The document provides an overview and critical analysis of the Mental Health Care Bill (MHCB) 2013 in India. It summarizes the key aspects of the bill, including its chapters covering preliminaries, determination of mental illness, rights of persons with mental illness, admission and treatment procedures, and oversight authorities. The analysis notes both merits of the bill in modernizing terminology and focusing on patient rights, but also drawbacks like potential over-inclusion of mental illness definitions and traditional providers as mental health professionals. Overall, the document aims to concisely outline and assess the provisions and implications of India's major mental health law reform.

1. MHCB 2013
Overview and Critical analysis
Dr. Cijo Alex
PG trainee in Psychiatry,
SMVMCH, Pondicherry

2. Contents
Background and need for mental health legislation
Evolution of mental health legislation in India
Overview of MHCB 2013
Critical analysis of MHCB 2013

3. Background

4. The need of mental health legislation
Necessary for protecting the rights of people with mental disorders, a vulnerable section
of society
To address the stigma, discrimination and marginalization in all societies and increased
likelihood of human rights violations
Provide a legal framework for addressing critical issues such as:
• Community integration of persons with mental disorders
• Provision of high quality care, improvement of access to care
• Protection of civil rights, promotion of rights to housing, education and employment
(WHO Resource Book on Mental Health, Human Rights and Legislation, 2005)

5. Earliest Acts from Britain :
Act for regulating private Madhouses, 1774 and County Asylums Act, 1808.
In British India, treatment and care of the mentally ill were governed by the
following acts.
1. The Lunacy Supreme court Act 1858(Act XXXIV of 1858)
2. The Lunacy District Courts Act 1858 (Act XXXV of 1858)
3. The Lunatic asylum Act 1858 (Act XXXVI of 1858)
4. The Indian Lunatic Asylums (Amendment)Act 1886 (Act XVIII of 1886)
5. The Indian Lunatic Asylums (Amendment)Act 1889 (Act XX of 1889)

6. Evolution of Mental Health Legislation in India
• Indian Lunacy act 1912
• Mental Health Act 1987
• Mental Health Care Bill 2013
• Disabilities act 1995

7. Mental Health Care Bill 2013
According to the Convention on Rights of Persons with Disabilities in
December 2006 at UN HQ, New York, which India signed on October
2007, the MHCB 2013 was drafted.
The MHCB 2013 is intended to replace the MHA of 1987

8. Overview of MHCB 2013

9. The MHCB 2013 has 136 clauses arranged in 16 chapters
Chapter I - Preliminaries
Chapter II – Determination of Mental illness and Capacity
Chapter III – Advance directive
Chapter IV – Nominated representative
Chapter V – Rights of persons with mental illness
Chapter VI – Duties of appropriate government

10. Chapter VII – Central Mental Health Authority
Chapter VIII – State Mental Health Authority
Chapter IX – Finance, Accounts and Audit
Chapter X – Mental Health Establishment
Chapter XI – Mental Health Review Commission
Chapter XII – Admission, Treatment and Discharge
Chapter XIII – Responsibilities of other agencies
Chapter XIV – Restriction of functions by Professions
Chapter XV – Offences and Penalties
Chapter XVI – Miscellaneous

11. Salient clauses under each chapter includes

12. Chapter I - Preliminaries
Clause 1 – Title, Extent and Commencement
Clause 2 - Definitions
 Mental health establishment means any health establishment, including
Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy
establishment and will include general hospitals also
 MHP means either a Psychiatrist , Psychologist , PSW , MHN or any one
with a qualification in Ayurveda , Unani or Homeopathy
 Minor means a person who has not completed the age of eighteen years
 Psychiatrist means a medical practitioner possessing a post-graduate
degree or diploma in psychiatry awarded by an university recognized by the
University Grants Commission

13. Chapter II – Determination of Mental
illness and Capacity
Clause 3 – Determination of Mental illness
 Internationally accepted criterion like ICD to be used
Clause 4 – Capacity
Every person , including a PMI is deemed to have capacity to make
treatment decisions if he/she can
 Understand the relevant information
 Retain that information
 Use that information and
 Communicate his decision.

