Indian laws related to psychiatry

 Mental health act (MHA) 1987

 Mental health care bill (MHC Bill )2013/14

LAWS RELATED TO PSYCHIATRY

Mental Health Act 1987

Mental health act was passed in 1987. This act replaced Indian Lunacy Act 1912. This act was introduced to consolidate the
laws related to madness and also to monitor treatment, detention and care of mentally ill persons. There were some
offensive terms in Indian Lunacy Act 1912 which needed to be replaced. the Indian Lunacy act was passed mainly to
monitor asylum based care and the psychiatric practice.

The need for a new act arose, was changing towards outpatient care which needed better laws for monitoring. Keeping
these things in perspective Indian Psychiatry Society presented a draft of the bill in 1950 named “Indian Mental Health
Act” which was forwarded to government of India. Finally after several modifications, the act was passed in 1987. It has 10
chapters and 98 sections.

Objective of MHA 1987:

1. To consolidate and amend the law relating to the treatment and care of mentally ill persons,
2. To make better provision with respect to their property and affairs and for matters connected therewith or incidental
there to.
The chapters are:

Chapter I (Preliminary): This chapter contains the definitions. Certain new terms have been introduced to replace previous
terms i.e. “mentally ill person” replaces the term “lunatic”, “Mentally ill prisoner” for “criminal lunatic”, “psychiatric
hospital” or “psychiatric nursinghome” for asylum. Some important definitions are:

"Mentally ill person" means a person who is in need of treatment by person of any mental disorder other than mental
retardation;

"Mentally ill prisoner" means a mentally ill person for whose detention in, or removal to, a psychiatric hospital, psychiatric
nursing home, jail or other place of safe custody, an order referred to in Sec. 27 has been made;

"Reception order" means an order made under the provision of this Act for the admission and detention of a mentally ill
person in a psychiatric hospital or psychiatric nursing home;

Chapter II (Mental health authorities): This chapter deals with the procedures for establishment of mental health authorities
at central and state levels. The central authority will perform following functions:

1. Be in charge of regulation, development, direction and coordination with respect to Mental Health Services under
the Central Government and all other matters which, under this Act
2. Supervise the psychiatric hospitals and psychiatric nursing homes and other Mental Health Service Agencies under
the control of the Central Government.
3. Advise the Central Government on all matters relating to mental health; and
4. Discharge such other functions with respect to matters relating to mental health as the Central Government may
require.
State authority will also perform similar functions at state level.
Chapter III (psychiatric hospitals and psychiatric nursing homes): Psychiatric hospitals and nursing homes should be
licensed by the concerned mental health authority. The license is valid for 5 yrs and has to be renewed every five years. The
license can be revoked if the hospital is not maintaining the standards described in the act or the maintenance is carried out
in a way detrimental to moral, mental or physical well being of the patients.

Separate psychiatric hospitals may be established or maintained for:

a. Those who are under the age of sixteen years;

b. Those who are addicted to alcohol or other drugs which lead to behavioral changes in a person ;
c. Those who have been convicted of any offence; and
d. Those belonging to such other or category of persons as maybe prescribed.

Chapter IV (admission and detention in psychiatric hospital or psychiatric nursing home): A mentally ill person may be
admitted in a psychiatric hospital or nursinghome in the following defined ways:

a. Admission as a voluntary patient

b. Admission under special circumstances
c. Reception order on application and on production of mentally ill person before magistrate
d. Admission as inpatient after inquisition
e. Admission as a mentally ill prisoner
a. Admission as a voluntary patient: Any person who considers himself to be suffering from mental illness and requests for
admission can be admitted in psychiatric hospital or nursing home if the medical officer in charge who examines the patient
in last 24 hrs, considers him fit for admission. If a voluntary boarder requests for discharge, the medical officer will
constitute a board consisting of 2 medical officers within 72 hrs of such request. If the board recommends, the admission of
the patient can be continued for up to 90 days as indicated.

