Mental Health Ordinance 2001

CONSTITUTIONAL POSITION AND REASONS

·        Replaces Lunacy Act 1912

o   A more sensitive law

o   Sensitive treatment of mental illness – omission of words like “idiot” or broad generalizations

o   Larger role for qualified professionals such as psychiatrists to determine mental illness and scope of mental illness

·        The need for regulation

o   Property/Estate Management

o   Management of the patient

·        Health a provincial subject after the 18^th Amendment

·        Mental Health Ordinance creates

o   a Mental Health Authority

o   Board of visitors

o   Court of protection

·        Confusion around the Mental health in terms of jurisdiction

 VOLUNTARY AND INVOLUNTARY TREATMENTS

Voluntary treatment: Any person suffering from a mental illness who seeks treatment voluntarily or whose relatives bring him/her for treatment or if a doctor has referred him/her for treatment and the person with mental illness consents to treatment will be examined by a psychiatrist and given appropriate treatment or recommendations. Assessment and/or treatment will be administered only after receiving informed written consent from the person with mental illness, or if it is a minor then by the guardian, or if an adult who by virtue of his mental state is not able to give consent, then by his/her spouse or nearest relative. The person giving consent may withdraw his/her consent for treatment at any time.




Involuntary treatment or admission: A person suffering from mental illness may be admitted against his/her consent if he/she is suffering from a mental illness to the extent that it warrants admission and/or treatment and if this is “in the interests of his own health or safety or (for) protection of others”

FOUR TYPES:

Involuntary admission for assessment: The period for this is up to 28 days from the day of the recommendation. The recommendation for this type of admission must be in writing from two medical officers one of whom must be a psychiatrist or a medical practitioner with experience in psychiatry. The patient or his/her relative has the right to appeal against this admission within 14 days of the recommendation.

Involuntary admission for treatment: The period for this is up to six months. An application for this may be made through a written recommendation by a psychiatrist and a medical officer, the two of whom will have seen the patient within 5 days of the recommendation. If the continuation of treatment is necessary at the end of six months the period of involuntary admission may be extended to another six months.

Involuntary admission for urgent assessment: The period is 72 hours. An application for this type of involuntary admission may be made by a relative or a medical officer when admission for assessment is needed on an urgent basis and a psychiatrist is not available. The period for this type of involuntary admission will lapse after 72 hours unless a psychiatrist makes a recommendation for involuntary admission for assessment within those 72 hours.

Emergency Holding: The period of emergency holding is 24 hours. This is allowable if a patient in an in-patient psychiatric facility wishes to or attempts to leave or discontinue treatment and (a) continuation of his/her treatment is necessary for his/her health or safety or for protection of others (b) a psychiatrist or a medical officer nominated by the psychiatrist is not available to write a recommendation.

COURT OF PROTECTION:

Any person filing an application for involuntary admission of the patient will have seen the patient within the last 14 days of the recommendation. The patient or his/her relative may file an appeal in the Court of Protection against the involuntary admission If a police officer sees a person whom he believes to be suffering from a mental disorder and whose current state seems to endanger him/her or others around him/her then the officer may deliver the patient to the nearest relative, or if no relatives are available, deliver him/her to a government health facility for 72 hours (urgent assessment) so that he/she may be examined by a psychiatrist or a nominated medical officer.



Assignment of Court of Protection: A district court that has the jurisdiction to handle cases under the MHO 2001


Assignment of Magistrate: A Judicial Magistrate assigned by the Government to hear cases under MHO 2001

Appointment of guardian for and/or manager of the property of a person with mental illness

If a person with mental illness owns property and his/her relatives claim that he/she is incapable of taking care of the property the Court of Protection may order an inquiry to determine whether the person alleged to be mentally ill is competent and capable to handle his/her person, affairs and property. The Court may assign two or more persons as assessors in this inquiry.

Where it is ascertained that a person is mentally ill and not capable of managing his/her affairs the Court of Protection my appoint any suitable person as a guardian for his/her care, may direct the person to be admitted for treatment in a mental health care facility and may order for his/her maintenance. The Court may also appoint a suitable person as manager to manage the property.
An inventory of all immovable property will be presented by the manager to Court within three months of the order.

Any major transactions by the appointed manager will be made after approval from Court and through a bank authorized by the Court.

If the Court believes that the person initially determined to be mentally ill is now recovered and competent and able to manage his/her affairs then the Court, after directing an inquiry for re-assessment of his/her state of mind, may set aside all orders related to appointment of guardian or manager.


Liability of cost of treatment and maintenance of persons with mental illness

The cost of treatment of a person admitted in a government run psychiatric facility will be covered by of the government unless another person has undertaken the cost or if the Court of Protection has ordered for provision of cost of care.

If a person with mental illness has the means or property with which the cost of treatment may be covered, or if the guardian/manager has the means to cover the cost, then the government or the local authority that are bearing the cost of treatment or maintenance may apply in the Court of Protection for their cost to be covered.

A person who holds a public office or is a public servant and who is determined to be mentally ill will continue to receive his/her pay or benefits that they are entitled to from the Government even after they cease to work due to their psychiatric condition.
Attempted suicide


A person who attempts suicide will be assessed by a psychiatrist and if found to be suffering from a mental illness will receive appropriate treatment for his/her illness.

Persons with mental illness who are detained in prisons

The Inspector General (if the accused is in the prison) or the Board of Visitors (if the accused is in a psychiatric facility) will visit such a person at least once in six months to ascertain and make a report on the state of mind of the accused.

Prisoners or offenders who are ascertained to be suffering from mental illness will be housed separately in a special security psychiatric facility built by the Government.
Specialized psychiatric treatment
All electro-convulsive treatment (ECT) will be administered under general anesthesia and advised by the psychiatrist in charge of the patient who will record the reasons for administering this procedure. Administration of long-acting anti-psychotic depot injections will only be carried out upon a psychiatrist’s advice and for a period advised in the prescription. Such cases will be reviewed periodically.

Psychosurgery will not be advised or conducted unless it is considered necessary and appropriate jointly by two psychiatrists, a neurosurgeon, a neurophysician, a physician, and one clinical psychologist.

                                                            MISCELLANEOUS

Confidentiality
A person with mental illness shall not be publicized nor his/her identity be revealed to public (through media etc.) unless the person chooses to publicize his/her own condition.



Informed consent
Any assessment or treatment of a person with mental illness shall begin only after obtaining his/her written informed consent, or if the person is a minor or not competent to give consent by virtue of his/her mental state, then with the consent of their guardian or nearest relative. This consent may be withdrawn by the mentally ill person or the relative at any time.

Offences

Following will be considered offences and may result in imprisonment up to one year and/or a fine of up to Rs. 50,000.

·        Making a false claim, statement or entry on an application, recommendation, report, record or documentation with the intent to get someone detained for assessment or treatment or with the intent to deceive otherwise.

·        Ill or inhuman treatment, abuse or willful neglect of any patient by anyone including staff of a mental health facility, or willful violation and neglect of any of the provisions of the MHO 2001.

·        Refusal or neglect by manager of patient’s property or estate to deliver accounts or the property in time specified by the Court.