The Indian Lunatic Asylum Act of 1858

The Indian Lunatic Asylum Act of 1858 was a significant piece of legislation enacted during
British colonial rule in India. It aimed to establish a system for the care and treatment of
individuals with mental illness.

Key Provisions of the Indian Lunatic Asylum Act of 1858

The Indian Lunatic Asylum Act of 1858 was a significant piece of legislation during the British
colonial era in India. Here are its key provisions:

1. Establishment of Lunatic Asylums

* Centralized Control: The Act established a centralized system for the management and
control of lunatic asylums across British India.
* Government Oversight: The government was given the power to establish, maintain, and
regulate these asylums.
* Infrastructure Development: The Act provided for the construction and maintenance of
adequate infrastructure within these asylums, including living quarters, medical facilities, and
security measures.
2. Admission Procedures
* Medical Certification: Individuals could only be admitted to a lunatic asylum based on the
medical certification of two qualified medical practitioners.
* Judicial Approval: The admission also required the approval of a magistrate or a judge,
ensuring legal oversight and preventing arbitrary confinement.
Care and Treatment
*3. Confinement and Control: The primary focus of the Act was on the confinement and
control of mentally ill individuals rather than their treatment and rehabilitation.
* Limited Therapeutic Interventions: The Act did not provide specific guidelines for
therapeutic interventions, and treatment options were often limited.
* Physical Restraint: Physical restraint methods were used to control patients, often leading
to human rights abuses.
Management and Supervision
4. Appointment of Superintendents: The Act mandated the appointment of superintendents
and medical officers to oversee the day-to-day operations of the asylums.
* Regular Inspections: The government was responsible for conducting regular inspections
of these institutions to ensure compliance with regulations and standards of care.
* Record Keeping: The Act required the maintenance of detailed records of patients,
including their medical histories, treatment plans, and behavior.

It's important to note that the Act was a product of its time and reflected the prevailing
medical and social attitudes towards mental illness. While it was a step towards recognizing
the need for specialized care, it also had significant limitations and often led to inhumane
treatment and confinement of individuals with mental illness.
The National Mental Health Programme (NMHP)

It was launched by the Government of India in 1982 to address the high burden of mental
disorders and the shortage of qualified professionals in the mental health field.

Later, in 1996, the district Mental Health Program was added to the NMHP Programme.

NMHP aims to provide accessible and affordable mental healthcare services to all
individuals.
The programme focuses on preventing, promoting, and treating mental health disorders.

NMHP works towards reducing the treatment gap and improving mental health literacy in the
country.

It emphasizes community-based care and strengthening mental health infrastructure.

The programme offers various interventions, including awareness campaigns, training for
healthcare professionals, and establishment of mental health clinics and facilities.

NMHP also supports integrating mental health services into the primary healthcare system.

The World Bank and WHO have been contacted for assistance with different National Mental
Health Programme components.

The Government of India funds state governments/UTs and nodal institutes under the
National Mental Health Programme to cover expenses for staff, equipment, vehicles,
stationary, contingencies, medicine, training, etc.

The Juvenile Justice Act, 1986

It was India's first formal law for juveniles. It was enacted to:
● Provide care, protection, treatment, development, and rehabilitation for neglected or
delinquent juveniles
● Adjudicate matters relating to delinquent juveniles
● Adopt a child-friendly approach
The Act's provisions include:
● Defining a juvenile as a child up to 16 years of age for boys and 18 years of age for
girls
● Classifying children as juvenile delinquents or neglected juveniles
● Keeping children in an Observation Home together during proceedings
● Prohibiting the detention of an arrested child in police custody or in jail
● Providing competent authorities and institutions with the necessary powers to deal
with juvenile problems
● Providing special powers to Juvenile Welfare Boards to deal with neglected juveniles
● Providing Juvenile Courts with the required powers to deal with delinquent juveniles
 ● Making provisions to protect juveniles even in case of offenses committed by such
juveniles

INDIA’S MENTAL HEALTH ACT, 1987

India gained independence in 1947, but continued to use the Indian Lunacy Act, 1912 until it
was replaced by the Mental Health Act, 1987.

