Optional Grouping: Hospital Admission & Discharge

Admission and Discharge in Mental Health Establishments

Admission and discharge in a mental health establishment can be in the following ways:

In the independent mode of admission and discharge, the person has the capacity to make mental health care and treatment decisions, or requires very less support in making such decisions. Therefore, as an independent patient, one consents to every treatment decision. The person is also free to discharge themselves from the establishment.

In the supported mode of admission and discharge,  the person with mental illness does not have the capacity to make mental health care and treatment decisions, or requires very high support in making such decisions.

In addition, separate rules exist for admission as a minor.

  1. The Mental Healthcare Act, 2017 [↩]

Independent Admission and Discharge

Independent admission means the admission of a person who has the capacity to make mental health care decisions, or requires very less support in making them. An independent patient is given treatment only after informed consent1 (i.e. permission given after complete knowledge of the treatment and its consequences). Additionally, an independent patient must follow the rules of the establishment, if admitted2.

Criteria for Admission

The mental health professional in charge of the establishment must ensure that3 :

  • The person has a mental illness severe enough to require admission,
  • They will benefit from the admission
  • They have understood the nature and purpose of admission
  • The person has made the request for admission of their own free will and have the capacity to take mental health care and treatment decisions.

Procedure for Admission

A person can admit themselves in an establishment if they want to and are above the age of 18 years. To do this, they must request the professional in charge of the establishment3. The professional does not require permission from anyone to admit an independent patient. For example, the nominated representative or the caregiver4.

Discharge

A person does not need the permission of the professional for discharge5. Additionally, they should be discharged immediately6. However, the person may be retained for 24 hours to assess whether they need to be admitted as a supported patient.  However, this happens only if the professional believes that7:

  • The person is unable to understand the nature and purpose of their decisions and requires substantial support from their nominated representative
  • They have recently threatened/attempted to cause physical harm to themselves
  • The person has recently behaved violently towards someone else or has caused someone else to fear physical harm from them
  • They have recently shown an inability to care for themselves to the extent that they pose a danger to themselves.

 

  1. Section 86(5),  the Mental Healthcare Act, 2017. [↩]
  2. Section 86(4),  the Mental Healthcare Act, 2017 [↩]
  3. Section 86(2),  the Mental Healthcare Act, 2017 [↩][↩]
  4. Section 86(6),  the Mental Healthcare Act, 2017 [↩]
  5. Section 86(7),  the Mental Healthcare Act, 2017 [↩]
  6. Section 88(1),  the Mental Healthcare Act, 2017 [↩]
  7. Section 88(3),  the Mental Healthcare Act, 2017 [↩]

Supported Admission and Discharge

The supported mode of admission and discharge means that the person being admitted does not have the capacity to make mental health care decisions, or requires very high support. All admissions in a mental health care establishment should be independent, except when supported admission is necessary1.

Supported Admission for 1 month

Criteria and Procedure for Admission

The nominated representative must make an application to the mental health professional in-charge of the establishment. The criteria is as follows:2.

  • A psychiatrist and a mental health professional/medical practitioner have examined the person within the last 7 days. Additionally, both must conclude that the mental illness is severe enough that they have recently:
    • Attempted/threatened to cause physical harm to themselves
    • Behaved violently towards someone else or have caused someone else to fear physical harm
    • Shown an inability to care for themselves to the extent that they pose a harm to themselves
  • The professional certifies (after considering the advance directive) that admission to the establishment is the least restrictive care option possible
  • The person is ineligible to be an independent patient due to inability to make treatment decisions independently and requirement of a very high support from their nominated representative.

Treatment

Before treatment, the following is considered:3

  • An advance directive, if any
  • Informed consent (i.e. permission given after complete knowledge of the treatment and its consequences). If the person is not able to give informed consent, the nominated representative may do so on their behalf4. In such a case, the consent must be recorded in the medical records by the professional in-charge. Additionally, the professional must review the person’s capacity to give consent every 7 days5.

Discharge 

Once the person stops meeting the criteria mentioned above, they may be discharged from the establishment. The professional must inform them/their nominated representative6.

For the next 7 days after discharge, they cannot be readmitted7. If these conditions are not met, they may remain in the establishment as a patient6.

Supported Admission for more than 1 month

Criteria and Procedure for Admission

If the person requires continuous treatment beyond 30 days or has to be readmitted within 7 days of discharge, the nominated representative must make an application to the professional in-charge. The professional will continue admission of the person if8:

  • Two psychiatrists have examined them independently within the last 7 days. Additionally, both conclude that the mental illness is severe enough that the person has consistently over time:
    • Attempted/threatened to cause physical harm to themselves
    • Behaved violently towards someone else or caused  someone else to fear physical harm
    • Shown an inability to care for themselves to the extent that they poses a harm to themselves
  • Both the psychiatrists certify (after considering the advance directive) that admission to the establishment is the least restrictive care option possible.
  • The person is ineligible to be an independent patient due to inability to make treatment decisions independently and requirement of a very high support from their nominated representative.

The Mental Health Review Board must review and permit such an admission9. The admission is for 90 days10. It can be extended to 120 days at the first instance, and after that, to 180 days at every instance, as required, with the Mental Health Review Board’s permission11.

Treatment 

Before treatment, the following is considered:12

  • The advance directive, if any
  • Informed consent (i.e. permission given after complete knowledge of the treatment and its consequences). If the person is not able to give informed consent, their nominated representative may do so on their behalf13, and in such a case, the consent must be recorded in the medical records by the professional, who must also review the person’s capacity to give consent every 15 days14.

Discharge 

Once the professional believes that the person has stopped meeting the criteria mentioned above, they will be discharged from the establishment, and the person and their nominated representative must be informed15. However, they may remain in the establishment as an independent patient16.

  1. Section 85(2),  the Mental Healthcare Act, 2017 [↩]
  2. Section 89(1),  the Mental Healthcare Act, 2017 [↩]
  3. Section 89(6),  the Mental Healthcare Act, 2017 [↩]
  4. Section 89(7),  the Mental Healthcare Act, 2017 [↩]
  5. Section 89(8),  the Mental Healthcare Act, 2017 [↩]
  6. Section 89(5),  the Mental Healthcare Act, 2017 [↩][↩]
  7. Section 89(15),  the Mental Healthcare Act, 2017 [↩]
  8. Section 90(2),  the Mental Healthcare Act, 2017 [↩]
  9. Section 90(4),  the Mental Healthcare Act, 2017 [↩]
  10. Section 90(8),  the Mental Healthcare Act, 2017. [↩]
  11. Section 90(9),  the Mental Healthcare Act, 2017 [↩]
  12. Section 90(11),  the Mental Healthcare Act, 2017 [↩]
  13. Section 90(12),  the Mental Healthcare Act, 2017 [↩]
  14. Section 90(13),  the Mental Healthcare Act, 2017 [↩]
  15. Section 90(15),  the Mental Healthcare Act, 2017 [↩]
  16. Section 90(16),  the Mental Healthcare Act, 2017 [↩]