The Mental Healthcare Act, 2017
CHAPTER XII: ADMISSION, TREATMENT AND DISCHARGE
Section 90: Admission And Treatment Of Persons With Mental Illness, With High Support Needs, In Mental Health Establishment, Beyond Thirty Days (Supported Admission Beyond Thirty Days)
Bare Act
(1) If a person with mental illness admitted under section 89 requires continuous admission and treatment beyond thirty days or a person with mental illness discharged under sub-section (15) of that section requires readmission within seven days of such discharge, he shall be admitted in accordance with the provisions of this section.
(2) The medical officer or mental health professional in charge of a mental health establishment, upon application by the nominated representative of a person with mental illness, shall continue admission of such person with mental illness, if -
- (a) two psychiatrists have independently examined the person with mental illness in the preceding seven days and both independently conclude based on the examination and, on information provided by others that the person has a mental illness of a severity that the person -
- (i) has consistently over time threatened or attempted to cause bodily harm to himself; or
- (ii) has consistently over time behaved violently towards another person or has consistently over time caused another person to fear bodily harm from him; or
- (iii) has consistently over time shown an inability to care for himself to a degree that places the individual at risk of harm to himself;
- (b) both psychiatrists, after taking into account an advance directive, if any, certify that admission to a mental health establishment is the least restrictive care option possible under the circumstances; and
- (c) the person continues to remain ineligible to receive care and treatment as an independent patient as the person cannot make mental healthcare and treatment decisions independently and needs very high support from his nominated representative, in making decisions.
(3) The medical officer or mental health professional in charge of the mental health establishment shall report all admissions or readmission under this section, within a period of seven days of such admission or readmission, to the concerned Board.
(4) The Board shall, within a period of twenty-one days from the date of last admission or readmission of person with mental illness under this section, permit such admission or readmission or order discharge of such person.
(5) While permitting admission or readmission or ordering discharge of such person under sub-section (4), the Board shall examine -
- (a) the need for institutional care to such person;
- (b) whether such care cannot be provided in less restrictive settings based in the community.
(6) In all cases of application for readmission or continuance of admission of a person with mental illness in the mental health establishment under this section, the Board may require the medical officer or psychiatrist in charge of treatment of such person with mental illness to submit a plan for community based treatment and the progress made, or likely to be made, towards realising this plan.
(7) The person referred to in sub-section (4) shall not be permitted to continue in the mental health establishment in which he had been admitted or his readmission in such establishment merely on the ground of non-existence of community based services at the place where such person ordinarily resides.
(8) The admission of a person with mental illness to a mental health establishment under this section shall be limited to a period up to ninety days in the first instance.
(9) The admission of a person with mental illness to a mental health establishment under this section beyond the period of ninety days may be extended for a period of one hundred and twenty days at the first instance and thereafter for a period of one hundred and eighty days each time after complying with the provisions of sub-sections (1) to (7).
(10) If the Board refuses to permit admission or continuation thereof or readmission under sub-section (9), or on the expiry of the periods referred to in sub-section (9) or earlier if such person no longer falls within the criteria for admission under sub-section (1), such person shall be discharged from such mental health establishment.
(11) Every person with mental illness admitted under this section shall be provided treatment, after taking into account -
- (a) an advance directive; or
- (b) informed consent of the person with the support from his nominated representative subject to the provision of sub-section (12).
(12) If a person with mental illness admitted under this section, requires nearly hundred per cent. support from his nominated representative, in making decision in respect of his treatment, the nominated representative may temporarily consent to the treatment plan of such person on his behalf.
(13) In a case where consent has been given under sub-section (12), the medical officer or mental health professional in charge of the mental health establishment shall record such consent in the medical records of such person with mental illness and review on the expiry of every fortnight, the capacity of such person to give consent.
(14) A person with mental illness admitted under this section, or his nominated representative or a representative of a registered non-governmental organisation with the consent of the person, may apply to the concerned Board for review of the decision of the medical officer or mental health professional in charge of medical health establishment to admit such person in such establishment and the decision of the Board thereon shall be binding on all parties.
