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1. MENTAL HEALTH care Act,2017 Chairperson : Dr. M. Vijayalakshmi , Assistant Professor. Presenter : Dr. V.Sudha Manaswini , Post Graduate.

2. Need for Legislation in Mental Health History of Mental Health Laws in India Mental Health Act 1987 Mental Health Care Bill, 2013 Mental Health Care Act, 2017 References Scheme of presentation

3. Mentally ill people are often victims of abuse, cruelty and neglect, with their legitimate rights being violated. Legislation plays an important role in providing a legal framework for addressing critical issues such as Community integration of persons with mental disorders. Provision of high quality care and improvement of access to care. Protection of civil rights, promotion of rights to housing, education and employment. NEED FOR LEGISLATION IN MENTAL HEALTH

4. History of Mental health laws in india India’s first Lunacy Act (Act 36) drafted in 1858 came with guidelines to establish mental asylums and procedures to admit patients. A paradigm shift is observed in management of mentally ill i.e. a shift from captivity to community integration in the period of post independence. In view of limited resources, integration of mental health with primary health care services was done.

5. INDIAN LUNACY ACT (ILA), 1912: Purpose of this act was to ensure custodial care and to prevent harm to society. This act guided the destiny of psychiatry in India. The name ‘’lunatic asylum’’ is changed to ‘’mental hospitals’’ This act first defined the procedure of admission and certification. It prevailed for more than 75 years. No provision of treatment, no protection of rights or provision of welfare and no limit is specified for involuntary admissions.

6. Indian Psychiatric Society was established in 1948. Indian Psychiatric Society had suggested various changes in Indian Lunacy Act and proposed Mental health bill in1949. After a long gap of 40years, Mental Health Act was passed in Parliament in 1987 and came into effect in all states in April,1993. Such long gap is due to delay in the formation of rules by various state governments.

7. DEFINITION - 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. It is spread in 10 chapters 98 sections. MENTAL HEALTH ACT, 1987

8. CHAPTER – I : Preliminary It deals with preliminaries of the act, definitions and provides for change of terminologies used in ILA, 1912. It applies to all over India, including Jammu and Kashmir. Definitions – “mentally ill person” - a person who is in need of treatment by reason of any mental disorder other than mental retardation. “psychiatric hospital” or “psychiatric nursing home” –a hospital established or maintained by the Government or any other person for the treatment and care of mentally ill persons.

9. “psychiatrist” - a medical practitioner possessing a post-graduate degree or diploma in psychiatry, recognized by the Medical Council of India. “reception order” - an order made under the provisions of this Act for the admission and detention of a mentally ill person. “Inspecting Officer” - a person authorized by the State Government or by the licensing authority to inspect any psychiatric hospital or psychiatric nursing home; “cost of maintenance” - in relation to a mentally ill person admitted in a psychiatric hospital or psychiatric nursing home, shall mean the cost of such items as the State Government may specify in this behalf.

10. CHAPTER – II : Mental Health Authorities This chapter deals with procedures for establishment of mental health authorities at central and state levels. Mental Health Authorities: Are in charge of regulation, development and coordination of Mental Health Services. Supervise the psychiatric hospitals and psychiatric nursing homes and other Mental Health Service agencies. Advice Government regarding matters of mental health. Discharge other functions with respect to matters relating to mental health.

11. CHAPTER – III : Psychiatric Hospitals and Psychiatric Nursing Homes Guidelines for establishment and maintenance of psychiatric hospitals and nursing homes which shall be done only with license. There is a provision for licensing authorities to process applications for license which have to be renewed every five years. On receipt of an application, the licensing authority shall make inquiries whether the psychiatry hospital may deem fit. Application for renewal of license shall be made not less than one year before the date on which period of validity of license is due to expire. An Inspecting Officer , at any time can inspect any psychiatric hospital.

