Mhca

Question 1

India’s first Lunacy Act (Act 36) drafted in ———- came with the guidelines ——₹which was replaced by the ———-

Answer 1

India’s first Lunacy Act (Act 36) drafted in 1858 came with the guidelines to establish mental asylums and procedures to admit patients, which was replaced by the Indian Lunacy Act (ILA) (Act 4) 1912.

Question 2

‘Indian Lunacy Act (ILA), 1912:

Answer 2

The purpose of this Act was to ensure custodial care and
to prevent harm to the society,

There was no provision of treatment, protection of rights or provision of welfare,
and there was no time limit specified for involuntary admissions.

Question 3

The Mental Health Act (MHA), 1987:

Answer 3

10 chapters and 98 sections
step towards the treatment centric paradigm of psychiatry
renamed mental hospitals as psychiatric hospitals/nursing home

Question 4

Mhca : no of chapters

Answer 4

16

Question 5

Mhca no of sections

Answer 5

126

Question 6

chapters of mhca

Answer 6

I preliminary
II Mental illness and capacity to make mental healthcare and treatment decisions
III advanced directive
IV NR
V rights of persons with mental illness
VI duties of appropriate govt
VII central mental health authority
VIII state mental health authority
IX Finance, accounts and audit
X MHE
XI MHRB
XII admission, treatment and discharge
XIII responsibilities of other agencies
VIV Restriction to discharge functions by professionals not covered by profession
XV offences and penalties
XVI misc

Question 7

Official Enactment

Answer 7

Received the assent of the President on 7th April, 2017
It came into force on 29 May, 2018

Question 8

“Mental healthcare (MHC)”

Answer 8

refers to any of the following being done for any person’s
mental illness or suspected mental illness:
- Analysis and diagnosis of a person’s mental condition and
- Treatment as well as
—Care and
—Rehabilitation of (Chapter I, Section 2)

Question 9

MHCA is applicable on whom all?

Answer 9

It is applicable on all mental health establishments as detailed below:
“Mental health establishment (MHE)” refers to: (Chapter I, Section 2)
any health establishment, including Ayurveda, Yoga and Naturopathy, Unani,
Sidha and Homoeopathy (AYUSH) establishment,
z Where persons with mental illness are admitted and reside at/kept in,
z For care, treatment, convalescence and rehabilitation,
z Either temporarily or otherwise;
z Includes any general hospital or general nursing home
z Whether private or public

(But does not include a family residential place where a person with mental illness
resides with his relatives or friends)

—z (Chapter X, Section 65) State mental health authority (SMHA) will classify MHEsinto different category as specified in Central Authority regulations.

Question 10

‘‘Mental health professionals (MHP)’’ (Chapter I section 2)

Answer 10

—z Psychiatrist: Postgraduate degree (MD/DPM/DNB) in Psychiatry from any of the
AYUSH disciplines from recognized universities (approved by UGC, NBE, MCI),
registered in state council
—z Clinical Psychologist: Postgraduate degree in Psychology/Clinical Psychology/
Applied Psychology or MPhil in Clinical Psychology/Medical psychology/Social Psychology following a full time 2-year course including Clinical training; recognized and approved by UGC Act, 1956 and RCI Act,1992
—z Psychiatric Social Worker: Postgraduate degree in Social work or MPhil in PSW following a full time 2-year course including Clinical training; recognized and approved by UGC Act, 1956
—z Mental Health Nurse: Diploma or degree in General nursing/ Psychiatric nursing recognized by the NCI and registered with the relevant State nursing council

Question 11

Capacity Assessment (Chapter II, Section 4)

Answer 11

Capacity to make decisions regarding his mental healthcare or treatment refers to ability to: a. Understand the information that is relevant to take a decision on the treatment or
admission or personal assistance; or
b. Appreciate any reasonably foreseeable consequence of a decision or lack of decision on
the treatment or admission or personal assistance; or
c. Communicate the decision under sub-clause (a) by means of speech, expression, gesture
or any other means.

Question 12

Advance Directive (AD)

Answer 12

A document expressing the way one wishes to receive or not receive mental health care or treatment and the individuals one wants to appoint as Nominated representative (NR) in order of precedence (Chapter III, Section 5).

Question 13

Who Can Make Advance Directive?

