“ B M Institute of Mental Health

Ahmedbad, Gujarat”

3rd Sep. 2016

Prepared by: Ragvendra Singh Khichi

Submitted to-

Mr. Saurabh Anand

Gujarat National Law University

 INTRODUCTION

Mental illness is defined as “a substantial disorder of thinking, mood, perception, orientation

or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability
to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol
and drugs, but does not include mental retardation which is a condition of arrested or
incomplete development of mind of a person, specially characterised by sub normality of
intelligence.”

In our country plenty of legal orders interact with mental disorders in order to protect the
interests of mentally ill, society and the state. These legislations are enacted to protect the
society from dangerous manifestations of mental illness. There are guidelines regarding
restrain, admission and discharge, procedures of civil and criminal action with regard to
mentally ill. But do these laws discuss about proper care and treatment? Are there provisions
for post discharge care and rehabilitation? In present study, an attempt has been made to
discuss Mental Health Act, 1987 and Mental Health Care Bill 2013 and suggestions to make
them more fundamental.

Mental Health Act, 1987

Objectives of the act

1. To establish central and state authorities for licensing and supervising the psychiatric
hospitals.
2. To establish such 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 who are unable to look after
themselves and are dangerous for themselves and or, others.
5. To protect the society from dangerous manifestations of mentally ill.
6. To regulate procedure of admission and discharge of mentally ill persons to the
psychiatric hospitals or nursing homes either on voluntary basis or on request.
7. To safeguard the rights of these detained individuals.
8. To protect citizens from being detained unnecessarily.
9. To provide for the maintenance charges of mentally ill persons undergoing treatment in
such hospitals.
10. To provide legal aid to poor mentally ill criminals at state expenses
11. To change offensive terminologies of Indian Lunacy act to new soother ones.

Positive aspects of the act

1. Replacement of offensive terminologies of Indian Lunacy act 1912 by new soft and
soothing terms. Thus upholding the dignity of mentally ill persons.
2. Establishment of licensing authorities to provide a check on licensing and working of
mental health hospitals. This will help in improving standards of mental health care.
3. Provision for establishment of new hospitals.
 4. Provision for out patient care thus avoiding unnecessary detention.
5. Simple procedures for admission and discharge of mentally ill persons to hospitals.
6. Appointment of guardians for maintaining property and person of mentally ill.
7. Provision for bearing the expenses of treatment by relatives and government.
8. Prohibition on any research on such subjects without proper consent.
9. Provision for separate places for children, addicts and convicted persons.

Criticism of the act

1. Change of older terminologies to newer ones might be good from theoretical aspects.
But practically will it be helpful in removing the social stigma attached to the illness.
This approach is just like a window dressing. This change should be implemented in
practice and not on paper.
2. Licensing authorities do not have a doctor who may be in a better position to assess the
facilities and services of these centers.
3. No mention is made of incorporating General hospitals and centers in this act rather they
are prohibited. Such hospitals if taken along may provide a better health care.
4. Much stress is laid on hospital admission and treatment. This again increases the cost of
health care. No provisions are made for home treatment.
5. Although the act provides for a simpler discharge procedure but no provisions are made
for after discharge care and rehabilitation, of patients.
6. In case no relative comes forward for discharge of patient, will that person be detained
indefinitely in hospital. Who will bear the expenses in such case? If Govt. then for how
long.
7. It is provided that research on such subjects can be carried out by consent of guardian. Is
it not like treating them as inanimate objects? This provision violates human rights.
8. There are no provisions for punishing the relatives and officers requesting unnecessary
detention of a person to such hospitals.
9. 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.
10. Act adopts different views for Govt. and private hospitals

The Mental Health Care Bill, 2013

The Statements of Objects and Reasons to the Bill, state the government ratified the United
Nations Convention on the Rights of Persons with Disabilities in 2007.  The Convention
requires the laws of the country to align with the Convention. The new Bill was introduced as
the existing Act does not adequately protect the rights of persons with mental illness nor
promote their access to mental health care.  The key features of the Bill are:

 Rights of persons with mental illness:  Every person shall have the right to access
mental health care and treatment from services run or funded by the government.  The
right to access mental health care includes affordable, good quality of and easy access
 to services. Persons with mental illness also have the right to equality of treatment,
protection from inhuman and degrading treatment, free legal services, access to their
medical records, and complain regarding deficiencies in provision of mental health
care.

 Advance Directive: A mentally-ill person shall have the right to make an advance
directive that states how he wants to be treated for the illness during a mental health
situation and who his nominated representative shall be.  The advance directive has to
be certified by a medical practitioner or registered with the Mental Health Board.  If a
mental health professional/ relative/care-giver does not wish to follow the directive
while treating the person, he can make an application to the Mental Health Board to
review/alter/cancel the advance directive.