12. CHAPTER – IV : Admission and Detention in psychiatric hospital or psychiatric nursing home. PART – I : Admission on voluntary basis PART – II : Admission under Special Circumstances PART – III : Reception Orders

13. PART – I : Admission on voluntary basis A mentally ill person (a major) may make a request for admission as a voluntary patient and in case of a minor, his guardian may make a request. On such request the medical officer in charge , after enquiry within 24 hours, may admit such a person if he thinks it is necessary. The medical officer shall discharge such patients on request by him or guardian, within 24 hours, unless he finds discharge against patient’s interest. Such cases are referred to Medical Board consisting of two medical officers, which if decides the same, the patient can be further admitted for a period not exceeding 90 days.

14. PART – II : Admission under Special Circumstances A mentally ill person may be admitted as in patient on a request by friends or relatives. Such request should be supported by two medical officers in charge and may admit the patient if they think it is necessary. Admission shall be for maximum of 90 days. A mentally ill patient admitted by relative or friend can also apply to the magistrate for discharge.

15. PART – III : Reception Order An application for reception order may be made by medical officer in charge of a mental hospital the spouse by any other relative to the magistrate. The magistrate can pass the Reception Order which is valid upto 30 days. Request for admission by a police officer if mentally ill person is dangerous to himself or others. Such persons will be discharged by magistrate on request by relatives or after they are certified as sane by the board of experts.

16. CHAPTER – V : Inspection, Discharge, Leave of Absence and Removal of Mentally ill persons PART I : INSPECTION The Central or State Government shall appoint not less than five visitors- one shall be a medical officer two social workers. Not less than three visitors, at least once in every month make a joint inspection of the psychiatric hospital. Every person who is detained in jail shall be visited once in every three months.

17. PART – II : Discharge The Medical Officer In-charge can order discharge of a patient on his own, on an application by the person on whose request the admission order was made, or on request of the person if he is found to be of sound mind. PART – III : Leave of Absence An application for leave of absence may be made to the medical officer in-charge. The Medical Officer in charge may grant leave of absence for such period which he may deem necessary and shall not exceed sixty days.

18. CHAPTER – VI : Judicial Inquisition regarding Alleged Mentally ill person possessing property, custody of his person and management of his property. When the alleged mentally ill person is possessed of property, an application for holding an inquisition into the medical condition may be made. If the mentally ill person is not capable of managing his property, the court shall make an order for the appointment of guardian. If the property is entrusted to District court, the court shall appoint any suitable person to be the manager of such property.

19. Where the person appointed as guardian is different from the manager, the manager shall pay to the guardian an allowance fixed by the authority. Duties of Manager To furnish inventory and annual accounts. To execute conveyances under orders of District Court. To perform contracts directed by District Court.

20. CHAPTER – VII : Liability to meet cost of maintenance of Mentally ill persons detained in Psychiatric Hospital or Psychiatric Nursing Home The cost of maintenance of a mentally ill person detained in any psychiatric hospital, be borne by Government of the State wherein authority which passed the order is subordinate. An application shall be made to District Court for payment of cost of maintenance of mentally ill person or from a person legally bound to maintain him.

21. CHAPTER – VIII : Protection of Human Rights of Mentally ill persons. Mentally ill persons shall be treated without violation of human rights. No mentally ill person under treatment shall be used for purposes of research unless it is of direct benefit to the person for purposes of diagnosis and treatment. No letters or other communication sent by or to mentally ill person under treatment shall be intercepted, detained or destroyed.

22. CHAPTER – IX : Penalties and Procedures Penalty for establishment or maintenance of psychiatry nursing home in contravention of Chapter –III shall be punishable for a term which may extend to three months or with fine of two hundred rupees or with both. Penalty for improper reception includes imprisonment for two years or with a fine of thousand rupees or with both. Any person who contravenes any of the provisions of the Act shall be punishable with imprisonment for six months or with fine of five hundred rupees or both.

23. CHAPTER – X : Miscellaneous It deals with miscellaneous matters not covered in other chapters of the Act like provision as to bonds, report by Medical Officer, pension of mentally ill person payable by government. The medical officer in charge of any mentally ill person detained has been discharged should make a report of his mental and physical condition to the authority.

