Theme: Mental Health

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.1. 
  • 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.

  1. Section 43,  the Mental Healthcare Act, 2017. [↩]

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.))

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.1. 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)).

  1. 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)).

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 Organisation.2 

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 male5.

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. [↩]

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 patient.6

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 patient.16

  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. [↩]

Rights of Persons with Mental Illness

Persons with mental illness have certain rights1 so as to safeguard them from discrimination and harm. These rights are:

Right to make an Advance Directive

An advance directive is a legal document. In other words, it specifies healthcare decisions that should be taken for a person in the event they are not capable of making such decisions. Persons with mental illness can take the help of a service provider, NGO or lawyer to make this document.

Right to appoint a Nominated Representative 

A nominated representative is a person who is appointed by a person with mental illness to discharge certain duties. This includes provision of support to the person while making treatment decisions, helping such a person get admitted to a mental health establishment if required, etc.

Right to Access Mental Healthcare

A person with mental illness has the right to access mental health care from government-funded mental healthcare services, such as inpatient and outpatient services, half-way homes, sheltered accommodation etc. They can also get services to support the family of the person with mental illness.

Right to Community Living 

A person with mental illness has the right to community living. They can live with and be a part of society and not be forced to live in isolation, etc. For example, someone with mental illness need not live in an abandoned. They can live in a residential area and be a part of society.

Right to Live with Dignity

Every person with a mental illness has a right to live with dignity. In other words, protection from cruel, inhuman or degrading treatment in any mental health establishment.

Right to Equality and Non-discrimination

Every person with mental illness has a right to equality and non-discrimination. For example, persons with physical illness have the same rights as those with physical illnesses.

Right to Information

A person with mental illness and their  nominated representative have the right to ask for information. For instance, information about the person’s mental illness, treatment plan, any side effects, about the criteria for admission in a mental health establishment, about the law governing provision of care to people with mental illness, etc. 

Right to Confidentiality

A person with mental illness has the right to confidentiality. This includes information on their mental health, mental healthcare and physical healthcare. However, there are certain exceptions to this. 

Right to Legal aid

A person with mental illness has a right to free legal aid. Legal aid means providing free of cost legal services including Representation by a lawyer in legal proceedings, payment of all costs including process fees, expenses of witnesses etc.

Right to Complain

In case of deficiency of care treatment and related services in a mental health establishment, a person with mental illness or their nominated representative have the right to complain. 

Right to Communication

A person with a mental illness who is admitted to a mental health establishment has the right to communicate with their personal contacts. This includes the right to receive or refuse visitors, to send and receive electronic mail, etc. 

The law punishes mental health establishment or any other person who violate these rights. The punishment is  jail time of up to 6 months and/or a fine up to Rs. 10,000 for the first offence. For any subsequent offence, the jail time is up to 2  years and/or with a fine between Rs. 50,000 to 2 lakhs2. You should complain against such a person, or approach the Court with the help of a lawyer.

  1. Mental Healthcare Act, 2017. [↩]
  2. Section 108,  the Mental Healthcare Act, 2017. [↩]

Making an Advance Directive

An advance directive is a legal document that specifies the healthcare decisions that should be taken for a person in case they are not capable of making such decisions. It comes into force when someone no longer has the capacity to make healthcare-related decisions. Once the person regains the ability to make mental healthcare decisions, then the advance directive ceases to be operational.

The document has to include1:

Only major persons  (those who have completed 18 years of age) can make this document. Please note that any decision taken by a person (when they have the ability to make such decisions) will override the advance directive2. However, if a person requires emergency treatment3then the directions in the advance directive need not be followed. For example, the advance directive does not apply in suicide cases.

To make the document, you should approach an NGO which works in this field or a lawyer, who will be able to help you out.

  1. Section 5(1), the Mental Healthcare Act, 2017. [↩]
  2. Section 5(4), the Mental Healthcare Act, 2017. [↩]
  3. Section 9, the Mental Healthcare Act, 2017. [↩]