MENTAL HEALTH

CARE BILL: CURRENT

STATUS
Chairperson: Prof. Pratap Sharan
Presenter: Dr. Ankit Gupta

OUTLINE

INTRODUCTION:
MENTAL HEALTH AND LEGISLATION
HISTORY OF MENTAL HEALTH LEGISLATION IN INDIA
INDIAN MENTAL HEALTH ACT 1987

MENTAL HEALTH CARE BILL

BACKGROUND
STRUCTURE
MAIN FEATURES

MHCB: KEY ISSUES

SUMMARY

MENTAL HEALTH AND

LEGISLATION

Necessary for protecting the rights of people with mental

disorders, a vulnerable section of society
Stigma, discrimination and marginalization in all societies,
increased likelihood of human rights violations
Provide a legal framework for addressing critical issues such
as:

Community integration of persons with mental disorders

Provision of high quality care, improvement of access to care
Protection of civil rights, promotion of rights to housing,
education and employment

More than care and treatment legislation narrowly limited to

provision of treatment in institution-based health services
(WHO Resource Book on Mental Health, Human Rights and Legislation, 2005)

MENTAL HEALTH AND

LEGISLATION

Presence of law: No national mental health legislation in 25%

of countries
Wide regional variations: European countries: 91.7%; Eastern
Mediterranean countries: 57%
Single legislation/dispersed across legislations: most countries
have consolidated mental health legislation, in which all
relevant issues incorporated in single legislative document
Updated law passed after 1990: 50% of countries, before
1960s: 15% of countries
Rights perspective: consolidated or dispersed across the
legislation(s)
(WHO Resource Book on Mental Health, Human Rights and Legislation,2005)

HISTORY OF MENTAL HEALTH

LEGISLATION IN INDIA

Elaborate descriptions of mental disorders in Ayurveda, but

care of mentally ill in asylums in India is a British innovation

1858

First Laws for controlling treatment of mentally ill in British India

1912

Indian Lunacy Act: regulation of asylums, procedures of

admission
and certification, judicial inquisitions for mentally ill
Protection of society from mentally ill, legal safeguard against
wrongful detention

1946

Bhore Committee report: mental hospitals out of date, designed

for detention and custody only

1949

IPS resolution to repeal 1912 Act and draft Indian Mental

Health Act

1959-60 Amendments attempted, experts failed to reach a consensus

1981

Mental Health Bill introduced in parliament and adopted in

(Banerjee,2014)
1987

INDIAN MENTAL HEALTH ACT 1987

PROGRESSIVE STEPS

More humane approach (terminology) to problems of the

mentally ill

Creation of authorities to protect their interests

Judicial safeguard for human rights and property

Admission/discharge
liberalized

Admission for minors with consent of a guardian

Separate provision for admission of involuntary patients

Centers for special populations (drug addicts, minors, prisoners

etc.)

Establishment/maintenance of psychiatric hospital

in private
(Trivedi,
2009)
sector

of

voluntary

patients

simplified

and

INDIAN MENTAL HEALTH ACT 1987

CRITICISM

Does not promote community mental health care or

integration with primary health care

Legal (compared to medical) considerations given more

weightage

Power of criminal court over admission of non criminal

mentally ill

Silent regarding choice and consent for treatment

No provisions for rehabilitation/aftercare of the mentally ill

Mentally retarded subjects excluded from purview of the bill

No importance to family/caregivers

No provision for transportation of unwilling patient except by

(Trivedi, 2009)
police

MENTAL HEALTH CARE BILL:

BACKGROUND
WHOs 10 Basic Principles of Mental Health Care Law:
1.
Promotion of mental health and prevention of mental
disorders
2.
Access to basic mental health care
3.
Mental health assessment in accordance with internationally
accepted principles
4.
Provision of least restrictive type of mental health care
5.
Self-determination
6.
Right to be assisted in the exercise of self-determination
7.
Availability of review procedures
8.
Automatic periodic review mechanism
9.
Qualified decision-makers
10. Respect for the rule of law
(WHO, 1996)

