CRITICAL EVALUATION OF MENTAL

HEALTH ACTS AND POLICIES

CURRENTLY PREVALENT IN THE
COUNTRY AND THEIR IMPLICATION IN
PROFESSIONAL ACTIVITIES

PRESENTEE : SUPERVISOR:

SRITAMA RAY DR. ANWESHA MONDAL

MPHIL 1 ST YEAR ASSISTANT PROFESSOR
INSTITUTE OF PSYCHIATRY(COE) INSTITUTE OF PSYCHIATRY(COE)
DEPARTMENT OF CLINICAL PSYCHOLOGY DEPARTMENT OF CLINICAL PSYCHOLOGY
 CONTENTS
 INTRODUCTION
 ACT
 MENTAL HEALTH ACT
 NEED FOR MENTAL HEALTH ACT
 MENTAL HEALTH ACT IN INDIA
 HISTORY
 EARLY LEGISLATION
 INDIAN LUNACY ACT
 MENTAL HEALTH ACT 1987
 MENTAL HEALTH CARE ACT 2017
 OTHER MENTAL HEALTH RELATED ACTS
 NATIONAL MENTAL HEALTH POLICY
 CONTENTS
CRITICAL EVALUATION
 SUCCESS OF INDIAN LUNACY ACT
 CRITICISM OF INDIAN LUNACY ACT
 SUCCESS OF MENTAL HEALTH ACT 1987
 CRITICISM OF MENTAL HEALTH ACT 1987
 SUCCESS OF MENTAL HEALTH CARE ACT 2017
 CRITICISM OF MENTAL HEALTH CARE ACT 2017
 CURRENT SCENARIO IN INDIA
 IMPLICATIONS IN PROFESSIONAL SETTINGS
INTRODUCTION
 What is an act?

 It is a set of statues created by legislature ,that concentrates on a

particular subject, and contains provisions relating to it.

 An act is originally a bill, which is proposed in the parliament first,

when it gets approval from both the houses, i.e. The Lok Sabha and
the Rajya Sabha and the president as well.
 What Is Mental Health Act?

 Mental health law is that area of law that is applied specifically to

persons with a diagnosis or possible diagnosis of mental illness, and to
the people involved in managing or treating others in this situation. The
Mental health care laws should address not only curative but also
preventive, promotive and rehabilitative aspects. Hence, legislation is
needed to prevent discrimination against persons with mental illness.
 Why do we need mental health act?

 For protecting the rights and dignity of persons with mental

disorders.
 developing accessible and effective mental health services.
 it provide legal framework to integrate mental health services into
the community
 to overcome stigma , discrimination ,exclusion of mentally ill
persons.
 to create enforceable standards for high quality medical care
 Mental Health Acts in India

Two different mental health approaches are prevalent.

 COMPREHENSIVE SINGLE LEGISLATION APPROACH: for dealing with persons with mental illness and

 SCATTERED APPROACH: where is there is no single legislation but provisions related to mental health are
inserted into other relevant legislations such as, issues concerning mental health and treatment may be
incorporated into general health, employment, housing or criminal justice legislation grant, to declare or to
restrict.
 History
Under British rule
Indian law has its ,contemporary
origin in Indian laws (Hindu
Arthasastra(400BC) and Islamic)are
and Manusmriti based on English
(100AD). common law.

In Islam era, The first law in

Sharia law relation to mental
came into illness in British
practice. India was the
Lunatic Removal
Act 1851, which
ceased in 1891.
 Early Legislation
After the takeover of Indian administration by the British crown in 1858, many
laws were introduced for the care of people with a mental illness, including:

 The Lunacy (Supreme Courts) Act 1858 (Act XXXIV of 1858)

 The Lunacy (District Courts) Act, 1858 (Act XXXIV of 1858)
 The Indian Lunatic Asylums Act, 1858 (Act XXXIV of 1858)
 The Military Lunatic Asylum Act, 1858 (Act XI of 1877)
 The Indian Lunatic Asylum (Amendment) Act,1886 (Act XVIII of 1886)
 The Indian Lunatic Asylum (Amendment) Act, 1889 (Act XVIII of 1889)
 Chapter XXXIV of the Code of Criminal Procedure, 1898
 Section 30 of the Prisoners’ Act 1900
 INDIAN LUNACY ACT(1912)
 Indian Lunacy Act, 1912 [ACT No IV of 1912] was derived from the English Lunacy Act, 1890.
 The main objective of Indian lunacy act was on preventing society from dangerousness of the
mentally ill people and taking care that no sane person is admitted in these asylums.

 Indian Lunacy Act, of 1912 contains four parts, eight chapters and 101 Sections.
 Part I – Definitions
 Chapter I Preliminary
 The first chapter dealt with the various definitions. The Indian lunacy act defined "asylum"
as, a mental hospital for lunatics established or licensed by the Central Government or any
State Government and "lunatic" as, an idiot or a person of unsound mind. This act also
defined "reception order" as, an order made under the provisions of this Act for the
reception into an asylum of a lunatic other than a lunatic so found by inquisition.