Answer 13

zz Any major who has capacity to make mental health care and treatment related decision can make Advance directive (Chapter III, Section 5)
zz The legal guardian shall have right to make an advance directive in writing in respect of a minor and all the provisions relating to advance directive, mutatis mutandis, shall apply to such minor till such time he attains majority. (Chapter III, Section 11 (4)).

Question 14

AD
1. when it comes into action or is evoked?
2. remain effective only till
3. can it be changes
4. AB initio void

Answer 14

When it comes into action or is evoked: Once person ceases to have capacity to make mental health care and treatment related decision
Remain effective only till: Person regains capacity
Can it be changed: Can be changed any number of times AB initio void: If made contrary to any existing law.

Question 15

How Can a MHP/MHE Access Advance Directive?

Answer 15

zz The person writing the advance directive and his nominated representative shall have a duty to ensure that the Medical officer in charge of MHE, Medical practitioner or MHP, has access to AD when required (Chapter III, Section 11(3)).
zz Section 91, every Board shall maintain online register of all ADs registered with it and make them available to concerned MHP as required.

Question 16

What is Liability of MHP in Relation to AD?

Answer 16

zz Duty bound to follow AD (Chapter III Section 10)
zz A medical practitioner or a mental health professional shall not be held liable for any
unforeseen consequences on following a valid advance directive Chapter III section 13(1). zz The medical practitioner or mental health professional shall not be held liable for not following a valid advance directive, if he has not been given a copy of the valid advance
directive [Chapter III, Section 13 (2)].

Question 17

Who can be appointed as NR?:

Answer 17

zz Any major person as per wish of persons making NR (Chapter IV, Section 14)
zz Who is competent to discharge the duties or perform the functions assigned to him under
this Act, (Chapter IV, Section 14)?
zz Who gives his consent in writing to the mental health professional to discharge his duties
under this Act. (Chapter IV, Section 14)?
zz Guardians are NR for minors unless the board decides otherwise (Chapter IV, Section 15) zz Any appointed NR may revoke or alter such appointment at any time (Chapter IV,
Section 15).

Question 18

How can NR be made?:

Answer 18

Nomination shall be made in writing on plain paper with the person’s signature or thumb impression of the person referred (Chapter IV Section 14).

Question 19

Can NR be Revoked?

Answer 19

The Board, on an application made to it by the person with mental illness, or by a relative of such person, or by the psychiatrist responsible for the care of such person, or by the medical officer in-charge of the mental health establishment where the individual is admitted or proposed to be admitted, may revoke, alter or modify if it feels NR is not acting in best interest of person or is not fit to discharge duties or is not willing (Chapter IV Section 16).

Question 20

Constitution of MHRB

Answer 20

a. A District Judge/officer of the State judicial services/retired District Judge (chairperson)
b. Representative of District Collector/Magistrate/Deputy Commissioner
c. Two members of whom 1 psychiatrist and the other a medical practitioner.
d. Two members PMI/Caregivers/member of organizations of PMI or Caregivers or NGOsworking in this field.

There can be 1 review board for many districts or vice versa as per need of district
CMHA Rules 2018, Chapter V, Section 17 states that at least one Board shall be constituted for a district and where it is not feasible, one Board for a group of two or more districts, not exceeding three districts, in the State.5

Question 21

SPECIFICS OF ESTABLISHING OR MAINTAINING A MENTAL HEALTH
ESTABLISHMENT

Answer 21

1. qualifications of mhp a/to act
2. registration of MHE with SMHA AND CMHA
3. penalty if unregistered
   1st contravention: 5-50,000
   2nd: 50000- 2 lac
   3rd: 2-5 lac

Whom to apply :
central govt MHE to apply to CMHA with DD of 20,000 drawn in favor of chairperson, CMHA

similar for state mhe

provisional registration for 6 months, within constitution of authority

Provisional registration
- Within 10 days, SMHA will issue Provisional registration without any inspection.
- Within 45 days, name and details of MHE on SMHA website
- Provisional registration is valid for 12 months
-provisional registration renewal has to be done within 30 days of expiry of previous provisional registration
- In case of delay, MHE shall be liable to pay the renewal fee of ` 20,000 to respective mental health authority (MHA)

permanent regis :

valid for 3 yrs
has to submit compliance
after receiving compliance, MHA has to give decision within 45 days for either granting permanent regis or rejection
if unacceptable, 6 months given for rectification

