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Table of Contents
REVIEW ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 2  |  Page : 114-117

Mental Healthcare Act 2017 – Role of nurse in enabling person with mental illness


1 PhD Nursing Scholar, Bengaluru, Karnataka, India
2 Associate Professor of Nursing- NIMHANS, Bengaluru, Karnataka, India
3 Associate Professor of Psychiatry- NIMHANS, Bengaluru, Karnataka, India
4 Professor of Psychiatry- NIMHANS, Bengaluru, Karnataka, India
5 Professor of Psychiatry NIMHANS, Bengaluru, Karnataka, India

Date of Web Publication21-Jan-2020

Correspondence Address:
Dr. Radhakrishnan Govindan
Department of Nursing, NIMHANS, Bengaluru - 560 029, Karnataka
India
Suresh Bada Math
Professor of Psychiatry NIMHANS, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IOPN.IOPN_29_19

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  Abstract 


The Mental Healthcare Act (MHCA) 2017 has come up with some major changes in the mental healthcare by introducing the concept of advance directives and nominated representatives and aims at strengthening the human rights of person with mental illness (PMI) and clearly emphasized the responsibility of the government. The objective of this article is to give a brief overview of the MHCA-2017 and specify the role of mental health nurses in enabling PMI and protects their rights, as they are also included in the mental health professionals.

Keywords: Advance directive, Mental Healthcare Act 2017, nominated representative, nurses role in Mental Healthcare Act 2017


How to cite this article:
Paul J, Govindan R, Manjunatha N, Kumar C N, Math SB. Mental Healthcare Act 2017 – Role of nurse in enabling person with mental illness. Indian J Psy Nsg 2019;16:114-7

How to cite this URL:
Paul J, Govindan R, Manjunatha N, Kumar C N, Math SB. Mental Healthcare Act 2017 – Role of nurse in enabling person with mental illness. Indian J Psy Nsg [serial online] 2019 [cited 2020 Mar 30];16:114-7. Available from: http://www.ijpn.in/text.asp?2019/16/2/114/276352




  Introduction Top


The Government of India ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2007, which facilitated the process of change in laws related to the rights of person with mental illness (PMI).[1] The Lunacy Act, 1912 and the Mental Health Act, 1987 have become outdated due to rapid advancement in the mental health-care delivery system. Mental illness is now treatable, and the approach and attitude have changed considerably. There was a perceived and felt need for a new act to suit the changing times and also a need for it to be in line with the UNCRPD. According to the National Mental Health Survey 2016 by NIMHANS, India, across 12 different states, the lifetime prevalence of mental disorder is 13.7% as a whole, which would mean that at least 150 million Indians are in need of urgent intervention.[2] More than half of the total burden of the mental illness is in vulnerable age groups such as adolescents and geriatric population.[3] To address this mammoth problem, “The Mental Healthcare Act 2017” was enacted, which is progressive and right based on nature.[1]


  Major Mile Stones in Indian Mental Health Legislation Top


[Chart 1]: Depicts the history of mental health legislation in India.




  The Mental Healthcare Act 2017 Top


In India, the Mental Healthcare Act (MHCA), 2017, was passed on April 7, 2017. The law was described as “An act to provide for mental health care and services for persons with mental illness and to protect, promote, and fulfill the rights of such persons during delivery of mental health care and services and for matters connected therewith or incidental thereto.”[4]


  Definition of Mental Health Nurse Top


According to the MHCA 2017, “Mental Health Nurse means, a person with a diploma or degree in general nursing or diploma or degree in psychiatric nursing recognized by the Nursing Council of India established under the Nursing Council of India Act, 1947 and registered as such with the relevant nursing council in the state.”[4] As per the current definition, any nurse with a diploma in nursing without any experience in psychiatric nursing is eligible to become a mental health nurse (MHN), which is quiet a debatable situation. At the same time, there is no specific comment on the definition of a psychiatric nurse. As the MHN has included in the mental health professionals with major role in admission and capacity assessment, there should be some clarity in the definition which gives due emphasis on the exposure of nurses in psychiatric nursing care.


  Chapters of Mental Healthcare Act, 2017 Top


The number of chapters has increased to 16 from 10. The act is progressive; the patient was centric and right based. The chapter 5 on “Rights of the person with mental illness” is the heart and soul of this legislation. The chapters are depicted in [chart 2].




