This presentation is on Mental Health Act, Indian Lunacy Act and Rights of Patient. Mental Health Nursing one of core subject of B.Sc. Nursing Third Year. BIBILIOGRAPHY R SREEVANI “A Guide to Mental Health & Psychiatric Nursing” 3rd Edition Jaypee Medical Publisher Pp: 345 to 350 Shelia L Vedibeck “Psychiatric Mental Health Nursing” 5th Edition Lippincott & Williams. Mary C Townsend “Essential of Psychiatric health nursing” 7th Edition F A Devis 2013. ANTONY JAMES T (2000): “A decade with the mental health act, Indian Journal of Psychiatry, 42(4) Kothari, Jaya “Moving towards autonomy & equity an analysis of mental health care bill 2013”

2. OBJECTIVES
Specific Objectives
At the end of teaching students will be able to,
•Describe their behavior in legal issues regarding mental
health Nursing.
•Explain the Mental Health Act
•Describe the nursing implication of MHA
•Describe the Indian Lunacy Act
•Enumerate the Mental Health Care Bill
•Enlist the rights of patient

5. History
The Indian Mental Health Act (MHA) was drafted by the
parliament in 1987, but it came into effect in all States and UT
of India in April 1993. This Act replaces the Indian Lunacy Act
1912.
Reason for Enactment
•The mentally ill individuals should be treated like any other
sick persons and the environment around them made as
normal as possible.
•The experience of working of the Indian Lunacy Act, 1912
has revealed that it has become outmoded with rapid
advancement of medical science, therefore become
necessary to make fresh legislation in accordance with new
approach.

6. Objectives of the Indian Mental Health Act
•To regulate admission into psychiatric hospitals and
psychiatric nursing home.
•To protect citizen from being detained in psychiatric
hospitals/nursing homes without cause.
•To protect society from the presence of mentally ill persons.
•To regulate maintenance charges of psychiatric hospital.
•To provide facilities for establishing guardianship of mentally
ill person who are incapable of managing their own affairs.
•To establish central and state authorities for mental health
services.
•To regulate the power of the government for establishing,
licensing and controlling psychiatric hospitals.
•To provide legal aid to mentally ill persons at state expense
in certain cases.

7. The Act is divided into 10 chapters consisting of
98 section

8. It contains the preliminary information. Some definitions included in this
are:
Psychiatric Hospitals: A hospital/nursing home established or
maintained by the government or any other person for the care of
mentally ill persons.
Mentally ill person: A person who is in need of treatment by reason of
any mental disorder other than mental retardation.
Psychiatrist: A medical Practitioner possessing a PG or diploma in
psychiatry recognized by the MCI.
Reception Order: An order made under the provision of this Act for the
admission and detention of mentally ill persons in a psychiatric
hospitals.
Old terms New terms
Lunatic Mentally ill person
Lunatic asylum Psychiatric hospital
Criminal Lunatic Mentally ill prisoner

9. It deals with establishment of Central and State authorities for
regulation and coordination of health services.
It provides guidelines for establishment and maintenance of psychiatric
hospitals/nursing homes.

10. It deals with the procedures for admission and detention n
psychiatric hospitals.
TYPES OF
ADMISSION
ADMISSION UNDER
VOULANTRAY
BASIS
SEC. 15 & 16.
ADMISSION UNDER
AUTHORITY/ORDER
RECEPTION ON
APPLICATION SEC.
20
RECEPTION ON
PRODUCTION
BEFORE
MEGISTRATE SEC.
23
RECEPTION AFTER
INQUEST SEC. 26
MENTALLY ILL
PRISONER SEC. 27
ADMISSION UNDER
SPEACIAL
CIRCUMSTENCES
SEC. 19

11. ADMISSION ON VOULNTARY BASIS
Request by
a
major/guardi
an of the
minor for
admission
to medical
officer
Medical
officer
makes
enquiries for
24 hours
If the MO is
satisfied for
admission
and opines
requirement
for
treatment.
Voluntary
admission
is made

12. ADMISSION UNDER SPECIAL CIRUMSTANCES
Involuntary Admission is made.
If the MO is satisfied for admission
Medical officer makers enquiries within 24 hours.
Patient is unwilling or unable to make a request for admission, a relative/friend
makes an application to the medical officer on belahf of patient

