Admission, treatment and discharge of an independent patient
Section 85, 86 and 88 of the Mental Healthcare Act, 2017 deals with the rules to be followed for the admission, treatment, and discharge of an independent patient.
An adult who can make a decision on their own
A person who has the capacity to make decisions about their mental healthcare and treatment, or requires very little support in making decisions about it
They get admitted to a psychiatric hospital by making a request on their own
Before they are treated, informed consent has to be taken from them
There are two conditions that must be met
- The person must be 18 years of age or above
- They must want to be admitted to a psychiatric hospital for the purpose of treatment
A person who does not meet these three conditions doesn’t qualify as one
When the medical officer/mental health professional assesses that the person is unable to
Understand the purpose and nature of treatment
Understand the likely effects of the treatment, or
Understand the likely result of not accepting treatment
Or, if the person requires a very high level of support in making decisions about their mental healthcare and treatment
They need to make a request
They can request the medical officer or mental health professional in charge of the psychiatric hospital to admit them.
The mental health professional must make an assessment
The medical officer/mental health professional must check if:
The person has a mental illness of a severity that requires admission.
The person with mental illness is likely to benefit from the admission and treatment offered.
The person has understood the nature and purpose of this admission and has made the request on their own free will.
An exception will figure in case of an emergency
During an emergency, if the person preferred as the second point of contact (nominated representative) is available, they must be informed. If not, no informed consent needs to be taken for treatment.
A situation where there is a high risk of danger
Situations, where the patient is at risk of death or permanent harm might be done to their health, or they might cause harm to themselves, to someone else, or to property.
A maximum time allotment rule exists in case of an emergency
They can be treated for a maximum period of 75 hours or for the time it will take to make an assessment of their mental health (which can’t exceed 75 hours). Whichever one of the two — 75 hours, or the assessment — is completed first, the patient must be discharged after.
Treatment that is needed in case of an emergency
Only treatment that is directly related to the emergency situation can be provided to the person.
ECT is not permitted
ECT can’t be given to a patient in case of an emergency.
Three procedures that are completely disallowed
ECT without the use of painkillers and muscle relaxants
Sterilization surgery as a treatment for mental illness
They must make a request, and can also leave without consent
They must be discharged by the relevant medical officer/mental health professional as soon as they have asked to leave
They can also leave without consent of the medical officer or mental health professional.
In case a mental health professional feels the need for an assessment
An independent patient can be prevented from leaving for a period of 24 hours if the mental health professional needs to assess if the patient is:
Unable to understand the nature and purpose of their decisions, and needs very high support from their second point of contact
Threatening or attempting to (or has threatened or attempted) cause physical harm to themselves or someone else.
Unable to care for themselves to the extent that there is a high risk of them putting themselves in harm’s way.
This will lead to one out of two possible outcomes
Depending on the finding, either
The independent patient will be admitted as a supported patient, or
They will be discharged after a maximum period of 24 hours
Mental healthcare act, 2017, https://www.prsindia.org/uploads/media/Mental%20Health/Mental%20Healthcare%20Act,%202017.pdf.