MENTAL HEALTH CARE ACT BY SHELI DUYA.pptx

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1. MENTAL HEALTH CARE ACT 2017 SHELI DUYA

2. History of MHA Pre-independence 1858- Indian Lunatic asylum act 1912- Indian Lunacy act • Post Independence 1947- Indian Psychiatric Society established 1987-Mental Health Act Mental Health Care Act 2017 (MHCA 2017) Forensic Psychiatry 2

3. MHA 1987 An Act to regulate and set standard for restrictive psychiatric treatment facilities To establish procedure for Guardianship for mentally ill who need it To protect Human Rights of mentally ill To set up authorities for development ,regulation and coordination of mental health services Forensic Psychiatry 3

4. MHCA 2017 India has more than 70 million mental health patients Less than 4000 psychiatrists There are 9.5-102 persons affected in 1000 of population About 8,00,000 people commit suicide worldwide every year, of these 135,000 (17%) are residents of India, a nation with 17.5% of world population Forensic Psychiatry 4

5. MHCA 2017 An Act to provide for mental health care and services for persons with mental illness To protect, promote and fulfil the rights of such persons during delivery of mental health care and services Convention on Rights of Persons with Disabilities : 13th December, 2006 at United Nations Headquarters 16 chapters / 126 sections Forensic Psychiatry 5

6. MHCA 2017 Chapter-I Preliminary “Disorder of mood, thought, perception, orientation and memory which causes significant distress to a person or impairs that person’s ability to meet the demands of daily life and includes mental conditions associated with the abuse of alcohol and other drugs, but does not include mental retardation” Forensic Psychiatry 6

7. MHCA 2017 Chapter-II Mental illness and capacity to make mental healthcare and treatment decisions without any discrimination Chapter-III Advance Directives Every person except minor has right to take advance directive by writing It empowers the patient to choose the treatment and appoint a representative If patient is minor, his/ her parent or care giver will act as representative Forensic Psychiatry 7

8. MHCA 2017 It will not be applicable at the time of emergency It is the duty of every psychiatrist to plan treatment, keeping advance directive in mind If any one, from psychiatrist to care giver, is unsatisfied can approach to the concerned board Chapter-IV Nominated Representatives Guidelines of choosing Nominated Representative Forensic Psychiatry 8

9. MHCA 2017 Chapter-V Rights of the person The appropriate government should make provisions of Mental health institutions in every district Mental ill person should not travel long distance Provisions for the mentally ill to live with dignity Rights of confidentiality Forensic Psychiatry 9

10. MHCA 2017 Chapter- VI It gives direction to the government to implement the programme Chapter-VII Central Mental health authority Chapter-VIII State Mental health authority Forensic Psychiatry 10

11. MHCA 2017 Chapter IX Finance, accounts and audit Chapter X Mental health establishments Every mental healthcare institution should be registered Establishment of new improvised institutions Forensic Psychiatry 11

12. MHCA 2017 Chapter-XI Mental Health Review Boards A district judge as chair person of board Two members of whom one shall be a psychiatrist and the other shall be a medical practitioner Two members who shall be persons with mental illness or caregivers or persons representing organizations of persons with mental illness Forensic Psychiatry 12

13. MHCA 2017 Chapter-XII Admission, treatment and discharge Independent admission Admission of Minors Supported admission up to 30 days Supported admission > 30 days Forensic Psychiatry 13

14. Independent Admission: Section 86 Any person who considers himself to have mental illness and desires admission, who is not a minor Admitted if the Medical officer or Psychiatrist is satisfied that Mental illness of severity requiring admission Patient should benefit from admission and treatment Request made is under free will Forensic Psychiatry 14

15. Independent Admission: Section 86 Has capacity to make mental health care decisions Informed consent Bound to rules and regulations of the establishment Limited to a period of 30 days To be informed to MHRB within 7 days of admission Forensic Psychiatry 15

