Review Article

Mental Healthcare Act 2017 – Role of Nurse in Enabling Person with

Mental Illness
James Paul1, Radhakrishnan Govindan2, Narayana Manjunatha3, C. Naveen Kumar4, Suresh Bada Math5

1
PhD Nursing Scholar, The Mental Healthcare Act (MHCA) 2017 has come up with some major
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Abstract
2
Associate Professor of
Nursing- NIMHANS,
changes in the mental healthcare by introducing the concept of advance directives
3
Associate Professor of and nominated representatives and aims at strengthening the human rights of
Psychiatry- NIMHANS, person with mental illness (PMI) and clearly emphasized the responsibility of
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4
Professor of Psychiatry- the government. The objective of this article is to give a brief overview of the
NIMHANS, 5Professor of MHCA‑2017 and specify the role of mental health nurses in enabling PMI and
Psychiatry NIMHANS, protects their rights, as they are also included in the mental health professionals.
Bengaluru, Karnataka, India
Keywords: Advance directive, Mental Healthcare Act 2017, nominated
representative, nurses role in Mental Healthcare Act 2017

Introduction The Mental Healthcare Act 2017

T he Government of India ratified the United Nations

Convention on the Rights of Persons with
Disabilities (UNCRPD) in 2007, which facilitated the
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
process of change in laws related to the rights of person for persons with mental illness and to protect, promote,
with mental illness (PMI).[1] The Lunacy Act, 1912 and and fulfill the rights of such persons during delivery of
the Mental Health Act, 1987 have become outdated mental health care and services and for matters connected
due to rapid advancement in the mental health‑care therewith or incidental thereto.”[4]
delivery system. Mental illness is now treatable, and the
approach and attitude have changed considerably. There Definition of Mental Health Nurse
was a perceived and felt need for a new act to suit the According to the MHCA 2017, “Mental Health Nurse
changing times and also a need for it to be in line with means, a person with a diploma or degree in general
the UNCRPD. According to the National Mental Health nursing or diploma or degree in psychiatric nursing
Survey 2016 by NIMHANS, India, across 12 different recognized by the Nursing Council of India established
states, the lifetime prevalence of mental disorder is under the Nursing Council of India Act, 1947 and
13.7% as a whole, which would mean that at least 150 registered as such with the relevant nursing council
million Indians are in need of urgent intervention.[2] More in the state.”[4] As per the current definition, any nurse
than half of the total burden of the mental illness is in with a diploma in nursing without any experience in
vulnerable age groups such as adolescents and geriatric psychiatric nursing is eligible to become a mental health
population.[3] To address this mammoth problem, “The nurse (MHN), which is quiet a debatable situation. At the
same time, there is no specific comment on the definition
Mental Healthcare Act 2017” was enacted, which is
of a psychiatric nurse. As the MHN has included in the
progressive and right based on nature.[1]
mental health professionals with major role in admission
Major Mile Stones in Indian Mental
Address for correspondence: Dr. Radhakrishnan Govindan,
Health Legislation Department of Nursing, NIMHANS, Bengaluru ‑ 560 029,
Chart 1: Depicts the history of mental health legislation Karnataka, India.
E‑mail: [email protected]
in India.
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DOI: How to cite this article: Paul J, Govindan R, Manjunatha N, Kumar CN,
10.4103/IOPN.IOPN_29_19 Math SB. Mental Healthcare Act 2017 – Role of nurse in enabling person
with mental illness. Indian J Psy Nsg 2019;16:114-7.

114 © 2020 Indian Journal of Psychiatric Nursing | Published by Wolters Kluwer ‑ Medknow

 Paul, et al.: Mental Healthcare Act 2017 – Role of Nurse in Enabling Person with Mental Illness

and capacity assessment, there should be some clarity in every such person upon application by the nominated
the definition which gives due emphasis on the exposure representative.[4] So here, a MHN plays a vital role in
of nurses in psychiatric nursing care. taking decision for admission for a PMI.
4. Right to access to public health care: As nurses are
Chapters of Mental Healthcare working close to the public, it is their responsibility
Act, 2017 to educate the public on their rights to access to the
public health care such as:
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The number of chapters has increased to 16 from 10.