  Role Of Mental Health Nurse in Mental Healthcare Act-2017 Top


As MHCA 2017 has given specific reference to the Mental Health Professionals and has refined the term “psychiatric nurse” with “Mental Health Nurse,” it is very important to understand the role of nurse while caring for a PMI, considering the changes in the act compared with the earlier act.[5]

1. As a member of the Central And State Mental Health Authority: One MHN having at least 15 years of experience in the field of mental health to be nominated as a member of the Central Mental Health Authority under section 34 (L) and in the State Mental Health Authority under section 46 (K)

2. Treatment Mode: As a mental health professional, the MHN has a responsibility to educate and give information to the patient and caregivers about the need and importance of making an advance directive and nominated representative to protect the rights of PMI.

  • In the event of a mental health situation, every person would have the right to specify how he would like to be treated by making an advance directive[4]
  • Nominated representative is the person who will be responsible for taking decisions with regard to treatment and admission.[4]


3. Admission procedure

  • Admission: Under MHCA 2017, the admission procedure has divided into two sections.


  1. Independent admission (Section 86):
  2. Supported admission (Section 89 and 90): Any person, who is incapable to make mental health care and treatment decisions independently and needs very high support in the mental health establishment (MHE), up to 30 days (Section 89) and can extended in accordance with the provision of section 90.


Under Section 89, the medical officer or mental health professional in charge of the MHE can admit every such person upon application by the nominated representative.[4] So here, a MHN plays a vital role in taking decision for admission for a PMI.

4. Right to access to public health care: As nurses are working close to the public, it is their responsibility to educate the public on their rights to access to the public health care such as:

  • The government should guarantee the right to access to mental health services for every person
  • Affordable and good quality of a minimum mental health services should be easily accessible in every district
  • Protection from inhuman treatment and right to have equality of treatment[4]
  • Decriminalization of suicide attempt: The MHCA-2017, decriminalized suicide attempt, which emphasis on providing support and treatment for the person who attempts suicide, as they are under severe stress and shall not punish for it. It also imposes the responsibility on the government to provide support to prevent the recurrence.[4]


5. Provide information about insurance coverage

  • The medical insurance company should provide all the facilities for PMI on the same basis, as it is available for physical illness
  • The treatment and care need to be provided in their own community, which enables the PMI to live with their families. The MHCA-2017 focuses on community-based rehabilitation and aims for social inclusion of PMI[4]


6. Role of MHN to protect the rights of PMI (from Section 18–28)[4]

  • Right to make an advance directive: The MHN must ensure that the PMI should get all the opportunity and has the right to make an advance directive toward the way he/she wants to be treated, once the patient becomes better
  • Right to appoint a nominated representative: A nominated representative is the person who is appointed by the PMI to take decision on all health-related situation on his/her behalf
  • Right to have free medicines and quality mental health services: The government should provide free mental health services of good quality and in sufficient quantity to all PMI without any discrimination and same as of general health services
  • Right to protection from cruel, inhuman and degrading treatment: A MHN is legally bound to protect the PMI from cruel, inhuman, or degrading treatment in any MHE
  • Right to live in a safe and hygienic environment and have basic amenities: A MHN must ensure a safe and hygienic environment with adequate privacy, proper clothing, and recreational facilities for every PMI admitted in any MHE
  • Right to refuse work and to get paid for the work done: Appropriate remuneration should be provided for the work done by a PMI and not to be forced if he/she is not interested to do so in any MHE
  • Right to protection and free legal aid: A MHN must ensure that a PMI shall have the right to receive free legal services and protection from all forms of abuse (physical, verbal, or sexual).[4]


7. Role of MHN to protect the PMI from prohibited procedures and practices

  • No Electro convulsive therapy (ECT) without anesthesia and restriction for minors: Direct ECT shall not be performed and it can be given only with the use of muscle relaxants and anesthesia. ECT shall be done for minors only in exceptional cases after getting informed consent of the guardian and prior permission of the board[6]
  • No mechanical restraints and restriction on physical restraints: There shall be no chaining of PMI, in any manner or form. The MHN should ensure that physical restraints shall be provided only when absolutely needed in a least restrictive method and should monitor the PMI very closely to prevent any injuries. Seclusion and solitary confinement are totally banned and submission of report to Mental Health Authority (MHA).[7]
  • No torturing, discrimination, or compulsion to wear uniforms: A MHN must ensure that the PMI has the right use his/her personal clothing and can deny the uniform of the MHE and shall be protected from any kind of discrimination
  • No sterilization and restriction on psychosurgery: Psychosurgery and sterilization of men/women shall not be performed as a treatment for mental illness without obtaining informed consent and approval from the board.