b. Admission under special circumstances: A patient may be admitted under special circumstances if a mentally ill patient
does not or is not able to express his willingness to admission in a psychiatric hospital or nursing home and the medical
officer in charge of hospital considers admission necessary for the interest of patient. This admission may extend up to a
period of 90 days. Every application under sub-section (1) shall be in the prescribed form and be accompanied by two
medical certificates, from two medical practitioners of whom one shall be a medical practitioner in the service of
Government. These certificates may not be needed, if the medical officer considers it satisfactory to have the patient
examined by two medical practitioners in the hospital.

c. Reception order: An application for a reception order may be made by

1. The medical officer-in-charge of a psychiatric hospital or psychiatric nursing home, or

2. By the husband, wife or any other relative of the mentally ill person.
A minor or a person who has not seen the patient in last 14 days can’t make an application for reception order. The
application must contain particulars of the case and supported by medical certificates by two medical practitioners (One of
them working government set up). Both of the medical practitioners must have seen the patient independently within the
last 10 days. It should have facts observed (MSE) and facts communicated (history provided) which has led to the opinion
formed by the practitioner.

A police officer will take under protection any mentally ill patient within the limits of his station if he considers him

1. Wandering and incapable of taking care of himself and

2. Reason to believe to be dangerous by reason of mental illness.
3. Patient who is neglected or cruelly treated
He will not detain this patient for more than 24 hrs and present him in front of magistrate for further proceeding with
magistrate’s authority. The magistrate will examine the patient, make necessary enquiries and have the patient examined by
medical officer. Magistrate may issue reception order for patient, if he thinks admission is necessary. If the magistrate
believes that the relatives are neglecting the patient, they may be charged with fine.

The medical officer of a hospital is bound to comply with the reception order.
Chapter V (Inspection, discharge, leave of absence and removal of mentally ill persons): The State or Central Government
will appoint for every psychiatric hospital and nursinghome a team for inspection. The no. of visitors should not be less
than five, of whom at least one will be a medical officer, preferably a psychiatrist and two social workers. The team will go
for inspection at least once a month and they will not have access to personal details of patient.

A patient or his guardian may apply for leave of absence from hospital for a period extending up to 60 days. This is
done with a bond signed by guardian regarding taking proper care of patient, preventing him from causing injury to self and
others and bringing back the patient on completion of leave period.

Chapter VI: This chapter deals with custody rights and property rights of alleged mentally ill persons. An application for
holding an inquisition into mental condition of a person can be made by his relative, public curator, district collector or
advocate general of state. The district court may appoint 2 assessors regarding two issues: whether the person is mentally ill
and if mentally ill, can he take care of himself and/or his property. The court may appoint a guardian or a manager. When
patient’s illness subsides, this provision may be changed.

Chapter VII: This chapter deals with liability to meet cost of maintenance of mentally ill persons detained in psychiatric
hospital or nursinghome.

Chapter VIII (Protection of human rights of mentally ill persons): The human rights of mentally ill person described in this
act are as follows:

1. No mentally ill person shall be subjected during treatment to any indignity (whether physical or mental) or cruelty.
2. No mentally ill person under treatment shall be used for purposes of research, unless -
a. such research is of direct benefit to him for purposes of diagnosis or treatment, or
b. Such person, being a voluntary patient, has given his consent in writing or where such person (whether or not a
voluntary patient) is incompetent, by reason of minority or otherwise, to give valid consent, the guardian or
other person competent to give consent on his behalf, has given his consent in writing, for such research.
3. Subject to any rules made in this behalf under Sec.94 for the purpose of preventing vexatious or defamatory
communications or communications prejudicial to the treatment of mentally ill persons, no letters or other
communications sent by or to a mentally ill person under treatment shall be intercepted, detained or destroyed.
Chapter IX: This chapter deals with penalties and procedures, if guidelines of this act are not followed.

Chapter X: This chapter deals with miscellaneous issues not dealt within other chapters of the act.