 This part deakt with

 INDIAN LUNACY ACT 1912,CONTD.
 Part II RECEPTION,CARE AND TREATMENT OF LUNATICS

It dealt with the Care and Treatment of Visitors.

 Even voluntary admission procedure was introduced.
 Two board of visitors need to sign before admission.
 The Magistrate shall personally examine the alleged lunatic and decide about
the case.
 The reception order can be issued by the Magistrate or Commissioner of
Police.
 INDIAN LUNACY ACT 1912(CONTD.)

PART III -JUDICIAL INQUISITION AS TO LUNACY

Chapter IV Proceedings in Lunacy in Presidency-towns Inquisition 102
Chapter V Proceedings in Lunacy outside Presidency-towns Inquisition.103
The Court may, upon application by family members, relative or friend, by order
direct an inquisition on, whether a person subject to the jurisdiction of the Court
who is alleged to be a lunatic, is of unsound mind and incapable of managing
himself and his affairs.After inquisition, the court make order for the provision of
maintenance of lunatic and his family members who are dependent on them, and
appoint manager for management of property.
 INDIAN LUNACY ACT 1912(CONTD.)

PART IV - MISCELLANEOUS

 Chapter VI Establishment of Asylums

 Chapter VII Expenses of Lunatics

 Chapter VIII Rules

The State Government may establish or license the establishment of asylums at such places as it thinks fit.
The State Government also had the power to cancel license .The State Government had power to make rules
regarding publication of rules, license requirements, to regulate the management of the asylums, to
prescribe places of detention and management of lunatics and also criminal lunatics.
 Indian lunacy act (1912)
HIGHLIGHTS


 1912 act guided the destiny of psychiatry in India.

 It was proposed to be regulated and supervised by central authority.
 Procedure of admission and registration was mentioned in this act.
 Psychiatrists were appointed as full time officers in these asylums.
 It is mainly based on custodial care.
 5 types of admission procedures were mentioned.
 voluntary
 Reception order with petition
 Reception order without petition
 Inquisition
 Criminal lunatic
 MENTAL HEALTH ACT 1987

 The Mental Health Act (MHA) was enacted in 1987, In 1947 when we got independence and Indian
Psychiatric society came into existence, ILA, 1912 was considered an inappropriate act for
mentally ill. Mental Health Bill by Rajya Sabha in 1986 and the Lok Sabha in 1987. This bill
received President's assent on May, 1987 but another 6 years were wasted before finally
implementing the act in April and came into force in 1993,
 It has been described as
 ‘An Act to consolidate and amend the law relating to the treatment and care of
 mentally ill persons, to make better provision with respect to their property and
 affairs and for matters connected therewith or incidental thereto’
Objective: Main objective is to establish governing bodies in central and state levels for licensing and
supervision of psychiatric hospitals.

 The MHA is divided into 10 chapters consisting of 98 sections.

 MENTAL HEALTH ACT 1987 CONTD.
 Chapter I - Preliminary-
 Instead of defining the mental illness, the Act defined ‘Mentally ill Person’ for enactment and logistic reasons. It defined
"Mentally ill person" as a person who is in need of treatment of any mental disorder other than mental
retardation.
Chapter II - Mental Health Authorities – It deals with the procedures for establishment of mental health authorities at
central and state levels.
 Chapter III - Psychiatric hospitals and psychiatric nursing homes- It lays down the guidelines for establishment
and maintenance of psychiatric hospitals and nursing homes. There is a provision for licensing authorities to process
applications for license which have to be renewed every five years.
 Chapter IV - Admission and detention in psychiatric hospital, or psychiatric nursing home - It deals with the
procedure of voluntary admission and involuntary admission and detention of mentally ill in psychiatric hospitals through
court’s reception order.It also provides admission of involuntary admission under special circumstances inwhich two
psychiatrists can detain a patient for not more than ninety days for.

 MENTAL HEALTH ACT 1987 CONTD.