UNITED NATIONS CONVENTION

FOR RIGHTS OF PERSONS WITH
DISABILITIES

UNCRPD adopted in Dec. 2006,ratified by Parliament of India

in May, 2008
All signatory countries required to bring their laws and
policies in harmony with it
All disabilities laws in India currently under revision

Paradigm shift: Disabilities - human rights issue rather than

social welfare concern

Based on presumption of legal capacity, equality and dignity

No explicit prohibition of forced interventions, but neither

does it permit compulsory mental health care

After UNCRPD, imperative for Govt. to revise MHA,1987

(Pathare et al 2010, Choudhary et al,
2011)

MENTAL HEALTH CARE BILL:

BACKGROUND

National consultation on MHA: January 2010

Centre for Mental Health Law and Policy, ILS College, Pune
First draft: February 28, 2010, Revised draft: April 23, 2010
Draft Mental Health Care Act (MHCA): based on inputs from 5
regional consultations, professional bodies and stakeholders
National consultation: March 23, 2011 (IPS participated)
MHCB (2013) introduced in Rajya Sabha, referred to
Parliamentary Standing Committee
Committee
took
opinions
of
experts/institutes/bodies/associations/
organizations
and
suggested amendments
The standing committees report suggesting amendments was
submitted on November 11, 2013
(StandingCabinet
Committee in
Report-MHCB
The amended bill approved by Union
January,2013)

STRUCTURE OF THE BILL

The Mental health Care Bill 2013 consists of 16 chapters and

136 clauses
CHAPTERS
I

Preliminary

II

Mental Illness and Capacity to Make Mental Health

Care and Treatment Decisions

III

Advance Directive

IV

Nominated Representative

Rights of Persons With Mental Illness

VI

Duties of Appropriate Government

VII

Central Mental Health Authority

VIII

State Mental Health Authority

(MHCB 2013, Rajya Sabha Secretariat)

STRUCTURE OF THE BILL

CHAPTERS
IX

Finance, Accounts and Audit

Mental Health Establishments

XI

Mental Health Review Commission

XII

Admission, Treatment and Discharge

XIII

Responsibilities of Other Agencies

XIV

Restriction to Discharge Functions by Professionals

Not Covered by Profession

XV

Offences and Penalties

XVI

Miscellaneous
(MHCB 2013, Rajya Sabha Secretariat)

MAIN FEATURES of MHC BILL

NOMENCLATURE
The proposed Act is Mental Health Care Act, concerned purely
with health care aspects of persons with mental illness
Management of property aspect omitted, will be covered by an
amended National Trust Act (to be named Legal Capacity Act)
STATEMENT OF OBJECTS AND REASONS
Protect, promote, fulfill rights of persons with mental illness
(PMI) during delivery of health care in institutions and
community
Ensure health care, treatment and rehabilitation in least
restrictive environment not intruding into rights and dignity
Improving capacity to develop full potential, facilitate integration
into community life
Fulfill
obligations under Constitution & International
Conventions
(MHCB 2013, Rajya Sabha Secretariat)
Improving accessibility to mental health care

MAIN FEATURES of MHC BILL

MENTAL HEALTH ESTABLISHMENT
All health establishments meant for care of PMI (Govt./others)
Where PMI are admitted (reside/ kept) for care, treatment,
convalescence, or rehabilitation (temporary or otherwise)
Includes general hospital/nursing home (Govt./others)
Excludes family residence if PMI resides with relatives/friends
QUALIFICATIONS
Lays down definitions with qualifications for:
Mental Health Professional:
Psychiatrist, AYUSH practitioner having a degree in Manas
Rog
Clinical psychologist, psychiatric social worker, registered
mental health nurse with degree in psychiatric nursing