Mental Health Care Bill 2013

Mental Health Care Bill, 2013 was tabled in Rajya Sabha on 19th August, 2013. It was passed by Rajya Sabha. But the bill
was not passed by Lok Sabha. If it was passed, it would have repealed MHA 1987.

The most important reason for introduction of this bill was that Indian government signed and ratified the United Nations
Convention on the Rights of Persons with Disabilities in 2007. The Convention requires the laws of the country to align
with the Convention. MHA 1987 was not able to serve this purpose, MHC bill, 2013 was introduced.

The objectives of MHC bill, 2013 are:

“To provide for mental health care and services for persons with mental illness and to protect, promote and fulfil
the rights of such persons during delivery of mental health care and services and for matters connected therewith or
incidental thereto.”

The bill consists of 16 chapters and 136 sections:P MAN RD CS FM MAR ROM
 I. Preliminary
II. Mental illness and capacity to make mental health care and treatment decisions
III. Advance directive
IV. Nominated representative
V. Rights of persons with mental illness
VI. Duties of appropriate government
VII. Central mental health authority
VIII. State mental health authority
IX. Finance, accounts and audit
X. 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

. Preliminary: In 1st chapter contain short title, extent and commencement(start) and definitions related to mental health.
The definitions provided in this chapter include advanced directive, appropriate government, board, caregiver, central
authority, clinical psychologist, commission, family, informed consent, least restrictive alternative, local authority,
magistrate, medical officer in charge, medical practitioner, mental health establishment, mental health nurse, mental
health professional, mental illness, minor, notification, prescribed, prisoner with mental illness, psychiatric social
worker, psychiatrist, regulations, relatives and state authority.
Few important definitions are as follows:
Mental illness: means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs
judgment, behaviour, capacity to recognize 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.

Prisoner with mental illness: means a person with mental illness who is an under-trial or convicted of an offence and
detained in a jail or prison.

Mental health establishment: means any health establishment, including Ayurveda, Yoga and Naturopathy, Unani, Siddha
and Homeopathy establishment, by whatever name called, either wholly or partly, meant for the care of persons with
mental illness, established, owned, controlled or maintained by the appropriate Government, local authority, trust, whether
private or public, corporation, co-operative society, organisation or any other entity or person, where persons with mental
illness are admitted and reside at, or kept in, for care, treatment, convalescence and rehabilitation, either temporarily or
otherwise; and includes any general hospital or general nursing home established or maintained by the appropriate
Government, local authority, trust, whether private or public, corporation, co-operative society, organisation or any other
entity or person; but does not include a family residential place where a person with mental illness resides with his relatives
or friends.

So, any place other than the family residential home where a mentally ill person is being kept is considered to be “mental
health care establishment”.

Psychiatrist: means a medical practitioner possessing a post-graduate degree or diploma in psychiatry awarded by an
university recognized by the University Grants Commission established under the University Grants Commission Act,
1956, or awarded or recognized by the National Board of Examinations and included in the First Schedule of Indian
Medical Council Act, 1956, or recognized by the Medical Council of India, constituted under the Indian Medical Council
Act, 1956, and includes, in relation to any State, any medical officer who having regard to his knowledge and experience in
psychiatry, has been declared by the Government of that State to be a psychiatrist for the purposes of this Act.
Informed consent: means consent given for a specific intervention, without any force, undue influence, fraud, threat,
mistake or misrepresentation, and obtained after disclosing to a person adequate information including risks and benefits of,
and alternatives to, the specific intervention in a language and manner understood by the person.

. Mental illness and capacity to make mental health care and treatment decisions: This chapter has got two components.
The first component deals with the determination of the illness and the second one deals with the treatment decisions.
The determination of mental A making a decision.

