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ORIGINAL ARTICLE  
Year : 2016  |  Volume : 58  |  Issue : 2  |  Page : 171-177
A review of reception order in the management of mentally ill persons in a psychiatric institute


1 Institute of Mental Health, Madras Medical College, Kilpauk, Chennai, Tamil Nadu, India
2 Department of Psychiatry, SRM Medical College Hospital and Research Centre, Potheri, Kattankulathur, Kancheepuram, Tamil Nadu, India

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Date of Web Publication10-Jun-2016
 

   Abstract 

Background: Mentally ill prisoners, when requiring admission in a psychiatric facility, have to be admitted only by a reception order of a judicial magistrate and convicts by warrants issued by the Government to jail superintendents and the superintendent of the hospital. Both can be only under Section 27 of The Mental Health Act, 1987.
Materials and Methods: A study of the contents of reception order and warrants regarding the acts and section under which they were issued over 1 year period for the admission of the patients in the criminal ward of the Institute of Mental Health was carried out.
Results: Only three reception orders quoted Section 27 out of 54 patients admitted under a reception order. Nineteen patients were admitted by the jail superintendents.
Discussion: Various issues that were found in the reception order and their consequences are discussed, and a possible response to these issues is mooted.
Conclusion: Almost none of the reception orders were found to be proper. This deficit needs to be rectified by sensitizing the various authorities.

Keywords: 1987, compulsory admissions, reception order, The Mental Health Act

How to cite this article:
Subramanian N, Ramanathan R, Kumar VM, Chellappan DK, Ramasamy J. A review of reception order in the management of mentally ill persons in a psychiatric institute. Indian J Psychiatry 2016;58:171-7

How to cite this URL:
Subramanian N, Ramanathan R, Kumar VM, Chellappan DK, Ramasamy J. A review of reception order in the management of mentally ill persons in a psychiatric institute. Indian J Psychiatry [serial online] 2016 [cited 2019 Sep 21];58:171-7. Available from: http://www.indianjpsychiatry.org/text.asp?2016/58/2/171/183787



   Introduction Top


Admission and management of psychiatric patients in a psychiatric nursing home or hospital is under a specific provision called The Mental Health Act (MHA), 1987.[1] There is no legal provision for the admission of these patients for physical illnesses. There are circumstances where judiciary is involved in admitting the mentally ill patients into a psychiatric facility by the court orders and convicts by jail superintendents. There are two instances:

In the first instance, two situations are possible.

  • Patients have to be detained against their will by reason of mental ill health, though there are no criminal charges against them (civil patients)
  • In persons who are accused of crimes and where there is an issue of their mental health comes into question (criminal patients).


In the second instance, two situations are possible.

  • When the person's competence to stand trial is in question
  • When the mental status of the person is in question at the time of alleged commission of crime.


In all the above instances, the medical officer in-charge is ordered by the judiciary to take charge, detain, and care the patients, under the provisions of the MHA, 1987.[1] Apart from these situations, the State Government can direct the jail superintendent to send prisoners who have been convicted of crimes to a mental health facility when they require treatment.

The MHA, 1987[1] defines “reception order” as an order made under the provisions of this act for the detention and care of a mentally ill person in a psychiatric hospital or psychiatric nursing home.

Reception order can be issued by judicial magistrates or by The Commissioner of Police by virtue of his/her office, being an executive magistrate for the purpose of the Code of Criminal Procedure, 1973[2](Central Act 2 of 1974), and shall exercise the powers as an executive magistrate, subject to such orders as the State Government may, from time to time, issue (The Chennai City Police Act, 1888,[3] Section 36 of MHA, 1987).

As per The Mental Health Act, 1987,[1] “mentally ill prisoner means a mentally ill person for whose detention in, or removal to, a psychiatric hospital or psychiatric nursing home, jail, or other places of safe custody, for whom an order referred to in Section 27 has been made”.