(15) Notwithstanding anything contained in this Act, if the medical officer or mental health professional in charge of the mental health establishment is of the opinion that the conditions under sub-section (1) are no longer applicable, such medical officer or mental health professional shall discharge such person from such establishment and inform such person and his nominated representative accordingly.
(16) The person with mental illness referred to in sub-section (15) may continue to remain in the mental health establishment as an independent patient.
Simplified Act
Simplified Explanation of Section 90 of The Mental Healthcare Act, 2017
(1) If someone with a mental illness needs to stay in a hospital longer than 30 days or needs to come back within 7 days after leaving, they must be admitted following the rules in this section.
(2) A person with mental illness can stay in the hospital if their appointed representative asks for it, and:
- Two psychiatrists, who checked the person in the last week, agree that the person's mental illness is serious and that the person is a danger to themselves or others, or can't take care of themselves.
- The psychiatrists believe that staying in the hospital is the best and least restrictive option, considering any advance directives (instructions given by the person for their future care).
- The person can't make decisions about their treatment on their own and needs a lot of help from their appointed representative.
(3) The person in charge of the hospital must tell a special board about any admissions or readmissions within 7 days.
(4) Within 21 days, the board will decide whether the person should stay in the hospital or be discharged.
(5) When making this decision, the board will consider if the person really needs to be in the hospital and if there's a less restrictive way to provide care in the community.
(6) The board might ask for a plan for community-based treatment and progress updates when considering applications for readmission or continued admission.
(7) A person can't stay in the hospital just because there are no community services available where they live.
(8) Initially, a person can be admitted to a hospital for up to 90 days under these rules.
(9) This stay can be extended first for 120 days, and then for 180 days at a time, as long as the rules are followed.
(10) If the board doesn't allow the person to be admitted or stay, or when the time limit is up (or earlier if the person no longer meets the criteria), the person must be discharged.
(11) Every admitted person must receive treatment that considers any advance directives or informed consent with help from their representative.
(12) If a person needs nearly complete help from their representative to make treatment decisions, the representative can temporarily agree to the treatment plan on the person's behalf.
(13) The hospital must record this consent and check every two weeks whether the person is now able to consent on their own.
(14) The person admitted, their representative, or a non-governmental organization can ask the board to review the hospital's decision to admit the person. The board's decision is final.
(15) If the hospital's in-charge thinks the person no longer meets the admission criteria, they must discharge the person and inform them and their representative.
(16) After being discharged, the person can choose to stay in the hospital as an independent patient if they want to.
Explanation using examples
Imagine John, a 40-year-old man with a history of bipolar disorder, has been admitted to a mental health establishment under Section 89 of The Mental Healthcare Act, 2017, due to a severe manic episode. He has been receiving treatment for the past month, but as the 30-day mark approaches, his doctors believe that he requires continued care beyond this period.
John's nominated representative, his sister Mary, applies for his continued admission under Section 90. Two independent psychiatrists evaluate John within the last week of his initial 30-day treatment period. They both conclude that John still poses a risk of harm to himself and cannot make healthcare decisions independently due to the severity of his illness. The psychiatrists consider John's advance directive, which favors hospital treatment over community care, and certify that continued hospitalization is the least restrictive care option for him at this time.
The medical officer in charge of the mental health establishment reports John's continued admission to the concerned Mental Health Review Board within seven days, as required by sub-section (3) of Section 90. The Board reviews John's case within the next 21 days and decides to permit the continued admission based on the evidence provided.
John's initial extended admission is limited to 90 days, as stated in sub-section (8). If he requires further treatment beyond this period, the process outlined in sub-sections (1) to (7) will need to be followed to extend his stay for additional specified periods.
Throughout his admission, John's treatment is provided with due consideration to his advance directive and with the informed consent of his nominated representative, as per sub-sections (11) and (12). His capacity to consent is regularly reviewed every fortnight according to sub-section (13).
If at any point the medical officer believes that John no longer meets the criteria for continued admission under Section 90, as per sub-section (15), John will be discharged but can choose to stay as an independent patient if he wishes, as mentioned in sub-section (16).