 Chapter V - Inspection, discharge, leave of absence and removal of mentally ill persons - It deals
with the inspection of the hospital by board of visitors, discharge of voluntary admitted and involuntary
admitted patient, leave of absence and removal of mentally ill persons.
 Chapter VI - Judicial inquisition regarding alleged mentally ill person possessing property,
custody of his person and management of his property - It deals with the management of property,
appointment of guardianship, custody of mentally ill persons and the manner in which the property is to
be dealt.
 Chapter VII - Liability to meet cost of maintenance of mentally ill persons detained in psychiatric
hospital or psychiatric nursing home - It deals with the maintenance of mentally ill persons in a
psychiatric hospital or psychiatric nursing homes.
 Chapter VIII - Protection of human rights of mentally ill persons - It deals with the protection of
human rights of mentally ill persons..
 Chapter IX - Penalties and procedure- It deals with the penalties and procedures for infringement of
guidelines of the act.
 Chapter X – Miscellaneous - It deals with miscellaneous matters not covered in other
 chapters of the act.
 MENTAL HEALTH ACT 1987
HIGHLIGHTS
 Certain terminologies have changed and was defined, such as mentally ill persons, psychiatric
nursing homes and hospitals
 The act led to creation of central and state mental health authorities,where the interests of the
mentally ill could be observed and manipulated better.
 The procedure for the admission and discharge of voluntary patients were simplified and liberalized.
 MHA included the establishment and maintenance of psychiatric hospitals and nursing homes in the
private sector.
 The MHA also included the prohibition on any research on subjects without prior consent.

 MHA considered separate centres for special population such as drug addicts and individuals under the
age of 16.

 It focused on the protection of the human rights.

 It promotes community participation in mental health services development and stimulates self help
development.
 It mentioned about maintaining the cost of mentally ill persons detained in the psychiatric hospitals.
 MENTAL HEALTH CARE ACT 2017
 The Ministry of Health and Family Welfare (MOHFW) address the issues that were
unadressed in MHCA 1987 and be compliant with UNCRPD drafted a new bill(2013),
that was later become MHCA act2017.This act was primarily driven by human rights
activists and nongovernmental organizations (NGOs), with very little involvement
from organizations of professions who are major stakeholders in the delivery of
mental health care.
 CHAPTER I

 The MHA 2017 is divided into 15 chapters

 Chapter 1: it deals with the preliminaries of the act and consists of definitions.
 “MENTAL ILLNESS” has been defined as “a substantial disorder of thinking, mood, perception,
orientation or memory that grossly impairs judgement, behaviour, capacity to recognise reality or meet
the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but
does not include mental retardation which is a condition of arrested or incomplete development of a
person, specially characterised by the sub-normality of intelligence”
 CLINICAL PSYCHOLOGIST was defined as “Having a post graduate degree in psychology or clinical
psychology or applied psychology and a master of philosophy in clinical psychology or medical and social
psychology obtained after completion of full time course of two years which includes supervised clinical
training from any university recognized by the University Grants commission established under the
university Grants Commission act,1956 and approved and recognized by rehabilitation council of
IndiaAct,1992 or such recognized qualifications as may be prescribed”
 chapter II

 Chapter 2: it deals with the determination of mental illnesses by an individual and the capacity to
make mental health care treatment decisions.
 Mental illness shall be determined in accordance with such nationally or internationally accepted
medical standards as may be notified by the central government.
 CHAPTER III AND IV

 Chapter 3: it deals with the advance directives, which gives the people to give in writing as to how they
want and don’t want to be treated and cared during a mental illness.
 ADVANCE DIRECTIVE
 A person who is not a minor having mental capacity can write directive as specified by mental health
authority regarding his intention for the way he/she wishes to be cared for and not to be cared for and
can appoint nominated representative (NR) in spite of whether he/she is having past illness or had
treatment for mental illness.’

 NOMINATED REPRESENTATIVE:
 Psychiatric illness may cause burden to caregivers and in turn can affect the care of PMI. The MHC act
2017 has given sections for support of PMI by way of NR. The NR can be a relative or caregiver, suitable
person appointed by board, or person of organization registered under societies registration act and may
be revoked by board. NR shall not be minor and has to give consent in writing to MHP. NR can seek
information of diagnosis and treatments, rehabilitation, planning discharge, application for admission,
and give content
 CHAPTER V
PROTECTION OF HUMAN RIGHTS

 Human rights are given major importance and includes the right to access MHC treatment, cost
affordability and good-quality mental health services, accessibility, and without
discrimination. The facilities include acute care and outpatient and inpatient treatment. There
are sections in MHC act 2017 for PMI to have a dignified life, protection from cruel treatment,
self-hygiene, privacy, proper clothing, pay for work, living in community, adequate food, no
tonsuring, no force of uniforms, emergency and ambulance services, mobile, e-mail facilities,
and free legal services. , right to information, right to confidentiality, restriction of release of
information in respect of mental illness, right to access medical records, right to personal contacts and
communication, rights to legal aid and right to make complaints about deficiencies in provision of services.
 Insurance for mental disorders and treating the PMI according to International guidelines. There
are provisions for not separating woman and child below 3 years of age and if separated for more
than 30 days it should be approved by authority.
 CHAPTER VI