13. ADMISSION UNDER AUTHORITY OF ORDER.
PETITION
EXAMINATION
DETERMINATAION
MEDICAL ADMIISTRATION
RELEASE
HOSPITALIZATION
EMERGENCY
SHORT TERM
LONG TERM

14. •Reception order on application
Only a relative or friend makes application to magistrate.
Application should be supported by two medical certificates,
Magistrate obtains consent from the medical officer in-charge of mental
hospital.
Admission under reception order is made.
•Reception order on production before magistrate
Mentally Ill patient exhibiting violent behavior detained by police officer.
Production in the court within 24 hours of detention.
Application is supported by two medical certificates.
Magistrate issues reception order.

15. •Reception order after inquest.
A district court holding an inquisition regarding any person
who is found to be mentally ill, in the interest of such person,
may, by order direct for admission. Every such order may be
varied from time to time.
•Admission of a mentally ill prisoner
A mentally ill prisoner may be admitted into a mental
hospital on order of the presiding officer or a court.

16. It deals mainly with the procedure to be followed for the discharge of
mentally ill persons from the mental hospitals.
•Discharge of a patient admitted on voluntary basis.
MO of hospital on recommendation from two medical practitioners
can issue direction for discharge of patient.
•Discharge of a patient admitted under special circumstances
A relative or a friend makes an application to the medical officer for care
and custody of the patient. The relatives are required to furnish a bond,
along with an undertaking that the mentally ill person shall be
prevented from causing injury to self and others.
•Discharge of a patient admitted on reception of order.
An application is made.
A certificate from medical officer-in-charge of psychiatric hospital.
A magistrate issues an order if patient is fit for discharge.

17. •Discharge of a mentally ill Prisoner
The hospital authorities have to report every 6 months about
the persons state of mind to the authority, which had ordered
detention. As soon as they find that the person is fit to stand
the trial, they have to inform about the same to the authority
concerned. The person is then handed over to the prison
officer for further legal action.
•Leave of Absence (section 45)
Leave of absence means, when mentally ill patients are
detained in a hospital, they may be given time limited leave,
to leave the hospital with permission to visit family members.
It is a step towards community treatment.

18. It deals with judicial enquiry regarding mentally ill persons possessing
property, their custody and management of property. Under section
54(1) a guardian may be appointed by court of law on behalf of an
alleged mentally ill person incapable of looking after self and property.
It deals with way and means to meet the cost of maintenance
of mentally ill persons detained in psychiatric hospitals. Under
section 78 when a mentally ill patient is detained as an
inpatient and does not have property to bear the cost of
treatment in such cases his expenses shall be borne by the
govt.

19. It is the latest addition to the act that contains very novel and explicit
provision for protection of human rights of mentally ill persons.
•No mentally ill person shall be subjected during treatment to any
indignity or cruelty.
•No mentally ill person under treatment shall be used for research
•No communication channels are broken.
It deals with procedures to be followed for the establishment
and maintenance of psychiatric hospitals/nursing homes, and
the penalties, which can be relatively severe and explicit, for
contravening them.

20. It deals with clarification pertaining to certain
procedures to be followed by the medical officer of
the hospital.

21. NURSING IMPLICATION OF MENTAL HEALTH ACT
A psychiatric nurse is in the ward 24 hours of the day and the
final responsibility of the ward management is on the nurse.
She should therefore, be well-versed in legal aspects of care
and treatment of the mentally ill. This knowledge helps her to
guide the patients and relatives in matters related to rights of
the patient and other aspects of mental health. The legal and
ethical contest of care is important for all psychiatric nurses
because it focuses concern on the rights of patient and the
quality care they receive.

23. It is derived from English Lunacy Act. 1890 and it contains
eight chapters, Act 4 of Indian Lunacy Act(IL A), 1912,
replaced Act 36 of the Indian Lunatic Asylums Act, 1858.
It was enacted to govern reception, detention and care of
lunatics and their property and to consolidate and amend
the laws related to lunacy. The act is divided into 4 parts 8
chapters and 100 section. The enactment of ILA of 1912
was followed by opening of many new asylums, and an
increase in awareness regarding the prevailing situation
of lunatics in such asylums.

