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Forensic Psychiatry

Dr. S. K. Roy Chaudhary

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Causes of Insanity

Hereditary:- genes and family history

Environmental:- such as stress or a history of abuse, especially if they happen in childhood

Biological factors such as chemical imbalances in the brain

A traumatic brain injury

A mother's exposure to viruses or toxic chemicals while pregnant

Use of alcohol or recreational drugs

Having a serious medical condition like cancer

Having few friends, and feeling lonely or isolated.

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Difference Between True and Feigned Insanity

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Symptoms	True	Feigned
Motive	Absent No history of crime	Present
Onset	Gradual	Sudden
Predisposing factors	Usually present Loss of money or near ones	Absent
Facial expression	Detached, vacant	Frequently changing exaggerated

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Cont.

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Signs & Symptoms	Uniformly Present whether observed or not	Present only when under observation Not fitting any disease
Insomnia	Present	Tries but sleeps after a day or two
Exertion	No apparent fatigue	Breaks down after a day or two
Habits	Dirty & Filthy	Not so

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Cont.

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Skin and Lips	Dry and harsh	Normal
Frequency of examination	Does not mind repeated examination	Resents for fear of detection

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Criminal Responsibility of An Insane Person

For being called a crime:-

Actus reus- Voluntary Conduct
Mens rea- Evil intent or guilty mind
Defendant's willful intent in order to prove guilt for most criminal charges
Moral Imperative- Morally it seems wrong to hold insane guilty
Perception of fairness- Sense of fairness of court undermined to equate sane and insane on same footing

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Mc Naughten Rule (Right- Wrong Test)

To establish a defence on the ground of insanity, it must be clearly proved that, at the time of committing the act, the party accused was labouring under such a defect of reason from disease of mind, as not to know the nature & quality of act he was doing, or if he did know it, he did not know he was doing what was wrong.

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Daniel Mc Naughten

Edward Drummond

Sir Robert Peel

1843

The M'Naghten rules (pronounced, and sometimes spelled, McNaughton) were a reaction to the acquittal in 1843 of Daniel M'Naghten on the charge of murdering Edward Drummond, whom M'Naghten had mistaken for British Prime Minister Robert Peel. M'Naghten fired a pistol at the back of Peel's secretary, Edward Drummond, who died five days later. The House of Lords asked a panel of judges, presided over by Sir Nicolas Conyngham Tindal, Chief Justice of the Common Pleas, a series of hypothetical questions about the defence of insanity. The principles expounded by this panel have come to be known as the M'Naghten Rules. M'Naghten himself probably would have been found guilty if they had been applied at his trial.^[When the tests set out by the Rules are satisfied, the accused may be adjudged "not guilty by reason of insanity" or "guilty but insane" and the sentence may be a mandatory or discretionary (but usually indeterminate) period of treatment in a secure mental hospital

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Section 84 of IPC�(Legal Test of Insanity)

Nothing is an offence which is done by a person who at the time of doing it is by reason of unsoundness of mind incapable of knowing the nature of the act or that he is doing what is either wrong or contrary to law

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Irresistible Impulse Test

A person is not responsible for an act committed under an impulse which he was unable to resist because of mental disease.
Court’s interpretation- Police man at the elbow test
Doctrine of partial Responsibility

There must be aberration or weakness of mind.
There must be a state of mind bordering on though not amounting to insanity.
There must be a mind so affected that the responsibility is diminished from full responsibility to partial responsibility.