A MHN nurse should comply with care for a woman with mental illness who is in MHE and shall not be separated from her child, if the child is below 3 years. The treatment provision for mental illness by any insurer shall be in par with provisions made for any physical illness. Any registered medical practitioner can initiate emergency treatment to any PMI if there is a threat to self, others, or property. If a MHN found any PMI who is incapable of taking care of himself/herself, found wandering, can approach the officer I/C of a police station for the protection of the same.

As MHN is a team member of the mental health professionals, MHN can be a part of the decision-making team for both independent and supported admission. It is the duty of the MHN to give due emphasis on the human rights like advanced directive and nominated representative. It is also very important to provide treatment and rehabilitate the person to ensure that no recurrence of suicide attempts, as he/she is suffering from severe stress and shall not be subjected to any investigation or prosecution. There should be close monitoring for the PMI, who is on physical restraints and should be reported immediately to the authorities. A MHN must ensure that informed consent has been obtained for any procedure or formalities. The promotion of mental health and preventive programs should be organized, and thereby create awareness by educating the family members about the rights of PMI. Proper documentation is very essential to protect ourselves and avoid any legal consequences.[5]


  Challenges in Implementation Top


MHCA 2017 is heavily influenced by the Western model of legislation. It is based on individual rights and patient centric and gives the individual total autonomy over them, which comes in the way of the treatment unless the patient gives informed consent. On the other hand, the act does not take into account of the family member's significant contribution, caregiver's burden, and the isolation and frustration they undergo because of PMI. Unlike the West, in India, the family is the key resource in the care of PMI. The act does not acknowledge or foster the contribution of family members' support and will in providing care.[1] There are acute shortages and irregular distribution of the Mental Health Professionals and lack of adequate funds in implementation of the Act.


  Conclusion Top


This historic legislation is a cornerstone of evolution on the rights of person with disabilities in India. As a result, disability concerns have come to a sharp focus and made revolutionary changes in the roles, obligations, provision, and responsibilities in the MHC Act 2017. The MHC Act 2017, empower MHNs as mental health professionals by providing an additional role in decision-making during admission under section 89 and capacity assessment of PMI, which mandates them to be updated with the current legislations of India while taking care of a PMI.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Math SB, Basavaraju V, Harihara SN, Gowda GS, Manjunatha N, Kumar CN, et al. Mental Health Care Act 2017 - Aspiration to action. Indian J Psychiatry 2019;61:S660-6.  Back to cited text no. 1
    
2.
Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India, 2015-2016: Summary. Bengaluru: National Institute of Mental Health and Neuro Sciences; 2016.  Back to cited text no. 2
    
3.
Mishra A, Galhotra A. Mental Health Care Act 2017: Need to wait and watch. Int J Appl Basic Med Res 2018;8:67-70.  Back to cited text no. 3
    
4.
Mental Health Care Act-2017. Available from: http://www.prsindia.org/uploads/media/Mental%20Health%Mental%20Healthcare%20Act.%20. 2017.pdf. [Last accessed on 2019 Nov 28].  Back to cited text no. 4
    
5.
Gandi S, Math SB, Kumar CN, Gowda GS, Prasad KM, Sivakumar T, et al. Updates in Mental Health Nursing. 1st ed. Bengaluru: NIMHANS Publication; 2019.  Back to cited text no. 5
    
6.
Pathare S, Sagade J. Amendments to the Mental Health Act-1987. New Delhi: The Ministry of Health and Family Welfare, Government of India; May, 2010. Available from: http://www.wbhealth.gov.in/metal_health/Acts_Rules/MHA_1987.pdf. [Last accessed on 2019 Nov 28].  Back to cited text no. 6
    
7.
Kumar MT. Mental Health Care Act 2017: Liberal in principles, let down in provisions. Indian J Psychol Med 2018;40:101-7.  Back to cited text no. 7
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  In this article
Abstract
Introduction
Major Mile Stone...
The Mental Healt...
Definition of Me...
Chapters of Ment...
Role Of Mental H...
Challenges in Im...
Conclusion
References

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