MAIN FEATURES of MHC BILL

MENTAL ILLNESS

A disorder of mood, thought, perception, orientation, or

memory

Which causes significant distress to a person

Or impairs a persons behavior, judgment, ability to recognize

reality or ability to meet the demands of normal life

Includes mental conditions associated with alcohol and drug

abuse

Excludes mental retardation

Determined in accordance with nationally and internationally

accepted medical standards

Not determined by social, political, economic, religious,

cultural or racial status as well non-conformity with beliefs of
ones community

MAIN FEATURES of MHC BILL

CAPACITY TO MAKE MENTAL HEALTH CARE AND
TREATMENT DECISIONS

Ability to understand information relevant to the decision and to

retain, use, or weigh the information as part of making decision
and communicate his or her decision by any means

All PMI regarded as competent to make decisions except when

they lack the ability as stated above

Expert Committee to
assessment of capacity

When a person makes a decision regarding his mental health

care or treatment perceived by others as inappropriate or wrong,
shall not mean that person does not have the capacity

prepare

guidance

document

for

MAIN FEATURES of MHC BILL

ADVANCE DIRECTIVES

Every person has a right to make written statement specifying:

Way s/he wishes to be (or not) cared/treated for a mental
illness
Individual(s) s/he wants to appoint as his/her nominated
representative

Registered with Mental Health Review Commission or

countersigned by medical practitioner certifying that person has
capacity

May be revoked, amended or cancelled by the person

Medical professionals are duty bound to follow a valid directive

To overrule, an appeal can be made to state panel of MHRC

Not applicable for emergency treatment

MAIN FEATURES of MHC BILL

NOMINATED REPRESENTATIVE

Any person (not minor) has right to appoint nominated

representative

In absence of such an appointment, certain individuals in order of

precedence shall be nominated representative

For a minor, legal guardian shall be nominated representative

(unless otherwise ordered by the state panel of the MHRC)

Application to revoke/ modify can be made to state panel of

MHRC

Nominated representative shall consider the current and past

wishes, values and best interests of the PMI while fulfilling his/her
duties

MAIN FEATURES of MHC BILL

RIGHTS OF PERSONS WITH MENTAL ILLNESS
Access mental health care, community living
Protection from cruel, inhuman and degrading treatment
Equality and non-discrimination
Confidentiality, right to access medical records
Personal contacts and communication, right to legal aid
Make complaints about deficiencies in provisions of
services

Obligatory to make provision for services required by PMI

Medical insurance for treatment of mental illness on same

basis as physical illness

Integration of mental health into general health care services

MAIN FEATURES of MHC BILL

DUTIES OF THE GOVERNMENT

Programs to promote mental health & prevention of mental

illness

Create awareness about mental health and to reduce stigma

Periodic sensitization and awareness training for Govt.

officials

Plan, develop
programmes

Train medical officers in public healthcare establishments &

prisons

Meet internationally accepted guidelines for no. of MHP on

basis of population within 10 years

Ensure effective co-ordination between services provided by

and

implement

educational

&

training

MAIN FEATURES of MHC BILL

CENTRAL/STATE
MENTAL
HEALTH
AUTHORITY
(CMHA/SMHA)
Ex-officio: Bureaucrats, DGHS, Directors (Institutes of mental
health)
1 each from mental health professional, psychiatric social
worker, clinical psychologist, mental health nurse
2 each from representatives of PMI, care-givers, NGOs
FUNCTIONS:
Register, supervise, regulate all mental health establishments
(MHE)
Develop quality and service provision norms for MHEs
National register of clinical psychologists, mental health
nurses and psychiatric social workers
Train
law enforcement officials, mental health, other

MAIN FEATURES of MHC BILL

MENTAL HEALTH REVIEW COMMISSION (MHRC)
Appoints Expert Committee to prepare guidance document
containing procedures for assessing capacity
Constitute Mental Health Review Board in the districts of each
State
Power to impose penalty, order cancellation of registration of
MHEs
Appeal against decision of Commission/Board made to High
Court
DISTRICT MENTAL HEALTH REVIEW BOARD (MHRB)
Register, review, alter, modify or cancel an advance directive
Appoint a nominated representative
Application against decision of psychiatrist in charge of MHE
Applications regarding non-disclosure of information

