safeguards which
ensure that these rights are protected
Features of the New Bill
1. Mental health Professionals
2. Mental Health Establishments
3. Legal Capacity
4. Informed Consent for treatment and researches
5. Rights of persons with mental illness
6. Administrative Bodies
7. New rules on admission, leave and discharges
8. Duties of the Government
9. Special Measure for Minors
10. Decriminalizes attempted suicides
11. Medical insurance to cover mental health treatment
12. Ban on ECT without anesthesia , psychosurgery and chaining
13. Nominated representatives
14. Emergency treatment
15. Granting Divorce
CHAPTERS
Chapter I: Preliminary
Chapter II: Mental illness and capacity to make mental health care and treatment decisions
Chapter III: Advance Directive
Chapter IV: Nominated Representative
Chapter V: Rights Of Person With Mental Illness
Chapter VI: Duties Of Appropriate Government
Chapter VII: Central Mental Health
Chapter VIII: State Mental Health
Chapter IX : Finance, accounts And Audit
Chapter X :Mental Health Establishments
Chapter XI: Mental Health Review Commission
Chapter XII: Admission, Treatment And Discharge
Chapter XIII :Responsibilities Of Other Agencies
Chapter XIV: Restriction To Discharge Functions By Professionals Not Covered By Profession
Chapter XV: Offences And Penalties
Chapter XVI: Miscellaneous
Appreciation of the MCHB 2016
Decriminalization of attempted suicide
Rights of person with mental illness
Provision for medical insurance for treatment for
mental illness
Duties of appropriate government
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. Patient should benefit from admission and treatment
C. Request made is under free will and not under undue
influence and has capacity to make mental health care
decision
D. Informed consent
E. Bound to rules and regulations of the establishment.
Discharge procedures
An independent patient may get himself discharged from the
mental health establishment without the consent of the medical
officer or mental health professional in charge of the MHE.
Minor : If the nominated representative no longer supports
admission or requests discharge of the minor, from the mental
health establishment, the minor shall be discharged thereof
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
Admission and Treatment up to 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 (10 days for Northeast) of
admission
Admission and treatment exceeding 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 patient
Consistent inability to take care of oneself
To be informed to MHRC, to be approved within 21
days (30 days for Northeast)
Limited to 90 days.
Renewal to 120-180 days.
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.
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 patient does not return, contact the patient on
leave, or nominated Representative or both
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 ? Any Registered Medical Practitioner, subject
to informed consent from the Nominated Representative.
When ? When its necessary to prevent :
a) Death or irreversible harm to health of the person, or,
b) Person inflicting serious harm to himself/others
c) Person causing damage to property
ECT is NOT permitted as an emergency procedure
Emergency treatment limited to 72 hrs (96 hrs for Northeast)
or till the person is assessed at a mental health establishment.
Disasters/emergencies, it may extend to 7 days.
Criticism/suggestions of Mental Health
Bill 2016
1. Mental Health Establishment
2. Capacity to make mental health care and treatment
3. Advance directives
4. Nominated representatives
5. Mental health review boards
6. Right to confidentiality
7. Discharge planning
8. Role of family members
9. Treatment guidelines
10. Lack of resources
Mental Health Establishments
NMHP mandates integration of mental healthcare
into primary healthcare
MHCB mandates all the establishments to take
license to treat patients
In MHA-1987, “any general hospital or general
nursing home established or maintained by the
government and which provides also for psychiatric
services” were excluded from the ambit of definition
“psychiatric hospital/ psychiatric nursing home”
Refusal of private hospitals and nursing homes
Hostels, prisons, jails, juvenile homes, temples, churches,
dargahs keeping patients with mental illness will be at stake
Anticipated “License Raj” of harassing MHC providers
Supposed to inflict greatest damage to the system of mental
health care delivery
Capacity to make MHC and treatment
Inadequate & can have dangerous consequences
Clause by default says everyone has capacity and right and so the
contrary has to be proved before involuntary admission
Psychotic patients with absent insights usually refuse admission
ultimately troubling the family
Permission be sought from the mental health board
Proposed admission by informed consent of family
Advance directives
To be followed by mental health professionals during treatment
Becomes difficult in Indian scenario when :
1. Treatment proposed in a costly/far to reach hospital
2. Treatment choice may be 2nd or 3rd choice some situations
3. Cochrane review studies doesn’t support advance directives in mental
illness
Can put family to heavy burden and difficulties
Nominated representatives
Selection by patient (with colored thought and perception) may be
affected by the illness
Nominated representative may break the Indian family system who
ultimately care for the patient after all odds
Costly treatment selection by the nominated representative can affect the
whole family
Ultimately at some point the family may disown the patient
Mental health review boards
Quasi judicial boards
May introduce hurdles in smooth treatment procedures
Limited boards to visit individual patient is questionable and delay in
addressing the issue is anticipated (e.g. festive seasons in India)
Tedious, prolonged and costly judicious procedures
Time limit for doctors while no time limit for boards 44
Right to confidentiality
The MHCB provides unlimited access to all the documents of the patient
by nominated representative
“Breach of confidentiality” by Mental health professionals as per Medical
council ethics, 2002
Impinges on fundamental rights “right to privacy”
Proposed disclosure of family members only in verbal form and written
form only on written request
Discharge planning
Ultimate decision of continuation of treatment or not
lies on patient/ nominated representative
“Continuity of care” is at stake due to lack of role of
family members and most of all the treating
psychiatrist/physician
Bill is silent about much needed community care
Finally pressure over the family members even if they
want treatment in proper way
Role of family members
Not only protects right of the patient but also
promotes family participation in active treatment
process
MHCB undermines the role of family members in
providing care
Bill needs to modified that in case of involuntary
treatment, presence of at least one family member
should be present
Management of property of person with severe mental
illness is absent
Treatment guidelines
Treatment should be as per national professional
guidelines
ECT has been established as a modality of choice in
many major psychiatric illnesses
The bill banns ECT during emergency management as
well as in minors
Withholding the same just for the permission of mental
health board is “delay in justified treatment”
Hands of treating Psychiatrist this way is curtailed to a
large extent
Lack of resources
Bills overloaded with right based ideology not fully
acceptable in Indian family structure
Logistic problems like poor infrastructure, inadequate
mental health workforce, low budget allocation for
MHC, siphoning fund of MHC to general health care
Bill needs to focus on smooth running of the MHC
rather than over exaggeration on compensation
Urgent need to introduce basic psychiatry at UG level
(MBBS) for learning of treatment of basic psychiatric
diseases
Neglected role of statutory body
MHA-1987 was conceived, piloted and drafted by the Indian
Psychiatry Society (IPS)
Though invited to the consultation process at different stages,
IPS was not assigned any role in drafting of the current Bill
IPS expressed apprehensions about a number of provisions in
the Bill as not considered to be in the interest of persons with
mental illness
MOHFW, for unknown reasons, entrusted the job of drafting
the current Bill and conducting the initial consultation process
to a private psychiatrist, who is not even an ordinary member
of the IPS
CONCLUSION
1. The MHCB, 2016 comes out to be a praiseworthy effort
for addressing the long standing problems encountered by
patients and practitioners in the sector of mental health
care.
2. The bill can bring a radical change in the field of mental
health care and service in our country.
3. Even though some sections of this bill are being
criticized but still this bill seems more humane and
appropriate in the current situation.
4. With further amendments in necessary areas this bill can
prove a blessing to the Mental health care system
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Thank you