The act is progressive; the patient was centric and right • The government should guarantee the right to
based. The chapter 5 on “Rights of the person with access to mental health services for every person
mental illness” is the heart and soul of this legislation. • Affordable and good quality of a minimum
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The chapters are depicted in chart 2. mental health services should be easily accessible
in every district
Role of Mental Health Nurse in Mental • Protection from inhuman treatment and right to
have equality of treatment[4]
Healthcare Act‑2017
• Decriminalization of suicide attempt: The
As MHCA 2017 has given specific reference to the MHCA‑2017, decriminalized suicide attempt,
Mental Health Professionals and has refined the term which emphasis on providing support and
“psychiatric nurse” with “Mental Health Nurse,” it is treatment for the person who attempts suicide, as
very important to understand the role of nurse while they are under severe stress and shall not punish
caring for a PMI, considering the changes in the act for it. It also imposes the responsibility on the
compared with the earlier act.[5] government to provide support to prevent the
1. As a member of the Central And State Mental recurrence.[4]
Health Authority: One MHN having at least 15 years 5. Provide information about insurance coverage
of experience in the field of mental health to be • The medical insurance company should provide
nominated as a member of the Central Mental Health all the facilities for PMI on the same basis, as it
Authority under section 34 (L) and in the State is available for physical illness
Mental Health Authority under section 46 (K) • The treatment and care need to be provided in
2. Treatment Mode: As a mental health professional, their own community, which enables the PMI to
the MHN has a responsibility to educate and give live with their families. The MHCA‑2017 focuses
information to the patient and caregivers about the on community‑based rehabilitation and aims for
need and importance of making an advance directive social inclusion of PMI[4]
and nominated representative to protect the rights of 6. Role of MHN to protect the rights of PMI (from
PMI. Section 18–28)[4]
• In the event of a mental health situation, every • Right to make an advance directive: The MHN
person would have the right to specify how he must ensure that the PMI should get all the
would like to be treated by making an advance opportunity and has the right to make an advance
directive[4] directive toward the way he/she wants to be
• Nominated representative is the person who will treated, once the patient becomes better
be responsible for taking decisions with regard to • Right to appoint a nominated representative:
treatment and admission.[4] A nominated representative is the person who
3. Admission procedure is appointed by the PMI to take decision on all
• Admission: Under MHCA 2017, the admission health‑related situation on his/her behalf
procedure has divided into two sections. • Right to have free medicines and quality mental
1. Independent admission (Section 86):
health services: The government should provide
2.  Supported admission (Section 89 and 90):
free mental health services of good quality and
Any person, who is incapable to make
in sufficient quantity to all PMI without any
mental health care and treatment decisions
discrimination and same as of general health
independently and needs very high support
services
in the mental health establishment (MHE), up
• Right to protection from cruel, inhuman and
to 30 days (Section 89) and can extended in
degrading treatment: A MHN is legally bound
accordance with the provision of section 90.
to protect the PMI from cruel, inhuman, or
Under Section 89, the medical officer or mental degrading treatment in any MHE
health professional in charge of the MHE can admit • Right to live in a safe and hygienic environment

Indian Journal of Psychiatric Nursing ¦ Volume 16 ¦ Issue 2 ¦ July-December 2019 115

 Paul, et al.: Mental Healthcare Act 2017 – Role of Nurse in Enabling Person with Mental Illness

and have basic amenities: A MHN must ensure • Right to protection and free legal aid: A MHN
a safe and hygienic environment with adequate must ensure that a PMI shall have the right to
privacy, proper clothing, and recreational facilities receive free legal services and protection from all
for every PMI admitted in any MHE forms of abuse (physical, verbal, or sexual).[4]
• Right to refuse work and to get paid for the 7. Role of MHN to protect the PMI from prohibited
work done: Appropriate remuneration should be procedures and practices
provided for the work done by a PMI and not to • No Electro convulsive therapy (ECT) without
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be forced if he/she is not interested to do so in anesthesia and restriction for minors: Direct ECT
any MHE shall not be performed and it can be given only
with the use of muscle relaxants and anesthesia.
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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
Chart 1: Depicts the history of mental health legislation in India wear uniforms: A MHN must ensure that the PMI