 Central and State Mental Health Authority: These are administrative bodies are
required to (a) register, supervise and maintain a register of all mental health
establishments,(b) develop quality and service provision norms for such
establishments, (c) maintain a register of mental health professionals, (d) train law
enforcement officials and mental health professionals on the provisions of the Act, (e)
receive complaints about deficiencies in provision of services, and (f) advise the
government on matters relating to mental health.  

 Mental Health Establishments: Every mental health establishment has to be

registered with the relevant Central or State Mental Health Authority.  In order to be
registered, the establishment has to fulfill various criteria prescribed in the Bill.

 Mental Health Review Commission and Board: The Mental Health Review

Commission will be a quasi-judicial body that will periodically review the use of and
the procedure for making advance directives and advise the government on protection
of the rights of mentally ill persons.  The Commission shall with the concurrence of
the state governments, constitute Mental Health Review Boards in the districts of a
state.  The Board will have the power to (a) register, review/alter/cancel an advance
directive, (b) appoint a nominated representative, (c) adjudicate complaints regarding
deficiencies in care and services, (d) receive and decide application from a person
with mental illness/his nominated representative/any other interested person against
the decision of medical officer or psychiatrists in charge of a mental health
establishment.

 Decriminalising suicide and prohibiting electro-convulsive therapy: A person

who attempts suicide shall be presumed to be suffering from mental illness at that
time and will not be punished under the Indian Penal Code.  Electro-convulsive
therapy is allowed only with the use of muscle relaxants and anaesthesia. The therapy
is prohibited for minors.

CRITICISM

the government realised that the existing act requires major revision and decided to make
new legislation rather than amending the existing one. When the initial draft was brought in
public domain, the mental health professionals representing two National Professional
Bodies, Indian Psychiatry Society and Indian Association for Social Psychiatry, and the
family members of persons with mental illness expressed serious concerns about the new
 legislation. Their anguish grew with time as not only they were kept out while preparing the
First Draft, but also they were not given a hearing during subsequent discussions in the
regional level consultation meetings.
The experts feel that the proposed legislation MHCB, 2013 has major drawbacks and in case
the present government decides to go ahead with the existing draft, it will be retrogressive
and will do more harm to the cause of mental health in the country than the existing MHA. 
The major problems in the MHCB are, the Bill marginalises the families, who, in India bear
the major burden of care of the mentally ill. In fact, as compared to the west, where family
support has broken down, joint and extended family system is still a vast Indian asset. The
MHCB totally ignores the parents and families and, for the first time proposes that the patient
can nominate any person as his nominated representative who will take all the major
decisions regarding his care and property. Since many mentally ill patients lack insight during
acute phase of illness, they can be easily cheated by the so-called nominated representatives,
leaving the parents and other close relatives helpless. Further, shifting the burden of care on
“other persons” who are not emotionally involved with the patients is unlikely to show
compassion needed for such patients in the Indian setting. The Bill seeks to segregate the
treatment of the mentally ill from the mainstream medical establishments and it is likely to
increase stigma.  
Mental illness, except those which are severe or in need of long term treatment in a high
dependency unit,  should be treated at par with medical/ surgical illnesses treatment for
which facilities should be freely available in the general hospitals.  MHCB proposes that all
the major decisions relating to treatment of mental illnesses will be taken by judiciary i.e.
Mental Health Review Commission.

If implemented, it will delay treatment, make it costly and complicated. The parents of minor
children will not be able to seek indoor treatment without the permission of Mental Health
Review Commission. The MHCB also proposes that patients suffering from major mental
illness cannot be treated without their consent. This not only will increase disruption in the
family, but will cause the severely mentally ill patients to cause disruption in society by
aimless roaming, violence, or they may even end up in prisons due to untreated illness. The
family members often seek the help from relatives and friends to bring such patients for
treatment.

Rehabilitation:The biggest challenge in the treatment of mental illness is the rehabilitation,

but MHCB  is totally silent about the care and rehabilitation of patients after discharge from
long- stay facilities . These patients will require constant care and support while staying in the
community and MHCB must address this issue like rest of the world has done. 
the present form, MHCB will be worse than existing Mental Health Act, 1987 and it will be
rejected by the mental health professionals and the caregivers. Indian  family system is our
heritage and the whole world is trying to learn from our rich family values. There are some
aberrations, largely families are sympathetic and caring while looking after the mentally sick.

