MENTAL ILLNESS

The Mental Health Care Act, 2017

Section (o) “Mental healthcare” 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;
Section 2 (s) “mental illness” means 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 subnormality of
intelligence.
NOMINATED REPRESENTATIVES
14. Appointment and revocation of nominated representative.
every person who is not a minor, shall have a right to appoint a nominated representative
Person so appointed
 shall not be a minor
 be competent to discharge the duties
 perform the functions assigned to him
 give his consent in writing to the mental health professional to discharge his duties and
perform the functions
when there is no nominated person- a relative, a care taker, or the Board shall appoint the
Director, Department of Social Welfare, or his designated representative as nominated
representative.
A person who has appointed any person as his nominated representative may revoke or alter such
appointment at any time.
15. Nominated representative of minor-
In case of minors, the legal guardian shall be their nominated representative unless the Board
directs otherwise.
If the board receives an application from mental health professional or any person acting in the
best interest of the minor, or receives evidences that the legal guardian is not acting in the best
interests of the minor or legal guardian is otherwise not fit to act as the nominated representative
of the minor, the Board may appoint a suitable individual to act as a NR.
In case no individual is available for appointment as a nominated representative, the Board shall
appoint the Director in the Department of Social Welfare of the State.
16. Revocation, alteration, etc., of nominated representative by Board- The board can revoke,
alter or modify the order for appointment of a NR on the application of –
 person with mental illness
 relative of such person
  psychiatrist responsible for the care of such person
 medical officer in-charge of the mental health establishment where the individual is
admitted
17. Duties of nominated representative
 consider the current and past wishes, the life history cultural background and the best
interests of the person
 provide support to the person with mental illness in making treatment decisions
 have right to seek information on diagnosis and treatment to provide adequate support
 have access to the family or home based rehabilitation services
 apply to the concerned Board against violation of rights of the person with mental illness
 appoint a suitable attendant
 have the right to give or withhold consent for research
RIGHTS OF PERSONS WITH MENTAL ILLNESS
18. Right to access mental healthcare
 Every person shall have a right to access mental healthcare and treatment from mental
health services run or funded by the Govt
 Mental health services shall be of affordable cost, of good quality, available in sufficient
quantity, accessible geographically, without discrimination on the basis of gender, sex,
sexual orientation, religion, culture, caste, social or political beliefs, class, disabilitiy or
any other basis and provided in a manner that is acceptable to persons with mental illness
and their families and care-givers.
 The appropriate govt shall be responsible to look after all these needs.
19. Right to community living
 right to live in, be part of and not be segregated from society
 where a mentally ill person has been abandoned by his family or relatives, the appropriate
Government shall provide support
20. Right to protection from cruel, inhuman and degrading treatment
 a right to live with dignity.
 shall be protected from cruel, inhuman or degrading treatment in any mental health
establishment
 live in safe and hygienic environment
 have adequate sanitary conditions
 to privacy
 proper clothing so as to protect such person from exposure of his body to maintain his
dignity
 be protected from all forms of physical, verbal, emotional and sexual abuse
21. Right to equality and non-discrimination
 Every person with mental illness shall be treated as equal to persons with physical illness
 no discrimination on any basis including gender, sex, sexual orientation, religion, culture,
caste, social or political beliefs, class or disability
  emergency facilities and emergency services for mental illness shall be of the same
quality
 living conditions shall be of the same manner, extent and quality as provided to persons
with physical illness
 Child under the age of 3yr shall not be separated from the mentally ill mother, when in
the opinion of the Psychiatrist she poses risk of harm to the child.
 medical insurance for treatment of mental illness on the same basis as is available for
treatment of physical illness
22. Right to information
 A person with mental illness and his nominated representative shall have the rights to the
following information.
 If complete information cannot be given to the person with mental illness at the time of
the admission or the start of treatment, it shall be the duty of the medical officer or
psychiatrist to ensure that full information is provided when the individual is in a position
to receive it.