Question 22

RIGHTS OF PERSONS WITH MENTAL ILLNESS THAT MENTAL HEALTH ESTABLISHMENTS MUST SAFEGUARD7

Answer 22

1. access to health (ch V sec 18)
2. Protection from Cruel, Inhuman and Degrading Treatment
   (Chapter V, Section 20)
3. Right to Equality and Non-discrimination (ch V, sec 21)
4. RTI (CH V SEC 22)
5. Right to confidentiality (CH v ec 23 )
6. Right to Restriction on Release of Information in Respect of Mental Illness (cv V sec 24)
7. Right to access medical records (chap V sec 25)
8. Right to Personal Contacts and Communication (Chapter V, Section 26)
9. Right to Legal Aid (Chapter V, Section 27)
10. Right to Make Complaint about Deficiencies in Provision of Services
    (Chapter V, Section 28)

Question 23

Admission
of minor on request of NR

Answer 23

• Chapter XII, Section 87
• (Use Form D for admission request of NR)
• Admission authorization based on opinion of
  2 Psychiatrist/1 Psychiatrist and other MHP/Medical professional (both should have seen patient on day of admission or in preceding 7days)
  Admission criteria:
• A mental illness of a severity requiring admission; * Person likely to benefit from admission and
  treatment;© (this is the least restrictive option)
  At time of admission check for:
• NR has to be legal guardian of minor
• In case of minor girl, female attendant is compulsory
  to stay with child (either a female NR or in case of male
  NR, a female attendant appointed by NR)
  Where to admit: Separate ward for children and adolescents
  Informing board: Inform within 3 days of admission and immediately of admission extending beyond 30 days → Board has to respond within 7 days
  MECT for minor: Prior approval from Board needed, else a prohibited procedure
  Periodic check for age: If patient turns major, change to Section 86

Question 24

sec 90 admissions

Answer 24

Admission authorization based on opinion of
2 Psychiatrist and other MHP/Medical professional (both should have seen patient on day of admission or in preceding 7days)

• Max admission permissible for 90 days
• Periodic check for capacity: Fortnightly
• Inform Board within 7 days of admission → Board
  has to dispose plea within 3 weeks
• If need of extending admission under section 90:
  – 1st time: 120 days
  – Subsequently: 180 days each time

Question 25

Admission of female with child <3 years

Answer 25

• Inform board within 72 hours
• Assess risk of harm to child at admission
• If mother temporarily separated from child due to risk, still allow supervised meetings periodically * Assess status fortnightly
• If admission and separation exceeds 30 days → inform board (Chapter V Section 21(2)(3)(4))

Question 26

duration of loa

Answer 26

any duration

Question 27

Emergency Treatment (Chapter XII, Section 94)

Answer 27

The emergency treatment referred to in this section shall be limited to seventy-two hours or till the person with mental illness has been assessed at a mental health establishment, whichever is earlier.

Question 28

Prohibited Treatment (Chapter XII, Section 95)

Answer 28

zz Electroconvulsive therapy without the use of muscle relaxants and anesthesia
zz Electroconvulsive therapy for minors
zz Sterilization of men or women, when such sterilization is intended as a treatment for
mental illness
zz Chained in any manner or form whatsoever.

Question 29

Chapter XII, Section 96

Answer 29

Restriction on psychosurgery for persons with mental illness.

Question 30

Use of Seclusion and Restrain (Chapter XII, Section 97)

Answer 30

1. only when: only means to prevent imminent and immediate harm to persons , authorised by psychiatrist in charge
2. not longer than absolutely necessary
3. MO or MHP in charge of MHE responsible for ensuring the method, nature of restraint, justification and durn of restraints are immediately recorded
4. not form of punishment or deterrent
5. NR informed within 24 h
6. ongoing supervision
7. monthly restraint reports to concerned board

Question 31

Decriminalization of Suicide (Chapter XVI, Section 115)

Answer 31

Notwithstanding anything contained in Section 309 of the Indian Penal Code any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished under the said Code.

Question 32

Insurance of mental illness

Answer 32

Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness (as right to equality and non- discrimination ) (Chapter V, Section 21

Question 33

OFFENCES: CONTRAVENTION OF PROVISIONS OF ACT

Answer 33

first contravention be punishable with imprisonment for a term which may extend to six months, or with a fine which may extend to ten thousand rupees or with both,

any subsequent contravention with imprisonment for a term which may extend to two years or with fine which shall not be less than fifty thousand rupees but which may extend to five lakh rupees or with both.