What are the authorities for mental healthcare under the law?
Under the law, there are three main authorities:
- Central Mental Health Authority – It is the central authority under the law, which has functions like to register all mental health establishments under the Central Government and maintain a register of all mental health establishments in the country, develop quality/service norms for mental health establishments under the Central Government, supervise all mental health establishments under the Central Government, receive complaints about deficiencies in provision of services, etc. (( Section 43, the Mental Healthcare Act, 2017.)).
- State Mental Health Authority – It is the authority on the state level under the law, which has functions like to generally register all mental health establishments in the State, to develop quality/service norms for mental health establishments in the State, supervise all mental health establishments in the State , receive complaints about deficiencies in provision of services, etc(( Section 55, the Mental Healthcare Act, 2017.)).
- Mental Health Review Board – It is the authority on the district level under the law, which has functions like to register, review, alter, modify or cancel an advance directive, to appoint a nominated representative, to adjudicate complaints regarding deficiencies in care, etc(( Section 82(1), the Mental Healthcare Act, 2017.)).
As of now, the authorities, particularly the Central Mental Health Authority and the Mental Health Review Boards, are largely not functioning. However, some states, such as Delhi, Kerala, etc. have constituted the State Mental Health Authority. You should seek information about the functioning of these authorities from your respective state.
What is the National Mental Health Policy?
The National Mental Health Policy of India was released in 2014 by the Ministry of Health and Family Welfare. The policy has recognized certain principles such as integrated care, equality, evidence based care and participatory and rights based approach to mental health.
Some of its goal are to provide universal access to mental healthcare in the country, decrease premature deaths due to mental illness, to increase access to mental healthcare for vulnerable groups such as homeless persons, to reduce suicide, etc. It recognizes the need for adequate funding, support for families and access to institutional care, among other things. Please see here for more details.
What is the National Mental Health Programme?
The Government of India launched the National Mental Health Program (NMHP) in 1982, and the District Mental Health Program was added to the NMHP in 1996. In 2003, it was re-strategized to include two schemes i.e. Modernization of State Mental Hospitals and Upgradation of Psychiatric Wings of Medical Colleges/General Hospitals.
The basic objectives of the NMHP are:
- To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future.
- To encourage the application of mental health knowledge in general healthcare and in social development.
- To promote community participation in the mental health service development.
- To enhance human resources in mental health specialties.
The NMHP has aimed to open centres for persons with mental illness, carry out awareness programs and interventions ,etc. Please see here for more details.
Who is a caregiver, according to the law on mental health?
A caregiver refers to a person who resides with a person with mental illness and is responsible for providing care to that person. This includes a relative or any other person who takes care of the person, either for free or with remuneration(( Section 2(e) the Mental Healthcare Act, 2017.)).
Can I leave for a few days from a mental health establishment where I am admitted?
If you want to take a leave from the mental health establishment where you are admitted, you should approach the mental health professional in charge of the establishment. He can grant a leave to you to be absent from the establishment under certain conditions (if any) for such time duration as determined by the professional(( Section 91, the Mental Healthcare Act, 2017.)).
If a prisoner who is in a mental health establishment absents himself without leave/discharge, he will be taken into protection by a police officer at the request of the professional in-charge and will be sent back to the establishment immediately(( Section 92, the Mental Healthcare Act, 2017.)).
What should I do if I find a person with mental illness who is being mistreated?
If you believe that a person with mental illness is being mistreated or neglected by the person who has the responsibility for his care, you should report this to the police officer in-charge of the police station within whose jurisdiction the person with mental illness resides(( Section 101(2) the Mental Healthcare Act, 2017.)).
Once the police have received the report, they will conduct the necessary investigation.
What are the duties of the police with relation to persons with mental illness?
The officer in-charge of a police station has the following duties:
Protecting Persons with Mental Illness
He must take under protection any person wandering within the limits of the police station and who is believed to have a mental illness who(( Section 100(1), the Mental Healthcare Act, 2017.)):
- Is not able to take care of himself
- Poses a risk to himself/others due to his mental illness
Once a person with mental illness has been taken into protection, the police must:
- Inform the person/his nominated representation the reasons for taking him into protection(( Section 100(2), the Mental Healthcare Act, 2017.)).