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Durham’s Rule

In 1954 in Durham case, Justice David Bazelon (USA) gave the ruling that an accused is not criminally responsible if his/her unlawful act was the product of mental disease or mental defect

In 1972 this rule was discarded by a court consisting of nine judges including justice Bazelon

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Curren’s Rule

This Rule came in force in 1961
It postulates that

“ An accused is not criminally responsible, if at the time of committing the act, he did not have the capacity to regulate his conduct to the requirements of law as a result of mental disease or defect”

It is similar to irresistible impulse test
Now discarded

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Model Penal Code Of American Law Institute

Test of Insanity given in the code is widely followed in courts of USA

People are not responsible for criminal conduct if at the time of such conduct, as a result of mental disease or defect, they lacked substantial capacity either to appreciate the criminality (wrongfulness) of their conduct or to conform their conduct to the requirement of law

The term mental disease or defect does not include abnormality manifested only by repeated criminal or otherwise antisocial conduct

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Other Terms Used

Guilty but Insane
Diminished Responsibility also called “Twinkie defence”

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Rights of Insane Persons Admitted in Mental Hospital

Right to Privacy & Dignity
To be visited by lawyers, clergies & private physicians + Privacy in talk
Not to be subjected to ECT, Lobotomy without informed consent of patient
Right to refuse treatment except in emergency or by court’s order

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Cont.

Right to receive visitors during visiting hours unless unfit which should be properly documented
Right to be free from excessive or unnecessary medication
Right to ‘least restrictive environment’ also called ‘ least restrictive alternative or less restrictive option’

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Seclusion

RESTRAINT

LEATHER CUFFS, ANKLETS

or STRAIGHT JACKETS

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Iron wrist shackles with chains and padlock; Germany ca. 17th century

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CHICAGO: An Ohio man who killed his roommate and ate part of his brain almost 40 years ago was denied parole for the sixth time, prison officials said on Thursday.��David Allen Chapin, 60, was deemed "unsuitable for release" by the Ohio parole board on Wednesday, said JoEllen Smith of the Ohio department of rehabilitation and correction.��Chapin shot Donald Liming in the eye in their apartment in Milford, Ohio, during an argument over religion on October 3, 1978. Chapin was a Baptist, while Liming had said he was a Catholic, a Buddhist and a pagan, the newspaper Cincinnati Enquirer reported.

At the time of the shooting, both men were 23 and longtime friends, the newspaper said.

�

�During the murder trial, Chapin pleaded not guilty by reason of insanity. He told a court ordered psychiatrist that he ate Liming's brain as part of a "mutual agreement" between the roommates, the newspaper said. Chapin, serving a life sentence at the Allen Correctional in Lima, Ohio, cannot be considered for parole again until December 2018, Smith said.

�

�Clermont county prosecutor Vince Faris said his office would continue to object to the release of Chapin, supporting relatives of Liming who want Chapin to remain in prison.

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Modern chain handcuffs made of hardened steel; Hiatt 2010

Modern steel legcuffs

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Straitjackets on display at Glenside Museum

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Civil Rights & Responsibilities

Inquisition

Court may direct an inquisition when a lunatic is alleged to be incapable of managing his property and if so certified by the physician. Then the court may appoint manager of the property
2^nd inquiry and necessary order may be passed when it is reported that sanity has returned.

Contract:-

A contract is invalid if one of the parties at the time of making it was by reason of insanity incapable of understanding it and forming judgement as to its effect upon his interests
However an honest contract when the other party was unaware of the insanity is valid. But not valid when undue advantage was taken of insanity

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Civil Rights & Responsibilities

Consent:-

An insane person can not give a valid consent

Marriage:-

An insane person cannot marry and if married then it is a ground for nullity of marriage even if consummated
Ground for divorce if becomes mad after marriage

Evidence:-

Not competent to appear as witness
Except during lucid interval

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Testamentary Capacity

Capacity to make a valid will :-

An understanding of the nature of the document
Knowledge of the property to be disposed off
An ability to recognise those who may have a moral claim on the property

Can make will under lucid interval

Can make will even if suffers from delusions provided these are not related to the will

Sound and disposing mind

If he has sufficient mental capacity to understand the nature and consequences of his acts

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Testamentary capacity n. having the mental competency to execute a will at the time the will was signed and witnessed. To have testamentary capacity the author of the will must understand the nature of making a will, have a general idea of what he/she possesses, and know who are members of the immediate family or other "natural objects of his/her bounty." Inherent in that capacity is the ability to resist the pressures or domination of any person who may try to use undue influence on the distribution of the testator's (will writer's) estate. a forensic specialist observes for signs of undue influence by a concerned party that exploits an emotionally vulnerable individual who might otherwise be cognitively intact. The testamentary capacity matter is most frequently raised posthumously, when an aggrieved heir contests the will entered into probate. For this reason, the forensic psychiatrist or forensic psychologist studies the testatrix’ cognition through videotape record of the drafting of the will, or by reviewing email, letters and other records.