It is defined as “An Act to consolidate and amend the law relating to the treatment and care
of mentally ill persons, to make better provision with respect to their property and affairs and
for matters connected therewith or incidental thereto. “

The Mental Health Act of 1987 is a significant piece of legislation in India that aims to
provide comprehensive care and protection for individuals with mental illness, the Act came
to pass in April, 1993.

Key Provisions of the Mental Health Act, 1987:

1. De-stigmatizing: outdated terms like ‘lunatic’ and ‘lunatic asylums’ were changed and
more inclusive terminology like ‘mentally ill person’ and ‘psychiatric hospital’ were
used. It aimed to change the attitude of the society by outlining certain rights of
mentally ill patients and aimed to de-stigmatise mental illnesses and disorders. It also
introduced the Central and State Mental Health Authorities, organisations that are
solely committed to deal with matters concerning the mental health of the population.

2. Admission Procedures: The Act outlines detailed procedures for admitting mentally ill
persons to psychiatric hospitals and nursing homes, including medical certification
and judicial oversight. Simplified admission and discharge policies, and facilitated
proxy consent for involuntary admission and the admission of minors (Rastogi 2005;
Nambi et al. 2016). The Act also introduced-separate inpatient services for people
with addiction-based problems and provided children with separate mental health
services. It provided guidelines for establishing and licensing psychiatric hospitals
and nursing homes.

3. Out-patient treatment: It was also the first of India’s mental health acts to consider
outpatient treatment and thus helped shift the focus of psychiatric care from the
psychiatric hospitals to the community, at least in theory.

4. Rights of Patients: It safeguards the rights of patients, such as the right to humane
treatment, protection from abuse, and access to legal representation.

5. Protection of Property and Affairs: The Act allows for the appointment of guardians to
manage the property and affairs of mentally ill persons who are incapable of doing so
themselves.

6. Inspection and Monitoring: The Act empowers authorities to inspect psychiatric

hospitals and nursing homes to ensure adherence to standards of care. The Central
 and State Mental Health Authorities continued to inspect the conditions in psychiatric
hospitals and made provisions for humane treatment of patients.

7. Research and Training: It encourages research and training in mental health to

improve the quality of care. The 1987 Act also gave consideration to research (which
was not present in the 1912 Act) and prohibited research without valid consent.
Despite these advances, the 1987 Act was heavily criticized for a number of reasons.

1. First, it failed to align with government policy, India’s Mental Health Pro- gramme or
many World Health Organization guidelines.

2. Second, the new legislation approached mental illness from a legal perspective
rather than a clinical one and consequently placed arguably excessive power in the
hands of judges rather than clinicians.

3. Third, even though the aim of the act was to reduce stigma, the Act did little to
address stigma or the inappropriate use of men- tal health legislation or to educate
society as a whole about mental illness. The police were often the only means of
transporting involuntary patients to hospital, which added to stigma, rather than
reducing it (Nambi et al. 2016).

4. Fourth, little consideration was given to psychiatry outside of admission to mental

hospitals.

5. A major injustice occurred where no relatives came forward to support a person in

hospital, as such people could then, in theory, be detained indefinitely. Sinec the law
regarding discharge and detention were not outlined clearly.

6. The Act simplified the admission and discharge processes (Rastogi 2005), but made
no men- tion of rehabilitation or care after discharge. Aftercare and prevention of
relapse were not integrated in the Act.

7. Even though the act encouraged research, it allowed relatives to provide consent on
the patient’s behalf. This was an ethical issue, as consent could be given for
research despite the actual patient not willing to participate.

Overall, some of the innovations of the 1987 Act were steps in the rights direction, but they
still fell short of the legislative standards of the time.