 Chapter 6: It deals with the promotion of mental health and preventive programmes, creating
awareness about mental health and illness and reducing stigma associated with mental illness, to take
measures as regard to human resource development and training and co-ordination within the
‘appropriate government’.
 Promotion of mental health programme and prevention of mental illness.
 plan, design, implement public health programmes to reduce suicides, attempted suicides.
 public media campaign should be done at regular interval.
 Programmes to reduce stigma are planned,designed,and implemented.
 periodic sensitization and awareness training of appropriate govt.officials.
 measures to address the human resource requirements of mental health services by planning,
implementing educational and training programmes and improve skills of the available human
resources.
 Train all the medical officers for emergency mental health care.
 CHAPTER VII AND VIII

 Chapter 7 and Chapter 8: both consist of the establishments of Central Mental

Health Authority and State Mental Health Authority.
 CENTRAL AND STATE MENTAL AUTHORITY:
 Central Mental Health (CMH) Authority comprises 20 members with 3-year term and maximum
age of 70 years and have to meet every 6 months and may be joined by tele-video conference.
CMH shall register MHE, have quality norms of MHE, supervise MHE, maintain national register
of MHP, train MHP.

State mental health authority shall meet not <4 times a year .
 CHAPTER IX AND X

 Chapter 9: it deals with the accounts and audits the Central and State Mental health
Authority has been asked to maintain and present to the Central Authority about the
received grants and the expenditure of those grants.
 Chapter 10: it deals with the mental health establishments.
 MHE registered as clinical establishment can apply for registration with fees
as prescribed, after fulfilling standards specified by authority and within 10
days without inquiry can get provisional registration having validity for 12
months.
 CHAPTER XII

 Chapter 11: it deals with the establishment, maintenance and functions of Mental Health
Review Boards by the State Government.
 Mental Health Review Board will be set up mostly in every district as per the CMH recommendation
and will be for a term of 5 years. Review board members can be holding office up to the maximum
age of 70 years and members comprise Honourable District Judge (retired also considered),
representative of district collector, psychiatrist, medical practitioner, and two persons can be either
PMI or caregivers or persons of NGO. The functions of board includes registering and reviewing AD,
appoint NR, decide objections against MHP and MHE, deciding for nondisclosure of PMI information,
visit jails, protect human rights.
 CHAPTER XII
Chapter 12: it deals with the ADMISSION, TREATMENT AND DISCHARGE PROCEDURE OF PATIENTS WITH MENTAL ILLNESS.
 Voluntary admission as per the MHA 1987 is changed as independent admission (Section 86 of MHC act 2017 and Section 17 of
1987) and refers to admission of PMI who has the capacity to make MHC and treatment decisions or requires minimal support in
making decision and has mental illness of severity requiring admission, likely to benefit or understand the nature and purpose
of admission. Informed consent has to be taken. The person admitted in this section may himself be discharged even without
the consent of medical officer.
 In cases of PMI not able to understand the purpose or nature of treatment resulting in not accepting the treatment and also
unable to take care himself, violent, then the PMI has to be admitted as supported admission (Section 89 of MHC act 2017))
after application given by NR provided PMI shall not be readmitted within 7 days.
 PMI who are wandering, not capable of taking care of himself can be taken under protection by police officer and after
informing NR they may produce before public health establishment (100 of MHC Act 2017, 23 of MHA 1987).
 In case of PMI is ill treated or neglected then the police officer may produce for 10 days in MHE and after assessment the
treatment of PMI has to be followed as per the provisions of the act (101,102 of MHC Act 2017),
 In case of prisoners act, Air force act, Army act, Navy act and code of criminal procedure can be treated at psychiatric ward
in medical wing of prison and when there is no facility of psychiatric ward they can be transferred to MHE after permission from
board (103 of MHC Act 2107)
 under section 121 of MHC Act there shall be screening for all inmates of prison during the time of entry including Mental
status examination, urine testing for common drugs of abuse, protocols for dealing prisoners with suicidal risk, counselling for
stress and prison after care services.
 admission of minor (Section 87 of MHC act 2017 )
 OTHER CHAPTERS

 Chapter 13: it deals with the duties of police officers in respect of persons with mental illness.
 Chapter 14: it deals with the restriction to discharge functions by professionals not covered by
profession.
 Chapter 15: it deals with the penalties that are to be imposed for establishing or maintaining mental
health establishments in contravention of provisions of this Act. It also highlights the punishment for
contravention of provisions of the Act or the rules and regulations of the Act.
 CHAPTER XVI
 MISCELLANEOUS:
 EMERGENCY

