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 22nd 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
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
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
 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.
 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
Chapters
 Chapter I – defines various expressions occurring in
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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
 Chapter VI- deals with judicial inquisition regarding
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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.
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
 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.
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
 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.
 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
 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.
 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 lunatic’s property for certain
purposes
 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.
 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.
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 person’s 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
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 one’s own condition and treatment
7. Right to refuse treatment
8. Right to not to participate in experimentation in the
absence of the patient’s informed, written consent
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, one’s own mental
health care records
13. Right to have jobs in the public sector
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
Nurse’s implications for protecting
patient’s rights
 To protect the patient’s rights the nurse should be
aware of these rights
 She should ensure that ward procedures and policies
should not violate patient’s rights
 Discussing these rights with the mental health team
and including these rights in the nursing care plan is
important in protecting the patient’s rights
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
Crime and psychiatric disorders
 It is common in schizophrenia, affective disorders,
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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
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.
 Criteria used to determine criminal responsibility
M’Naghten’s rule
2. Irresistible Impulse Act
3. Durham’s rule / product rule
4. American Law Institute (ALI) test
1.
Civil responsibility of a mentally ill
 Management of property
 Marriage
 Testamentary capacity
 Right to vote
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
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.
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 16th September 1985, the above Act was replaced
and Act 61 of NDPSA 1985 was enforced
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
 -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.
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
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
 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
 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.
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.
 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
 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.
Roles and responsibility of nurses
 Approach the client with warm and accepting manner
 Should have adequate knowledge about admission and
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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 patient’s data
 Maintain privacy of patient while doing any
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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
patient’s rights
Watchful for mentally ill criminals.