. Advance directive: Every person, who is not a minor, shall have a right to make an advance directive in writing,
specifying any or all of the following, namely:
a. the way the person wishes to be cared for and treated for a mental illness;
b. the way the person wishes not to be cared for and treated for a mental illness;
c. The individual or individuals, in order of precedence, he wants to appoint as his nominated representative.
Manner of making an advanced directive: It must be made on plain paper with the person’s signature or thumb impression.
It needs to be signed by 2 eye witnesses and signed by a medical practitioner certifying that the person had the capacity to
take mental health care or treatment decisions and it was made out his free will. It must be registered with the Board in the
district where the person is ordinarily resident. The advance directive shall be valid only after it has been submitted to the
relevant board and the board following a hearing, has certified the validity of the advance directive. If advanced directive
has not been duly signed by medical practitioner or not submitted to the concerned board, the board may determine its
validity.

The advanced directive will come to effect only when the person loses the capacity to take a treatment decision. A
person can change his advanced directive as many times he wishes to do. It is responsibility of the patient to provide the
advanced directive to the treating mental health care professional. It is duty of the treating doctor to follow advanced
directive when treating a patient. If the treating psychiatrist or patient’s relative want not to follow advance directive, they
should apply to the concerned board to review, alter, modify or cancel the advance directive. The advanced directive does
not apply for emergency treatment. A medical practitioner or a mental health professional shall not be held liable for any
unforeseen consequences on following a valid advance directive.

. Nominated representative: Every person who is not a minor has the right to appoint a nominated representative. The
nomination is done on plain paper with the person’s signature or thumb impression of the person who has been referred
in subsection. The nominated representative must not be a minor, must be competent to discharge his duties and must
give his consent in writing to mental health professional to discharge his duties and perform the functions assigned to
him.
All persons with mental illness shall have capacity to make mental health care or treatment decisions but may
require varying levels of support from their nominated representative to make decisions.

If the patient doesn’t have a nominated representative then the following persons will be considered nominated
representative in order of prededence:

a.The individual appointed as the nominated representative in the advance directive

b.A relative, or if not available or not willing to be the nominated representative of such person; or
c.A care-giver, or if not available or not willing to be the nominated representative of such person; or
d.A suitable person appointed as such by the concerned Board; or
e.If no such person is available to be appointed as a nominated representative, the Board shall appoint the
Director, Department of Social Welfare, or his designated representative, as the nominated representative of the
person with mental illness.
The duties of nominated representative:

a. Consider the past and current wishes and best interest of persons with mental Illness.
b. Provide support to the person with mental illness in making treatment decisions.
c. Right to seek information on diagnosis and treatment to provide adequate support to the person with mental illness;
d. To be involved in discharge planning and can apply for discharge on behalf of patient.
e. Can apply to the mental health establishment for admission
f. right to give or withhold consent for research
 g. Apply to the concerned Board against violation of rights of the person with mental illness in a mental health
establishment;
V. Rights of persons with mental illness:

a. Right to access mental healthcare: every person has a right to access mental health care and treatment from
mental health services run or funded by the appropriate Government. This must be provided at affordable
cost, of good quality, available in sufficient quantity, accessible geographically, without discrimination and
in a manner that is acceptable to persons with mental illness and their families and care-givers.

b. Every person with mental illness will have a right to live in society as its part and not continue to stay in
mental health care establishment merely because he does not have a family or is not accepted by his family
or is homeless or due to absence of community based facilities.
c. Every person with mental illness will have a right to live with dignity.
d. Every person with mental illness shall be protected from cruel, inhuman or degrading treatment in any
mental health establishment.
e. Every person with mental illness shall be treated as equal to persons with physical illness in the provision of
all health care.
f. The Insurance Regulatory Development Authority established under the Insurance Regulatory Development
Authority Act, 1999 shall endeavour to ensure that all insurers make provisions for medical insurance for
treatment of mental illness on the same basis as is available for treatment of physical illness.
g. A person with mental illness and his nominated representative shall have the rights to the information of
h. A person with mental illness shall have the right to confidentiality in respect of his mental health, mental
health care, treatment and physical health care.

