Article

Mental health care act (MHCA) 2017: What Child mental health professionals need to know?

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Abstract

Mental health care act, 2017 has adopted a rights based approach towards persons with mental illness. For the first time, child mental health related issues are given some importance in comparison to earlier Mental health act, 1987. We, bring here highlights of the act as pertinent to legal aspects of child mental health treatment. Act advocates for increased monitoring, regulation of admission, treatment and research involving minors. © 2018, Indian Association for Child and Adolescent Mental Health. All rights reserved.

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... It is well-known that coercing adolescents to comply with treatment protocols results in difficulties in establishing and maintaining an effective therapeutic alliance. Therefore, along with parents', children and adolescents should be part of discussions with mental health professionals so that all their concerns may be systematically addressed (Siddeswara et al., 2018). ...
... Discharge of independent patients: (2) Where a minor has been admitted to a MHE under section 87 and attains the age of 18 years during his stay in the MHE, the medical officer in charge of the MHE shall classify him as an independent patient under section 86 and all provisions of this Act as applicable to independent patient who is not minor, shall apply to such person Section 89: Admission and treatment of persons with mental illness, with high support needs, in MHE, up to 30 days (supported admission) (9) The medical officer or MHP in charge of the MHE shall report the concerned Board, (a) within 3 days the admissions of a woman or a minor; (b) within 7 days the admission of any person not being a woman or minor Section 95. (1) Notwithstanding anything contained in this Act, the following treatments shall not be performed on any person with mental illness (a) ECT without the use of muscle relaxants and anesthesia; (b) ECT for minors; (c) sterilization of men or women, when such sterilization is intended as a treatment for mental illness; (d) chained in any manner or form whatsoever (2) Notwithstanding anything contained in subsection (1), if, in the opinion of the psychiatrist in charge of a minor's treatment, ECT is required, then, such treatment shall be done with the informed consent of the guardian and prior permission of the concerned board those standards and requirements. It is known that children with mental illness including developmental disorders need a cognitively stimulating yet safe environment to address their unique needs (Kelly McGuire et al., 2015;Siddeswara et al., 2018). Therefore, specific guidelines and standards of care regarding infrastructure, personnel, and other logistic facilities would be useful after taking into consideration the inputs of parents and mental health professionals. ...
... Siddeshwara et al [13] also pointed out that while the Juvenile Justice Act (JJA 2015) allows 16-to 18-year-old adolescents to be tried as adults for heinous crimes, adolescents under the age of 18 are paradoxically denied the right to make mental health choices. Though the comparison is not between heinous crimes and mental illnesses, the difference in the presumption of cognitive maturity points out the existing contradiction within the legal system. ...
Article
Full-text available
Mental illnesses are proven to have their onset in the mid-teens, making early mental healthcare interventions necessary among adolescents. While school-based mental health awareness programmes have gained prominence in recent years, adolescents identify issues around confidentiality, privacy and the need for parental consent impinging on their autonomy, as barriers to accessing mental healthcare, for their perceived needs. We aim to discuss the various ethical dilemmas faced by community mental health providers in using age as a sole marker for determining autonomy for adolescents, focusing on the potential impact of these challenges on adolescent mental healthcare and wellbeing.
... This has been raised in particular in relation to electroconvulsive therapy (Duffy et al., 2018;Duffy et al., 2019). Access to all forms of mental healthcare is especially important issue for children and adolescents as they experience a significant treatment gap in India (Sharan and Kumar, 2016;Siddeswara et al., 2018). ...
Chapter
This chapter focuses on the incorporation of the United Nations’ Convention on the Rights of Persons with Disabilities (CRPD) into Indian law, chiefly through the Rights of Persons with Disabilities Act, 2016 and Mental Healthcare Act, 2017. It examines the extent to which Indian legislation meets CRPD requirements relating to ‘equality and non-discrimination’ (CRPD Article 5), ‘women with disabilities’ (Article 6), ‘children with disabilities’ (Article 7), ‘awareness-raising’ (Article 8), ‘accessibility’ (Article 9), ‘right to life’ (Article 10), ‘risk and humanitarian emergencies’ (Article 11), ‘equal recognition before the law’ (Article 12), ‘access to justice’ (Article 13), ‘liberty and security of person’ (Article 14), ‘freedom from torture or cruel, inhuman or degrading treatment or punishment’ (Article 15), ‘freedom from exploitation, violence and abuse’ (Article 16), ‘protecting the integrity of the person’ (Article 17), ‘liberty of movement and nationality’ (Article 18), ‘living independently and being included in the community’ (Article 19)Article 19 Living independently and being included in the community, ‘personal mobility’ (Article 20), ‘freedom of expression and opinion, and access to information’ (Article 21), ‘respect for privacy’ (Article 22), ‘respect for home and the family’ (Article 23), ‘education’ (Article 24), ‘health’ (Article 25), ‘habilitation and rehabilitation’ (Article 26), ‘work and employment’ (Article 27), ‘adequate standard of living and social protection’ (Article 28), ‘participation in political and public life’ (Article 29) and ‘cultural life, recreation, leisure and sport’ (Article 30). Overall, Indian legislation addresses the great majority of CRPD requirements although certain areas could be improved (e.g. political rights, liberty of movement, nationality) and greater consideration given to implementation and monitoring.
Article
The widespread reach and ease of use make technology a handy tool for today's practicing mental health professional (MHP), especially in light of the Mental Healthcare Act (MHCA) 2017, the essence of which safeguards the rights of patients while squarely placing the onus on MHPs. In order to keep up with the changing times, it is imperative for the MHP to be aware of the potential of technology to not only aid delivery but also ease the burden of care while being MHCA-compliant. In addition, the article calls for a more proactive role of the MHP in driving change in terms of leveraging technology in mental health settings. It looks at how certain tools can be incorporated across a range of scenarios right from wellness applications and facilitating medical adherence to aiding crisis intervention and extending quality care services in remotes areas. The article briefly outlines a framework involving various stakeholders at different levels as well as the channels in which the technology can be leveraged while keeping the patients' rights front and center. The potential barriers that an 'e-ready' MHP can expect and directions for moving ahead are discussed, keeping a critical eye on the lacunae in using technology. © 2019 Indian Journal of Psychiatry | Published by Wolters Kluwer - Medknow.
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