THE MENTAL HEALTHCARE

ACT 2017
 WHAT IS MENTAL HEALTH?
The WHO states Mental Health and well-being are fundamental
to quality of life, enabling people to experience life as
meaningful, become creative and active citizens.

What is Mental Health Care?

"Mental health care 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.
 NORMALIZING CONVERSATIONS
ABOUT MENTAL HEALTH
• Mental health is just as essential as physical health.
Normalizing the conversation about mental health empowers
people to talk and get the help they need.

• The celebrities who are the role models for

a large no of audience have played a major role in
. normalizing the issues people face and normalizing
that it is ok to seek help and talk about
"its ok to not be ok" these issues which were
at one time a taboo topic.
Mental Health
conversation
is normal
MOVIES THAT HAS HELPED TO NORMALISE CONVERSATION ABOUT
MENTAL HEALTH

The movie has done a fair job of sensitising the

audience to the myriad mental diseases that
may afflict a person, without coming off as
overly preachy and it managed to incorporate
difficult issues like depression, therapy,
and traumatic past into its plot.
MOVIES THAT HAS HELPED TO NORMALISE CONVERSATION ABOUT
MENTAL HEALTH

'Chhichhore' made us realize how little we talk about

our mental health and what we lose while engaging in
the rat race of being successful.
MENTAL HEALTH IN THE HIGH SCHOOL CURRICULUM
 MENTAL HEALTH IN THE WORKPLACE

• Workplace can have a huge role in your overall health

and welfare. Working in a negative environment can
have the opposite effect and take a heavy toll on
your emotional health.

• Long hours, understaffing, a lack of support, and

harassment in the workplace can ramp up your
stress levels and contribute to mental health
problems such as anxiety, depression, and
substance abuse.
BACKGROUND OF MENTAL HEALTH ACT
2017

• On march 27th of 2017, the Mental Healthcare

Act 2017 was passed, which got its approval from
the Honourable President of India
in April 2017.
• The Act rescinded the existing Mental Healthcare
Act 1987.
• The MHCA(Mental health care act) 2017 aims to
provide mental healthcare services for
persons with mental illness.
 WHAT WAS THE NEED OF A NEW ACT
• India was part of the Ratification of United
Nations Convention on the Rights of Persons
with Disabilities(UNCRPD) in Oct 2007 and the
local laws of india did not align with the laws
of the United Nations Convention on the Rights
of Persons with Disabilities(UNCRPD)
henceforth some of the changes were made

• Mental Health Act, 1987 was not adequate to

protect the rights of persons with
mental illness
 THE MENTAL HEALTH ACT, 1987
VS
THE MENTAL HEALTHCARE ACT, 2017

THE MENTAL HEALTH THE MENTAL HEALTHCARE

ACT, 1987 ACT, 2017
(MH ACT, 1987) (MHC ACT, 2017)

• NO relief to patients on rehabilitation and treatment •

plans
2. NO consideration of the financial, social,
or emotional burdens to the patients as well
as their caregivers.
3. Do Not provide for rights of mentally
ill persons.
4. Prioritised institutionalisation
of mentally ill persons.
Relief given to patients on
rehabilitation and treatment plans
2. Consideration of the financial, social,
or emotional burdens to the patients as well
as their caregivers.
3. It also provides for rights of mentally
ill persons.
 MENTAL HEALTH CARE AND ITS PARADIGM
SHIFT

THE MENTAL HEALTHCARE

INDIAN LUNACY ACT ACT, 2017
(IL ACT 1912) (MHC ACT, 2017)
Custodial care of persons with Protect Human Rights during
mental illness treatment
THE MENTAL HEALTH ACT, 1987
(MH ACT, 1987)

Treatment of persons with

mental illness
 AIM & OBJECTIVE OF
THE ACT

• To provide care and support to the people

suffering from mental illness
• To promote protect and fulfill the rights of the
people during the delivery of the healthcare
services
• To remove the stigma attached to such mental
health issues.
• To fulfill international obligations relating to
mental healthcare services
IMPORTANT PROVISIONS OF MENTAL HEALTH CARE
ACT (2017)
• The Mental Health Care Act 2017 is split into 16
Chapters
• The Act recognises the right of PwMI to make
decisions regarding their mental healthcare and
treatment, with the presumption, that they have the
capacity to do so unless proven otherwise.
• Every person shall have a right to make an AD
stating how he wishes, his mental illness to be
treated and cared and how not to be.
• Every person shall have a right to appoint an NR to
support him, in case of need, in taking treatment
related decisions.
 CHAPTERS UNDER THE MENTAL HEALTH CARE
ACT (2017)