23. Right to confidentiality
 A person with mental illness shall have the right to confidentiality in respect of his mental
health, mental healthcare, treatment and physical healthcare
 All health professionals shall have a duty to keep all such information confidential which
has been obtained during care or treatment expect whereas necessary for the best interest
of the patient.
24. Restriction on release of information in respect of mental illness
 No photograph or any other information relating to a person with mental illness
undergoing treatment at a mental health establishment shall be released to the media
without the consent of the person with mental illness.
25. Right to access medical records
 right to access their basic medical records
 e mental health professional in charge of such records may withhold specific information
in the medical records if disclosure would result in serious mental harm to the person or
harm to other persons.
26. Right to personal contacts and communication
 the right to refuse or receive visitors and to refuse or receive and make telephone or
mobile phone calls.
 a person with mental illness informs the medical officer of the mental health
establishment that he does not want to receive mail or e-mail from any named person in
the community, the medical officer may restrict such communication
27. Right to legal aid
 entitled to receive free legal services to exercise any of his rights given under this Act.
  It is the duty of magistrate, police officer, person in charge to inform the person with
mental illness that he is entitled to free legal services under the Legal Services Authorities
Act, 1987
28. Right to make complaints about deficiencies in provision of services
 Any person with mental illness or his nominated representative, shall have the right to
complain regarding deficiencies in provision of care, treatment and services in a mental
health establishment to the medical officer or mental health professional in charge -> The
Board -> State Authority

CONSTITUTION & HEALTH

o Right to health refers to and means the most attainable levels of health that every
human being is entitled to.
The origin of the right to health dates as far back as 1946 when the first international
organization, World Health Organisation (WHO) came into existence to formulate
health terms as human rights.
o The right to health is an essential component of human dignity, and it is the
responsibility of governments to ensure that this right is protected and promoted for
all individuals, regardless of their gender, race, ethnicity, religion, or socioeconomic
status.
o Part IV of the Constitution under the Directive Principles of State Policy
(DPSP) ensures social and economic justice to its citizens. Therefore, Part IV of the
Constitution directly or indirectly relates to public policy in terms of health.
2. Related Provisions in India:
o International Conventions: India is a signatory of the Article 25 of the Universal
Declaration of Human Rights (1948) by the United Nations that grants the right to a
standard of living adequate for the health and well-being to humans including food,
clothing, housing and medical care and necessary social services.
o Fundamental Rights: Article 21 of the Constitution of India guarantees a fundamental
right to life & personal liberty. The right to health is inherent to a life with dignity.
o DPSP: Articles 38, 39, 42, 43, & 47 put the obligation on the state in order to ensure the
effective realization of the right to health.
o Supreme Court in Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996)
held that in a welfare state, the primary duty of the government is to secure the welfare
of the people and moreover it is the obligation of the government to provide adequate
medical facilities for its people.
o Parmanand Katara Vs Union of India (1989), Supreme Court had ruled that every
doctor whether at a government hospital or otherwise has the professional obligation to
extend his services with due expertise for protecting life.
  India needs to significantly increase its investment in healthcare infrastructure and
resources, including medical facilities, equipment, and healthcare professionals. This can be
achieved through increased public spending on healthcare and increased private sector
investment.
 To improve access to healthcare, India needs to address the barriers that prevent individuals
from accessing healthcare services, including financial constraints, transportation, and
discrimination.
 This can be achieved through targeted policies and programs, such as health insurance
schemes and mobile healthcare units.
 There is a need to create a designated and autonomous agency to perform the functions of
disease surveillance, information gathering on the health impact of policies of key non-
health departments, maintenance of national health statistics, enforcement of public health
regulations, and dissemination of information to the public.

MEDICAL ETHICS
Medical ethics is that applied branch of ethics which describes the moral principles by which a
medical practitioner must conduct themselves.
