The mental health act, 1987 The Indian mental health act
governs the welfare of mentally ill patients in our country. This
act came to force on 22 nd may 1987, mental health act was drafted
by parliament in 1987, but it cane into effect in April 1993 This
act replaces the Indian Lunacy act of 1912, which had earlier
replaced the Indian Lunatic Asylum act of 1858
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Reason for amendment of act 1987 The attitude of the society
towards persons afflicted with mental illness has changed
considerably, and it is now realized that no stigma should be
attached to such illness. Mentally ill persons are to be treated
like any other sick persons and the environment around them should
be made as normal as possible The experience of the working of
Indian Lunacy Act, 1912, has revealed that it has become out mode,
with rapid medical advances, it has become necessary to have fresh
legislation, with new approach
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Objectives of mental health act, 1987 To regulate admission to
psychiatric hospitals or psychiatric nursing homes of mentally ill
persons who do not have sufficient understanding to seek treatment
on a voluntary basis, and to protect the rights of such persons
while being detained To protect society from the presence of
mentally ill persons who have become or might become a danger to
others To protect citizens from detained in psychiatric hospitals
or psychiatric nursing homes with out sufficient cause
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To regulate responsibility for maintenance charges of mentally
ill persons who are admitted to psychiatric hospitals or
psychiatric nursing homes. To provide facilities for establishing
guardianship or custody of mentally ill persons who are incapable
of managing their own affairs. To provide for the establishment of
Central Authority and State Authorities for Mental Health
Services.
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To regulate the powers of the Government for establishing,
licensing and controlling psychiatric hospitals and psychiatric
nursing homes for mentally ill persons. To provide for legal aid to
mentally ill persons at State expense in certain cases
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Chapters Chapter I defines various expressions occurring in the
Act Chapter II- empowers the State Government to establish State
authority for Mental Health Services Chapter III- empowers the
central government or state government to maintain psychiatric
nursing homes Chapter IV- deals with admissions and detention in
psychiatric hospital or psychiatric nursing home Chapter V- deals
with inspection, discharge, leave or absence and removal of
mentally ill patients
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Chapter VI- deals with judicial inquisition regarding alleged
mentally ill person possessing property, custody of his person and
management of his property Chapter VII- deals with liability to
meet cost of maintenance of mentally ill persons detained in
psychiatric hospital or psychiatric nursing homes. Chapter VIII-
deals with protection of human rights of mentally ill persons.
Chapter IX- deals with procedures to be followed for establishing
and maintaining psychiatric hospitals Chapter X- deals with
clarification in certain procedures, to be followed by medical
officer in charge.
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Criticism of the act Change of older terminologies to new
terminologies might be good from theoretical aspects but should be
implemented. Licensing authorities do not have a doctor who may be
in a better position to access the facilities and services of these
centers Concept of establishing new hospitals might appear good but
in developing country like ours, this may be a costly affair
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There is no mention about incorporating General hospitals and
centers in this act rather they are prohibited. Such hospitals if
taken along may provide a better health care More emphasis is given
to hospital admission and treatment, where as there is no
provisions for home treatment No provisions are made for care and
rehabilitation of patients after discharge No provision for
punishing the relatives and officers requesting unnecessary
detention of ward in such hospitals.
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Indian Lunacy Act 1912 Indian Lunacy Act was derived from
English Lunacy Act 1890 and it includes total 8 chapters Chapter I-
this section deals with preliminary information including some
definitions:- The definitions are 1. Asylum-An asylum or mental
hospital for lunatics established or licensed by the central or
state Govt. 2. Cost of maintenance- it includes the cost of
lodging, maintenance, clothing, medicine and care of lunatics and
any expenditure incurred in removing such lunatic to and from an
asylum
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Criminal lunatic- it means any person for whose detention in,
or removal to an asylum, jail or other place of safe custody, an
order has been made in accordance with the provisions of section
330 or sections 335 and 336 of the Code of Criminal Procedure, 1973
or of section 30 of the Prisoners Act, 1900, or of section 103 A of
the Indian Army Act, 1911.
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Chapter II- It deals with reception of lunatic, reception order
on petition, reception order in case of lunatics from foreign
states in India, reception order otherwise than on petition,
reception and detention of criminal lunatics Chapter III- it deals
with procedures to be followed for providing care and treatment
including appointment of visitors, monthly inspection by visitors,
discharge of lunatics, temporary release of lunatics, removal of
lunatic, escape and re- capture
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In chapter III, the term PAROLE is defined as permission given
to patients to perform certain rituals or attend certain family
functions. During parole patient can leave hospital at any time,
and can be brought back to the hospital forcefully, if he does not
with in a maximum period of 90 days.