MAIN FEATURES of MHC BILL

REGISTRATION OF MENTAL HEALTH ESTABLISHMENT

Licensing has been replaced with registration, to be done by

SMHA

For registration, every MHE shall fulfill:

minimum standards of facilities, minimum qualifications for
personnel, maintenance of records and reporting

Different standards for different categories of MHE

Cancellation of registration in case:

MHE fails to maintain minimum standards, conviction of
offence under this Act, violation of rights

Inspection by inspecting officers and provision of visitors

dropped

SMHA can inspect or conduct an inquiry in respect of any

MAIN FEATURES of MHC BILL

INDEPENDENT ADMISSION (Section 95)
Any person requesting admission of his own free will
Person has understood nature and purpose of admission
Not to be given treatment without his informed consent
Discharge request cannot be refused by MHPs
May prevent discharge for 24 hrs to allow assessment for
supported admission
ADMISSION OF A MINOR (Section 96)
Exceptional
circumstances, application of nominated
representative
Independent examination by 2 psychiatrists in preceding 7
days
Admitted
only when community based alternative
failed/unsuitable
No irreversible treatment for mental illness of a minor

MAIN FEATURES of MHC BILL

SUPPORTED ADMISSION UP TO 30 DAYS (Section 98)

Admission on request of a nominated representative

Independent examination by 2 psychiatrists

Risk of bodily harm or violence to self or to others, or lack
of capacity to care for self
Admission is least restrictive care option possible
Need very high support from nominated representative

Treatment taking into account advance directives or informed

consent with support of nominated representative

Admission limited to 30 Days, informed to state panel within 7

days

Cannot be readmitted under this section within 7 days of

discharge

MAIN FEATURES of MHC BILL

SUPPORTED ADMISSION BEYOND 30 DAYS (Section 99)
Already admitted under section 98, criteria of admission still
valid
Or requiring admission within 7 days of discharge under
section 98
Extended after independent examination by 2 psychiatrists
Must inform state panel of MHRC, get approved within 21
days
Limit:
90 days, renewal on application by nominated
representative
EMERGENCY TREATMENT
Any
medical practitioner
with consent of nominated
representative
In certain specified emergency situations, at any health

MAIN FEATURES of MHC BILL

PROHIBITED TREATMENTS
Unmodified ECT and sterilization of PMI prohibited
ECT of minor only with consent of guardian, permission of
Board
Psychosurgery only performed on approval of SMHA
RESTRAINS AND SECLUSIONS
PMI cannot be chained in any manner whatsoever
Restrains and seclusions to be used when only means
available
Authorized by psychiatrist in charge, not used longer than
necessary
DUTIES OF POLICE OFFICERS
Assigned duties to take any wandering PMI in protection
Taken to nearest public health establishment within 24 hours

KEY ISSUES

DEFINITIONS

AUTONOMY AND LEGAL CAPACITY

ADVANCE DIRECTIVES

MENTAL HEALTH REVIEW COMMISSION

INCLUSION OF GHPUs

UNMODIFIED ECT

ECT FOR MINORS

DECRIMINALIZATION OF SUICIDE

OTHER ISSUES

STANDING COMMITTEE REPORT

KEY ISSUES
DEFINITION OF MENTAL ILLNESS

Major improvement, guides as to what constitutes mental

illness

Uses social model rather than a purely medical model

Exclusion of mental retardation severely criticized

Inclusion of Substance use Disorders also criticized

Considered very broad and over-inclusive by some, includes

persons with minor mental illnesses and may increase stigma

DEFINITION OF MHP AND MHE

Inclusion
of
controversial

GHPUs,

rehabilitation/halfway

homes

Inadequate no.(Choudhary
of socialetworkers/psychologists/psychiatric
al, 2011; Kothari & Chatur, 2012; Antony, 2014)
nurses meeting qualification as per definition limit their