Disposing mind and memory refer to the mental ability to understand in general what one owns, one's family relationships, and the meaning and effect of the will at the time of making a will. This is also known as sound mind and memory. Sound mind is the state of mind of a person which is sufficient to reason and reach a judgment upon ordinary subjects, like other rational men. A person who asserts that s/he is not of sound mind must prove it by clear evidence.

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Ethics in Psychiatry

Informed consent to be taken regarding diagnosis, prognosis, risks and benefit of alternative courses of treatment
Treat patient to improve his condition rather than for the convenience of caretakers.
Involuntary hospitalisation restricts freedom so rules of fair procedure for admission to be followed.
Treatment to restore and maximize patient’s competence to make his own decisions.

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81

.

[

Mentally ill persons to be treated without violation of human rights

]

(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

-

(i)

such research is of direct benefit to him for purposes of diagnosis or treatment; or

(ii)

such person, being a voluntary patient, has given his consent in writing or where such person

(whether or not a volunt

ary 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 be

half under section 94 for the purpose of preventing

vexatious or defamatory communications or communications prejudicial to the treatment or

mentally ill persons, no letters or other communications sent by or to a mentally ill persons under

treatment shall

be intercepted, detained or destroyed

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Ethics in Psychiatry(Cont.)

Sexual activity with a current or a former patient is unethical and medical registration will be cancelled if proved.
In several countries including India it is a criminal offence.
Insurance companies do not cover for such malpractice cases

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Mental Healthcare Act 2017

An Act to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental there to

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Mental Healthcare Act 2017

It has replaced Mental Health Act 1987
The first Act was ‘Indian Lunacy Act’ of 1912
It equates doctors of modern science with AYUSH physicians for the treatment of psychiatric disorders
Mental illness means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour or capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with abuse of alcohol and drugs, but does not include mental retardation.
Mental illness shall be determined according to the latest edition WHO classification of diseases

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Mental Illness Shall Not Be Determined on the Basis of

(a) political, economic or social status or membership of a cultural, racial or religious group, or for any other reason not directly relevant to mental health status of the person;
(b) non-conformity with moral, social, cultural, work or political values or religious beliefs prevailing in a person’s community.

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Mental Healthcare Act 2017

WHEREAS the Convention on Rights of Persons with Disabilities and its Optional Protocol was adopted on the 13th December, 2006 at United Nations Headquarters in New York and came into force on the 3rd May, 2008;�AND WHEREAS India has signed and ratified the said Convention on the 1st day of October, 2007;�AND WHEREAS it is necessary to align and harmonise the existing laws with the said Convention.
BE it enacted by Parliament in the Sixty-eighth Year of the Republic of India

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Mental Healthcare Act 2017

The determination of mental illness of a person shall not mean that he is of unsound mind unless so declared by a competent court
Every person including a person with mental illness shall be deemed to have the capacity to make decisions regarding his mental healthcare or treatment if such person has the ability to understand information relevant for such decision and its consequences

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Advance Directive

5. (1) 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.

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Conditions of Advance Directive

10. It shall be the duty of the psychiatrist to give treatment to a person with mental illness, in accordance with his valid advance directive.
11. (1) Where a mental health professional or a relative or a care-giver of a person desires not to follow an advance directive such mental health professional or the relative or the care-giver of the person shall make an application to the concerned Board to review, alter, modify or cancel the advance directive.