There are plethora of ‘codes of conduct’ and laws in place to regulate the medical profession in India
both at individual and organisational levels but complaints have been increasingly large against the
unethical practices of physicians due to the increasing public awareness.
Prior to 2019, The Ethics committee of Medical Council of India was in charge of upholding the
principles of Medical Ethics and impart punishment to errant doctors in violation of MCI code of
Medical Ethics
After the enactment of NMC Act, 2019 MCI was dissolved and a fresh board for Ethics and Medical
Registration was constituted.
The Ethics and Medical Registration Board at National Medical Commission has got its new
president, duly appointed by Ministry of Health and Family Welfare as per the National Medical
Commission Act, 2019.
Ethics and Medical Registration Board is constituted by Central Government.
FUNCTIONS OF ETHICS AND MEDICAL REGISTRATION BOARD
 Maintain National Registers of all licensed medical practitioners;
 Regulate professional conduct and promote medical ethics in accordance with the
regulations made under this Act:
 Provided that the Ethics and Medical Registration Board shall ensure compliance of the
code of professional and ethical conduct through the State Medical Council in a case
where such State Medical Council has been conferred power to take disciplinary actions
in respect of professional or ethical misconduct by medical practitioners under
respective State Acts;
  Develop mechanisms to have continuous interaction with State Medical Councils to
effectively promote and regulate the conduct of medical practitioners and professionals;
 Exercise appellate jurisdiction with respect to the actions taken by a State Medical
Council.
INDIAN MEDICAL COUNCIL (PROFESSIONAL CONDUCT, ETIQUETTE AND
ETHICS) REGULATIONS, 2002- talks about humanity, prescribe drugs with generic names
and he/she shall ensure that there is a rational prescription, maintain the medical records,
privacy & confidentiality, Doctor-patient relation & duty etc.
NUREMBERG CODE OF MEDICAL ETHICS-
The Nuremberg Code is a set of ethical principles and guidelines for human experimentation
that originated from the Nuremberg Trials held after World War II. The trials were conducted
to prosecute prominent members of the medical profession and the Nazi regime for war crimes,
crimes against humanity, and unethical medical experiments carried out on human subjects
during the war. The Nuremberg Code was established in 1947 as a response to the atrocities
committed by Nazi physicians and researchers.
 Participants must have the capacity to consent, and they must be provided with all relevant
information about the nature, purpose, risks, and potential benefits of the research.
 The experiment should avoid causing unnecessary physical or mental suffering or injury to
the subjects.
 The experiment should be based on the results of prior animal experimentation and a
knowledge of the natural history of the disease or other problem under study.
 The experiment should be preceded by experiments on animals
 The subject should have the freedom to withdraw from the experiment at any point if they
feel physically or mentally unable to continue. The researcher must be ready to terminate
the experiment if it appears that the subject is likely to be injured.
HELSINKI NUREMBERG CODE OF MEDICAL ETHICS-
The Declaration of Helsinki was created following the Nuremberg Trials, in which many
individuals who were involved in Nazi experimentation on humans were prosecuted with
crimes against humanity. The Declaration borrowed the ideals from the Code, and has since
evolved through a series of revisions into an expansive document.
The Declaration of Helsinki is designed to protect human subjects participating in medical
research. It was developed from the Nuremberg Code, the Declaration of Geneva, and the
International Code of Ethics.
The Declaration of Helsinki outlines many ethical principles and guidelines to ensure the
safety, health, and wellbeing of any human subjects participating in medical research. It began
as a short document that borrowed from other principles like the Nuremberg Code, but has
since evolved to become a more expansive and descriptive set of guidelines.
Respect for individuals, the right to make informed decisions, recognition of vulnerable groups,
protect the life, health, dignity, integrity, right to self-determination, privacy, and
confidentiality of personal information. focus on clinical research
MEDICAL TOURISM
Medical tourism can be defined as the process of traveling outside the country of residence for
the purpose of receiving medical care.