i. All persons with mental illness shall have right to access their medical records.
j. Right to personal contacts and communication: every person with mental illness has right to make contacts,
refuge to make contacts, sending or receiving mails or making phone calls during admission.
k. Right to legal aid: every person with mental illness has right to get free legal services to exercise his rights.
l. Right to make complaints about deficiencies in provision of services.
VI. Duties of appropriate government:

a. Promotion of mental health and preventive programmes.

b. Creating awareness about mental health and illness and reducing stigma associated with mental illness.
c. Take measures as regard to human resource development and training, etc.
d. Co-ordination within appropriate government.
VII. Central mental health authority:

Establishment of Central Authority: Central government should establish central mental health authority within 9 months of
assent of this act to the president.

Functions of central authority:

a. Register and maintain register of all mental health care establishments.

b. Develop quality and service provision norms for different types of mental health establishments under the Central
Government;
c. Supervise all mental health establishments and receive complaints.
d. Maintain a national register of clinical psychologists, mental health nurses and psychiatric social workers.
e. Train all persons including law enforcement officials, mental health professionals and other health professionals
about the provisions and implementation of this Act.
f. Advise the Central Government on all matters relating to mental health care and services.
VIII. State mental health authority:

Establishment: State government should establish state mental health authority within 9 months of assent of this act to the
president.
Functions of State Authority:

a) Register all mental health establishments in the State except those referred to in section 43 and maintain and publish
(including online on the internet) a register of such establishments;

(b) Develop quality and service provision norms for different types of mental health establishments in the State;

(c) Supervise all mental health establishments in the State and receive complaints about deficiencies in provision of
services;

(d) register clinical psychologists, mental health nurses and psychiatric social workers in the State to work as mental healt h
professionals, and publish the list of such registered mental health professionals in such manner as may be specified by
regulations by the State Authority;

(e) Train all relevant persons including law enforcement officials, mental health professionals and other health
professionals about the provisions and implementation of this Act;

(f) Discharge such other functions with respect to matters relating to mental health as the State Government may decide:

IX. Finance accounts and audit: There is central mental health authority fund and state mental health authority fund. This
chapter deals with the grants provided by central government to central authority, creation of central mental health
authority fund, accounts and audit of central authority and submission of annual report of central authority. The functions
of SMHA are similar.

X. Mental health establishments: Every person or organization planning to establish a metal health establishment must
apply in a prescribed format to respective mental health authority. If the authority is satisfied that the establishment fulfils
the minimum standards specified by the authority, then only registration is provided. The authority will specify the
minimum qualifications for the mental health care professionals and minimum standards for different categories of mental
health establishments.

XI. Mental health review commission: Central government will appoint a review commission within 9 months of assent of
bill to president. This chapter deals with details of constitution, composition, qualification for appointment of members,
term of office, salaries and allowances of review commission. The powers and functions of the Board are:

a. To register, review, alter, modify or cancel an advance directive;

b. To appoint a nominated representative;
c. To receive and decide application from a person with mental illness or his nominated representative against the
decision of medical officer or psychiatrists in charge of mental health establishment or mental health establishment
under section 96 or section 98 or section 99;
d. To receive and decide applications in respect to non-disclosure of information
e. To adjudicate complaints regarding deficiencies in care and services
f. To visit and inspect prison or jails and seek clarifications from the medical officer in charge of health services in
such prison or jail.
XII. Admission, treatment and discharge:

Section 94: “Independent patient or an independent admission” means admission of a person with mental illness to mental
health establishment, who has the capacity to take treatment decisions or requires minimal support in making decisions.

Section 95: Independent admission and treatment: any person with mental illness who has the capacity to make treatment
decisions can be admitted to mental health establishment on his request if the treating psychiatrist feels that his wellness
warrants admission. The person understands the nature and purpose of admission. There is no need for consent from
nominated representative or guardian in this case. Such patient will receive treatment with his informed consent only during
hospitalization and can apply for discharge whenever he wishes to.