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Upon receipt of the application under sub-section (1), the Board shall, after giving

an opportunity of hearing to all concerned parties (including the person whose advance

directive is in question), either uphold, modify, alter or cancel the advance directive after

taking into consideration the following, namely:––

(a) whether the advance directive was made by the person out of his own free

will and free from force, undue influence or coercion; or

(b) whether the person intended the advance directive to apply to the present

circumstances, which may be different from those anticipated; or

(c) whether the person was sufficiently well informed to make the decision; or

(d) whether the person had capacity to make decisions relating to his mental

healthcare or treatment when such advanced directive was made; or

Manner of

making

advance

directive.

Maintenance

of online

register.

Revocation,

amendment

or cancellation

of

advance

directive.

Advance

directive not

to apply to

emergency

treatment.

Duty to

follow

advance

directive.

Power to

review, alter,

modify or

cancel

advance

directive.

SEC. 1] THE GAZETTE OF INDIA EXTRAORDINARY 7

(e) whether the content of the advance directive is contrary to other laws or

constitutional provisions.

(3) The person writing the advance directive and his nominated representative shall

have a duty to ensure that the medical officer in charge of a mental health establishment or a

medical practitioner or a mental health professional, as the case may be, has access to the

advance directive when required.

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Conditions

13. (1) A medical practitioner or a mental health professional shall not be held liable for any unforeseen consequences on following a valid advance directive.
(2) 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

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NOMINATED REPRESENTATIVE

14. (1) Every person who is not a minor, shall have a right to appoint a nominated representative.
Shall be made in writing on plain paper with signature/ thumb impression also of representative
Where no representative appointed following will deemed in order of precedence

The individual appointed as the nominated representative in the advance directive
a relative/ a care-giver/
A suitable person/ Director, Department of Social Welfare, or his designated representative will be appointed by the Board

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(2) The nomination under sub-section (1) shall be made in writing on plain paper with the

person’s signature or thumb impression of the person referred to in that sub-section.

(3) The person appointed as the 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 to discharge his duties and

perform the functions assigned to him under this Act.

Provided that a person representing an organisation registered under the Societies

Registration Act, 1860 or any other law for the time being in force, working for persons with

mental illness, may temporarily be engaged by the mental health professional to discharge

the duties of a nominated representative pending appointment of a nominated representative

by the concerned Board.

(5) The representative of the organisation, 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 of the person’s treatment, and such medical

officer or psychiatrist, as the case may be, shall accept him as the temporary nominated

representative, pending appointment of a nominated representative by the concerned

Board. The appointment of a nominated representative, or the inability of a person with

mental illness to appoint a nominated representative, shall not be construed as the lack of

capacity of the person to take decisions about his mental healthcare or treatment.

(9) All persons with mental illness shall have capacity to make mental healthcare or

treatment decisions but may require varying levels of support from their nominated

representative to make decisions.

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RIGHTS OF PERSONS WITH MENTAL ILLNESS

Every person shall have a right to access mental healthcare and treatment of affordable cost, of good quality, available in sufficient quantity, accessible geographically, without discrimination on the basis of gender, sex, sexual orientation, religion, culture, caste, social or political beliefs, class, disability or any other basis and provided in a manner that is acceptable to persons with mental illness and their families and care-givers

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Integration of Mental Healthcare With General Healthcare.

Integrate mental health services into general healthcare services at all levels-including primary, secondary and tertiary.
Ensure that the long term care in a mental health establishment for treatment of mental illness shall be used only in exceptional circumstances.
Even short term admission will be used as a last resort

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Ensure that as a minimum, mental health services run or funded by Government shall be available in each district;
If Govt facility is not available then cost of treatment in private hospital of that district will be borne by Govt.
Persons with mental illness living below the poverty line whether or not in possession of a below poverty line card, or who are destitute or homeless shall be entitled to mental health treatment and services free of any charge
Government shall notify Essential Drug List and all medicines on the Essential Drug List shall be made available free of cost to all persons with mental illness

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Every person with mental illness shall,––

(a) have a right to live in, be part of and not be segregated from society; and

(b) not continue to remain in a mental health 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.