16. Admission of minor: Section 87 The nominated representative of the minor shall apply to the medical officer May admit the minor if two psychiatrists have examined the minor Mental illness of a severity requiring admission In the best interests of the minor The nominated representative under all circumstances stay with the minor Inform MHRB within 72 hours Forensic Psychiatry 16

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19. Discharge : Section 88 On request Minor becoming major under inpatient care, can decide as independent patient Forensic Psychiatry 19

20. Supported Admission: Section 89 Upon application by Nominated Representative 2 mental health professionals, including a Psychiatrist, after independent examination Recently threatened or attempted to cause bodily harm Recently behaving violently towards another person, or causing another person to fear bodily harm Recently shown inability to care oneself to a degree that places at risk of harm to oneself Forensic Psychiatry 20

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22. Supported Admission: Section 90 As requested by the NR Continue admission in the establishment beyond 30 days Re examination will be done by 2 psychiatrists Consistent inability to take care of oneself To be informed to MHRB To be approved within 21 days Limited to 90 days Renewal to 120-180 days Forensic Psychiatry 22

23. Leave of absence: Section 91 Granted by - Medical officer or Psychiatrist After securing consent of Nominated Representative Power with the practitioner to terminate when appropriate to do so If the patient does not return, contact the person on leave or Nominated Representative If patient requires IP care, MO may contact the local Police Office Forensic Psychiatry 23

24. Absence without leave: Section 92 Without discharge, absents one-self Taken into protection by Police Officer at the request of the Psychiatrist in charge and brought back Forensic Psychiatry 24

25. Transfer of patients: Section 93 Transfer of persons with mental illness from one mental health establishment to another MHE Forensic Psychiatry 25

26. Emergency Treatment: Section 94 By any Medical Practitioner, subject to informed consent from the Nominated Representative To prevent death or irreversible harm to health of the person Person inflicting serious harm to himself/others Person causing damage to property ECT is not permitted as an emergency procedure Emergency treatment limited to 72 hrs or till the person is assessed at MHE Disasters/emergencies, it may extend to 7 days Forensic Psychiatry 26

27. Prohibited Procedures: Section 95 Electro-convulsive therapy without the use of muscle relaxants and anaesthesia Electro -convulsive therapy for minors Sterilisation of men or women, when such sterilisation is intended as a treatment Chained in any manner or form whatsoever Restriction of Psychosurgery : Section 96 Restraints and Seclusion : Section 97 Forensic Psychiatry 27

28. Discharge Planning: Section 98 Before discharge shall consult with Patient / Nominated Representative Family Member / Care giver Psychiatrist can prevent discharge for 24 hrs Recent suicide attempt/threatening Violence towards others Inability to care for oneself Forensic Psychiatry 28

29. MHCA 2017 Chapter-XIII It is the duty of police to give protection to any mentally ill person wandering outside in the area of police station Chapter-XIV Restriction to discharge functions by professionals not covered by profession Forensic Psychiatry 29

30. MHCA 2017 Chapter-XV Offences and Penalties Unauthorized institutions will be punished 5000-50000 for 1st time, up to 2 Lakhs for 2nd time Chapter-XVI Miscellaneous Power to call for information by Central Government Power of Central Government to issue directions Forensic Psychiatry 30

31. Summary It empowers the mentally ill person to choose the treatment and appoint individual as nominated representatives who can take decisions on behalf of them Recognition of the rights and dignity of the patient Every citizen has the right to access mental health care and treatment Forensic Psychiatry 31

32. Summary Free treatment to those who are homeless or below poverty line. Have the right to confidentiality with respect to his mental health, mental health care and treatment Provisions for medical insurance for treatment of mental illness Forensic Psychiatry 32

33. Summary This act abolished the ECT for children and made provisions for giving modified ECT An attempted suicide will be presumed, unless otherwise proven, to have been under severe stress at the time Forensic Psychiatry 33

34. Comments & Queries 34 Forensic Psychiatry

35. Thank You! 35 “Education is not the amount of information, that is put into your brain and runs riot there undigested” - Swami Vivekananda Forensic Psychiatry