24. Positive Aspects of Mental Health Act Replacement of offensive terminologies of ILA, 1912 which helped in upholding dignity of mentally ill persons. Establishment of licensing authorities to provide a check on licensing and working of mental health hospitals. Provision for establishing separate psychiatric hospitals for different categories of patients. Provision of outpatient care thus avoiding unnecessary detention. Mentally ill person to be treated without violation of human rights. Appointment of guardians for maintaining property of a person with mental illness. Provision for bearing the expenses of treatment by Government in certain cases.

25. Certain important issues not included in MHA, 1987 Suicide Prevention Integrating psychiatric care into primary care Consultation Liaison Psychiatry Confidentiality and Informed consent Ethical Issues related to difficulty in discharging patients.

26. It is introduced in Rajya Sabha on August 19, 2013 and passed on 8 th August 2016 and in Lok Sabha on 27 th march 2017 . Definition : It is a bill “to provide for mental health care and services for persons with mental illness and to protect, promote and fulfill the rights of such persons during delivery of mental health care and services and for matters connected therewith or incidental thereto.” MENTAL HEALTH CARE BILL, 2013

27. Need for a new law : The Convention on Rights of Persons with Disabilities and its Optional Protocol was adopted on the 13th December, 2006 at United Nations Headquarters in New York and came into force on the 3rd May, 2008. India has signed and ratified the said Convention on the 1st day of October, 2007. Hence it is necessary to align and harmonize the existing laws with the said Convention.

28. An act to provide for mental health care and services for persons with mental illness to protect , promote and fulfill the rights of such persons during delivery of mental health care and services and for matters connected therewith or incidental thereto. Official Enactment Received the assent of the President on 7 th April, 2017 It came into force on 29 th May, 2018. It is divided into 16 chapters and 126 sections. MENTAL HEALTH CARE ACT, 2017

29. Chapter I - Preliminary DEFINITIONS – Mental health care (MHC) includes analysis and diagnosis of a person’s mental condition and treatment as well as care and rehabilitation of such person for his mental illness or suspected mental illness. Mental illness means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life. It includes mental conditions associated with the abuse of alcohol and drugs , but excludes mental retardation.

30. Mental Health Establishment Any health establishment including Ayurveda , Yoga, Naturopathy, Unani , Sidha and Homeopathy (AYUSH) establishment. Where persons with mental illness are admitted and reside at or kept in For care, treatment, convalescence and rehabilitation Either temporarily or otherwise Includes any general hospital or general nursing home Whether private or public.

31. MENTAL HEALTH PROFESSIONALS (MHP) : Psychiatrist – medical practitioner possessing a postgraduate degree or diploma in psychiatry awarded by an university recognized by University Grants Commission or MCI. Clinical Psychologist – a person having a postgraduate degree in Psychology or Clinical Psychology or Applied Psychology or MPhil in Clinical Psychology/ Medical Psychology/ Social Psychology following a full time 2 year course including clinical training. Psychiatric Social Worker – a person having a postgraduate degree in social work or MPhil in PSW following a full time 2 year course in clinical training. Mental Health Nurse – person having a degree or diploma in general nursing or psychiatric nursing recognized by Nursing Council of India and registered with relevant State mental healthcare.

32. Chapter ll - Mental illness and capacity to make mental health care and treatment decisions Capacity Assessment – Capacity to make decisions regarding his mental health care or treatment refers to ability to Understand the information that is relevant to take a decision on the treatment or admission or personal assistance. Appreciate any reasonably foreseen consequence of a decision or lack of decision on the treatment or admission or personal assistance Communicate the decision under subclass (1) by means of speech, expression, gesture or any other means

33. Chapter lll – Advance Directive A document expressing the way one wishes to receive or not receive mental health care or treatment and the individuals one wants to appoint as Nominated Representative in order of precedence. Any major who has capacity to make mental health care and treatment related decisions can make Advance Directive. It comes into action once person ceases to have capacity to make mental health care and treatment related decision. It remains effective till person regains capacity. It can be changed any number of times.