KEY ISSUES
AUTONOMY AND LEGAL CAPACITY

Reaffirms right to decide care, complying with Art.12 of

UNCRPD
Functional approach, laying down functional areas of
capacity

Landmark in paradigm of mental health & human rights

discourse

Support by human right activists, law experts and NGOs

Does not specify need for legal capacity while appointing a

nominated representative, like advance directive

Some advocacy groups argue: clauses on autonomy riddled

with many conditions making impossible for individual to
(Kothari & Chatur, 2012; Davar, 2012)
express choice

ADVANCE DIRECTIVES

Patient autonomy vs. Possibility of involuntary treatment

Both conceptually and practically there are many difficulties

Extensive meta-analysis (Cochrane review)

Lack supporting data to recommend for people with SMI

Legal issues: competence for execution and revocation,

activation, conflict resolution structures and misuse

Giving right to consent/refuse treatment before onset of

psychiatric illness does not protect best interests

Future decisions for potentially unforeseen circumstances ?

(Sarin et al. 2012; Sarin 2014)

ADVANCE DIRECTIVES

Autonomy not always dominant principle in many LMI

countries

Cultural emphasis: reciprocity, family, joint decision-making

Financial/human resources: potential barrier in India

Unorganized nature of services, limited access, makes use of

advance directives particularly challenging

IPS Position:
More needs to be done before legal enforcement
considered
Introducing brand new concept positioning family & patient
as adversaries may harm patients' interests
(IPS 2012; Shields et al. 2013; Kala, 2014)

ADVANCE DIRECTIVES

Feasibility study by SCARF in Tamilnadu (2011)

123 patients of F2O/F25 interviewed to assess their capacity

92 of 93 patients with capacity completed advance directives

Themes: areas and facility of treatment, nominated decisionmakers

Many patients symptomatic, 1/3rd of patients from rural areas

Feasible with suitable adaptations, need to replicate studies

Concerns regarding their enforceability at this juncture

(Thara et al. 2012)

ADVANCE DIRECTIVES

Qualitative study assessing feasibility, utility in Tamilnadu in

2013
Urban/rural outpatients at NGO The Banyan, diagnosed
with SMI

Semi-structured interviews with clients (n = 39) and carers (n

= 12)

Clients engaged in no. of forms of decision-making (passive,

active, and collaborative)

Most unfamiliar with concept, felt important to have say in

treatment choices

Carers concerned about user capacity to make decisions

After completing, clients reported an increase(Shields

in self-efficacy
et al. 2013)

Need to better understand and adapt to suit care context in

UNMODIFIED ECT

APA and RCPsych assume that ECT is always modified

WHO states that practice of unmodified ECT should be

stopped

WPA position statement: modified ECT standard, when

choice of modified ECT not there, case by case decisions to
be made

IAPP and IPS Position statement:

Unmodified ECT not a routine treatment
Only on case by case basis, when modified ECT cannot be
administered and benefits outweigh risks
Strong indication for ECT confirmed by a second
psychiatrist
(Andrade et al. 2012, Rajkumar, 2014)
Physical conditions posing risk with unmodified ECT be
treated

UNMODIFIED ECT

Very little data obtained from well-designed studies

Rarely, associated with musculoskeletal complications,

arrhythmia, aspiration, hemorrhage and anxiety

What extent adverse outcomes attributed to unmodified ECT

due to ECT in general or associated environment?