Medical treatment can be given for mental illness by registered medical practitioner to a PMI either at
MHE or at community for a maximum period of 72 h with informed consent of NR to prevent death or
irreversible harm to health of person or person inflicting serious harm to himself or person causing
serious damage to property.
 Banning ECT:ECT without anesthesia, sterilization of PMI, and chained procedures shall not be
performed. PMI shall not be kept in seclusion and only physical restraint should be used to prevent
imminent harm and to be recorded in medical notes.
 Attempt to commit suicide is not a crime but a cry for help. The biggest change and the most
commendable one in the MHCA 2017 is that of decriminalizing suicide. a person who commits suicide is
presumed to have severe stress and shall not be punished. However, the clause “unless proved
otherwise” of this section may make police to investigate for the cause. There will be no prosecution or
legal proceedings against authority or board when done in good faith.
 SCRAPPING OF 377 SECTION OF IPC
 The IPS and MHCA playing a role in the landmark judgment that repealed section 377 of IPC . The IPS
has to be commended for its continued efforts to bring equal rights and a life of dignity for the
Lesbian, Gay, Bisexual, Transgender, Questioning/Queer (L.G.B.T.Q) community and to get the
section 377 of IPC repealed. The position statement from IPS was accepted by the Supreme Court
and nondiscrimination clauses of the MHCA 2017 were quoted in the judgment.
 OTHER MENTAL HEALTH RELATED ACTS
There have been significant advances with respect to mental health legislation in India. These achievements
include legislations that can be divided into legislations having direct implication (substantial coverage) and
indirect implication (only relevant issues are covered).
 Those legislations which have direct implications on persons with mental illness are;

 A) Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995(PWD
1995)242,
 B) National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental
 C)Retardation and Multiple Disabilities Act, 1999 (NTA 2001)
 Legislations which have indirect implications on persons with mental illness are as
 Follows
 a) Narcotic Drugs & Psychotropic Substances Act, 1985 (NDPS 1985),
 b) Rehabilitation Council of India Act, 1992 (RCI 1992)
 c) Human Rights Act 1993 (HRA 1993)246,
 d) Juvenile Justice (Care and Protection of Children) Act, 2000 (JJA 2000)
 e) Protection of Women from Domestic Violence Act, 2005 (DMV 2005)
 PERSONS WITH DIABILITIES ACT(PWD),1995

 Persons with Disabilities Act (Equal Opportunities, Protection of Rights and Full Participation) 1995was
unanimously passed by both houses of the Parliament on 22nd December 1995.
 This law is an important landmark and a significant step in the direction of ensuring
 equal opportunities for people with disabilities and their full participation in nation building.

 The Act provides for both preventive and promotional aspects of rehabilitation like education,
employment and vocational training, job reservation, research and man power development, creation of
a barrier-free environment, rehabilitation of persons with disability, unemployment allowance for the
disabled, special insurance scheme for disabled employees and establishment of homes for persons with
severe disability. Disability due to mental illness has been acknowledged but equal footing with other
disabilities has not been achieved.
 NATIONAL TRUST ACT

 This Act was enacted in the year 1999 for the welfare of persons with autism, cerebral palsy, mental
retardation and multiple disabilities to enable and empower them to live as independently and as close
to the community to which they belong and to facilitate the realization of equal opportunities and
protection of rights. The Act provides for many welfare measures.
 RIGHT OF PERSON WITH DISABILITIES (RPWD),2016
 After India signed and ratified the UNCRPD in 2007, the Rights of PWD Act, 2016 (RPWD Act, 2016) was
passed by both the houses of the Parliament. It was notified on December 28, 2016 after receiving the
presidential assent.
 In the RPWD Act, 2016, the list has been expanded from 7 to 21 conditions .and it now also includes
cerebral palsy, dwarfism, muscular dystrophy, acid attack victims, hard of hearing, speech and language
disability, specific learning disabilities, autism spectrum disorders, chronic neurological disorders such as
multiple sclerosis and Parkinson's disease, blood disorders such as haemophilia, thalassemia, and sickle
cell anaemia, and multiple disabilities.
 free education for children with disabilities between 6 to 18
 The Act criminalizes the service provider and the family for providing treatment of persons with severe
mental illness even though the person may be at a clear risk to himself or to others. The section 7(2) has
been inserted for a good cause of protecting PWD from acts of abuse, violence and exploitation.
 CURRENTLY PREVALENT MENTAL HEALTH
POLICIES
 The first draft of mental health policy was prepared in late 2001 and came into existence in2003.
 According to WHO “Mental health policies describes the values, objectives and strategies of the
government to reduce the mental health burden and to improve mental health.”
 a) Provision of basic mental health care in the community by integrating the mental health system into
the general health care delivery system (Primary Health Centers). Identification and treatment of
persons with mental disorders to be done by the health workers and primary care physicians.
 b) To launch extensive information and communication activities about the nature, course and the
availability of treatment for mental disorders .
 c) To facilitate adequate psychosocial care of the recovered mentally ill in the community by making
linkages with non-governmental organizations locally
 d) Initiate mental health promotional activities in schools and colleges
 e) To develop active public-private partnerships
 Various innovative approaches adopted in the current NMHP include rural and urban mental health,
school mental health, adolescent mental health, suicide prevention and public private partnership
Features of national mental health policy