Section 96: Admission of minor: a minor patient will be admitted only when his nominated representative has applied for
admission, and if two psychiatrists or one psychiatrist or one mental health professional or one psychiatrist and one medical
practitioner have examined the patient on the day of admission or in the previous 7 days and both independently concluded
that the patient warrants admission. Admission of a minor which continues for a period of thirty days shall be immediately
informed to the concerned Board. The board will review all admissions of minor beyond 30 days and every subsequent 30
days, within 7 days of being informed.

Section 97: Discharge of independent patients: An independent patient admitted under section 95 must be discharged
immediately if patient requests for it or disagrees with admission. But in such condition, a mental health professional may
prevent discharge of this patient for 24 hrs to allow admission of patient under section 98. When a minor admitted under
section 96 attains age of 18 yrs then he must be treated as an independent patient.

Section 98: Supported admission: This section describes supported admission of a patient in mental health establishment up
to a period of 30 days upon application by the nominated representative of the person. The person has been independently
examined on the day of admission or in the preceding seven days, by one psychiatrist and the other being a mental health
professional or a medical practitioner, and both independently concluding on examination and, if appropriate, on
information provided by others, that the person has a mental illness of such severity that the person:

i. Has recently threatened or attempted or is threatening or attempting to cause bodily harm to himself; or
ii. Has recently behaved or is behaving violently towards another person or has caused or is causing another person to
fear bodily harm from him; or
iii. Has recently shown or is showing an inability to care for himself to a degree that places the individual at risk of
harm to himself;
After completion of 30 days, the patient’s stay can be continued as independent admission as per section 95 or
supported admission as per section 99.

During the hospital stay the patient will be treated according to his advanced directive, if not available with informed
consent from patient with support from his nominated representative. If patient needs 100% support from his nominated
representative for treatment decisions then the capacity of patient to give consent should be reviewed every 7 days.

The medical officer or psychiatrist in charge of the mental health establishment shall report the concerned Board
within three days of admission of a woman or a minor and within seven days of admission of any person not being a
woman or minor.

Patient, his nominated representative or any NGO on patient’s behalf can apply to the board against the decision of
admission of the patient.

If patient admitted under this act has been discharged and is admitted again within a period 7 days then readmission is
done under section 99.

Section 99: This section deals with:

1. Readmission of patient within 7 days of discharge of admission under section 98

2. Continuous admission beyond 30 days.
For this 2 psychiatrists must examine the patient independently in last 7 days and they must conclude that patient warrants
admission. The in charge of mental health establishment will report admissions under this section to concerned board
within 7 days of admission. The board will review this admission within 21 days of admission and consider discharge or
continuous admission of such patient. The admission under this section may extend up to 90 days in first instance, followed
by up to 120 days and after that 180 days each time after complying with the provisions.

Section 100: this section deals with leave of absence of patient from mental health establishment.

Section 101: Absence without leave or discharge: If a patient leaves mental health establishment without leave or
discharge, he shall be taken into custody by police officer on request of the in charge of the establishment.

Section 102: This section deals with Transfer of persons with mental illness from one mental health establishment to
another mental health establishment.

Section 103: Emergency treatment: Any medical treatment including treatment for mental illness may be provided by a
medical practitioner with the informed consent of nominated representative where it is immediately necessary to prevent
death or irreversible harm to health of patient; person inflicting serious harm to himself or to others or causing harm to
property belonging to self or others. Electroconvulsive therapy is not included in emergency treatment. Emergency
treatment is considered for 72 hrs or till the patient is examined in mental health establishment.

Section 104: Prohibited procedures: the following treatments shall not be performed on any person with mental illness:

a) Electro-convulsive therapy without the use of muscle relaxants and anesthesia;

b) Electro-convulsive therapy for minors;
c) Sterilization of men or women, when such sterilization is intended as a treatment for mental illness;
d) Chained in any manner or form whatsoever.
If ECT is to be given to minor patient, it must be done after prior permission from the concerned board.