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Chapter IV- it deals with Jurisdiction in Lunacy in presidency
towns, powers of court in respect of attendance and examination of
lunatic, power to direct district court to make inquisition in
certain cases, judicial powers over person and estate of lunatic,
power to dispose of lunatics property for certain purposes
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Chapter V- it deals with custody of lunatics and management of
their estates, remuneration of managers and guardians etc. Chapter
VI- it deals with establishment of asylums include establishment or
licensure of asylums by the state government, provision for
admission of lunatics in asylums outside a state.
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Chapter VII- it deals with expenses of lunatics, payment of
cost of maintenance in licensed asylums in certain cases by
government, application of property in the possession of a lunatic
found wandering, order of court and enforcement, fixation of costs
of maintenance, saving of liability of relatives to maintain
lunatic. Chapter VIII- it deals with publication of rules, penalty
for improper reception or detention of lunatics, provision as
bonds, protection to persons acting under act, power to give effect
to warrants and orders of certain courts outside India.
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Bill of rights of mentally ill patients Title V, section 501 of
Mental Health Systems Act 42 U.S.C defines a Bill of Rights for
Mentally Ill Patients. 1. Right to treatment and services under
conditions that support the persons personal liberty. 2. Once
disability is certified, the person can avail benefits of travel
allowances in Indian Railways, and an accompanying relative 3.
Right to an individualized, written or service plan
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4. Right to ongoing participation in the planning of services
to be provided. 5. Provision for certain tax benefits for
psychiatric patients 6. Right to be provided with a reasonable
explanation of all aspects of ones own condition and treatment 7.
Right to refuse treatment 8. Right to not to participate in
experimentation in the absence of the patients informed, written
consent
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9. Right to freedom from restraints and seclusions 10. Right to
humane treatment environment that affords reasonable protection
from harm and appropriate privacy 11. Right to confidentiality of
records 12. Right to access, upon request, ones own mental health
care records 13. Right to have jobs in the public sector
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14. Right to have access to telephones and mails to converse
with others privately 15. Right to assert grievances with respect
to infringement of the bill of Rights 16. Right to referral as
appropriate as appropriate to other providers 17. Right to wear own
clothes
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Nurses implications for protecting patients rights To protect
the patients rights the nurse should be aware of these rights She
should ensure that ward procedures and policies should not violate
patients rights Discussing these rights with the mental health team
and including these rights in the nursing care plan is important in
protecting the patients rights
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Forensic psychiatry Forensic psychiatry is the branch of
medicine that deals with disorders of the mind and their relation
to legal principles. The basic forensic psychiatry includes 1.
Crime and psychiatric disorders 2. Criminal responsibility 3. Civil
responsibility 4. Laws relating to psychiatric disorders 5.
Admission procedures of patients in a psychiatric hospital 6. Civil
rights of the mentally ill 7. Psychiatrists and the court
Slide 24
Crime and psychiatric disorders It is common in schizophrenia,
affective disorders, epilepsy, personality disorders and drug abuse
cases. Usually they commit offence because They do not understand
the implication of their behavior Due to delusions and
hallucinations Abnormal mental states like confusion, excitement
etc Drug related violence
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Criminal responsibility According to section 84 of the Indian
Penal Code of 1860 nothing is an offence which is done by a person
who, at the time of doing it, by reason of unsoundness of mind, is
incapable of knowing the nature of the act. Or that he is doing
what is either wrong or contrary to law.
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Criteria used to determine criminal responsibility 1. MNaghtens
rule 2. Irresistible Impulse Act 3. Durhams rule / product rule 4.
American Law Institute (ALI) test
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Civil responsibility of a mentally ill Management of property
Marriage Testamentary capacity Right to vote
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Laws relating to psychiatric disorders Laws relating to
psychiatry in India Mental health related legislations Civil laws
relating to mental ill persons Civil laws relating to psychiatry
Suicide and Indian law The narcotic drugs and psychotropic
substances
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Civil rights of the mentally ill There are legal efforts to
safeguard the human rights of mentally ill. A person who is
supposed to look after the mentally ill person and who does not
take proper care and shows cruelty, may be summoned by the court,
on receipt of such an information either from the public or the
police. Anybody subject the mentally ill to physical or mental
indignity while in hospital also will be prosecuted, and a mentally
ill person shall not be used in research with out obtaining from
him or the significant others.