Government shall, within a reasonable period, provide for or support

the establishment of less restrictive community based establishments including half-way homes, group homes and the like for persons who no longer require treatment in more restrictive mental health establishments such as long stay mental hospitals

Every person with mental illness shall be protected from cruel, inhuman or degrading treatment in any mental health establishment and shall have the following rights, namely:—

(a) to live in safe and hygienic environment;

(b) to have adequate sanitary conditions;

(c) to have reasonable facilities for leisure, recreation, education and religious

practices;

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(d) to privacy;

(e) for proper clothing so as to protect such person from exposure of his body to maintain his dignity;

(f) to not be forced to undertake work in a mental health establishment and to

receive appropriate remuneration for work when undertaken;

(g) to have adequate provision for preparing for living in the community;

(h) to have adequate provision for wholesome food, sanitation, space and access to articles of personal hygiene, in particular, women’s personal hygiene be adequately addressed by providing access to items that may be required during menstruation;

(i) to not be subject to compulsory tonsuring (shaving of head hair);

(j) to wear own personal clothes if so wished and to not be forced to wear

uniforms provided by the establishment; and Right to community living. Right to protection from cruel, inhuman and degrading treatment.

(k) to be protected from all forms of physical, verbal, emotional and sexual

abuse.

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Every person with mental illness shall be treated as equal to persons with physical illness in the provision of all healthcare facilities like- emergency services, ambulance, quality of living conditions, and all other facilities.
A child under three years shall not be separated from mother admitted except for the safety of the child.
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
A person with mental illness/ nominated representative shall have the rights to the following information, namely:––

(a) Under which provision of the law the patient is being admitted.

(b) of his right to apply for review to the Board regarding his admission.

(c) the nature of the person’s mental illness and the proposed treatment plan and side effects of the treatment

(d) receive the information in a language and form that such person receiving the

information can understand.

A person with mental illness shall have the right to confidentiality in respect of his mental health, mental healthcare, treatment and physical healthcare.

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All health professionals providing care or treatment to a person with mental illness shall have a duty to keep all such information confidential which has been obtained during care or treatment with the following exceptions, namely: nominated representative, other health professionals providing care, to protect any other person from harm or violence (only such information that is necessary to protect); release of information upon an order by concerned Board or the Central Authority or High Court or Supreme Court or any other statutory authority competent to do so; and release of information in the interests of public safety and security.
No photograph or any other information relating to a person with mental illness shall be released to the media without the consent of the person with mental illness.
The right to confidentiality shall also apply to all information stored in electronic or digital format in real or virtual space.
All persons with mental illness shall have the right to access their basic medical records as may be prescribed.

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The mental health professional may withhold specific information in the medical records if disclosure would result in,––serious mental harm to the person with mental illness; or likelihood of harm to other persons.
A person with mental illness admitted to a mental health establishment shall have the right to refuse or receive visitors and to refuse or receive and make telephone or mobile phone calls at reasonable times subject to the norms of such mental health establishment.
A person with mental illness admitted in a mental health establishment may send and receive mail through electronic mode including through e-mail. Or refuse to receive mails/ emails from particular person or community
A person with mental illness shall be entitled to receive free legal services to

exercise any of his rights given under this Act.

Any person with mental illness or his nominated representative, shall have the

right to complain regarding deficiencies in provision of care, treatment and services in a mental health establishment to the in charge doctor/ the board / or the state authority in not satisfied

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Central / State Mental Health Authority

Maintain a register of all mental health facilities under central Govt. and also compile information from all state govt. regarding facilities under their control.
Develop quality and service provision norms for different types of mental health establishments under the Central/ State Government
Supervise all mental health establishments under the Central / State Government and receive complaints about deficiencies of services;
Maintain a national / State register of clinical psychologists, mental health nurses and psychiatric social workers based on information provided by all State Authorities.
Train all persons including law enforcement officials, mental health professionals and other health professionals about the provisions and implementation of this Act;

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MENTAL HEALTH ESTABLISHMENTS

Means any health establishment, including AYUSH, run by private or public authority, where persons with mental illness are kept for treatment, either temporarily or otherwise; and includes any general hospital or general nursing home but does not include a family residential place where a person with mental illness resides with his relatives or friends;
No person or organization shall establish or run a mental health establishment unless it has been registered with the Authority under the provisions of this Act.