Chart 2: Depicts the chapters of Mental Healthcare Act 2017

116 Indian Journal of Psychiatric Nursing ¦ Volume 16 ¦ Issue 2 ¦ July-December 2019

 Paul, et al.: Mental Healthcare Act 2017 – Role of Nurse in Enabling Person with Mental Illness

has the right use his/her personal clothing and significant contribution, caregiver’s burden, and the
can deny the uniform of the MHE and shall be isolation and frustration they undergo because of PMI.
protected from any kind of discrimination Unlike the West, in India, the family is the key resource
• No sterilization and restriction on psychosurgery: in the care of PMI. The act does not acknowledge or
Psychosurgery and sterilization of men/women foster the contribution of family members’ support and
shall not be performed as a treatment for mental will in providing care.[1] There are acute shortages and
illness without obtaining informed consent and irregular distribution of the Mental Health Professionals
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approval from the board. and lack of adequate funds in implementation of the Act.
A MHN nurse should comply with care for a woman
with mental illness who is in MHE and shall not be
Conclusion
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separated from her child, if the child is below 3 years. This historic legislation is a cornerstone of evolution on
The treatment provision for mental illness by any insurer the rights of person with disabilities in India. As a result,
shall be in par with provisions made for any physical disability concerns have come to a sharp focus and made
illness. Any registered medical practitioner can initiate revolutionary changes in the roles, obligations, provision,
emergency treatment to any PMI if there is a threat to and responsibilities in the MHC Act 2017. The MHC Act
self, others, or property. If a MHN found any PMI who 2017, empower MHNs as mental health professionals by
is incapable of taking care of himself/herself, found providing an additional role in decision‑making during
wandering, can approach the officer I/C of a police admission under section 89 and capacity assessment
station for the protection of the same. of PMI, which mandates them to be updated with the
current legislations of India while taking care of a PMI.
As MHN is a team member of the mental health
professionals, MHN can be a part of the decision‑making Financial support and sponsorship
team for both independent and supported admission. Nil.
It is the duty of the MHN to give due emphasis on the Conflicts of interest
human rights like advanced directive and nominated
There are no conflicts of interest.
representative. It is also very important to provide
treatment and rehabilitate the person to ensure that no References
recurrence of suicide attempts, as he/she is suffering
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from severe stress and shall not be subjected to any Kumar CN, et al. Mental Health Care Act 2017 ‑ Aspiration to
investigation or prosecution. There should be close action. Indian J Psychiatry 2019;61:S660‑6.
monitoring for the PMI, who is on physical restraints 2. Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K,
and should be reported immediately to the authorities. Singh LK, et al. National Mental Health Survey of India,
2015‑2016: Summary. Bengaluru: National Institute of Mental
A MHN must ensure that informed consent has been
Health and Neuro Sciences; 2016.
obtained for any procedure or formalities. The promotion 3. Mishra A, Galhotra A. Mental Health Care Act 2017: Need to
of mental health and preventive programs should be wait and watch. Int J Appl Basic Med Res 2018;8:67‑70.
organized, and thereby create awareness by educating 4. Mental Health Care Act‑2017. Available from: http://www.
the family members about the rights of PMI. Proper prsindia.org/uploads/media/Mental%20Health%Mental%20
documentation is very essential to protect ourselves and Healthcare%20Act.%20. 2017.pdf. [Last accessed on 2019 Nov
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et al. Updates in Mental Health Nursing. 1st ed. Bengaluru:
Challenges in Implementation NIMHANS Publication; 2019.
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wbhealth.gov.in/metal_health/Acts_Rules/MHA_1987.pdf. [Last
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