• The District Mental Health Programme (DMHP) The DMHP was

developed as an approach to deliver mental health care through
primary health care for the entire district.
• Urban Mental Health Programme (UMHP) is a new addition to
the NMHP to cater the needs of the mental health challenges of
stress, IT sector revolution and urbanisation.
• Preparatory phase ,
• Adolescent and School Mental Health Programme
• College mental health programme.
• Improvement in health manpower status: It is envisaged to
support the development of 11 regional Institutes of Mental Health
with a onetime grant of Rs 30 crores for infrastructure
development.
• 30 medical colleges to start/strengthen their post graduate
programme in mental health.
• Research and mental health
Features of NMHP

• Information, Education and Communication activities :

Development of public awareness material such as video
clippings, posters radio/ TV messages and wall writings.
• Training material for under graduate / post graduates in the
form of videos, interactive CDs for use on the net / distant
education have to be developed.
• Support money to assist both the central and the state
Mental Health Authorities.
• Public-Private-Partnership Efforts of the government alone
are inadequate to realize all the goals of NMHP. The role of
NGOs and related organizations in all components of NMHP has
been recognized.
• Monitoring the implementation of DMHP in the country
• Suicide prevention Several vulnerable populations require
life skills training and/or counselling to prevent suicides
• Stress management
CRITICAL EVALUATION
 INDIAN LUNACY ACT
SUCCESS

 1912 act guided the destiny of psychiatry in India.

 It ensured that no sane person is admitted in the asylums.
 It was the first act meant for indian lunactics.
 It was able to provide adequate custodial care for the patients.
 It mentioned management of property affairs
 Clearly defined admission procedure and certification process
 INDIAN LUNACY ACT
CRITICISM
 This Act had offensive terminologies i.e Lunatic person and Criminal Lunatic, which were needed to
be changed.
 it lacked prevention and promotion components in the area of mental health. The admission to
asylum was solely based on the judgment of the Magistrate. This gives rise to the question as to
whether the Magistrate could do justice to the patient requiring treatment without the knowledge of
mental illness.
 Even in case of voluntary admission, there was a mandatory clause that, two board of visitors need to
sign for admission and also for discharge. There was no scope for emergency treatment. Though
chapter III is titled care and treatment, unfortunately there is no discussion on the issue of treatment
methods and consent.
 the interest of the mentally ill was governed by one central authority, which led to the ignorance of
benefits and problems concerned with the mentally ill.
 MENTAL HEALTH ACT 1987
SUCCESS
 More humane approach to problems of mentally ill persons by changing the terminology e.g.
 lunatics and criminal lunatics have been replaced by the term mentally ill person and mentally ill
prisoner etc. and new chapters on management of their property and protection of human rights
 have been included.
 Creation of Central and State Mental Health Authorities- a welcome step to safeguard the
 interests of the mentally ill person under one authority.
 Procedure for admission and discharge of voluntary patients have been simplified and
 liberalized. In this act, no consent from two visitors is required as well as no written request is
 Required.
 Minor can be admitted with the consent of a guardian under this act. This provision is not there in
 the Indian Lunacy Act, 1912.
 MENTAL HEALTH ACT
SUCCESS

 Separate provision for admission of involuntary patients under category “Admissions Under
Special Circumstances”
 Special centres for special population like drug addicts, under 16 years, mentally ill
prisoners etc.
 Establishment and maintenance of psychiatric hospitals and psychiatric nursing homes in
private sector which was not in the earlier law
 Discharge procedure have been made easy and more simplified
 There are new different addition in this law like protection of human rights of mentally ill
persons, penalties, cost of maintenance and management of properties of mentally ill
persons
 Prohibition on any research on subjects without proper consent.
 MENTAL HEALTH ACT 1987
CRITICISM
 Human rights and mental health care delivery were not adequately addressed in this act.(Narayan et
al,2011)
 Human rights activists have questioned the constitutional validity of MHA 1987 because it involved the
curtailment of personal liberty without a provision of a review by any judicial body.
 Nothing was mentioned regarding rehabilitation and treatment of patients after discharge from
hospital.(Dhandha,2010)
 Hospital Standards:
 In MHA, definitions of ‘convalescent home’ and “psychiatric hospital” and“ psychiatric nursing
home” are clubbed together and all these terms are equated for legal purposes.
 Failure of implementing system in MHA
 In the current MHA (1987) the review processes or appeal processes for mentally ill patients are,
approaching the legal system, which is already overburdened and not available easily.
 CRITICISMS

 some of the judiciary and law enforcing agencies have limited knowledge of the existence of such an
Act and consequently this MHA is poorly implemented and
 utilized.
Unaddressed Issues by MHA, 1987
Substance Dependence MHA remains silent on the issue of admission and treating persons with
substance dependence without any behavioral changes who refuse consent for treatment.
Death of mentally ill patients inside the hospital The issue of death during custodial care of a
mentally ill patient is not addressed in MHA.
 Emergency situations: There are no guidelines for providing ambulance under MHA (1987) for
emergency crisis intervention to help families caring for a mentally ill family member. Many primary
health care doctors hesitate to treat or intervene in psychiatric emergency crisis situation.
 Choice of treatment: MHA (1987) is silent regarding the consent for treatment, and
 the method to be adopted . Forced treatment should be distinguished from involuntary admission.
Forced treatment requires to be defined and the procedure needs to be outlined.
 WHAT’S NEW IN MHCA 2017?