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The Mental Health Establishment for registration shall have:-

(a) the minimum standards of facilities and services as may be specified by

regulations made by the Authority;

(b) the minimum qualifications for the personnel engaged in such establishment

as may be specified by regulations made by the Authority;

(c) provisions for maintenance of records and reporting as may be specified by

regulations made by the Authority

The Authority may, suo motu or on a complaint received from any person with

respect to non-adherence of minimum standards specified by or under this Act or contravention of any provision thereof, order an inspection or inquiry of any mental health establishment, to be made by such person as may be prescribed

Any mental health establishment aggrieved by an order of the Authority refusing to grant registration or renewal of registration or cancellation of registration, may, within a period of thirty days from such order, prefer an appeal to the High Court in the State

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Every mental health establishment shall display the certificate of registration in a conspicuous place in the mental health establishment in such manner so as to be visible to everyone visiting the mental health establishment
Every mental health establishment shall display within the establishment at conspicuous place (including on its website), the contact details including address and telephone numbers of the concerned Board.
MENTAL HEALTH REVIEW BOARDS
The State Authority shall, by notification, constitute Boards to be called the

Mental Health Review Boards, for the purposes of this Act.

Located in every district headed by district judge-working retired or a person qualified to be appointed. Members- from district magistrate, psychiatrists, and patients or caregiver. All appointed by State authority chairman.

Patients or their representatives or NGOs can apply to board for redressal of grievances from mental health establishments.

Appeal against the decision of the board lies with high court of the state.

1) Subject to the provisions of this Act, the powers and functions of the Board

shall, include all or any of the following matters, namely:––

(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 mental health professional in charge of mental health establishment or mental

health establishment under section 87 or section 89 or section 90;

(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.

Central

Authority to

appoint

Expert

Committee to

prepare

guidance

document.

Powers and

functions of

Board.

32 THE GAZETTE OF INDIA EXTRAORDINARY [PART II—

(2) Where it is brought to the notice of a Board or the Central Authority or State

Authority, that a mental health establishment violates the rights of persons with mental

illness, the Board or the Authority may conduct an inspection and inquiry and take action to

protect their rights.

(3) Notwithstanding anything contained in this Act, the Board, in consultation with

the Authority, may take measures to protect the rights of persons with mental illness as it

considers appropriate.

(4) If the mental health establishment does not comply with the orders or directions of

the Authority or the Board or wilfully neglects such order or direction, the Authority or the

Board, as the case may be, may impose penalty which may extend up to five lakh rupees on

such mental health establishment and the Authority on its own or on the recommendations

of the Board may also cancel the registration of such mental health establishment after

giving an opportunity of being heard

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81. (1) The Central Authority shall appoint an Expert Committee to prepare a guidance document for medical practitioners and mental health professionals, containing procedures for assessing, when necessary or the capacity of persons to make mental health care or treatment decisions.

85.(1)“independent patient or an independent admission”

refers to the admission of person with mental illness, to a mental health establishment, who has the capacity to make mental healthcare and treatment decisions or requires minimal help.

86. (1) An adult can get himself admitted as an independent patient.

(7) Subject to the provisions contained in section 88 an independent patient may get himself discharged from the mental health establishment without the consent of the medical officer or mental health professional in charge of such establishment.

87. An attendant(a female for female patients) shall stay with minor admitted patients for the entire duration of stay in the hospital

A minor shall be discharged on request of nominated representative.

