Optional Grouping: Mental Health Overview

What is Mental Illness?

Mental illness is a health condition1 which involves substantial disorder of thinking, mood, perception and orientation or memory. This may lead to gross impairment of judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life. Abuse of drugs or alcohol may also result in a mental condition.Some examples of mental illness are substance abuse disorder, bipolar disorder, etc. This does not include mental retardation i.e. incomplete intellectual development. Persons with mental illness also have rights under the law including the right to confidentiality, right to treatment, etc. 

Determination of Mental Illness

To determine whether one has a mental illness it must be determined according to nationally/internationally accepted medical standards, like the International Classification of Disease of the World Health Organisation2 

These reasons cannot determine whether a person is mentally ill3:

  • Past treatment for a mental illness4
  • Political, economic or social status
  • Belonging to a cultural, racial or religious group, or for any other reason not directly relevant to mental health status of the person; 
  • Refusal to conform to moral, social, cultural, work, political, or religious values prevalent in one’s community.

Please note that one cannot be considered as a person of unsound mind, merely because they have a mental illness. Only a Court can declare a person to be of unsound mind5. 

Capacity to Make Treatment Decisions

The capacity to make mental healthcare-related decisions depends on the conditions given above6 :

  • The ability to understand relevant information on mental healthcare related issues, such as admission, personal assistance or treatment. Please note the information given to the person has to be comprehensible. For example, Ram cannot hear properly. The information given to him will be using means that will enable him to understand it7. 
  • The ability to understand the consequences of a decision on the treatment, admission or personal assistance
  • The ability to communicate the formed decision through speech, expression, gesture, etc. 

If one takes a decision that others think is incorrect or inappropriate, that solely will not mean that one does not have the capacity to make such a decision8. For example, against the wishes of his parents, Ram decides not to go to a mental health establishment. The sole fact that Ram’s parents think that a decision is inappropriate does not mean they do not have the capacity to make such a decision.

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

Emergency Treatment

Under the law, emergency treatment refers to any medical and mental health care treatment. It can be provided by a registered medical practitioner to a person with mental illness1. For this, the consent of the nominated representative is required, if they are available.

The immediate treatment prevents2:

  • The death or harm to the person
  • The person from inflicting serious harm to themselves and/or to others
  • The person from causing serious damage to their or others’ property

However, this does not allow the use of electroconvulsive therapy3. Further, it does not allow to use any treatment not directly related to the criteria mentioned above4.

In addition, this treatment is limited to 72 hours under normal circumstances or up to 7 days during an emergency5.

  1. Section 94(1),  the Mental Healthcare Act, 2017 [↩]
  2. Section 94(1),  the Mental Healthcare Act, 2017. [↩]
  3. Section 94(3),  the Mental Healthcare Act, 2017 [↩]
  4. Section 94(2),  the Mental Healthcare Act, 2017 [↩]
  5. Section 94(4),  the Mental Healthcare Act, 2017 [↩]

Mental Health of Children

The rules for admission and discharge of a child or minor (below 18 years of age) are different from those of adults. In case a child requires admission in a mental health establishment, the nominated representative should apply to the mental health professional in charge of the establishment for the child’s admission1.

Criteria for Admission

The professional in charge may admit the child to the mental health establishment if2 two health professionals, one of whom is a psychiatrist, have independently examined them in the last seven days. Both the professionals must independently conclude that:

  • The child has a mental illness severe enough to require admission
  • The admission will be in the best interests of the health, safety and wellbeing of the child
  •  Admission is required to satisfy the child’s healthcare need
  • All community-based alternatives to admission are unsuitable to the child’s needs

Provisions for Stay

Certain conditions need to be fulfilled, under the law, when a child is admitted at an establishment. These conditions are:

  • To accommodate the child separately from adults3
  • The child’s environment must consider their age and developmental needs3
  • The child’s environment should of the same quality as other hospitals where children are admitted for other medical treatment3
  • The nominated representative/an attendant appointed by the nominated representative must stay with the child in the establishment for the entire duration of their stay4. For girls, the nominated representative must appoint a female attendant who will stay with her, if the nominated representative is male.5.

Treatment

The nominated representative should give informed consent for any treatment given to a child. In other words, permission must given after complete knowledge of the treatment and its consequences6.

Discharge

The mental healthcare establishment should discharge the child, if the child’s nominated representative does not support admission or requests discharge.7.

  1. Section 87(2),  the Mental Healthcare Act, 2017 [↩]
  2. Section 87(3),  the Mental Healthcare Act, 2017 [↩]
  3. Section 87(4),  the Mental Healthcare Act, 2017 [↩][↩][↩]
  4. Section 87(5),  the Mental Healthcare Act, 2017 [↩]
  5. Section 87(6),  the Mental Healthcare Act, 2017 [↩]
  6. Section 87(7),  the Mental Healthcare Act, 2017 [↩]
  7. Section 87(8),  the Mental Healthcare Act, 2017 [↩]