REHABILITATION COUNCIL OF INDIA ACT 1992

The Rehabilitation Council of India Act, 1992 is an Act of Parliament in India that established
the Rehabilitation Council of India (RCI).
Key provisions of the Act: ◦
1. Establishment of the Rehabilitation Council of India (RCI) as a statutory body
responsible for regulating and standardizing training programs and services in the
field of rehabilitation for persons with disabilities.
 2. ◦ Composition of the Council: The Act outlines the composition of the Rehabilitation
Council of India, which includes a Chairperson, Vice-Chairperson, Secretary, and
other members appointed by the central government. The members are tasked with
different departments, including persons with disabilities, experts in rehabilitation,
and representatives from relevant ministries and organizations.
3. ◦ Functions of the Council: The Act delineates the functions of the Rehabilitation
Council of India, which include:
a. ◦ Accrediting institutions that offer courses in rehabilitation-related fields.
b. ◦ Setting guidelines and standards for curriculum, infrastructure, and faculty
qualifications.
c. ◦ Conducting inspections and assessments of educational and training
programs.
d. ◦ Promoting research and development in the field of rehabilitation.
e. ◦ Granting recognition and certification to professionals in the rehabilitation
sector.
4. ◦ Powers of the Council: The Act empowers the Rehabilitation Council of India to take
necessary measures to fulfill its objectives, including the power to make regulations,
levy fees, and issue guidelines for the implementation of the Act.
5. ◦ Recognition of Qualifications: The Act provides for the recognition of qualifications
in the field of rehabilitation conferred by institutions approved by the Rehabilitation
Council of India.
6. ◦ Offenses and Penalties: The Act specifies offenses and penalties for contravening
its provisions, including fines and imprisonment for individuals or institutions found
guilty of unauthorized use of the term "rehabilitation professional" or other related
offenses.
7. ◦ Advisory Committees: The Act allows the Rehabilitation Council of India to
constitute advisory committees to assist in the performance of its functions and
duties.

THE NATIONAL TRUST FOR WELFARE OF PERSONS WITH

AUTISM, CEREBRAL PALSY, MENTAL RETARDATION AND
MULTIPLE DISABILITIES ACT, 1999
Objectives of the Act This Act provides for the constitution of a national body for the Welfare
of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities. Such a
national body will be a trust whose objects shall be as under:
(a) to enable and empower persons with disability to live as independently and as fully as
possible within and as close to the community to which they belong;
(b) to strengthen facilities to provide support to persons with disability to live within their own
families;
(c) to extend support to registered organisation to provide need based services during the
period of crisis in the family of persons with disability;
(d) to deal with problems of persons with disability who do not have family support;
(e) to promote measures for the care and protection of persons with disability in the event of
death of their parent or guardian;
(f) to evolve procedure for the appointment of guardians and trustees for persons with
disability requiring such protection;
(g) to facilitate the realization of equal opportunities, protection of rights and full participation
of persons with disability; and
(h) to do any other act which is incidental to the aforesaid objects. The Act received the
assent of the President on 30th December, 1999 and extends to the whole of India.

The Mental Health Care Act (MHCA), 2017

With MHCA 2017, India reformed its mental health laws making it fully aligned with the UN
Convention on the Rights of Persons with Disabilities (UNCRPD), focusing on the promotion
of the rights to community inclusion, dignity, autonomy, empowerment, and recovery for all
people with mental illness.
The preamble of the Act has two parts:
1. Provide for mental health care and services for persons with mental illness; and
2. To protect, promote, and fulfill the rights of such persons during the delivery of mental
health care and services.

