This document provides an overview of mental health laws and policies in India, including: 1. It summarizes the history of mental health acts in India from the 1858 Indian Lunatic Asylum Act to the present-day Mental Health Care Bill of 2013. 2. It describes the key aspects and chapters of the Indian Lunacy Act of 1912 and the Mental Health Act of 1987, including definitions, admission procedures, and establishment of psychiatric hospitals. 3. It outlines the proposed amendments in the Mental Health Care Bill of 2013, such as expanded definitions of mental illness, the introduction of advance directives and nominated representatives, and establishment of new governing bodies.

1. PRESEN TER - D R. MAY U RI MO H A N TY ,
RESI D EN T- 3 R D Y EA R,
BH A RATI H O SPI TA L.
MENTAL HEALTH ACT

2. CONTENTS
• History
• Indian lunacy act,1912
• Mental health act,1987
 Chapters
 Prerequisites for psychiatric hospitals
 Admission & detention in psychiatric hospitals
 Reception order
• Mental health bill,2013
 Definition
 Chapters
 Amendments proposed
 Advanced directive
 Nominated representative
 Admission & discharge
 Mental health establishment
 Mental health review commission

3. HISTORY
• Mental health care acts in india was covered in two phases-
pre-independence and post independence.
• Pre-independence-
1858- Indian Lunatic asylum act of 1858
1912- Indian Lunacy act of 1912
• Post Independence
1947- Indian Psychiatric Society established
1987-Mental health Act of 1987
• Mental health care bill (Proposed) ,2013

4. INDIAN LUNACY ACT
• Act 4 of 1912
• Replaced Lunatic Asylums Act , Act 36 of 1858
• Enacted to govern reception, detention and care of lunatics and
their property, and to consolidate and amend the laws relating
to lunacy.
• 8 chapters consisting of 100 sections
• Provided punishment if two or more “lunatics” are illegally
detained for gain in any place other than asylum.

5. MENTAL HEALTH ACT , 1987
• It is an “act to consolidate and amend law relating to mentally
ill persons, to make better provision with regard to property
and affairs and for matters connected therewith & connected
thereto”.
• Act is divided into 10 chapters consisting of 98 sections.

6. CHAPTERS
• Chapter I – Definition
• Chapter II – Mental Health authorities
• Chapter III – Psychiatric Hospitals & Psychiatric nursing
homes
• Chapter IV – Admission & detention in psychiatric hospitals or
psychiatric nursing homes
• Chapter V- Inspection , discharge, Leave of absence and
removal of mentally ill persons

7. • Chapter VI – Judicial inquisition regarding mentally ill person
possessing & managing his property
• Chapter VII – liability to meet cost of maintenance of mentally ill
persons detained in psychiatric hospitals
• Chapter VIII – Protection of human rights of mentally ill persons
• Chapter IX – penalties & procedures
• Chapter X - Miscellaneous

8. • Reception Order
Order for admission and detention of a mentally ill person by a psychiatric hospital.
• Psychiatric Hospital-
Hospital established or maintained by government or any other person for treatment &
care of mentally ill persons & includes a convalesent home established & maintained by
govt or private party . It doesn’t include general hospitals with psychiatry wards.
 It gave definition to ‘Mentally ill persons’ replacing ‘lunatics’ & ‘psychiatric hospital’
replacing ‘asylum’.
OUTDATED TERMS NEW TERMS
Nursing Home/Asylum Psychiatric Hospital
Lunatic Mentally ill person
Criminal Lunatic Mentally ill prisoner

9. PREREQUISITES FOR PSYCHIATRIC
HOSPITALS
(ESTABLISHMENT OR MAINTENANCE)
• A valid license granted under the act by licensing authority
if :
1. Receipt of application for license.
2. On enquiry, such establishment or maintenance is
necessary.
3. Minimum facilities for admission, treatment & care of
mentally ill persons.
4. Incharge is a medical officer who is a psychiatrist
5. License is not transferable or heritable.
6. Valid license for 5 years following which needs renewal.

10. • License can be revoked if licensing authority feels that :
1. Psychiatric hospital not maintained by licensee in accordance of
the act.
2. Maintenance is carried out in a detrimental to moral, mental or
physical well-being of patients.