CHAPTER-1
It contains basic definitions like mental
health , caregiver,etc

SPECIAL FEATURES
It defines clearly the mental illness

CHAPTER-II
Mental illness and capacity to make mental
healthcare and treatment decisions
without any discrimination.
A NEW DEFINITION OF MENTAL HEALTH UNDER
MHA(2017)
• Mental illness was defined as any mental disorder
and seldom as mental retardation but the new act
provides a broader definition the new definition has
been recorded under section 2(1) (s)
• It states mental illness is 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 & drugs.
 CHAPTERS UNDER THE MENTAL HEALTH CARE
ACT (2017)

CHAPTER-III
It deals with the Advance directives.
Features:
• Every person except minor has right to take advance
directive by writing
• It empowers the patient to choose his/her treatment and
appoint a representative to take decision on behalf of
patient.
• If patient is minor, his/ her parent or care giver
will act as representative.
 CHAPTERS UNDER THE MENTAL HEALTH CARE
ACT (2017)

• It will not be applicable At the time of emergency.

• It is the duty of every psychiatrist to plan treatment
keeping advance directive in mind.
• If any one from psychiatrist or care giver are unsatisfied
can approach to the concerned board.
CHAPTER-IV
Guidelines of choosing Nominated Representative.
 ADVANCE DIRECTIVE (AD)

• Advance Directive is a written document made by a

ADVANCE person stating how they would like or not like to be
treated in the situation that they have a mental
DIRECTIVE
illness and are unable to make decisions about their
treatment.

• The Advance Directive is effective only when the

person ceases to have capacity and is not able to
make decisions regarding their mental health care
and treatment.
 ADVANCE DIRECTIVE (AD)
• An Advance Directive can be challenged before a Menta
Health Rehabilitation Board on grounds that:

ADVANCE 1. It was not made out of a person’s free will

DIRECTIVE but under force or threat by another person.
2. The Advance Directive was not intended to apply
to present circumstances.
3. The person was not sufficiently well informed to
make a decision
4. The person did not have capacity to make decision
5. The Advance Directive is contrary to any law
or the Constitution
 NOMINATED REPRESENTATIVE (NR)

Who are Nominated Representatives?

• Individual appointed by a person with mental illness

to represent them in matters related to their mental
healthcare, provide support and take decisions on
their behalf when they don’t have capacity

• The Nominated Representative should not be a

minor,must be competent to perform their duties and
give consent for the same in writing.
 NOMINATED REPRESENTATIVE (NR)

The NR has the following duties:

• Consider the current and past wishes, life history,

values, cultural background and best interests of the
person.
• Provide support in making treatment decisions.
• Provide care while the person is admitted or
receiving treatment.
• Apply to the Mental Health Review Board in case of
any rights violations or complaints.
 CAPACITY
Under the section 4(1) of the act it is stated
that 'every person, including a person with mental
illness shall be deemed to have capacity to make decisions
regarding his mental health care or
treatment , if such person can understand the
information which is relevant to take a decision on the
treatment or admission or personal assistance & can
appreciate any reasonably foreseable consequence
of a decision or lack of decision on the treatment or admission
or personal assistance as well
as communicate the decision by means of speech, expression,
gesture or any other means.
 CHAPTERS UNDER THE MENTAL HEALTH CARE
ACT (2017)

CHAPTER-V
• It consists of Various Rights of mentally ill person.
• The appropriate government should make provisions of
Mental health institutions on every district.
• Mental ill person should not travel long distance for
treatment.
• It made provisions for the mentally ill person to live with
dignity.
• Woman with child should be separated for the safety of
the child and it should be reviewed in every
15 days.
 RIGHTS OF PERSONS WITH MENTAL ILLNESS

Right to Personal Contacts and Right to Equality and Non

Communication Discrimination

Right to Legal Aid Right to Information

Right to Access Medical Right to Community Living

Records
CAN THE RIGHT OF PERSON WITH MENTAL
ILLNESS BE TAKEN AWAY ?

• Section 19 of MHCA 2017 states that "A person may

be either admitted involuntarily to a mental health
facility as a patient or can be retained as an
involuntary patient in the mental health facility if:-
• Because of that mental illness, there is a likelihood
of immediate or imminent harm to that person or to
other persons in close proximity
2. In the case of a person whose mental illness is
. severe and whose judgement is impaired and
failure to admit or retain that person.
CAN THE RIGHT OF PERSON WITH MENTAL
ILLNESS BE TAKEN AWAY ?

it is likely to lead to a serious deterioration

in his or her condition or will prevent the
giving of appropriate treatment.
3. The mental health facility may receive
involuntarily admitted patients only if the
facility has been designated to do so by a
competent authority
(
(
 CHAPTERS UNDER THE MENTAL HEALTH CARE
ACT (2017)