Indications for unmodified ECT:

Lack of anesthesiological support (lack of facilities,

funding,qualified anesthetists, monopoly by surgical
specialties)

Urgent need of ECT, contraindication for anesthesia/muscle

relaxant

Unaffordability of anesthesiological support

(Andrade et al. 2012)

UNMODIFIED ECT

Case for modified ECT: aesthetics and acceptance by patient

Unmodified ECT: visually unappealing, form of torture,

negative portrayal in media/popular culture

Why does IPS not work towards:

Greater collaboration with anesthesiologists?
Setting up modified ECT facilities in rural and semi-urban
areas?
Training psychiatrists in basic anesthesia and life support
skills?

Does not deal fairly on grounds of beneficence, nonmaleficence, justice, harmful consequences likely to outweigh
benefit in long run
(Rajkumar, 2014)

ECT IN MINORS

ECT for children/adolescents used since 4th decade of last

century

Efficacy for affective, psychotic disorders, and catatonia in

minors

Evidence supporting use of ECT with equal clinical efficacy

as adults

AACAP also endorsed use of ECT in its guidelines

Laid down 3 criteria to consider use of ECT
Diagnosis, Severity of symptoms, Lack of treatment
response

No credible evidence for adverse impact on developing brain

No significantly increased risk of acute or delayed cognitive

(Gazhiuddin et al. 2004; Balhara & Mathur, 2012)
damage, decline in social functioning and school

MENTAL HEALTH REVIEW

COMMISSION

Quasi-judicial body, administrative and adjudicatory functions

Elaborately designed and well conceptualized

First level of interaction of PMI with mental healthcare system

for protection of rights

A whole new regime compared to MHA which gave unbridled

power to Magistrate, now reduced to only a few specific
cases

Consensus with UNCRPD: right to self determination, access

to post-admission review, protection from human right
violations

Establishing District boards makes it easily accessible for all

(Kothari & Chatur, 2012)

MENTAL HEALTH REVIEW

COMMISSION

Makes admission/discharge procedures lengthy, complicated

especially in case of involuntary patients and minors

Burden of large no. of applications, time taken for disposal

may delay treatment

Impact on functioning of GHPUs (acute and emergency care

units)

Impact on caregivers: bureaucratic hurdles in getting

treatment for their family members

Feasibility of entertaining each complaint and conducting

reviews to determine capacity in all involuntary patients

Requirement of 6 members/board in each district may make it

difficult to set up functioning boards

INCLUSION OF GHPUs
IPS Position statement:

Inclusion of GHPUs (involved in acute care) is a retrogressive

step

Small sized, open ward system under eyes of community

Needed for UG/PG teaching and admit patients of different

types including cases not usually admitted in a long stay
facility

Patients admitted with family member, no possibility of any

neglect

Will be full of involuntary admissions and long staying patients

jeopardizing care of acute illnesses and emergencies

Open for inspection on behalf of MCI, RCI and affiliating

university
(IPS 2012)

Minimum standard of care as per guidelines by regulatory

INCLUSION OF GHPUs
Inclusion considered necessary to:

Ensure minimum standards of a psychiatric hospital different

from a general hospital

Reduce possibility of human rights violations in form of

unnecessary restraints and non-consensual treatment

Regulation of clinical research and prevention of unethical

practices

Focus of care shifting to general hospitals where majority of

PMI will seek treatment in future, will requires regulation

Part of rights-based approach in compliance with UNCRPD

( Sarin 2010; Math et al. 2011)

DECRIMINALIZATION OF SUICIDE

Welcomed by mental health professionals, legal experts as

well as advocacy and human rights groups

Changes view from criminal offence to public health problem

Obligatory for state to provide care to reduce risk of

recurrence

Punishment (Section 309) previously justified by some as a

deterrent against the act of suicide

Heavy debate regarding humanitarian aspect of Section 309

Courts continually commented on its constitutionality and

desirability but judicial opinion on suicide varied and
contradictory

Needed to reduce stigma, increase reporting and treatment

(Srinivas, 2008; Bhaumik, 2013)
seeking

DECRIMINALIZATION OF SUICIDE

Some experts criticized part of bill shall be presumed, unless

proved otherwise, to be suffering from mental illness
Some have no diagnosable mental illness, attempt suicide
because of psychosocial problems
Person will be subject to mental health treatment against will
:
Nominated
Representative making application for
supported admission and 30 day institutionalization
Police officer can take under protection and deliver to
public health establishment
Person exempt from punishment and not prosecution,
police may remand into custody, produce before a
(Davar et al. 2013)
Magistrate