11. ADMISSION & DETENTION IN
PSYCHIATRIC HOSPITALS
Admission in one of the following ways :
1. Voluntary
2. Special circumstances (not more than 90 days)
3. Reception order on application
4. Reception order on production of mentally ill person before
magistrate
5. Inpatient after inquisition
6. Mentally ill prisoner

12. RECEPTION ORDER
• A reception order for admission can be obtained from
magistrate by:
a. A petition or application which contains particulars of
case and is presented by husband or wife of alleged
mentally ill person.
b. Supported by two medical certificate , one of which
shall be from a medical practitioner in the service of
Government.

13. • Reception order without petition can be issued by a Magistrate, if
an officer in-charge of a police station arrests a: Wandering
mentally ill person, who is believed to be incapable of taking care
of himself, or Dangerous or Ill treated or neglected mentally ill
person

14. MENTAL HEALTH CARE BILL 2013
• “to provide for mental health care and services for persons
with mental illness and to protect, promote and fulfill the
rights of such persons during delivery of mental health care
and services and for matters connected therewith or incidental
thereto “
• 16 chapters and 137 clauses.

15. DEFINITION OF MENTAL ILLNESS
“Disorder of mood, thought, perception,orientation and memory
which causes significant distress to a person or impairs that
person’s ability to meet the demands of daily life and includes
mental conditions associated with the abuse of alcohol and other
drugs, but does not include mental retardation”

16. STATEMENT OF OBJECTS AND REASONS
• The United Nations Convention on the Rights of Persons with
Disabilities, which was signed by the Government of India in
October, 2007, made it obligatory on the Government to align the
policies and laws of the country with the Convention.
• Bill was introduced by then health minister - Ghulam Nabi Azad on
7th august in Rajya sabha.
• The need for amendments to the Mental Health Act, 1987 was felt
by the fact that the related law, i.e., the Persons with Disabilities
(Equal Opportunities, Protection of Rights and Full Participation)
Act, 1995 was also in the process of amendment.

17. CHAPTERS
• Chapter I – PRELIMINARY
• Chapter II – MENTAL ILLNESS AND CAPACITY TO
MAKE MENTAL HEALTH CARE AND TREATMENT
DECISIONS
• Chapter III – ADVANCE DIRECTIVE
• Chapter IV – NOMINATED REPRESENTATIVE
• Chapter V- RIGHTS OF PERSONS WITH MENTAL
ILLNESS

18. • Chapter VI – DUTIES OF APPROPRIATE GOVERNMENT
• Chapter VII – CENTRAL MENTAL HEALTH AUTHORITY
• Chapter VIII – STATE MENTAL HEALTH AUTHORITY
• Chapter IX – FINANCE, ACCOUNTS AND AUDIT
• Chapter X - MENTAL HEALTH ESTABLISHMENTS
• CHAPTER XI -
MENTAL HEALTH REVIEW COMMISSION

19. • CHAPTER XII- ADMISSION, TREATMENT AND DISCHARGE
• CHAPTER XIII- RESPONSIBILITIES OF OTHER AGENCIES
• CHAPTER XIV - RESTRICTION TO DISCHARGE
FUNCTIONS BY PROFESSIONALS NOT COVERED BY
PROFESSION
• CHAPTER XV- OFFENCES AND PENALTIES
• CHAPTER XVI - MISCELLANEOUS

20. AMENDMENTS PROPOSED
• Definition of mental illness
• Advance directive
• Nominated representative
• Admission procedures like independent admissions, supported
admissions
• Treatment procedures like emergency
• Insurance for mental illnesses
• Shelter homes , supported accomodation, community based
rehabilitations
• rights for person with mental illness to seek information about
illness , treatment plan & procedures

21. • New governing bodies like mental health review commission
(MHRC) and state wise mental health review boards( MHRB).
• ECT without anaesthesia is banned & psychosurgery is
restricted.
• Medical research on person with mental illness can be done
with their free and informed consent.
• Decriminalizes suicide

22. ADVANCED DIRECTIVE
• Right to make an Advanced directive –right to decide how a
patient should or should not be cared and treated for a mental
illness in the future.
• Every person who is not a minor has the right to make an
advance directive specifying any of the following
a) the way a person wishes to be cared for and treated for a
mental illness
b)the way he wishes not to be so cared for and treated for a
mental illness
c)nominated representative.