34. Power to review, alter, modify or cancel advance directive It shall be the duty of every medical officer in charge of a mental health establishment and the psychiatrist in charge of a person’s treatment to propose or give treatment to a person with mental illness A mental health professional or a caregiver, if does not wish to follow, they can apply to Mental Health Review Board and the following situations can be reviewed:

35. Whether it was made by person out of his own free will and free from force or undue influence Whether the person intended the advance directive to apply to the present circumstances which may be different from those anticipated. Whether the person had capacity to make decisions relating to his mental healthcare or treatment when it was made. Whether the content of advance directive is contrary to other laws or constitutional provisions.

36. Liability of medical health professional in relation to advance directive A medical practitioner or a mental health professional shall not be held liable for any unforseen consequences on following a valid advance directive. The medical practitioner shall not be held liable for not following a valid advance directive if he has not been given a copy of it .

37. CHAPTER lV - Nominated Representative Any major person can be appointed as per wish of person making nominated representative . Who is competent to discharge the duties or perform the functions assigned to him under this Act Who gives consent in writing to the mental health professional to discharge his duties under this act.

38. Guardians are Nominated Representative for minors unless the Board decides otherwise. Any appointed Nominated Representative may revoke or alter such appointment at any time. Nomination shall be made in writing on plain paper with the person’s signature or thumb impression of the person referred.

39. When no Nominated Representative has been appointed: The following persons for the purposes of this Act in order of precedence shall be deemed to be NR: A relative A caregiver A suitable person appointed as such by the concerned board If no such person is available, the Board shall appoint the Director, Department of Social Welfare or his designated representative as Nominated Representative.

40. Duties of Nominated Representative: Consider the current and past wishes, life history, values, cultural background and the best interests of person with mental illness. Give particular credence to the views of the person to the extent that he understands the nature of decisions under consideration Provide support to the person in making treatment decisions in high support admissions Apply to the mental health establishment for admission Be involved in discharge planning Appoint a suitable attendant Have the right to give or withhold consent for research

41. CHAPTER V – Rights of Persons with Mental illness Right to access mental health care. Right to community living Right to protection from cruel, inhuman and degrading treatment. Right to information. Right to confidentiality.

42. Restriction on release of information in respect of mental illness. Right to access medical records. Right to personal contacts and communication Right to legal aid. Right to make complaints about deficiencies in provision of services.

43. Chapter Vl – Du ties of Appropriate Government Promotion of mental health and preventive programmes . Creating awareness about mental health and illness and reducing stigma associated with mental illness. Take measures as regard to human resource development. Take measures to ensure coordination with concerned Ministries and Departments such as health, law, home affairs, women and child development that address issues of mental health care.

44. Chapter Vll – Central Mental Health Authority Composition - Central Mental Health Authority comprises of secretary, joint secretaries of department of health and family, Director general of health services, director of central institutes, mental health professional with 15 years experience, psychiatric social worker, clinical psychologist, Mental Health Nurse, two members of PMI, caregivers, persons of nongovernmental organization (NGO), and persons relevant to mental health.

45. The Central Mental Health Authority shall: Register all mental health establishments under the control of Central Government. Develop quality and service provision norms for different types of mental health establishments under the Central Government. Supervise all mental health establishments under the Central Government and receive complaints about deficiencies in provision of services. Maintain a national register of clinical psychologists, mental health nurses and psychiatric social workers Train all persons including law enforcement officials, mental health professionals about the provisions and implementation of this Act. Advise the Central Government on all matters relating to mental health care and services.

46. Chapter VllI – State Mental Health Authority Register all mental health establishments in the State except those referred in the above chapter, maintain and publish a register of such establishments. Develop quality and service provision norms for different types of mental health establishments in the State. Supervise all mental health establishments in the State and receive complaints about deficiencies in provision of services Register clinical psychologists, mental health nurses and psychiatric social workers in the State to work as mental health professionals. Train all relevant persons including law enforcement officials, mental health professionals and other health professionals about provisions and implementation of this Act.

47. Chapter IX – Finance, Accounts and Audit Central Mental Health Authority Fund includes : Any grants and loans made to the Authority by Central Government All fees and charges received by the Authority under this Act All sums received from other sources decided by Central Government The Central Authority shall maintain proper accounts which shall be audited by the Comptroller and Auditor-General of India.