CHAPTER- VI
• It gives direction to the government to implement the
programme.
CHAPTER-VII
• Gives provisions of forming Central Mental health
authority.
CHAPTER-VIII
• Gives provisions of forming State Mental health
authority.
 CENTRAL/STATE MENTAL HEALTH
AUTHORITY (CMHA/SMHA)

• CMHA/ SMHA are regulatory bodies set up under the

Central and State Governments respectively for
implementing the MHCA, laying down minimum standards
for mental health care services, registration of mental health
establishments and registering mental health professionals.
• They also have the duty to conduct social audits (every
three years) and/or inspections and inquiries for mental
health establishments to ensure that they are complying with
the minimum standards notified under the MHCA and are
protecting the rights of persons with mental illness
 CHAPTERS UNDER THE MENTAL HEALTH CARE
ACT (2017)

CHAPTER IX
Finance, accounts and audit.

CHAPTER X

• Mental health establishments every mental healthcare

institution should be registered.
• Establishment of new improvised institutions.
 CHAPTERS UNDER THE MENTAL HEALTH CARE
ACT (2017)
CHAPTER-XI
Constitution of Mental Health Review Boards.
Every state has to form a review board which is consist of
• A district judge as chairperson of board.
• Two members of whom one shall be a psychiatrist and
the other shall be a medical practitioner.
• Two members who shall be persons with mental illness or
caregivers or persons representing organizations of
persons with mental illness or non-governmental
organisations working in the field of mental health
CHAPTER-XII
Admission, treatment and discharge
 ADMISSIONS & TREATMENT
INDEPENDENT
ADMISSIONS
wherein a person
with mental illness can make
an application
to admit themselves .
Treatment can be given
only with informed consent of
the person.
SUPPORTED
ADMISSIONS
wherein the person with mental illness does not
have capacity or requires high support and the
Nominated Representative submits an
application for admission for a period up to 30
days or more. Supported admission is allowed
only if the person
(i) is attempting or threatening to cause
harm to the self or others
(ii) is unable to take care of
the self
 ADMISSIONS IN MENTAL HEALTH
ESTABLISHMENT
• There are a total of about 47 establishments across
all of the states of India where a mentally ill
person can seek help and get cured.
• The major problem with these are people do not
know where to seek help right ?
=>So the 24x7 Toll-Free Mental Health
Rehabilitation Helpline Kiran (1800-599-0019)
provides assistance in about 13 languages
and supports persons with Mental Illness.
 SAFE PLATFORMS PROVIDING FREE &
AFFORDABLE ONLINE THERAPY
• To deal with the emotional and mental consequences of the pandemic
like depression, anxiety, isolation and more
there are a bunch of doctors and platforms offering
free and inexpensive online consultations.

• Talk To Therapist https://talktotherapist.com/

• Dr Safe Hands https://drsafehands.com/
• Therapize India https://www.therapizeindia.com/
• Mind Peers https://mindpeers.com/
 ADMISSION BY SELF
FILL AND SIGN A FORM

UNDERGO EXAMINATION

ADMISSION TO THE FACILITY

PERSON WITH MENTAL ILLNESS

GIVES INFORMED CONSENT

DISCHARGE
 ADMISSION WHEN ADMITTED VIA NOMINATED
REPRESENTATIVE (NR)

NR SUBMITS THE FORM

EXAMINATION BY
2 MH PROFESSIONALS

ADMISSION TO THE FACILITY

TREATMENT, NR SUPPORTS IN ANY
DECISION MAKING OR MAKES
DECISION ON BEHALF OF THE PATIENT

DISCHARGE
 ADMISSIONS & TREATMENT

• Treatment can be given with informed consent

of the person. If the person can’t make
decisions, the NR can give informed consent.
• It allows for emergency treatment by any
medical practitioner in any location for a period
of 72 hours only in situations where there is a
threat to life of the person or the person might
destroy property
ABOLISHMENT THE BARBAROUS TREATMENTS

• It also affirms that a person with mental illness

shall not be subjected to electroconvulsive therapy
(ECT) therapy without the application of muscle
relaxants and anaesthesia.
• Electroconvulsive therapy for minors is prohibited.
• Chaining in any manner or method whatsoever is
banned.
 CHAPTERS UNDER THE MENTAL HEALTH CARE
ACT (2017)

CHAPTER-XIII
Duties of police officers in respect to mentally ill person
It is the duty of police to give protection to any mentally ill
person wandering outside in the area of police station.