 DEFINITION OF MENTAL ILLNESS AND DIFERRENT PROFESSIONS

 ADVANCE DIRECTIVE
 NOMINATED REPRESENTATIVE
 PROTECTION OF THE RIGHTS OF MENTALLY ILL PERSON
 INSURANCE FOR MENTALLY ILL PERSONS
 ROLE OF APPROPRIATE GOVERNMENT
 CENTRAL AND STATE MENTAL AUTHORITY
 REGISTRATION OF MENTAL HEALTH ESTABLISHMENTS.
 ESTABLISHMENT OF MENTAL HEALTH REVIEW BOARD
 ADMISSION PROCEDURE AND DISCHARGE
 BANNING UNMODIFIED ELECTRO- CONVULSIVE THERAPY ( Narayanan et all,2011)
 DECRIMINALIZING SUICIDE(bhaumik,2013)
 SCRAPPING SECTION 377 IPC
 MENTAL HEALTH CARE ACT 2017
CRITICISM
 The MHCA 2017 has introduced a lot of new concepts like the mental health capacity, which as of now
is ambiguous and ill defined. As per the clause, everyone by default is presumed to have the capacity
and the right to consent. It is the responsibility of the treating mental health professional to prove
otherwise if the provision of supported admission has to be invoked.In the absence of any clear
guidelines from the MOHFW regarding the assessment of mental health capacity, perhaps it would
be helpful to refer to McArthur’s Competence Assessment Tool for Treatment. Institute of Human
Behavior and Allied Sciences also has come up with an informal mental health capacity assessment
proforma, and NIMHANS will soon come out with its own guidelines.
 Advance directive (AD) is a form of medical will which the mental health professionals have to follow in
case of nonemergency when there is a loss of capacity to consent for treatment. This throws up new
challenges to the professionals when the instructions in the AD are not in alliance with the best
practice guidelines or when the treatment proposed is expensive or in a setup which is far to
reach. This can put an extra burden on the caregivers and the family.(Gowda,2019)
 The concept of the nominated representative (NR) has been introduced. In the United Kingdom, “NR”
stands for nearest relative who would make decisions on behalf of the mentally ill in case of loss of
capacity to consent. However, the MHCA defines NR differently. Any person nominated by the patient
can be the NR once ratified by the Mental Health Review Board (MHRB). This person needs to be
consulted for all treatment-related decisions and his/ her opinion supersedes that of the nearest
relative. Again, this can throw up a lot of challenges to the treating professional and may also strain
the Indian family system, and affect the family dynamics of patients and caregivers.(Gowda,2019)
 CRITICISM

 The new act’s accessibility, availability of mental health services are ambiguous and unrealistic
given the lack of infrastructure, resources. According to WHO (2005)in 100000 population 0.2%
psychiatrist and 0.03% psychologists,0.03 psychiatric social workers and 0.05% nurses are serving. The
amount of mental health professionals are really less.(Antony,2014)
 Over inclusive definition of mental illness as described in MHCA2017 has significant impact on social
stigma.(Antony,2014)
 Management of minors are not so well defined.(Narayan et all,2011)
 Decriminalizing suicide is more as a stop gap arrangement by creating presumption of mental illness in
every case of suicidal attempts unless proved otherwise.(kumar,2018)
 ECT is mostly direct in INDIA; banning unmodified ECT limits it’s use in different mental health
establishment. Whereas, modified ECT is expensive. Anaesthetic backup that is needed for modified
ECTis mostly unavailable in India.
 CURRENT SCENARIO IN INDIA