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Supported Admissions:- Under section 89 on certification from two doctors one being a psychiatrists for a period of 30 days

The person is ineligible to receive care and treatment as an independent

patient because the person is unable to make mental healthcare and treatment decisions independently and needs very high support from his nominated representative in making decisions.

The medical officer or mental health professional in charge of the mental health establishment shall report to the concerned Board,––

(a) within three days of the admissions of a woman or a minor;

(b) within seven days the admission of any person not being a woman or minor.

90. (1) If a person with mental illness admitted under section 89 requires continuous admission and treatment beyond thirty days or a person with mental illness discharged under sub-section (15) of that section requires readmission within seven days of such discharge, This shall also be reported to the board.

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(a). Two psychiatrists have independently examined the person with mental illness in the precedingthe preceding seven days and both independently conclude based on the examination and, on information provided by others that the person has a mental illness of a severity that the person––

(i) has consistently over time threatened or attempted to cause bodily

harm to himself; or

(ii) has consistently over time behaved violently towards another person or has consistently over time caused another person to fear bodily harm from him; or(iii) has consistently over time shown an inability to care for himself to a degree that places the individual at risk of harm to himself;

(b) both psychiatrists, after taking into account an advance directive, if any, certify that admission to a mental health establishment is the least restrictive care option possible under the circumstances;

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(8) Period of admission limited to 90 days at first instance

(9) May be extended to 120 days and then 180 days each time on certain conditions

(10) Shall be discharged if the board if the board does not give permission

(15) The incharge doctor can discharge if the patient considered fit

(16) The patient can continue to be admitted as independent patient.

91. Leave of absence allowed as considered necessary

92. If a patient admitted U/S 103 (relevant sections of armed forces acts) runs away without leave then of information will be arrested and sent back to the hospital

93. The patient can be transferred from one hospital to another within the state or outside the state

94. Any registered medical practitioner is allowed to treat with consent of the patient or his nominated representative in emergency but not give ECT and treatment period restricted to 72 hours or in case of disaster up to 7 days

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95 Prohibited Procedures:-

1. (a) electro-convulsive therapy without the use of muscle relaxants and

anaesthesia;

(b) electro-convulsive therapy for minors; without permission of board

(c) sterilisation of men or women, when such sterilisation is intended as a treatment for mental illness;

(d) chained in any manner or form whatsoever.

96. Psychosurgery will only be performed with prior consent of patient/ and the board.

97. Seclusion or solitary confinement, or physical restraint may only be used when, it is the only means available to prevent imminent and immediate harm to person concerned or to others; And it will be recorded

99. Research can be conducted with informed consent of patient and where patient unable then consent of state authority provided the proposed research follows all the national and international guidelines

approval has been obtained from the institutional ethics committee

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100. Duties of Police Officers:- Take under protection any wandering mentally ill person or if he is risk to himself or others and take him to health establishment for assessment within 24 hrs. Not to keep in police lock up or prison. Search family members and drop him there if the doctor permits

101. Police will report to magistrate all cases where a mentally ill person is being neglected or ill treated

102 The magistrate will send the patient to mental health establishment for assessment and plan of treatment for a period of 10 days.

103. (1) An order under armed forces act or Cr.P.C. directing the admission of a prisoner with mental illness into any suitable mental health establishment, shall be sufficient authority for the admission of such person in such establishment.

104. Applies to all State run custodial institutions (including beggars homes, orphanages, women’s protection homes and children homes)

105 An accused under trial will also be referred if alleged to be mentally ill

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106. No mental health professional or medical practitioner shall discharge any duty or perform any function not authorised by this Act or specify or recommend any medicine or treatment not authorised by the field of his profession.

107. Mental health establishment without registration fine five thousand to fifty thousand on first occasion then up to two lakhs and then up to five lakhs on all subsequent detection. Health professionals working in unregistered mental health establishment to be fined up to 25 thousand

108. Contravention of any provision of this Act - six months imprisonment, or fine up to ten thousand or both for the first timer then 2 years and fine not less than fifty thousand but may be up to 5 lakh

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10/08/2022