Here are some notes about the Mental Healthcare Act of 2017:
1. Determining mental illness:
a. Mental illness shall be determined in accordance with such nationally or
internationally accepted medical standards (including the latest edition of the
International Classification of Disease of the World Health Organisation)
b. No person or authority shall classify a person as a person with mental illness,
except for treatment of the mental illness or in other matters as covered under
this Act or any other law for the time being in force.
c. Mental illness of a person shall not be determined on the basis of political,
economic or social status or membership of a cultural, racial or religious
group, non-conformity with moral, social, cultural, work or political values or
religious beliefs, Past treatment or hospitalisation in a mental health. The
determination of a person's mental illness shall alone not imply or be taken to
mean that the person is of unsound mind unless he has been declared as
such by a competent court.
2. Capacity to make mental healthcare and treatment decisions.—
a. Every person, including a person with mental illness can make decisions regarding
his mental healthcare or treatment if such person has ability to— (a) understand the
information that is relevant to take a decision on the treatment or admission or
personal assistance; or (b) understand any reasonably foreseeable consequence of
a decision or lack of decision on the treatment or admission or personal assistance;
or (c) communicate the decision by speech, expression, gesture or any other means.

3. Rights: The act establishes the rights of people with mental illness, including the right to
access mental health care, Right to equal treatment and non-discrimination, Right to
protection from cruel, inhuman and degrading treatment, Right to community living. Right to
information, Restriction on release of information in respect of mental illness, Right to access
medical records, Right to personal contacts and communication.
4. Procedures: The act outlines the procedures for admission, treatment, and discharge of
people with mental illness.

5. Decriminalization: The act decriminalizes suicide attempts by people with mental illness.
Responsibilities: The act establishes responsibilities for certain agencies, such as police
officers who are required to report if they believe a person with mental illness is being
mistreated. Section 115 of the MHCA states that attempted suicide is to be considered the
result of severe stress, and the individual is not to be prosecuted. Instead, it places an onus
on the government to ensure that a person has access to support services.

6. Penalties: The act establishes penalties for violating its provisions, including imprisonment
and fines. Under Prohibited procedures.9 (a) electro-convulsive therapy without the use of
muscle relaxants and anaesthesia; (b) electro-convulsive therapy for minors;

7. Electroconvulsive therapy: The act prohibits electroconvulsive therapy (ECT) without the
use of muscle relaxants and anesthesia. It also prohibits ECT for minors. Under Prohibited
procedures. (a) electro-convulsive therapy without the use of muscle relaxants and
anaesthesia; (b) electro-convulsive therapy for minors;

8. Chaining: The act bans chaining people with mental illness.

9. Advance directives: 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 he wants
to appoint as his nominated representative.

10. Government responsibility: The act ensures that both the central and state governments
provide the necessary services. Promotion of mental health and preventive programmes.
Creating awareness about mental health and illness and reducing stigma associated with
mental illness.

Criticisms-
1. mental health professionals led by psychiatrists have opposed the MHCA's
autonomy-centric provisions. Interestingly, one of the most common concerns of
mental health professionals has been that persons with severe mental illness often
refuse treatment, lack insight about their best interests, choose inappropriate
alternatives or are incompetent to make decisions even though they may appear as
making informed decisions (Math et al., 2019; Antony, 2016; Sarin, 2012; Duffy et al.,
2018).

2. A prevailing sentiment among psychiatrists is that the MHCA is ‘heavily influenced by

the western model of legislation. It is based on individual rights, is patient centric, and
gives the individual total autonomy … ’ while ‘unlike the west, in India, the family is
the key resource in the care of PMI’ (Math et al., 2019, p.661).

3. The concept of Advance Directive (AD) is not in keeping with the socio-cultural
realities of India. Provision of AD requires the PMI to have sufficient knowledge of
treatments available for mental illness and make informed decisions that will be
beneficial to him/her. In reality, it is only presumptive and most patients in India may
not have such level of knowledge. Many times patients with mental illness refuse
treatment due to impaired insight and poor judgment temporarily or may be unaware
of the consequences of various treatment choices. They have to be explained and
advised about various treatment options and its relative benefits. AD made at a stage
of illness where patients have impaired insight or loss of personal and social
judgment that has a potential to improve with treatment, may not be in their best
interest. It is also impossible to establish retrospectively that the AD was made when
the patient had the capacity to do so.

