Theme: Health & Environment

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.)).

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.)).

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.

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.)).

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. 

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.

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.)).

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.))

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.)).

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)).