Mental Health Act-

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Dr. Vishal medicovishal@yahoo.co.in Mental Health Act : Critical aspect

INTRODUCTION:

INTRODUCTION Protecting the rights Accessible and effective mental health services Legal framework To overcome stigma Standards for high quality medical care Protect civil, political, social and economic rights Right of access to education, employment and social security .

History:

History Indian Lunacy asylum Act, Act 36 of1858 Indian Lunacy Act, Act 4 of 1912 1946- Bhore Commitee 1947- Indian Psychiatry Society 1949- adhoc Committee 1978- Introduced in Loksabha 1981- Re-introduced in Loksabha Passed rajyasabha (1986), Loksabha (1987) 1993-Act came into effect

Objectives of the act:

Objectives of the act 1. To establish central and state authorities 2. To establish psychiatric hospitals and nursing homes. 3. To provide a check on working of these hospitals. 4. To provide for the custody of mentally ill persons 5. To protect the society from dangerous manifestations of mentally ill.

Objectives of the act:

Objectives of the act 6. To regulate procedure of admission and discharge 7. To safeguard the rights 8. protect citizens from being detained unnecessarily. 9. To provide for the maintenance charges of mentally ill persons 10.To provide legal aid to poor mentally ill criminals at state expenses 11. change offensive terminologies of Indian Lunacy act

Facts::

Facts: At the time of conception of law, 1.private psychiatry was still in infancy 2.growth and development of private psychiatry was not foreseen The field of psychiatry itself has grown

The Act:

The Act “Act to consolidate and amend the law relating to the treatment and care of mentally ill persons, to make better provisions with respect to their property and affairs and for matters connected therewith or incidental thereto”

Division:

Division 10 chapters 98 sections

Chapter I::

Chapter I: Deals with preliminaries of the act, definitions and provides for change of offensive terminologies used in Indian Lunacy act 1912. Terminologies used in the act New term Previously used terms Psychiatric hospital Nursing home Asylum Mentally ill person Lunatic Mentally ill prisoner Criminal Lunatic

Chapter I::

Chapter I: Other important terminologies used in the act 1. Reception order 2. Psychiatric hospital or nursing home 3. Medical officer 4. Medical officer in-charge 5. Mentally ill person 6. Mentally ill prisoner

Chapter I: (criticism):

Chapter I: (criticism) 1.Medical officer: “ A registered medical practitioner.” - Ayurvedic or homeopathic medical officer ? 2. Mentally ill person: “person who is in need of treatment by reason of any mental disorder other than mental retardation” -not specify the types of mental illness to be included -Mentally retarded subjects have been excluded.

Chapter I::

Chapter I: 3. Licensed psychiatric hospital or licensed psychiatric nursing home: “ means a psychiatric hospital or psychiatric nursing home as the case may be licensed, or deemed to be licensed, under the Act” -discriminatory, uniform policy should be adopted.

Chapter II::

Chapter II: Deals with the procedures for establishment of mental health authorities at central and state levels. Authority- In-charge Supervise Advise Discharge Members Official, Non-official Criticism -budgetary provisions

Chapter III::

Chapter III: guidelines for establishment and maintenance of psychiatric hospitals and nursing homes. provision for licensing authorities to process applications for license Valid- License Revoke- License Criticism: 1. No mention is made of incorporating General hospitals 2.Licensing process should be made simpler. 3.No Provision for checking & working of licensing authorities

Chapter IV::

Chapter IV: It deals with the procedures of admission and detention of mentally ill in psychiatric hospitals. 1.Reception order with petition 2.Reception order without petition 3.Voluntary admission

Chapter IV: (criticism):

Chapter IV: (criticism) Temporary treatment order Emergency addmission set criteria and procedure for involuntary admission

Chapter V::

Chapter V: It deals with the inspection, discharge, leaves of absence removal of mentally ill Criticism: 1.No provisions are made for after discharge care and rehabilitation, of patients. 2.Much stress is laid on hospital admission and treatment 3.No provisions are made for home treatment.

Chapter VI::

Chapter VI: It deals with the judicial inquisition regarding alleged mentally ill persons possessing Application District Court- appoints Guardian, Manager Criticism: control one's inherited assets requires the opinion of a medical professional

Chapter VII::

Chapter VII: It deals with the maintenance of mentally ill persons in a psychiatric hospital or psychiatric nursing homes. Criticism: No provision for patients with no estate and no relative, the state should be made responsible for such patients.

Chapter VIII::

Chapter VIII: It deals with the protection of human rights of mentally ill persons. Research Communication Criticism: - Once a person is admitted to mental hospital he is termed insane or mad -informed consent for experimental treatment

Chapter IX & Chapter X::

Chapter IX & Chapter X: These sections pertained to “Penalties and Procedures” “Miscellaneous”

positive changes in the MHA, 1987:

positive changes in the MHA, 1987 More humane approach to problems of mentally ill persons Creation of Central and State Mental Health Authorities- Procedure for admission and discharge Minor can be admitted with the consent of a guardian under this act. 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.

positive changes in the MHA, 1987 ( Cont.):

positive changes in the MHA, 1987 ( Cont.) Establishment and maintenance of psychiatric hospitals and psychiatric nursing homes in private sector Discharge procedure have been made easy simplified New different addition – protection of human rights of mentally ill persons, penalties, cost of maintenance and management of properties Prohibition on any research on subjects without proper consent.

Critical aspects of MHA 1987 as a whole:

Critical aspects of MHA 1987 as a whole 1.The act doesn't reflect the govt. policy on mental health framed in 1978 as well as Mental Health Programme,1987 2. No attention to WHO guidelines 3. Legal considerations have been given more weightage in comparison to medical ones 4. Failed to remove the criminal flavour by keeping the power of criminal court to exert its control over admissions and discharge of non criminal mentally ill persons 5. No importance to family and community psychiatry.

Critical aspects of MHA 1987 as a whole:

Critical aspects of MHA 1987 as a whole 6.There are no provisions for punishing the relatives and officers requesting unnecessary detention of a person to such hospitals 7. Once a person is admitted to mental hospital he is termed insane or mad by the society. There should be provisions in the act to educate the society against these misconceptions 8. Much stress is laid on hospital admission and treatment. This again increases the cost of health care. No provisions are made for home treatment 9. The act has no provision for transportation of an unwilling patient except by police

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