 According to NIMHANS,2016 report

 Current morbidity rate 13.7%
 10.6% currently seeking intervention 150 million Indians are in need of urgent intervention.
 Approximately 1 in 40 and 1 in 20 people are suffering from past and current episodes of depression
all over the country.
 According to reports from the Indian Union Ministry of Health and Family Welfare, the country needs
around 13,000 psychiatrists.
 To achieve an ideal ratio of psychiatrists to population is about 1: 8000 to 10,000 but currently has
just about 3,500 - which is about one psychiatrist for over 2 lakh people!
 With regard to other mental health professionals the ratio is even worse - the need of Clinical
Psychologists is 20,000 and there are only 1000 available;
 for Psychiatric Social Workers, the requirement is 35,000, but only 900 are available, for Psychiatric
Nurses, we need 30,000 and only 1500 are available
 one-third of the global burden of mental illnesses in next 10 years.
 IMPLICATIONS IN PROFESSIONAL
SETTINGS
 MHCA 2017 comes out to be a praiseworthy effort for addressing patients and clinicians in the sector of
mental health.
 One useful implication for different professions related to mental health care are providing exact definitions
of different professions ,and in each field it made registration of the professionals mandatory. This could
reduce illegal practice and provide quality support to PMI.
 Given the current indian scenario, the morbidity rate being 13.7%, and limited number mental health
professionals, this act prompts state mental health and central mental health authority to set up more mental
health establishments and recruiting more numbers of qualified registered professionals.
 To meet this growing demands of professionals more universities under university grant commission and with
RCI (in case of clinical psychologists) approval should be established.
 As the current MHCA is focused on human rights, Informed consent, advance directives the professionals
should be very cautious regarding approach to the treatment plan , management and admission in mental
health establishments.They need to have extensive documentation at every step.
 There is a need to adapt collaborative approach with the media, police, NGOs, human rights activists, etc. It
is imperative that they are seen as partners and taken on board. Mental health professionals need to actively
write articles on mental health in periodicals, appear in debates, and conduct regular workshops and
education programs on mental health and the MHCA for police, media, and NGO.


Thank you
References
Agarwal AK, Gupta SC. Ethics in psychiatry. In: Vyas JN,Ahuja N, editors. Textbook of Postgraduate Psychiatry. JPB Publishers; 2003.
Antony, J. (2014) Mental Health Care Bill 2013: a disaster in the offing? Indian Journal of Psychiatry, 56(1), 3–7.
Antony J, A decade with the mental health act, 1987. Indian Journal of Psychiatry.
Applebaum P.S. The Supreme Court looks at Psychiatry. Am J Psychiatry 1984; 141:827-835
Bhaumik, S. (2013) Mental health bill is set to decriminalise suicide in India. BMJ, 347, f5349.
Chanpattana, W., Kunigiri, G., Kramer, B. A., et al (2005) Survey of the practice of electroconvulsive therapy in teaching hospitals in India.
Journal of ECT, 21, 253–254.
Dhandha A. (2010) Status Paper on the Rights of Persons Living with Mental Illness in Light of the UNCRPD. In Harmonizing Laws with UNCRPD.
Report prepared by the Centre of Disability Studies. Human Rights Law Network.
Gangadhar, B. N. (2013) Mental Health Care Bill and electroconvulsive therapy: anesthetic modification. Indian Journal of Psychological
Medicine, 35, 225–2
Gopikumar, V. & Parasuraman, S. (2013) Mental illness, care and the bill: a simplistic interpretation. Economic and Political Weekly, 48(9), 69–
73.
Glenn HP. Legal Traditions of the World. Oxford University Press; 2000. pp. 255–76
Kala, A. (2013) Time to face new realities: Mental Health Care Bill, 2013. Indian Journal of Psychiatry, 55, 216–219.
.KumarMT mentalhealthcare Act 2017,liberal in principles,Let down in provisions Indian J Psychol.Med 2018;40:101-7
Mental Health Care Act 2017. The way ahead: Opportunitiesand Challenges. Indian J Psychol Med 2019;41:113-8
Molanguri U. Ethics in psychiatric society. Telangana JPsychiatry 2017;3:57-60.
Ministry of Law and Justice. The Mental Healthcare Act;2017. Gazette of India. Available from:
http://www.egazette.nic.in/WriteReadData/2017/175248.pdf [Last cited on
2019 Jan 27].
Md. M. Firdosi, Zulkarnain Z.Ahmad (2016) Mental Health Law in India: Origins and Proposed Reforms
6.Nambi S. Forensic psychiatry revisited. Indian J Psychiatry. 2010;52:S306–8.
Narayan, C. L., Narayan, M. & Shikha, D. (2011) The ongoing process of amendments in MHA-87 and PWD Act-95 and their implications on
mental health care. Indian Journal of Psychiatry, 53, 343–350.
Prateek Rastogi (2005): Mental Health Act 1987- An Analysis. JIAFM; 27(3).

Szasz TS. The myth of mental illness. Am Psychol 1960; 15:113-118

Szasz T.S Law, Liberty and Psychiatry: An inquiry into the social usage of Mental Health Practices. New York:MacMillan, 1963.
Wilkinson G, Russell FG, Marks I, et al. Case reports and confidentiality: Opinion is sought medical and legal. Br. J. Psychiatry 1995;116: 555-
558
WHO (World Health Organization): Mental Health Atlas. (2005). WHO Press, Geneva.