Aim of Research trip :

On 03 Sep. 2016, students of BSW LLB, GNLU conducted a field trip in B M Institute of Mental
Health to understand ground reality of this field and how that institute works and what problems
are they facing while dealing with the patients.
B.M. INSTITUTE OF MENTAL HEALTH

B M Institute of Mental Health (BMIMH), established in 1951, is a pioneering institution

driven on an inter-disciplinary, dynamic and psychotherapeutic model. Clinical diagnosis,
training, care and academic pursuit in the frontier area of Mental Health, Education and
Disability Rehabilitation is the core work of the institute. The Institute is registered under
Bombay Public Trust Act, Persons with Disability (PWD) Act, Rehabilitation Council of
India and National Trust and is recognized by Government of Gujarat.

Mission
• To help Special-Need Children get Integrated Services
• To participate in the broad field of Mental Health and Behavioral Research
• To develop as an Institute of Importance for Mental Health Education and Services.

The Various Service And Therapy Units,:

 Out Patient Department  Psychology Unit  Occupational Therapy Unit  Speech

Therapy Unit  Special Education Unit  Diet Therapy  Day Care Unit  Multi
Category Workshop  Sharda

Test and Tools

Developmental Test (DQ Test)  Developmental Screening Test (DST)  Vineland

Social Maturity Scale (VSMS)  Developmental Assessment Scale for Indian Infants
(DASII) Intelligence/Cognitive ability Test (IQ Test)  Binet-Kamat Test of Intelligence
(BKT)  Malin Intelligence Scale for Indian Children (MISIC)  Wechsler Intelligence
Scale for Children (WISC)  Wechsler Adult Intelligence Test (WAIS)  Bhatia Battery
Performance Test of Intelligence  Raven’s Progressive Matrices Personality Tests 
Children’s Apperception Test (CAT)  Thematic Apperception Test (TAT)  Rorschach
Ink Blot Test (RIBT)  16 Personality Factor Test of Personality  NEO-PI – Adolescents
 NEO-PI – Adult Neuropsychological Tests for Brain Dysfunction  AIIMS
Neuropsychological Test Battery  PGI-BBD  Bender Gestalt Test (BGT) Autism
Spectrum Disorder (ASD) Assessment  Childhood Autism Rating Scale  Indian Scale for
Autism Assessment Attention Deficit Hyperactivity Disorder (ADHD) Assessment 
Conner’s ADHD Rating Scale  Gillium’s ADHD Rating Scale

Many courses are also offered by this institute such as Post Graduate Diploma in
Rehabilitation Psychology ,Diploma in Special Education- Mental Retardation and many
more. Also it gives opportunity to students for the voluntary services as a internship or pro
bono work. They basically works with children as they think it is easier to deal with them and
easy to rehabilitate them as chances of success is more when we deal with situation at early
stage. As those children or adult can’t get graduate they are provided vocational training in
this institute to make them self dependent. Many students of this institute are today working
in the market, and earning there. They provide a different school for these chidren named
sharda.

Observations
This institute is doing very god job. It is working for the society and trying efforts to make
them aware and breaking the social stigma related to mental health and patients. It provides
the vocational training to the patients and help them to sell things made by them in the market
and earn their livlihood which somewhere build the feeling of self satisfaction and confidence
in the them. today in our society we need to change our behaviour towards the mentally ill
patient they are also human being they have their own feelings, they also need love and
affection. We should not treat them badly. While we should me more careful and responsible
towards them. What I observe is that government is not doing much for that institute ,they
need funds to pay the doctors and psychologists as these doctors visit there once or twice in
week so they need financial support. I don’t know why government is not paying much
attention towards such a philanthropic work. Mental illness is a disease not a disability. Many
issues are their another issue is for disable persons or I want to say differently abled people.
schools don’t accept disabled students they don’t give them admission which breaks their
confidence totally. RTE that is Right to Education in that also nothing is specially mentioned
for disable person. Somewhere we have to be more sensitive towards them. They do not want
reservation but education. By giving them reservation you cant get rid off your
responsibilities If they don’t get education which is a fundamental right of a individual what
they will do with the reservation. However, no matter how progressive the new mental health
bill is, it is still just a baby-step in the direction of reform.
Fact file 
* 70 mn: Approximate number of people suffering from mental illnesses in
India
* 3000: Number of psychiatrists in India
* 11500: Estimated requirement of psychiatrists
* 500: Number of clinical psychologists in India
* 17250: Estimated requirement of clinical psychologists
* 400: Number of psychiatric social workers
* 23000: Estimated requirement of psychiatric social workers 
Source: A NHRC 2012 publication

So this is the condition of india we have scarcity of psychiatrists, clinical psychologists and
psychiatric social workers as somewhere that stigma is attached with this profession so. But
as GNLU started this BSWLLB course and many institutes are focusing on social work I
hope the scarcity of psychiatric social workers become less with time and more
and more people come forward for this.
FROM SOMEWHERE WE HAVE TO BREAK AND FROM SOMEWHERE WE HAVE
TO START.