23. NOMINATED REPRESENTATIVE
1. Right to appoint a nominated representative.
2. The nomination shall be made in writing on plain paper with the
person’s signature or thumb impression of the person referred to.
3. Nominated representative shall not be a minor, be competent to
discharge the duties or perform the functions assigned to him
under this Act, and give his consent in writing to the mental
health professional

24. 4. In case no nominated representative was chosen, following people
will be chosen for the purpose of this act:––
(a) the individual appointed as the nominated representative in the
advance directive or
(b) a relative,
(c) a care-giver
(d) a suitable person appointed as such by the concerned Board; or
(e) if no such person is available, the Board shall appoint the Director,
Department of Social Welfare, or his designated representative, as the
nominated representative of the person with mental illness

25. 5. The representative of the organization, referred to in the proviso
to sub-section (4), may make a written application to the medical
officer in charge of the mental health establishment or the
psychiatrist in charge , as the case may be, to accept him as the
temporary nominated representative.
6. A person who has appointed any person as his nominated
representative under this section may revoke or alter such
appointment at any time.
7. The Board may revoke an appointment made by it under this
section, and appoint a different representative under this section.

26. RIGHTS & DUTIES OF NOMINATED
REPRESENTATIVE
• Duty to support PMI in making treatment decision.
• Information on diagnosis & treatment.
• Right for discharge planning.
• Consent for treatment modalities.
• Appoint a suitable attendee.

27. ADMISSION
• Independent Admission
• Admission of a minor
• Supported Admission upto 30 days
• Supported Admission beyond 30 days

28. Admission
Independent admission Admission
of Minor
Supported
admission under 30
days
Supported
admission beyond
30 days
• Not a minor
• Self requests for
Admission
• Severity of illness
needs Admission
• PMI benefits from
Admission
• Not under
influence
• Doesn’t need
Support for
decisions
• Capable to take
decisions
Application by
nominated
representative
of minor
• Severity of illness
requires
admission
• To ensure his or
her health, well-
being or safety,
• Community based
alternatives to
admission have
been shown to
have failed
Application by
nominated
representative
• Bodily harm to
himself; or
• Behaving violently
towards another
person or is causing
another person to
fear bodily harm
from him; or
• Inability to care for
himself to a degree
that places the
individual at risk of
harm to himself
Application by nominated
representative beyond thirty
days or readmission within 7
days of such discharge
• Bodily harm to
himself; or
• Behaving violently
towards another person
or is causing another
person to fear bodily
harm from him; or
• Inability to care for
himself to a degree
that places the
individual at risk of
harm to himself

29. Discharge
Independent admission
• On request
• Minor becoming
major under
inpatient care &
can decide as
independent
patient.
• Psychiatrist in
charge
Admission of Minor
• nominated representative
• On becoming an adult
• Psychiatrist in charge
Supported admission
under 30 days
• At end of 30
days no longer
meets criteria
for admission
• Nominated
representative
• Psychiatrist in
charge
Supported
admission
beyond 30 days
• Nominated
representative
• Mental health
review board
• Psychiatrist in
charge

30. LEAVE OF ABSENCE
• Granted by medical officer/ Psychiatrist after consent from
nominated representative
• Power to terminate with Psychiatrist
• If person doesn’t return, contact the person on leave or
nominated representative
• If patient on leave requires patient care and nominated
representative feels so, police officer can be sought out to get
back PMI.

31. ABSENCE WITHOUT LEAVE
• Taken into protection by police officer at the request of
psychiatrist in charge and brought back to establishment

32. EMERGENCY TREATMENT
• By any registered medical practitioner , subject to informed
consent by nominated representative
• To prevent:
a) Irrevesible harm to health of PMI or death
b) Person inflicting harm to self or others
c) Person causing damage to property
• Emergency treatment limited to 72 hours
• In disasters extended to 7 days
• Ect is not emergency procedure

33. PROHIBITED PROCEDURES
• Ect without anaesthesia
• Ect for minor
• Sterilisation of men/women as treatment for mental illness
• Chained in any manner

34. • ECT with consent of nominated representative & permission
of board
• Psychosurgery with consent of PMI & board.

35. MENTAL HEALTH ESTABLISHMENTS
• “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;

36. REGISTRATION OF MENTAL HEALTH
ESTABLISHMENT
(1) No person or organisation shall establish or run a mental health
establishment unless it has been registered with the Authority under the
provisions of this Act.
“Authority” meaning—
(a) Hospitals under Central Government, the Central Authority;
(b) Hospitals not included in (a) , the State Authority.
(2) Every person or organisation who proposes to establish or run a mental
health establishment shall register the said establishment with the Authority
under the provisions of this Act.
(3) The Authority shall, on receipt of application , on being satisfied that such
mental health establishment fulfills the standards specified by the Authority,
issue a certificate of registration in such form as may be prescribed:

37. (4) Every mental health establishment shall, for the purpose of registration and
continuation of registration, fulfill––
(a) the minimum standards of facilities and services;
(b) the minimum qualifications for the personnel
(c) provisions for maintenance of records and reporting
(d) any other conditions as may be specified by regulations made by the
Central Authority.
(5) The Authority may––
(a) classify mental health establishments into such different categories, as may
be specified by regulations made by the Central Authority;
(b) specify different standards for different categories of mental health
establishments;
(c) while specifying the minimum standards for mental health establishments,
have regard to local conditions.