14. Chapter III – Advance directive
Clause 5 – Advance directive
Every person , who is not a minor , shall have the right to make an advance directive in
writing specifying
 How to be cared for mental illness
 How not to be cared for mental illness
Clause 6 – 13 – Clauses related to advanced directive
 An advanced directive can be made in writing on a plain white paper with signature or
thumb impression and attested by two witnesses And registered in the Board And signed
by a MHP stating he is having the capacity to do so
 The advanced directive can be revoked , amended or cancelled by the person at anytime
 The advanced directive is not valid in emergency treatment under section 103
 The board has the right to cancel or modify the advanced directive if needed

15. Chapter IV – Nominated
representative
Clause 14 – Nominated representative
 Every person , who is not a minor , shall have a right to appoint a nominated
representative
 The nomination can be made in writing on a plain paper with the persons signature or
thumb impression
 If no representative is available , a relative or any one appointed by the board will act as
nominated representative
Clause 15 – 17 – Clauses related to nominated representative
 The board has the right to revoke , cancel or change of the nominated representative
 Duties of nominated representative includes giving support to the PMI

16. Chapter V – Rights of persons with
mental illness
Clause 18 – Right to access mental health care
Clause 19 – Right of community living
Clause 20 – Right of protection from cruel, inhuman and degrading treatment - Right to live in safe
and hygienic environment , to live in privacy , not to be forced to work in the MHE , not to be
forcefully head shaven and not to be forced to wear uniforms
Clause 21 – Right of equality and non – discrimination
Clause 22 – Right to information - The PMI and nominated representative will have the RTI for the
clause under which patient is admitted, nature of illness and treatment options available.
Clause 23 – 25 – Right of confidentiality and right to access medical records
Clause 26 – Right to personal contacts and information - Right to receive and refuse visitors , Right
to receive and make phone calls
Clause 27 – Right to legal aid
Clause 28 – Right to make complaints

17. Chapter VI – Duties of appropriate government - Clauses 29 –
32
Chapter VII – Central Mental Health Authority - Clauses 33 – 44
– Composition and duties of CMHA
Chapter VIII – State Mental Health Authority - Clauses 45 – 56 –
Composition and duties of SMHA
Chapter IX – Finance, Accounts and Audit - Clauses 57 – 64 –
Grants, Funds and auditing
Chapter X – Mental Health Establishment - Clause 65 – 72 -
Registration, review and inspection of MHE by board

18. Chapter XI – Mental Health Review
Commission
Clause 73 – 93 - Composition and duties of MHRC and MHRB - Board
 The MHRC will be HQ at Mumbai
 MHRC shall consist of a President and four members
 President would be a High Court Judge
 Members include a Psychiatrist , a PMI , a Care giver or NGO and a Public
administrator
 The MHRB or Board will be headed by the District Judge
 Members include two MHP with at least one Psychiatrist , Representative
of District Collector and two PMI/Care givers/NGOs

19. Chapter XII – Admission, Treatment
and Discharge
Clause 95 – Independent admission
 Any person , who is not a minor and who considers himself to be mentally ill can
be admitted to any MHE for treatment , provided
He has the severity needed for admission
He will benefit from the admission and
He has the capacity to consent.

20. Clause 96 – Admission of a minor
 The nominated representative should apply to the Psychiatrist
 Two Psychiatrists or One psychiatrist and one MO or One psychiatrist and one
MHP should independently see the minor and certify the need for admission.
 Minor should be accommodated separately from adults and along with the
nominated representative
 Board should be informed within 3 days of admission.

21. Clause 97 – Discharge of Independent admission
 Any patient admitted under section 95 as an independent patient has the right to
be discharged at any time.
 However a MHP can prevent the discharge of a PMI admitted under section 95 for
a period of 24 hours so as to assess him for admitting under section 98.