Section 27 of the MHA, 1987,[1] an order under Section 30 of Prisoners Act, 1900 (3 of 1900) or under Section 144 of the Air Force Act, 1950 (45 of 1950) or under Section 145 of the Army Act, 1950 (946 of 1950) or under Section 143 or Section 144 of the Navy Act, 1957 (62 of 1957), or under Section 330 or Section 335 of the Code of Criminal Procedure, 1973 (2 of 1974), are the provisions under various acts which direct the reception of a mentally ill prisoner into a psychiatric hospital or psychiatric nursing home.

In case of convicted criminal prisoners, the power to send them to the psychiatric facility has been delegated to the jail superintendent (Prisons Act, 1894,[4] Chapter VIII, Section 39, Tamil Nadu amendment 39A GO No.: Tamil Nadu Act 5 of 1940, S.3).

Prisoners, under trials and convicts, who have mental illness detained under reception order of judicial magistrate at the Institute of Mental Health, Kilpauk, Chennai, are taken up for this study.

The order by which such persons are sent to psychiatric facility should have some basic requirements, as per the “The Mental Health Act 1987” or “Act III of 1900”[4] and under which section of the act admission was ordered. This is important for proper admission, management, and eventual discharge of such patients.

There are at least three situations where the medical officer is in difficulties. (1) When such patients need to be sent to general hospitals for physical ailments requiring specialist care either as outpatient or inpatient. In case of patients with criminal issues, they need to be sent with armed police escorts, which is not required for other patients, (2) when civil patients improve in their mental condition, they can be sent on a short period of leaves of absence of <60 days which is not applicable for criminal patients, and (3) when a patient has improved in his/her mental condition, discharge of such cases from mental hospital will differ based on the status (civil or criminal) of that patient. In the case of persons undergoing trial for alleged crimes or when convicted of crimes, the medical officer will have to assist the court or the home department as the case may be, in their decisions regarding the management of such patients by reporting the condition and progress.

To elucidate the appropriateness of the reception order, a study was envisaged. An audit in medical field is assessment of the procedures to see if they fulfill the statuary or procedural requirements. This study was carried out to analyze the reception orders issued by judicial magistrates or warrants by jail superintendents as the case may be, for admitting criminal patients in the hospital during a period of 1 year from January 2014 to December 2014 and to collate the results to see if they are according to the procedures.

Approval was obtained from the Madras Medical College Ethical Committee.


   Materials and Methods Top


Seventy-three persons were admitted by the judicial system due to provisions of various acts which entail trial and punishment and these 73 persons have a mental health issue in the Institute of Mental Health, Kilpauk, Chennai-10, in the year 2014. A perusal of the reception order of the judicial magistrate or warrants of the jail superintendent was carried out to assess the completeness of the orders. These were analyzed to assess, if the reception order or warrants contains or mention of (a) The Mental Health Act, 1987 or Act III of 1900 and (b) appropriate subsection accompanying such orders.


   Results and Discussion Top


Of the 73 patients admitted during the year 2014 in the criminal ward, 54 (73.97%) were admitted by the reception order of the judicial magistrate and the remaining 19 (26.02%) were by the jail superintendents.

In the first group of 54, 3 (5.6%) were women and the remaining 51 (94.4%) were men. In case of 19 convicts, 1 (5.3%) was a women and the rest were men, i.e., 18 (94.7%) [Table 1].
Table 1: Admissions by reception order by judicial magistrate

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Of 54 patients admitted by judicial magistrate, only 19 (35%) had the mention of the relevant act. In Kandrkunta et al (2014)[5] study it was found 58% and in kumar et al(2014)[6] it was 3.7%. Out of the 19 patients who had the act mentioned 16 (29.63%) had the relevant section mentioned. Of the remaining 34 (62.96%) did not have a reference of the mental health act whereas in Kandrakunta et al (2014) 30%, the mental health act was not mentioned. In these cases the reception order mentions they were to be admitted for treatment without quoting the proper act let alone the subsection provisions. One (1.85%) was ordered to be admitted under Indian lunacy act [Table 2].
Table 2: Mental health acts sections quoted in the order