- Take the person to the nearest public health establishment within 24 hours for assessment of his healthcare needs(( Section 100(3), the Mental Healthcare Act, 2017.)). It will be the responsibility of the medical officer in-charge of the public health establishment to arrange the person’s assessment(( Section 100(5), the Mental Healthcare Act, 2017.)).
- After the assessment, if the person does not need to be admitted to an establishment, the police officer must take the person to his house or to a Government establishment for homeless persons (if the person is homeless)(( Section 100(6), the Mental Healthcare Act, 2017.)).
Reporting Mistreatment of Persons with Mental Illness
If the officer believes that a person who resides within the limits of the police station has a mental illness and is being mistreated or neglected, he must report that to the Magistrate(( Section 100(1), the Mental Healthcare Act, 2017.)).
Locking Persons with Mental Illness
The police cannot, in any situation, lock the person with mental illness in a jail or detain him(( Section 100(4), the Mental Healthcare Act, 2017.)).
Can someone be forced to get treatment for a mental illness?
Under the law, a person with mental illness can be admitted to a mental health establishment by his nominated representative for treatment. However, there is very specific criteria for such an admission, which is known as supported admission.
The government only has the power to get a person assessed for mental healthcare needs. Except this, the government has no power regarding a person’s treatment for mental health. For example, the Magistrate may order that a person is admitted to a mental health establishment for a maximum duration of 10 days for assessment of his healthcare needs(( Section 102(1), the Mental Healthcare Act, 2017.)), and the police have certain powers with respect to persons with mental illness who are found wandering within the jurisdiction of the police station.
Who can I go to if I require help with my mental health?
If you require help with your mental health, you can go to a mental health professional. A mental health professional refers to the following(( Section 2(r), the Mental Healthcare Act, 2017)):
- A psychiatric social worker, which requires a postgraduate degree in Social Work and a Master of Philosophy in Psychiatric Social Work of two years, including supervised clinical training from any University recognised by the University Grants Commission, or other qualifications, as prescribed(( Section 2(x), the Mental Healthcare Act, 2017.))
- A professional registered with the concerned State Mental Health Authority
- A professional having a postgraduate degree (Ayurveda) in Mano Vigyan Avum Manas Roga or a postgraduate degree (Homoeopathy) in Psychiatry or a postgraduate degree (Unani) in Moalijat (Nafasiyatt) or a postgraduate degree (Siddha) in Sirappu Maruthuvam.
What is the punishment for running mental health establishments that are not registered under the law?
It is mandatory for every mental health establishment to be registered under the law. Depending on whether the establishment is under the central government or state governments, the establishment must be registered with the Central Mental Health Authority or State Mental Health Authority.
If someone carries on a mental health establishment without registration, he may be punished with a fine between Rs. 5,000 to Rs. 50,000 for the first offence, and for the second offence, with a fine between Rs. 50,000 to Rs. 2 lakhs, and for every subsequent offence, with a fine between Rs. 2 lakhs to Rs. 5 lakhs(( Section 107(1), the Mental Healthcare Act, 2017.)).
Further, if someone knowingly works at an unregistered establishment as a mental health professional, he may be punished with a fine of Rs. 25,000(( Section 107(2), the Mental Healthcare Act, 2017.)).
Can research be conducted on a person with mental illness?
Research can be conducted on persons with mental illness in the form of psychological, physical, chemical or medicinal intervention. However, this can be done only when the person’s free and informed consent has been obtained(( Section 99(1), the Mental Healthcare Act, 2017.)). Research can be conducted based on a person’s case study notes even without his consent, as long as his identity is not revealed(( Section 99(4), the Mental Healthcare Act, 2017.)).
In case the person is unable to give consent but does not resist participation, the professional conducting the research can take permission from the State Mental Health Authority(( Section 99(2), the Mental Healthcare Act, 2017.)). The Authority can give permission only after getting the consent from the person’s nominated representative and after ensuring the following(( Section 99(3), the Mental Healthcare Act, 2017.)):
- The research cannot be conducted on any other person, such as a person capable of giving consent. For example, Ram is suffering from a very rare form of a mental illness, and the proposed research must be conducted on a person suffering from that mental illness only.