Patients travel because of high costs of healthcare in their home country, excessive delays in
accessing a medical or surgical intervention, and to seek treatments that may be considered
inadequate, unsafe or unavailable in their home countries.
In India the only laws that particularly deal with medical tourism is visa laws that provide for a
separate category of visa known as medical visa granted for a period of one year or for the
duration of the treatment whichever is less. This can also be extended in case the treatment will
take a longer time for another one year by the Ministry of Health Affairs on the
recommendation of Foreign Regional Registration Offices and State Governments.
In case of any negligence or medical malpractices are:
THE CONSUMER PROTECTION ACT, 1986-
A “consumer” who hires or avails of any “services” for consideration is entitled to sue for any
“deficiency in service” and claim compensation. “Deficiency” is usually construed to mean any
fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of
performance of any service.
The Indian legal framework is very limited when it comes to medical tourism. There is nobody,
which has been designated for the purpose of addressing grievances and complaints arising
from either negligence or deficiency in service in case of medical tourism. There is no specific
agency or required form for registration of their grievances or complaints. This is a major
lacuna that arise when it comes to medical tourism in India.
Compensation is also another issue as these patients are living abroad most of them do not wait
to file a case and seek compensation due to the slow judicial proceedings, even though there are
efficient mechanisms in place to check if the compensation awarded is being provided or not.
There needs to be a way to ensure that there is speedier disposal of cases so that they can return
back to their countries immediately.
Many hospitals charge extra money from these patients than compared to Indians who avail the
same treatment. Most of the time many private hospitals charge a higher cost for the treatments
availed by these foreigners. They charge unnecessarily for treatments, rooms, medicines which
is provided at a cheaper cost for Indian but at an exorbitant price for outsiders. This is due to
the lack of regulation from the side of the government. There definitely needs to be some
method to regulate this, some kind of a regulatory body or some kind of laws at least needs to
be in place to handle this matter.
CONS OF MEDICAL TOURISM
 cultural and language barriers.
 time consuming.
 Additional cost such as flight, hotel, transportation, food, tours, etc
 If something goes wrong during the medical procedure, sometimes you have little
recourse depending on the medical provider and the country you choose.
  Traveling too soon after surgery can sometimes cause serious complications.
TREATIES AND CONVENTIONS
1. World Health Organization (WHO) Guidelines:
The World Health Organization provides guidelines and recommendations on various aspects
of health services, including medical tourism. While not legally binding, these guidelines
contribute to shaping international standards.
2. International Covenant on Economic, Social, and Cultural Rights (ICESCR):
This covenant recognizes the right to the highest attainable standard of health. Countries that
are parties to the ICESCR are obligated to ensure access to healthcare facilities, goods, and
services, which may have implications for medical tourism.
3. Cross-Border Healthcare Directive (European Union):
The European Union has a directive on cross-border healthcare that allows EU citizens to seek
medical treatment in other EU member states and be reimbursed under certain conditions.
While not directly related to medical tourism globally, it provides a framework for cross-border
healthcare within the EU.
COMPARISON WITH
Malaysia-
Malaysia has specific regulations for medical tourism, and the Malaysia Healthcare Travel
Council (MHTC) oversees the industry. The MHTC is responsible for promoting and regulating
medical tourism in the country.
The MHTC ensures compliance with quality standards and ethical practices in healthcare
services provided to international patients.
The MHTC works to ensure the quality of healthcare services offered to medical tourists.
Accreditation standards and compliance with regulations contribute to maintaining high
standards in the industry.
South Korea
The Patient Protection Act in South Korea emphasizes patients' rights and protection. It outlines
the rights of patients to receive necessary medical information, consent to treatment, and have
their privacy respected. This legislation ensures that patients, including medical tourists, are
well-informed and protected.
South Korea has a Medical Tourism Promotion Act that addresses various aspects of medical
tourism. The legislation aims to promote and facilitate medical tourism, providing a legal
framework for the industry's growth.