CHAPTER-XIV
It restricts unauthorized duty and medication.
CHAPTER-XV
It deals with penalty and punishment unauthorized institutions
will be punished with 5000-50,000 for
1st time and upto 2 lakhs for 2nd time.
 CHAPTERS UNDER THE MENTAL HEALTH CARE
ACT (2017)

• Any person who do the work against the Act, are liable to
give upto ten thousand rupees or six months of jail or
both.
CHAPTER-XVI
MISCELLANEOUS
• Power of Central Government to issue directions.
• Special provisions for States in north-east and hill States
DECRIMINALIZING SUICIDE
• According to the Section 115 of Mental
Healthcare Act (MHCA), 2017, Any person
who attempts suicide will be presumed to be
under severe stress and will not be tried and
punished under Section 309, Indian Penal
Code, 1860 unless it is proven by
investigating authorities that the person was
not under severe stress.
• This is a milestone judgement which
has annulled Section 309 IPC
DECRIMINALIZING SUICIDE
• The Supreme Court in Common Cause v. Union
of India in 2018 had recommended to the
Parliament to consider decriminalising the
offence, saying the provision had become archaic

• P Rathnam v. Union of India held section 309 was

unconstitutional and void as it violates Article 21.
 INSURANCE COVER

Herein referred under Section 21(e) of the Act,

"Any Health services provided to persons with

physical illness shall be provided in same manner,
extent and quality to persons with mental illness."
 EMPLOYEES STATE INSURANCE SCHEME

• It was established in 1948, the statutory

insurance scheme managed by the Employees
State Insurance Corporation is responsible for
provision of both monetary reimbursements as
well as medical benefits to employees (&
dependent family members in the case of a
deceased insured person) working in the formal
sector. At its helm, the act provided for coverage
of factories which have been 'using power' and
employing 10 or more workers.
 EMPLOYEES STATE INSURANCE SCHEME

• ·The same is jointly funded (contributed by both

the employer and the employees and partially
contributed by the government)
• ·Employees' State Insurance Corporation
(ESIC), established by ESI Act, is an
autonomous corporation under the Ministry of
Labour and Employment. the corporation can
raise loans and take measures for discharging
such loans with the prior sanction of the central
government.
 EMPLOYEES STATE INSURANCE SCHEME
• As per the Employees State Insurance Act,
the definition of sickness as defined under .
Section 2(20) states
"A condition that requires medical treatment &
abstention from work on medical grounds "
• The complex jointly funded structure of the scheme
allows it to operate through its own facilities
established under the ESIS for provision of medical
benefits.However the same hinders the availment
of the scheme, given the following grounds
under which coverage is provided.
 POSITIVE ASPECTS OF MENTAL HEALTHCARE ACT,
2017

This Act has several positive aspects in the form of

• Clear definitions of few important terms not given in
earlier Act, e.g., ‘mental illness’, ‘caregiver’, ‘clinical
psychologist’, ‘psychiatric social worker’, ‘mental
health nurse’, ‘family’ & ‘relative'.
2. Provides more autonomy to mentally ill
individuals by keeping provision of capacity
to make mental healthcare & treatment
decisions
 POSITIVE ASPECTS OF MENTAL HEALTHCARE ACT,
2017

3. Keeping the provision of ‘advance directives’ for the

patients
4. Keeping the provision of ‘appointment & revocation
of nominated representative’ of mentally ill people
5. Decriminalization of suicide
6.Every person with mental health illness will have
right to protection from cruel, inhuman,
& degrading treatment.
 CRITICISM AND THE WAY FORWARD

• In simple words, it applies to those who have severe mental

disorders. This does not include mental retardation which is
a condition of arrested or incomplete development of mind
of a person.
• This act empowers accessibility to mental
health services for all. However, with already
inadequate medical infrastructure at district
and subdistrict levels, the financial burden
to be borne by the state governments will be
massive unless the central government
allocates a larger portion of the budget to incur
the expenditure.
 CRITICISM AND THE WAY FORWARD
• The newly introduced decriminalization of suicide is definitely a great move.
There could be very much a possibility of misuse of this bill.
In cases of dowry-related burning/attempted homicide,
this can be twisted as attempted suicide.
• As this act provides Advance Directives it increases the work
of psychiatrist whose number is very less in our country.
• Does not provide Advance Directive to the minor
children.
• The inclusion of establishments concerned with
practices such as Ayurveda, Yoga and Naturopathy
under the definition of "Mental establishments"
in the act signal at a long list of preventive
healthcare practices which has been at the expense of
curative healthcare.
 SUGGESTIONS & THE WAY FORWARD

• Extend and strengthen existing systems of primary care

to deliver health services for these disorders.
• Make cost effective interventions available to those
who will benefit.
• Conduct operational research to
demonstrate the cost-effectiveness of
specific treatments and health services
in local settings.
• Create national centres for training
and research
 SUGGESTIONS AND THE WAY FORWARD

• Mental health services should be accessible, equitable

and affordable
• Government should downsize large psychiatric hospitals
• There should be a national database of services
and human resources available for mental
health care in the country, and this should
be periodically updated.
• The State and Central Governments should
follow a stepped care approach to mental
health services
THANK YOU

DR SWATI JINDAL GARG