4. Judicial officials are tasked with decisions about treatment, admission, and discharge
of patients in mental health establishment (MHE), which is illogical and unnecessary.
These are clinical (medical) decisions best left to a psychiatrist. This also slows the
system down making it inefficient.

5. Procedures laid down for admission and treatment of PMI with high support needs
are highly complicated, and impractical, leading to delay and denial. Conventionally,
advice for hospitalization is the prerogative of the treating doctor in all
medical/surgical specialties and patient is asked to give written consent for the same,
whereas, in MHCA, it is the patient or the NR who seeks admission by filing a formal
application on a specified form to the medical officer in-charge of the MHE. This
seems an unnecessary step. The admission should be possible on the
recommendation of the psychiatrist with the written consent of the patient or NR as
the case may be. Patients and families in need of immediate treatment in such a
severe situation feel harassed, and unsupported.
6. In the Act, mental illness has to be considered dangerous and very severely
disturbing for the purpose of supported/involuntary admission. However, Most PMIs
are not dangerous and may need supported inpatient treatment early on in the
course of illness before they become dangerous. Many times involuntary treatment is
needed much before such a degree of severity is reached when the patient may have
lost insight or judgment. Prolonging the duration of untreated mental illness reduces
the potential for recovery.
 7. In the Act, the concept of Nominated Representative (NR) is the authority and right to
take treatment decisions for the PMI in case the patient is unable to do so. This
concept is alien to Indian Society. NR is applicable in situations where there are no
families as caretakers, as is prevalent in western societies, or if the PMI is homeless
or abandoned.
Thinking that someone other than the close family members would act in the best
interest of the PMI is a far-fetched argument.
There is also a risk of vested interests getting designated as NR.
Thus, denying the first right to family to take decisions about the treatment of PMI
alienates the family and creates distrust, distress, and disruption, weakening the
social fabric.

The Mental Healthcare Bill, 2011

The Mental Healthcare Bill, 2011, was an act that aimed to provide access to mental health
care and services for people with mental illness. The bill's objectives included:
● Protecting the rights of people with mental illness
● Treating people with mental illness like other people with health problems
● Creating an environment that supports recovery, rehabilitation, and full participation
in society
Some of the bill's provisions included:
1. Decriminalizing suicide- The bill recommended decriminalizing suicide to reduce the
burden on patients, carers, and the legal system.

2. Establishing central and state mental health authorities- The bill required the
establishment of central and state mental health authorities, and for all mental health
establishments to be registered with them.

3. Creating a Mental Health Review Commission- The bill established a Mental Health
Review Commission to periodically review the use of advance directives and advise
the government on the protection of the rights of people with mental illness.

4. Nominated representative Any person who is 18 years of age, and above, and is
competent can appoint a person who is above 18 years age as a “nominated
representative (NR)”.

5. Consent The Bill gives great importance to free and fully informed consent. The
autonomy of the individual

6. Confidence The bill emphasises the confidentiality of patient-related information in

both the virtual and real spaces.

7. Standard of care The Central Mental Health Authority has prescribed minimum
standards for facilities, personnel training, and services.
8. Legal capacity According to the Bill, all patients with mental illness have legal
capacity and may/ may not require support to exercise their legal capacity. The level
of safeguards provided is based on the level of support needed. T

9. Supported admissions This measure was earlier known as “admission under special
circumstances” under which a patient could be admitted for up to 90 days under a
single admission process. Under the Bill, this period has been reduced to 30 days,
and may be extended up to 90 days.

10. Prohibited treatment There is a prohibition on electro-convulsive therapy (ECT)

without the use of muscle relaxants and anaesthesia (unmodified ECT). Prohibiting
electroconvulsive therapy (ECT) for minors

11. Discharge planning To ensure continuity of care with a proper referral and briefing of
the caregiver/family member of the patient.

12. Advance directives One new feature of the Bill, which needs to be evaluated in
greater detail, is the inclusion of the provision of “advance directives”. The draft
allows the provision of amending, cancelling or revoking the advance directive to the
individual at any point of time.