38. (6) the Authority shall, within a period of eighteen months from
the commencement of this Act, by notification, specify the
minimum standards for different categories of mental health
establishments.

39. Submit an application
provisional certificate by concerned Authority - valid for a period of
twelve months
Authority publish in print and in digital form within a period of forty-five
days
period of six months from date of notifying such standards, apply and obtain
permanent registration
Authority within a period of thirty days grant permanent certificate of
registration
Every mental health establishment has to display the certificate
PROCEDURE FOR REGISTRATION OF
MENTAL HEALTH ESTABLISHMENTS

40. CENTRAL MENTAL HEALTH
AUTHORITY
• The Central Government shall, within a period of nine months
from the date on which this Act receives the assent of the
President, by notification, establish, for the purposes of this Act,
an Authority to be known as the Central Mental Health
Authority.
• Composition of Central Authority :
1. Secretary or Additional Secretary in the Department of Health
and Family Welfare –chairperson
2. Joint Secretary in the Department of Health and Family
Welfare - members

41. 3. Joint Secretary in the Department of Ayurveda, Yoga and
Naturopathy, Unani, Siddha and Homeopathy— member ex officio;
4. Director General of Health Services––member ex officio;
5. Joint Secretary in the Department of Disability Affairs of the
Ministry of Social Justice and Empowerment–– member ex officio;
6. Joint Secretary in the Ministry of Women and Child
Development–– member ex officio;
7. Directors of the Central Institutions for Mental Health ––
members ex officio;

42. 8. one mental health professional as defined as having at least fifteen
years experience in the field, to be nominated by the Central
Government—member;
9. one psychiatric social worker having at least fifteen years
experience in the field, to be nominated by the Central Government–
–member;
10. one clinical psychologist having at least fifteen years experience
in the field, to be nominated by the Central Government––member;
11. one mental health nurse having at least fifteen years experience in
the field of mental health, to be nominated by the Central
Government––member;

43. 12. two persons representing persons who have or have had mental
illness, to be nominated by the Central Government––members;
13. two persons representing care-givers of persons with mental
illness or organisations representing care-givers, to be nominated by
the Central Government—members;
14. two persons representing non-governmental organisations which
provide 25 services to persons with mental illness, to be nominated
by the Central Government––members.
• The members of the Central Authority referred to in clauses (h) to
(n) of sub- 30 section (1) of section 34 shall hold office as such for
a term of three years from the date of nomination and shall be
eligible for re-appointment:

44. STATE MENTAL HEALTH AUTHORITY
• Every State Government shall, within a period of nine months from the date on
which this Act receives the assent of the President, by notification, establish, for
the purposes of this Act, an Authority to be known as the State Mental Health
Authority.
• The State Authority shall consist of the following chairperson and members:—
(a) Secretary or Principal Secretary in the Department of Health of State
Government–– chairperson ex officio;
(b) Joint Secretary in the Department of Health of the State Government, in charge
of mental health–– member ex officio;
(c) Director of Health Services or Medical Education––member ex officio;

45. (d) Joint Secretary in the Department of Social Welfare of the State
Government— member ex officio;
(e) Superintendent of any of the Mental Hospitals in the State or Head
of Department of Psychiatry at any Government Medical College, to
be nominated by
the State Government–– member;
(f) one eminent psychiatrist from the State not in Government service
to be nominated by the State Government–– member;
(g) one mental health professional as defined as having of least fifteen
years experience in the field, to be nominated by the State
Government—member;

46. (h) one psychiatric social worker having at least fifteen years
experience in the field, to be nominated by the State Government–
–member;
(i) one clinical psychologist having at least fifteen years experience
in the field, to be nominated by the State Government––member;
(j) one mental health nurse having at least fifteen years experience
in the field of mental health, to be nominated by the State
Government––member;
(k) two persons representing persons who have or have had mental
illness, to be nominated by the State Government––member;
(l) two persons representing care-givers of persons with mental
illness or organisations representing care-givers, to be nominated
by the State 20 Government ––members;
(m) two persons representing non-governmental organisations
which provide services to persons with mental illness, to be
nominated by the State Government — members.