DECRIMINALIZATION OF SUICIDE

Concerns regarding issue of abetment of suicide. Many

cases arise from instances of Domestic Violence
Presuming that person was suffering from mental illness,
can be argued that victim may be predisposed to suicidal
tendencies

This legal presumption especially when allegation cannot be

refuted (in completed suicide), may lead to dilution of
culpability of accused

Legal presumption of mental illness in case of suicide may

create situations where institutionalization may be misused

Law does not address case of deliberate self harm refusing

treatment in emergency department
(Davar et al. 2013)

OTHER ISSUES
RIGHTS AND NEEDS OF CHILDREN

Takes no account of specific developmental needs,

differences and multi-agency nature of childrens services

Does not consider developments in maturation

competence requiring involvement in decision making

No attention to extra treatment needs (shelter, occupation,

education etc.) of children and adolescents

of

PENALTIES

Fine for maintaining an unregistered MHE extends only to Rs.

5 Lakh. Lucrative for unregistered institutions to get away by
just paying fine

Does not mention penalties/punishment for govt.

(Antony, 2014)
functionaries at various levels who fail to deliver services

OTHER ISSUES

Preventive and promotive aspects of mental health not

addressed and no definition of mental health provided

Lack of link between governing authority and implementing

authority like MHRC/SMHA/District Panel of MHRC

No indication about method of provision of huge resources

required to provide quality care for a large population of PMI

Concerns and rights of caregivers of PMI inadequately

addressed

Traditional health practice in relation to mental health ignored

(Sarin,2012; Math et al. 2011)

OTHER ISSUES
forced

injections,

covert

Issues like
mentioned

medication

not

Silent on mental health care of homeless mentally ill person

not needing admission

Apart from sections relating to transfer, it does not apply in

custodial care institutions including prisons

No time limit for transfer from custodial centers mentioned

STANDING COMMITTEE REPORT:

AMENDMENTS PROPOSED

Suggestions given by Standing committee and approved by

MoHFW:
Definition of clinical psychologist (to comply with RCI
norms)
Definition of capacity (change in presumption against
capacity of mentally ill)
Clarification of process of challenging advance directives
Definition of halfway homes/supported accommodations
Obligation of IRDA to provide medical insurance for mental
illness
Clearly defining exceptions to right to confidentiality
Safeguard against misuse of medical records
(Standing Committee Report-MHCB 2013)

STANDING COMMITTEE REPORT:

AMENDMENTS PROPOSED

Division of regulatory power between CMHA and SMHA

Constitution of MHRC (appointment of 2 psychiatrists)
Informed consent for ECT of minors
Prohibiting seclusion of mentally ill
Right to withdraw consent from research
Provision of mental health care in custodial institutions
Presumption of severe stress instead of mental illness in
case of suicide attempt

(Standing Committee Report-MHCB 2013)

SUMMARY

Over the past century, focus of mental health legislation has

undergone a paradigm shift
From segregating mentally ill on account of safeguarding the
society to integration into community, enhancing access to
care and protecting rights of persons with mental illness
MCHB is an effort to balance aspirations of all stakeholders in
field of mental health
Several progressive provisions in keeping with international
conventions and WHO guidelines
Comparable to mental health care reforms in other countries

SUMMARY

Questions over provision of finances and infrastructure for

implementation
Apprehension of medical community regarding its
consequences in psychiatric practice and clinical care
Human rights activists and advocacy groups welcome its
right-based approach
Need for further deliberation on the bill before it is adopted as
an Act

THANK YOU