- The research is necessary to promote the mental health of the population represented by that person.
- The knowledge that will be gained from the research is relevant to the health needs of the person
- There is no conflict of interest in any kind.
- The research is in line with national and international guidelines and regulations, and ethical approval has been obtained from the relevant institutions.
Please note that any consent given by the person with mental illness or his nominated representative can be withdrawn at any time(( Section 99(5), the Mental Healthcare Act, 2017.))
Is mental healthcare covered under insurance?
Yes. Every insurer must provide for medical insurance for mental illness on the same basis as for physical illness(( Section 21(4), the Mental Healthcare Act, 2017.)).
Can a person with mental illness be subjected to solitary confinement or physical restraint?
A person with mental illness cannot be subjected to seclusion (solitary confinement), under the law(( Section 97(1), the Mental Healthcare Act, 2017)).
Further, a person cannot be physically restrained unless:
- Physical restraint is the only way for preventing immediate harm to the person or others
- Physical restraint is authorised by the psychiatrist who is in charge of the person’s treatment
However, physical restraint cannot be used unless the medical professional wants to prevent any significant harm(( Section 97(2), the Mental Healthcare Act, 2017)), and cannot be used as a punishment or due to shortage of staff(( Section 97(4), the Mental Healthcare Act, 2017)).
The details of the restraint, including the method, nature, duration and justification for its use, must be recorded in the person’s medical notes by the professional duty(( Section 97(3), the Mental Healthcare Act, 2017)). Further, the nominated representative of the person needs to be informed within 24 hours(( Section 97(5), the Mental Healthcare Act, 2017)).
What kind of procedures are prohibited on persons with mental illness?
The following forms of treatment cannot be performed on persons with mental illness(( Section 95(1), the Mental Healthcare Act, 2017)):
- Psychosurgery (i.e. surgery of a person’s neurological system, such as the rain), unless the person’s informed consent and approval from the Mental Health Review Board has been obtained(( Section 96(1), the Mental Healthcare Act, 2017)).
- Electroconvulsive therapy (passing small electrical currents through a person’s brain) without the use of muscle relaxants and anaesthesia
- Electroconvulsive therapy for minors. However, it may be used if(( Section 95(2), the Mental Healthcare Act, 2017)) the psychiatrist in-charge of the minor believes it is necessary with informed consent of the guardian and permission from the Mental Health Review Board.
- Sterilisation (surgery to make one biologically incapable of reproduction), if it used for treatment for mental illness
- Chaining in any manner. For example, to restrain a person physically by chaining them up.
What does an unsound mind mean?
Having a mental illness is not in and of itself grounds for having an unsound mind(( Section 3(5), the Mental Healthcare Act, 2017.)). Having an unsound mind has been determined by Courts to mean that one has such a mental condition that one cannot be expected to be aware of the consequences of their actions. Some examples of such unsoundness of mind include dementia, loss of memory, hallucinations, etc. (( State Of Rajasthan v. Shera Ram)). Under the law, medical insanity does not matter, but only legal insanity(( Hari Singh Gond v. State Of M.P)).
If one is considered to have an unsound mind, they cannot be held liable for an offence(( Section 84, the Indian Penal Code, 1860.)). Further the onus of proving that one committed a crime due to unsoundness of mind will be on the accused(( State Of Rajasthan v. Shera Ram)).
What are mental healthcare establishments?
Mental health establishments are(( Section 2(p), Mental Healthcare Act, 2017)) any health establishments funded or run by the government, and meant for the care of people who are suffering from mental illnesses or where such people reside, temporarily or not, for treatment and rehabilitation. These include establishments for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy and any general hospital/nursing home, run or funded by the government. However, this does not include a family residential place where a person with mental illness resides with his relatives or friends.
What are mental healthcare services?
Mental healthcare services refer to analysis and diagnosis of someone’s mental condition including treatment, care and rehabilitation(( Section 2(o), Mental Healthcare Act, 2017)).
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