Section 105: Restriction on psychosurgery for persons with mental illness: Psychosurgery will not be performed without
informed consent from patient and approval of concerned board.

Section 106: Restraints and seclusion will be done only to prevent imminent and immediate harm to patient and others and
must be authorized by psychiatrist in charge of patient’s treatment. The nominated representative must be informed within
24 hrs of every incidence of applying restrains and seclusion. All incidences of restraint and seclusion will be reported to
concerned board on monthly basis.

Section 107: Discharge planning: When planning for discharge, the treating psychiatrist should plan for future treatment
after discussion with patient, family members and future consultant psychiatrist.

Section 108: The professionals conducting research will obtain free and informed consent from all persons with mental
illness. In interventional studies, when patient is not able to give consent, it must be obtained from state authority.

XIII. Responsibilities of other agencies:

a) Duties of police officers in respect of persons with mental illness: A police officer will take under protection a
mentally ill person who is found wandering or is risk to himself or others. He will take the patient to nearest health
care establishment within 24 hrs of taking him under protection.
b) If a person with mental illness is being ill treated or being abused, then the police officer in charge of that area will
take patient under their protection and present him in front of magistrate. Magistrate may order the patient to be
assessed, treated and admitted in mental health establishment as indicated.
XIV. Restriction to discharge functions by professionals not covered by profession: No mental health professional or
medical practitioner shall discharge any duty or perform any function not authorized by this Act or specify or recommend
any medicine or treatment not authorized by the field of his profession.

XV. Offences and penalties: Penalty for establishing or maintaining mental health establishment in contravention of
provisions of this act ranges from 5000 to 50,000 Rs for first offence, 50,000 to 2 lakhs for second time and 2 lakhs to 5
lakhs for third time. For breaking other rules, the punishment ranges from 6 months to 2 yrs with or without fine.

XVI. Miscellaneous:

Any person who attempts suicide will be presumed to be suffering from mental illness at the time of committing suicide
until proven otherwise and shall not be liable to punishment under the 309 IPC. The government has duty to provide, care
and treatment to such persons.

Positive aspects of MHC Bill 2013:

1. The main focus of this bill is protection of rights of mentally ill patients.
2. Decriminalization of suicide is a progressive step.
3. The broadening of definition of mental health establishment is going to prevent abuse and treatment by unscientific
means of mentally ill patients in establishments not previously considered in this category.
4. Prohibition of sterilization and chaining of patients is a step towards stopping abuse of mentally ill patients.
Criticism of MHC Bill 2013:

1. Application of this bill is going to increase the paper work of mental health professionals manifold. (Antony 2013)
2. The infrastructure in our country is not capable of dealing with provision of advanced directive. Application of
advanced directive was not successful even in developed countries. Provision of advanced directive exclusively to
mentally ill patients is not appropriate. The resources may not always be available for treatment as per the guidance of
advanced directive.
3. The definition of mental illness has been broadened. The stigma associated with mental illness may prevent patients
from seeking treatment. (Antony 2013)
4. The manpower needed to implement this bill is huge which is going to be an obstruction in its implementation.
5. There is no mention from where funds will be obtained to implement this bill.
6. The nominated representative has access to all the information regarding patient’s records, details of diagnosis and
treatment. This may jeopardize patient’s privacy and may be detrimental in related legal issues.
7. Unmodified ECT is a practical reality in many mental hospitals and is very useful and frequently a life saving
procedure. This has been prohibited. The prohibition of use of ECT in minor is also a problematic issue.
8. The broadening of definition of mental health establishment is going to discourage the admission of patients in general
hospital settings.
9. The board that is going to monitor the treatment and assessment of mentally ill persons by psychiatrists is not
constituted primarily by doctors and is separate from medical council of India. This separates psychiatry from other
branches of medicine. (Antony 2013)
There is lack of emphasis on community care of the mentally ill persons.