HEALTH INSURANCE
 THE EMPLOYEES' STATE INSURANCE (ESI) ACT is a social security and health
insurance scheme in India. It provides health insurance coverage to employees and their
dependents, primarily in the organized sector. The ESI Act is administered by the
 Employees' State Insurance Corporation (ESIC), a statutory body under the Ministry of
Labour and Employment, Government of India.
The ESI Act applies to specified categories of employees, including those working in factories,
establishments, and certain hazardous industries. Employees earning below a specified monthly
wage limit are covered under the scheme.
Both employees and employers contribute to the ESI scheme. The employee's contribution is a
percentage of their monthly wages, while the employer contributes a matching amount. These
contributions fund the health insurance and social security benefits provided by the scheme.
The primary benefit under the ESI Act is health insurance coverage. It includes medical
benefits for insured employees and their dependents. The coverage extends to a range of
medical services, including hospitalization, maternity, disability, and sickness benefits.
Employees covered under the ESI Act are entitled to medical facilities at ESI dispensaries,
hospitals, and recognized medical institutions. The ESIC runs a network of hospitals and
dispensaries where insured individuals can receive medical treatment and services.
The ESI Act provides cash benefits to insured employees during periods of sickness, maternity,
and temporary or permanent disablement.
Female employees covered under the ESI Act are entitled to maternity benefits, including paid
leave and medical expenses related to childbirth.
In case of temporary or permanent disablement due to an employment injury, employees are
eligible for disability benefits. These benefits are provided to compensate for the loss of
earning capacity.
 EMPLOYEE GROUP INSURANCE refers to insurance coverage provided by an employer
for a group of its employees. Group health insurance is one of the most common forms of
employee group insurance. It typically covers medical expenses, hospitalization, and
sometimes dental and vision care for employees.
Group insurance policies are negotiated by the employer on behalf of a large number of
employees. This group negotiation results in cost savings compared to individual insurance
policies, making it a more affordable option for employees. Group insurance contributes to the
overall welfare of employees by providing them with financial security.
Contributions made by the employer toward group insurance premiums are often eligible for
tax benefits under the Income Tax Act.
 PM-JAY/AYUSHMAN BHARAT is the world’s largest health insurance/ assurance scheme
fully financed by the government. Over 12 crore poor and vulnerable entitled families are
eligible for these benefits.
It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care
hospitalization across public and private empanelled hospitals in India.
PM-JAY provides cashless access to health care services for the beneficiary at the point of
service, that is, the hospital.
 The SOCIAL SECURITY CODE, 2020 has been enacted in India to consolidate and amend
the laws relating to social security with the goal of extending social security to all
employees and workers, including those engaged in unskilled labor.
The Code includes provisions for medical benefits, which may cover health insurance,
hospitalization, and other healthcare-related expenses.
The Code typically involves contributions from both employees and employers to fund the
social security benefits, including medical insurance. The contributions are often a percentage
of the employee's wages.
Government initiatives such as Ayushman Bharat and other health insurance schemes
complement the provisions of the Social Security Code, providing additional coverage to
unskilled laborers.
 The INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA
(IRDAI) is the regulatory body overseeing the insurance sector in India.
IRDAI establishes and enforces the regulatory framework for private health insurance in India.
The guidelines issued by IRDAI set the standards and norms for insurance companies offering
health insurance policies. Insurance companies are required to submit their health insurance
products to IRDAI for approval before offering them to the public.
IRDAI has introduced guidelines for the standardization of health insurance policies to make it
easier for customers to compare different plans.
IRDAI lays down norms for the fair and prompt settlement of health insurance claims.
Insurance companies are required to adhere to these guidelines to ensure that policyholders
receive timely and hassle-free claim settlements.
IRDAI mandates certain covers in health insurance policies, such as maternity benefits and
coverage for specific illnesses.
IRDAI & MENTAL ILLNESS
IRDAI has issued guidelines mandating insurance companies to provide coverage for mental
illnesses.
IRDAI has provided a broad definition of mental illnesses to encompass a range of conditions.