48. Chapter X – Mental Health Establishments Registration of Mental Health Establishment – Every person or organization who proposes to establish or run a MHE shall register with Central Mental Health Authority or State Mental Health Authority. State Mental Health Authority will classify MHEs into different category as specified in Central Authority regulations and within eighteen months from the commencement of this Act will specify minimum standards for different categories.

49. All Central Government Mental Health Establishment to apply to Central Mental Health Authority in form B of CMHA rules with demand draft of 20,000 rupees drawn in favor of Chairperson, CMHA. All State Government Mental Health Establishments and any other non-governmental MHEs of the State to apply to State Mental Health Authority in form B of SMHA rules with demand draft of 20,000 rupees drawn in favor of Chairperson, SMHA. Every Mental Health Establishment on date of commencement of Act shall apply for Provisional registration within 6 months of constitution of Authority.

50. Provisional Registration is issued within 10 days and is valid for 12 months. Once rules are laid for requirement of minimum standards for different categories of Mental Health Establishments, one can apply for permanent registration. If Mental Health Authority on enquiry agrees, permanent registration is given and is valid for 3 years. In case of change of ownership of Mental Health Establishment, registration remains valid and should inform about the change to the Mental Health Authority within 1month .

51. CHAPTER Xl – Mental Health Review Boards Constitution of Mental Health Review Board A District Judge/ officer of the State Judicial Services/ retired District Judge. Representative of District Collector/ Magistrate/ Deputy Commissioner. 2 members of whom one Psychiatrist and the other a Medical practitioner. Two members of Persons with mental illness/ Caregivers/ Member of organizations of persons with mental illness or NGOs working in this field.

52. Power and Functions of Mental Health Review Board: To register, review, alter, modify or cancel an advance directive. To appoint a nominated representative. To receive and decide application from a person with mental illness or any other interested person against the decision of medical officer. To receive and decide applications in respect of non disclosure of information. To adjudicate complaints regarding deficiencies in care and services. To visit and inspect prison or jails and seek clarification from the medical officer in charge of health services.

53. CHAPTER – Xll : Admission , Treatment and Discharge Admission of person with mental illness as independent patient : Capacity to make decisions is intact and gives consent. No treatment shall be given without person’s informed consent. Person can be admitted on own request without need for Nominated Representative.

54. Criteria for admission include – A mental illness of severity requiring admission Person likely to benefit from admission and treatment Person has understood nature and purpose of admission and has the capacity to make treatment decisions without support. Discharge – Independent patient may get discharged from the mental health establishment without consent of the medical officer. If Mental Health Professional has reasons to believe patient cannot be discharged on patient’s request, admission can be converted to “admission with high support need” with consent from Nominated Representative and Information to Board.

55. M.O on receipt of request Make inquiry with period not exceeding 24 hrs If satisfied ADMIT VOLUNTARY (MHA 1987) Persons with mental illness (capacity To make MH care treatment decisions) Desires to admit Requests m.o or mhp if satisfied Person has not understood 89. supported ADMIT,INFORMED CONSENT TREATMENT Can get Discharged by himself Threatened,violent, Inability to care himself If discharge of voluntary patients is not in interest of patient then within 72 hrs constitute board of 2 M.0’S SEEK OPINION NEEDS FURTHER RX SHALL NOT BE DISCHARGED INDEPENDENT (MHCA 2017)

56. Admission of Minor : Admission authorization based on opinion of 2 psychiatrists or 1 psychiatrist and other mental health professional or medical professional. Admission criteria – A mental illness of a severity requiring admission. Person likely to benefit from admission and treatment. Person should be admitted in a separate ward for children and adolescents.

57. In case of a minor female, a female attendant shall compulsory stay with the child. Nominated Representative has to be legal guardian of minor. Inform to the Board within three days of admission and immediately of admission extending beyond thirty days. If the Nominated Representative no longer supports admission of the minor under this section or requests discharge of the minor, the minor shall be discharged.