47. MENTAL HEALTH REVIEW BOARD
Each Board shall consist of––
(a) a District Judge, or an officer of the State judicial services who is
qualified to be appointed as District Judge or a retired District
Judge who shall be chairperson of the Board;
(b) (b) representative of the District Collector or District Magistrate
or Deputy Commissioner of the districts in which the Board is to
be constituted;
(c) two members who shall be mental health professionals of whom at
least one shall be a psychiatrist;
(d) two members who shall be persons with mental illness or care-
givers or persons representing organisations of persons with
mental illness or care-givers or non-governmental organisations
working in the field of mental health.

48. POWERS AND FUNCTIONS OF BOARD.
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 or any other interested person 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 non-disclosure of
information specified under sub-section (3) of section 25;
(e) to adjudicate complaints regarding deficiencies in care and services
specified under section 28;
(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.

49. MENTAL HEALTH REVIEW
COMMISSION
(1) The Central Government shall, within nine months from the date
on which this Act, constitute the Mental Health Review
Commission to exercise the powers conferred upon and to perform
the functions assigned to it under this Act.
(2) The head office of the Commission shall be at Mumbai.
(3) Composition of Commission :
• The Commission shall consist of a president and four members.
• The president and members of the Commission shall be appointed
by the President of India
• Provided that in case a serving Chief Justice of a High Court or a
Judge of the High Court with five years experience is appointed as
the president of the Commission, he shall be appointed in
consultation with the Chief Justice of India.

50. 4. Out of the four members referred to in section 74, one each shall
be chosen from amongst—
(a) psychiatrists having at least fifteen years experience in the field;
(b) persons with mental illness or representatives of persons with
mental illness;
(c) representatives of families and care-givers to person with mental
illness or of non-Governmental organisations working in the field of
mental health;
(d) persons having at least fifteen years of experience in public
administration.

51. Mental health act Mental health bill
Patients Mentally ill persons Person with mental illness
(PMI)
Psychiatric hospitals • Doesn’t include general
hospitals with psychiatry
ward.
• Called Mental Health
establishment
• Includes general hospitals
with psychiatry ward
Admission 1. Voluntary
2. Special circumstances
(not more than 90 days)
3. Reception order on
application
4. Reception order on
production of mentally
ill person before
magistrate
5. Inpatient after
inquisition
6. Mentally ill prisoner
1. Independent Admission
2. Supported Admission
upto 30 days
3. Admission of a minor
4. Supported Admission
beyond 30 days

52. Emphasis Regulation of Psychiatric
hospitals & treatment of
mentally ill person
Right of person with mental
illness
Advance directive absent present
Nominated representative absent present
Governing bodies • Central Authority
• State Authority
• Central mental health
authority
• State mental health
authority
• Mental health review
commission

53. AGAINST MENTAL HEALTH BILL,2013

54. CRITICAL APPRAISAL
• over-inclusive definition for mental illness likely to increase
stigma. Also suggests that we need to have a precise definition.
• huge resource-mobilization
• Urges all psychiatrists to come together because bill threatens
future of psychiatry
• No words on how it would persuade victims of "mental
illnesses," mild and severe, to avail services from the right
kind of institutions, overcoming their stigma-based inhibitions.

55. • Punishment for private individuals or companies, who while
running institutions, fail to comply with prescribed regulations .
• No regulations about government functionaries that may fail the
promises they offer.
• No elaboration of methods of prevention of exploitation of mentally
ill persons in "non-mental-health institutions," as is happening now.
• No definite budget for the bill.
• matter of state government & not central.

56. • A 'mentally ill person' stating that a person who is determined on
the basis of a due process, as needing compulsory treatment in a
mental health establishment, because of either serious mental
disease, or profound mental retardation.”
• He also suggested that mental health establishments wouldn’t have
relatives during admission period.
• General hospitals not to be treated as mental health establishment.
• Advance directive only for PMI is unfair, should be applied in
other fields as well.

57. • Psychiatrists to be projected in bad light
• It’s a measure to control this branch of physicians.
• Guidance document to guide diagnosis & treatment. As well as ban
on ECT without anaesthesia.

59. CRITICAL APPRAISAL
• resource burden
• increase burden on caregiver and mental health professionals
• Restriction on treatment modality
• No details on budgets and promises made
• mental health act has still not been fully applied

60. FOR MENTAL HEALTH BILL,2013

61. THANK YOU