Insurance companies are required to include mental health coverage in their health insurance
policies. This inclusion ensures that individuals seeking insurance coverage have access to
mental health benefits, similar to coverage for physical illnesses.
IRDAI guidelines emphasize that insurance companies should not discriminate against
individuals with a history of mental illnesses. This ensures that individuals with pre-existing
mental health conditions are not unfairly treated when seeking insurance coverage
FUNCTIONS OF IRDAI
1. Regulation and Supervision:
  Formulating regulations and guidelines to govern the insurance industry in India.
IRDAI establishes rules related to licensing, solvency margins, policy terms, and
conditions, ensuring that insurers comply with these regulations.
2. Licensing and Registration:
 Granting licenses to insurance companies to operate in India. IRDAI determines
the eligibility criteria and ensures that only financially sound and reputable
entities enter the insurance market. It also oversees the registration of insurance
intermediaries, such as agents and brokers.
3. Consumer Protection:
 Safeguarding the interests of policyholders and ensuring fair treatment by
insurance companies. IRDAI sets norms for the protection of policyholders'
rights, reviews policy wordings, and addresses grievances through the Integrated
Grievance Management System (IGMS).
4. Promotion of Insurance Awareness:
 Promoting insurance awareness and education among consumers. IRDAI takes
initiatives to enhance financial literacy regarding insurance products, their
benefits, and the importance of insurance in managing financial risks.
5. Policyholder Protection Fund (PPF):
 Managing the Policyholder Protection Fund to safeguard the interests of
policyholders in case of financial failure or insolvency of an insurance company.
The fund is used to compensate policyholders for their valid claims.
6. Market Conduct and Fair Practices:
 Ensuring fair business practices in the insurance industry. IRDAI monitors the
market conduct of insurers and insurance intermediaries to prevent unfair
practices, mis-selling, and violations of regulatory norms.
7. Monitoring Solvency:
 Monitoring the financial health of insurance companies to ensure solvency and
financial stability. IRDAI sets solvency margins that insurers must maintain to
meet their liabilities and protect the interests of policyholders.
8. Product Approval:
 Approving insurance products before they are offered to the public. IRDAI
ensures that insurance products are fair, transparent, and meet the needs of
consumers. Insurers need to obtain approval for new products and modifications
to existing ones.
9. Promotion of Innovation:
 Encouraging innovation in insurance products and services. IRDAI aims to foster
a competitive and dynamic insurance market by allowing insurers to introduce
innovative products that meet the evolving needs of consumers.
10. Regulation of Intermediaries:
 Regulating insurance intermediaries, including insurance agents, brokers, and
surveyors. IRDAI establishes guidelines for the licensing, conduct, and
remuneration of intermediaries to ensure professionalism and ethical practices.
11. Market Development:
  Facilitating the development and growth of the insurance market in India. IRDAI
works to expand the reach of insurance services, encourage new entrants, and
foster a competitive and inclusive marketplace.

SECTION 2 (6C) OF INSURANCE ACT, 1938 defines Health Insurance Business as the
effecting of contracts which provide for sickness benefits or medical, surgical or hospital
expense benefits, whether in-patient or out-patient travel cover and personal accident cover.
WHO CANNOT GET MEDICAL INSURANE? IRDAI GUIDELINES, 2019
 Pre-existing disease
 Self inflicted injuries
 Disease arising out of abuse of alcohol or drugs
 Infertility or In vitro fertilization
 Cosmetic treatment or plastic surgery
NFHS DATA
Households with any usual member covered under a health insurance/financing scheme 41% in
NFHS-5 (2019-21) which was around 28.7% in NFHS-4 (2015-16).
The central and state governments’ budgeted expenditure on healthcare touched 2.1 % of GDP
in FY23 and 2.2% in FY22, against 1.6% in FY21, as per the Economic Survey 2022-23 tabled
in Parliament by finance minister Nirmala Sitharaman.