58. Nominated representative( NR ) of Minor Application to M.O 2 Psychiatrists or 1 psychiatrist+1mhp 1 psychiatrist+1 mp Minor admitted, seperate accomodation NR should stay with minor Informed consent by NR MENTAL HEALTH REVIEW BOARD IF beyond 30 days inform Guardian of minor Request M.O ADMIT as voluntary patient MHA 1987 MHCA 2017

59. Admission of a person with mental illness with high support needs up to thirty days: Capacity to make treatment decisions is impaired . Admission authorization based on opinion of two psychiatrists and other mental health professional or medical professional (both should have seen patient on day of admission or in preceding 7 days). The Board shall be informed within 3 days of admission of women or minor patient. Assessed for availability as well as acceptability of Advance Directive and Nominated Representative.

60. Admission criteria – Unable to understand the nature and purpose of his decisions and requires substantial support from Nominated Representative Has recently threatened or attempted or is threatening or attempting to cause bodily harm to himself. Has recently shown or is showing an inability to care for himself to a degree that places the individual at risk of harm to himself. Any patient admitted under this section needing readmission within 7 days of discharge can be directly admitted.

61. 19. By a relative or a friend of the mentally ill person +2 MEDICAL CERTIFICATES (1 MUST BE GOVT) kept as an inpatient in a psychiatric hospital ( SHOULD NOT EXCEED 90 DAYS ) 89 . Application by NR ( Shall not be readmitted Within 7 days) Examined by 1 psychiatrist+1mhp Take account of Advance directive ADMIT(MAX 30 days) Consent by NR Report to board Review consent Every 7 Days >30 days 2 psychiatrists in last 7 days < 30 days if the medical officer- in-charge is satisfied & SPECIAL CIRCUMSTANCES SUPPORTED

62. Admission of a person with mental illness with high support needs beyond thirty days: The admission may be continued beyond thirty days if the person has a mental illness of a severity that he has consistently over time threatened and attempted to cause bodily harm. Behaved violently towards another person. Shown an inability to care for himself to a degree that places the individual at risk of harm to himself. The medical officer or mental health professional shall report all admission or readmission under this section, to the concerned Board within a period of seven days of admission .

63. EMERGENCY TREATMENT – Any medical treatment, including treatment for mental illness, may be provided by any registered practitioner in community or hospital with consent of Nominated Representative in following situations to prevent : Death or irreversible harm to the health of the person. The person inflicting serious harm to himself or to others. The person causing serious damage to property belonging to himself or to others where such behavior is believed to flow directly from the person’s mental illness. The emergency treatment referred to in this section shall be limited to seventy two hours or till the person with mental illness has been assessed at a mental health establishment, whichever is earlier.

64. Prohibited Treatment : Electroconvulsive therapy without the use of muscle relaxants and anesthesia Electroconvulsive therapy for minors . Psychosurgery shall not be performed as a treatment for mental illness unless – The informed consent on whom surgery is being performed has been given. Approval from the concerned Board to perform the surgery has been obtained.

65. Physical restraint may only be used when – It is the only means available to prevent imminent harm to person concerned or to others It is authorized by the psychiatrist in charge of the person’s treatment at the mental health establishment . Physical restraint shall not be used for a period longer than it is absolutely necessary to prevent the immediate risk of significant harm. The mental health professional in-charge shall be responsible for ensuring that the method, nature, justification and duration of restraint shall be recorded in medical notes. The Nominated Representative of the person with mental illness shall be informed about every instance of restraint within a period of twenty four hours .

66. CHAPTER Xlll – Responsibilities of other agencies. Duties of police officers in respect of persons with mental illness – To take under protection any person found wandering and believed to have mental illness or to be a risk to himself or others. Police officer within 24 hours will take the person to a Public Health Establishment for assessment. If medical assessment does not reveal mental illness, the person shall be taken to his residence or to a Government establishment if he is homeless.

67. If officer in-charge of a police station, finds that any person with mental illness is being ill treated or neglected, shall report to local Magistrate . For a person with mental illness or suspected of mental illness, Magistrate may pass order for Assessment and treatment in a Public Mental Health Establishment. Admission order of maximum 10 days for assessment in a public Mental Health Establishment for assessment and treatment if any.