24. Chapter 1: It contains some preliminary information and
definitions.
Chapter 2: It contains mainly the procedures to be followed
to admit a patient.
Chapter 3: It describes the procedure to be followed for
administrating care, treatment and discharge.
Chapter 4: It deals with proceeding of lunacy in presidency
town.
Chapter 5: It deals with proceedings in lunacy outside
presidency town.
Chapter 6: It deals with establishment of asylums.
Chapter 7: It deals with expenses of lunatics
Chapter 8: It deals with rules to be imposed by the State
Govt. regarding care of lunatics.

26. The mental health care bill, 2013 was introduced in
the Rajya Sabha on August 19, 2013. The abolishes
the Mental Health Act, 1987.
REASONS TO THE BILL
The new Bill was introduced as the existing Act does
not adequately protect the rights of persons with
mental illness nor promotes their access to mental
healthcare.

27. •THE KEY FEATURES
•Every person shall have the right to access mental health care and
treatment from services run or funded by govt.
•A mentally ill person shall have the right to make an advance directive
that states how he wants to be treated for illness. Every mental health
establishment has to be registered with the relevant Central or State
Mental Health Authority, These authorities are in addition responsible
for supervising and maintaining a register of all mental health
establishment.
•A person who attempts suicide shall be presumed to be suffering from
mental illness at that time and will not be punished under the Indian
Penal Code.
•Electro-convulsive therapy is allowed only with the use of muscle
relaxants and anesthesia. The therapy is prohibited for minors.
•Mental health review commission will be a quasi-judicial body that will
periodically review the use of and the procedures for making advance
directives and advise the government on protection of rights of mentally
ill person.

29. Chapter 8 of Mental Health Act 1987 contains a very
novel and explicit provision of protection of human
rights, Universal Declaration of Human Rights in Article
24(1) explicitly mentions. “Every one has the right to a
standard of living adequate for the health and well-being
of himself and his family, including food, clothing,
housing and medical care and necessary services”.
Article 5 of UDHR states no one shall be subjected to
torture or to cruel, inhuman or degrading treatment or
punishments. Mental illness is also recognized as
disability according to sections 2 of the Person with
Disability Act. 1995

30. RIGHTS OF PATIENTS
•The right to wear their own clothes.
•The right to have individual storage space for their private
use.
•The right to keep and use their own personal possessions.
•The right to spend a sum of their money for their own
expenses.
•The right to have reasonable access to all communication
media likes telephone, letter writing and mailing.
•The right to see visitors every day.
•The right to hold civil service status.
•The right to manage and dispose of property and execute
wills.

31. NURSING IMPLICATION IN PROTECTION OF RIGHTS
Psychiatric patients are often the least capable of protecting their own rights. It
is, therefore, one of the responsibilities of the nurse to guide the patient and
relatives.
•To protect patients rights, the nurse should be aware of these rights in the first
place.
•She should ensure that ward procedures and policies should not violate
patients rights.
Discussing these rights with the mental health team and including these rights
in the nursing care plan is all part of her responsibility in protecting the patients
right.

32. Summary
•Mental Health Act
HISTORY
OBJECTIVES
CHAPTER
•Nursing Implication of Mental Health
Act
•The Indian Lunacy Act
INTRODUCTION
CHAPTERS
•Mental Healthcare Bill 2013
•Rights of Psychiatric Patients
NURSING IMPLICATION

35. BIBILIOGRAPHY
R SREEVANI “A Guide to Mental Health &
Psychiatric Nursing” 3rd Edition
Jaypee Medical Publisher Pp: 345 to 350
Shelia L Vedibeck “Psychiatric Mental Health
Nursing” 5th Edition Lippincott & Williams.
Mary C Townsend “Essential of Psychiatric health
nursing” 7th Edition F A Devis 2013.
ANTONY JAMES T (2000): “A decade with the
mental health act, Indian Journal
of Psychiatry, 42(4)
Kothari, Jaya “Moving towards autonomy &
equity an analysis of mental health care
bill 2013”

36. "Unexpressed emotions will never die. They are buried alive and will
come forth later in uglier ways."