22. Clause 98 – Supported admission
 The nominated representative should apply to the psychiatrist
 Two Psychiatrist or One psychiatrist and MO or One psychiatrist and one MHP should
independently see the PMI and certify the need of admission as
 Threat to self
 Threat to others or
 Threat to objects and
 Inability to make valid and competent decisions
 Admissions under section 98 should be informed to the board within 3 days if minor or lady or else
within 7 days.
 The period of admission under section 98 would be 30 days
 After 30 days , PMI may be admitted under section 99

23. Clause 99 – Supported admission beyond 30 days
 If a PMI needs supported admission beyond 30 days or if a PMI needs readmission within 7 days of
discharge , then section 99 should be used
Clause 100 – Absence on leave
 A PMI admitted under section 96 , 98 or 99 maybe granted leave from the MHE by the psychiatrist
Clause 101 – Absence without leave or discharge
 A PMI who absents himself from the MHE without leave or discharge is liable to be taken under
protection by the Police upon request from the MHP

24. Clause 103 – Emergency treatment
 Any Registered Medical Practitioner can initiate emergency treatment to
any PMI if there is
- Threat to self
- Threat to others or
- Threat to objects or property
 Advanced directive is not valid for emergency treatment
 ECT should not be used as an emergency treatment

25. Clause 104 – Prohibited procedures
 ECT without anesthesia
 ECT for minors (below 18)
 Sterilization as a treatment for mental illness
 Chaining in any manner
Clause 105 – Psychosurgery
 Psychosurgery needs informed consent and permission of the board
Clause 106 – Physical restraints
 Should be used only when absolutely needed and least restrictive method to be used

26. Chapter XIII – Responsibilities of other
agencies
Clause 109 – Duty of police
 It is the duty of the police to bring any PMI wandering to a MHE
 They should not be put in lock up or jail

27. Chapter XIV – Restriction of functions by Professions
Chapter XV – Offences and Penalties
Chapter XVI – Miscellaneous
Clause 124 – Decriminalization of Suicide
 Any person who attempts to commit suicide shall be presumed to be
suffering from mental illness at the time of attempting suicide and
shall not be liable to punishment under this section. (ie dissolution of
IPC 309)

28. Critical Analysis of MHCB 2013

29. Comparison of MHA 1987 and MHCB 2013
MHA 1987 MHCB 2013
Terminology Mentally ill PMI , MHE , MHP
Focus Law Rights of PMI
Authorities Government CMHA , SMHA , MHRC , MHRB
Newer provisions Advanced directive ,
Nominated representative , Emergency
treatment , Prohibited ECT and MECT to
minors , Prohibited Chaining,
Decriminalization of suicide.

30. IPS position statement of MHCB 2013
 Modern in terminology and its approach is progressive
 Exemption from prosecution to those who attempt suicide is much
needed and most welcome
 Blanket prohibition of ECT for patients below 18 years is based on
sentiments rather than on science. There is no evidence whatsoever that
ECT is unsafe below age 18 years.
 Prohibition of Unmodified ECT would stop the ECT from being
administered at small and remote locations - anesthetic support is not
available even for routine surgery.
 Advance Directives: Most of the countries where it has been used have
had mixed results.

31. Also James Antony et al and Narayan et al have critically evaluated
the MHCB in IJP along with many others in various journals like Delhi
Journal of Psychiatry and popular media.

32. Summary of Critical appraisal of MHCB
2013

33. Merits of MHCB 2013
 Newer and reformed terminology like PMI , MHP and MHE
 Decriminalization of suicide
 Focus on the rights of PMI
 Stringent rules in supported admission
 Newer options like advanced directive, nominated representative etc.

34. Drawbacks of MHCB 2013
 Over inclusiveness of mental illness
 Avoidance of MR from mental illness
 An array of new bodies like CMHA , SMHA , MHRC and MHRB which
requires huge funding
 Poor representation of Psychiatrist in bodies like MHRC and MHRB
 Over inclusion of traditional system professional’s into the definition of
MHP
 Avoiding MECT in minors without any scientific basis
 Need to report to MHRB every details which may cause delay in patient
care
 How advanced directive will be accepted in a traditional country like India

35. Thank You