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Acts related to narcotic and psychotropic substances and
illegal drug trafficking The Opium Act of 1857 was revised first in
1878 In 1950, the Opium Act 1878 was revised as the Opium and
Revenue Laws Act 1950. On 16 th September 1985, the above Act was
replaced and Act 61 of NDPSA 1985 was enforced
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Contents of the Act The Act includes narcotic drugs (opium,
poppy, straw, cannabis, cocaine, coca and all related drugs) and
psychotropic substances (76 drugs and their derivatives) In this
act if a person produces, possesses, transports, imports, sells,
purchases, or uses any narcotic drugs or psychotropic substances
(except Ganja), he shall be punishable with - rigorous imprisonment
for not less than 10 years which may extend up to 20 years, and
fine 1 lakh to 2 lakh rupees
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-for repeat offense a rigorous imprisonment of 15 years, which
may extend to 30 years, and a fine of 1.5 lakh to 3 lakh rupees
-for handling Ganja, a rigorous imprisonment up to 10 years and a
fine up to 1 lakh rupees - NDPSA Act will seize the property, and
death penalty if a person is found to be trafficking more than or
equal to 1 kg of pure heroin, despite warning on first
attempt.
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Admission and discharge procedures (gvrnd by MHA) Admission on
voluntary basis- patient has to apply to medical officer, if he is
a minor, the guardian can make this. The Medical Officer should
make an enquiry with in 24 hours, and should admit patient if
needed and treatment will be continued for a period not exceeding
90 days Admission under special circumstances- any mentally ill
persons who does not or is unable to express his willingness for
voluntary admission is kept in a mental hospital or psychiatric
nursing home on an application made by his relatives. The
prescribed application form along with certificates of 2 medical
officers is required to admit him
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Admission under reception order On application- an application
can be made only by the relatives not other than husband, wife,
guardian or a friend for the admission of mentally ill persons.
This application is made out to magistrate in writing along with
two medical certificates, one of them issued by gazatted medical
officer. The magistrate now obtains consent from medical officer in
charge of mental hospital for the admission of a mentally ill
person
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On production before the magistrate- A police officer, may take
in to protection of any person wandering with in the limits of his
station who is a suspect of mentally ill, and can be a threat to
himself or others, and this person should be produced in front of
the magistrate with in 24 hours of detention. Magistrate gives an
order to the medical officer to examine and admit the patient
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Admission in emergency- a medical officer may order the
admission of a mentally ill person if he thinks the mentally ill
person is a threat to self or others, and the patient should be
produced before magistrate with in 24 hours of detention.
Magistrate can pass an order on examination. Temporary admission-
the magistrate can issue an order for temporary admission if he
finds the mentally ill dangerous to the public or to self.
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Discharge of mentally ill patients Voluntary discharge- the
voluntary admitted patients may give a written request to leave the
hospital, when maximum relief has been attained from treatment
Discharge of patient admitted under special circumstances- a friend
or relative can make a request for discharge of a mentally ill
patient to the concerned medical officer. If the medical officer
feels satisfied with the treatment outcome, then the friend or
relative has to assure the security of the patient after
discharge.
Slide 38
Discharge of patient admitted on reception order- an
application can be made to the magistrate along with a medical
certificate from medical officer in charge, and if the magistrate
finds the patient fit, may issue an order for discharge. Discharge
of a patient admitted by police- it can be done when family members
are ready to give an agreement in writing to take care of their
patient and also the satisfactory opinion of medical officer
isneeded
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Leave of absence- an application for leave of absence on behalf
of the mentally ill person, not being a mentally ill prisoner
undergoing treatment as an inpatient in any mental hospital or
psychiatric nursing homes may be made to medical officer in charge.
The application should be duly signed by the family member along
with an agreement stating about proper care and safety of patient
and others. The Leave of Absence is granted for a maximum of 60
days.
Slide 40
Roles and responsibility of nurses Approach the client with
warm and accepting manner Should have adequate knowledge about
admission and discharge procedure of patient Take informed consent
from patient or family members to perform various procedures in the
client Follow various guidelines giver regarding application of
restraints and seclusions She should protect the basic human right
of patient Maintain confidentiality of patients data
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Maintain privacy of patient while doing any procedures All
records should be kept strictly confidential Inform concerned
person if client escapes from unit Keep hazardous objects away from
patients Make sure that hospital policy does not violate patients
rights Watchful for mentally ill criminals.