Educationals

The positive qualities of the new Act

The admission procedure are simplified to some extent

The two new provisions of the Mental Health Act in Admission Procedure are:

• Admission of minor (below age 18) by the parents/guardian
• Admission under special circumstances (maximum 90 days).

The old barbaric terminology has been changed with respect to psychiatric patients and hospitals.
The establishment of Mental Health Authorities, both at the Center and the state is a welcome step. These authorities are expected to function as friend, philosopher and guide to the Mental Health Services. Provisions have been made for establishing separate hospitals for those who are under the age of 16 years and also for those who are addicted to alcohol and other drugs and for other special groups. Emphasis on outpatient care has been made to safeguard the human rights of the mentally ill person. Stringent punishment has also been provided for those who subject the mentally ill to physical and mental indignity within hospitals.

Critical view about the Mental Health Act 87

• The notion of a care in the community has not been addressed in the current legislation. No effort has been made to provide after care services for the discharged patients. There seem to be no thinking over the alternative to hospital care.
• Psychiatrists, running private psychiatric nursing home are facing too many medico-legal problems, difficulties and interference in the administration with regard to:
  • Getting and renewing licences.
  • Board of visitor's control over their nursing home.
  • Constituting a medical board for their day to day hospital procedure like issuing certificates for admission to and discharge and leave absence etc.
• Patients examined by psychiatrists and admitted in a psychiatric nursing home should not be compelled to undergo further examination by medical and/ or non-medical visitors. It goes against the fundamental rights of a citizen or his family and such an exposure of any responsible citizen or his family and disclosure of his psychiatric illness to the knowledge of the public may amount to indignity and cruelty.
• In the present act the matter of consent and competence has not been adequately addressed.
• Does an involuntary admission (eg: admission through a reception order) necessarily imply competence? Can drugs and ECT be given without any informed consent? What is their statutory criteria for competence? Who will judge competence, doctors or the judges?

Admission procedure in a psychiatric hospital

The admission in a psychiatric hospital or nursing home can be made in one of the following manners:

• Voluntary Admission
  • By the patient's request, if he is major
  • By the guardian, if a minor (a new provision)
• Admission under special circumstances It is an involuntary hospitalization when the mentally ill person does not or cannot express his willingness for admission. Admission is made, if a relative or a friend of the mentally ill person applies in writing for admission and the medical officer in-charge of the hospital is satisfied that the admission will be the interest of the mentally ill person. The duration of admission cannot exceed 90 days.
• Admission through reception orders.

a) Reception order on application

An application for a reception order may be made by the medical officer in-charge of a psychiatric hospital or nursing home or by the husband, wife or any other relative of the mentally ill person. This application for admission should accompany the medical certificates from two medical practitioners of whom one should be a Government doctor. On receipt of this application the magistrate may issue a reception order for admission after he is satisfied that the alleged person is suffering from mental illness.

b) Reception orders on production of a mentally ill person before a magistrate

(Admission of a dangerous wandering mentally ill person). The police officer in-charge of a police station may take into protection any person found wandering at large whom he has reason to believe to be mentally ill. He should produce him before the nearest magistrate within 24 hours. The magistrate shall examine the person and assess his capacity to understand and if he is satisfied that the said person is a mentally ill person, the magistrate may pass a reception order, authorizing the detention of the said person as an inpatient in a psychiatric hospital, and later should the medical officer certify that such a person is a mentally ill person, he should be given care and treatment in a psychiatric hospital.

Every officer in charge of a police station, who has reason to believe that any mentally ill person is cruelly treated or is not under proper care and control by relatives or other persons, shall report this to a magistrate. This complaint to the magistrate can also be submitted by any individual. The magistrate may summon such relatives along with the patient and order the relative or other person to take care of the mentally ill person. If this relative willfully neglects to comply with this order he shall be punishable with a fine up to Rs 2,000. If there is no person legally bound to maintain this mentally ill person he can issue a reception order for admission to a psychiatric hospital.

c) Admission as an in-patient for inquisition

A district court holding an inquisition regarding any person who is found to be mentally ill, may direct such a person for admission in a psychiatric hospital.

Inquisition is examination or investigation whether the person who is alleged to be mentally ill is of unsound mind and incapable of managing his affairs.

Application can be made by

• Any relative.
• Advocate General.
• Public Prosecutor, or
• District Collector.

The magistrate will give notification and the order for an enquiry.