68. Prisoners with Mental illness: An order under Prisoners Act, Army Act, Navy Act directing the admission of prisoner with mental illness, shall be sufficient authority for the admission to which he may be lawfully transferred. The medical officer of a prison shall send a quarterly report that there are no prisoners with mental illness . The Board may visit the prison and ask the medical officer as to why any the prisoner with mental illness if any, has been not transferred to a mental health establishment. The medical officer in-charge of a mental health establishment wherein a prisoner with mental illness is detained, shall once in six months, make a special report regarding condition of such patient to the authority.

69. CHAPTER XIV – Restriction to Discharge functions by Professionals not covered by Profession No mental health professional or medical practitioner shall discharge any duty or perform any function not authorized by this Act or specify or recommend any medicine or treatment not authorized by the field of his profession.

70. CHAPTER XV – Offences and Penalties Penalties for establishing or maintaining mental health establishment in contravention of provisions of this Act: Whoever carries on a mental health establishment without registration First contravention – five thousand Second contravention – fifty thousand to two lakh rupees Subsequent contravention – five lakh rupees Whoever knowingly serves as a mental health professional in a mental health establishment without registration, shall be liable to a penalty of twenty five thousand rupees.

71. Any person who contravenes any of the provisions of this Act First contravention – imprisonment for six months or fine of ten thousand rupees or with both. Subsequent contravention – imprisonment for two years or with a fine of fifty thousand to five lakh rupees or with both. Offences by companies – Where an offence is committed by a company, every person who at the time the offence was in-charge of the company shall be deemed to be guilty.

72. PROTOCOLS TO BE FOLLOWED TO PREVENT PENALTIES UNDER MHCA, 2017

73. CHAPTER XVl – Miscellaneous Power to call for information Power of Central Government to issue directions Power of Central Government to supersede Central Authority. Power of State Government to supersede State Authority. Power of Central or State Authority to make regulations. Special provisions for States in North-east and hill states.

74. Presumption of severe stress incase of attempt to commit suicide – Notwithstanding anything contained in section 309 of Indian Penal Code any person who attempts to commit suicide shall be presumed to have severe stress and shall not be tried and punished . The appropriate Government shall have a duty to provide care, treatment and rehabilitation to a person having stress who attempted to commit suicide to reduce the risk of recurrence of attempt.

75. Critical Appraisal of Mental Health Act, 2017. Making the most of Mental Healthcare Act 2017: Practitioners’ perspective by Vijaykumar et. al., published in Indian Journal of Psychiatry, 2019. The act provides a framework and regulation on how a person with mental illness should be treated. There is much emphasis on the protection of human rights of persons with mental illness. The MHCA 2017 brings about more impetus on documentation, with reasons for decisions made and care given are important for good practice. Regular training through workshops is required to understand the practical implications of different provisions of the act.

76. Cost estimation for the implementation of the Mental Healthcare Act 2017 by Suresh Bada Math et.al published in Indain Journal of Psychiatry. The conservative annual estimated cost on the government to implement MHCA, 2017 would be 94,073 crore rupees. Mental Healthcare Act 2017 – Aspiration to action by Suresh Bada Math et. Al published in Indian Journal of Psychiatry The act fails to acknowledge and foster the role and contribution of family members in providing care to PMI. Concepts such as “Advance directives” and “Nominated representatives” appear to be idealistic, and aspirational , but not evidenced based in the Indian context considering the resources.

77. Mental Health Act, 1987; No.14 of 1987, Gazette of India. Mental Health Care Act, 2017, Gazette of India. Jolitha RC, Prerna Kukreti , Dinesh Kataria . Forensic Psychiatry an Indian Perspective. Jaypee publications 2018 Textbook of Postgraduate Psychiatry, JN Vyas and Niraj Ahuja . Making the most of Mental Healthcare Act 2017: Practitioners’ perspective by Vijaykumar et. al., published in Indian Journal of Psychiatry, 2019. Mental Health Care Act, 2017 : Review and upcoming issues by Prasanna Kumar et. al. Mental Healthcare Act 2017 – Aspiration to action by Suresh Bada Math et. Al published in Indian Journal of Psychiatry. REFERENCES

78. THANK YOU