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An analysis was carried out to find out the sections of the MHA, 1987, under which the admissions were ordered. In the 19 (35.19%) patients for whom the act was mentioned, it was found that 11 (20.37%) were under Section 24 of the MHA, 1987, 3 (5.56%) were under Section 27, 1 (1.85%) was under Section 23(1), and another one (1.85%) under Section 19. For 3 patients (5.55%), section was not mentioned. One patient was ordered to be admitted under the Indian Lunacy Act, 1912,[7] under Section 14. (This act has been superseded by MHA 1987.) Their mental health issue is under the purview of The Mental Health Act, but they had come under the court's scrutiny because of a crime committed. Such persons cannot be admitted under any section other than Section 27 of the MHA, 1987.

Out of 54 patients referred to the hospital by judicial magistrates, only 3(5.56%) had proper reception order with sec and Act (section 27 of MHA 1987) of this for 2(3.7%) under section 27 and for another one multiple sections 20 and 27 were mentioned. Section 20 of The Mental Health Act is about application of a reception order dealing with persons who are of unsound mind, but do not have any crimes alleged against them, Subsection 20(1) is about the persons who can apply for reception order. Section 20(2) is about reception order for further detention of requiring treatment for more than 6 months. This Section 20 deals with the involuntary admission that is about mentally ill person who is not willing to undergo treatment on voluntary basis and hence does not come into the legal purview of the Indian Penal Code (IPC), but is apprehended only due to his/her unsoundness of mind and unwillingness for treatment on his/her own. Hence, for a patient against whom criminal charges as per the IPC are pending, being a prisoner, Section 27 itself is sufficient and Section 20 need not be coupled.

Next, 11 (20.37%) were admitted under Section 24 of MHA, 1987, of this, 5 (9.26%) were under Section 24 without mention of any subsection. Then, 2 (3.7%) were under Section 24 (1). Further 4 (7.4%) were admitted under Section 24 (2). Section 24 is about production of a mentally ill person who does not have any crimes alleged against him/her, and the subsequent proceedings of the court in his/her regard. This is in conjunction with Section 23, which is about powers and duties of a police officer in regard to the mentally ill person.

Further, Section 28 of MHA, 1987, is about detention of alleged mentally ill person pending report by medical officer, Subsection (1) when any person alleged to be a mentally ill person appears or is brought before a magistrate under Section 23 or under Section 25, the magistrate may, by order in writing, authorize the detention of the alleged mentally ill person under proper medical custody in an observation ward of a general or psychiatry hospital or nursing home or in any suitable place for a period not exceeding ten days for enabling any medical officer to determine whether a medical certificate in respect of the alleged mentally ill person may properly be given under clause (a) of Subsection (2) of Section 24.

From the above, it is clear that Section 24 is meant for the mentally ill person who has so far not involved in criminal charge, but dangerous, hence it is like a preventive measure and not meant for who has already committed an offence as per the IPC.

One patient was admitted under Section 23(1) of MHA, 1987, r/w 3 (2) (c) r/w 14 of Foreigners Act 1946.[8] Section 23 (1) is about the duties of a police officer and not about detention of any prisoners. According to Sec 14 of the Foreigners' act a foreigner found without a valid passport or visa will be booked under IPC. penalty for contravention of provisions of the act will entail punishment under the said law. Hence, he/she was admitted in a criminal ward which was approved by visitors committee consisting of a judicial magistrate. Clearly, Section 23(1) will not be appropriate in this situation.

One patient was ordered to be admitted under Section 19 of MHA; this section is about admission of mentally ill persons under special circumstances. Under this section, any mentally ill person who does not or is unable to express his/her willingness for admission as a voluntary patient, may be admitted based on an application made in that behalf by a relative or a friend. Every application under this section shall be accompanied by two medical certificates in the prescribed form, from two medical practitioners of whom one shall be a medical practitioner in the service of the government. Otherwise, if the medical officer in charge of the psychiatric hospital or psychiatric nursing home concerned may cause a mentally ill person to be examined by two medical practitioners working in the hospital or the nursing home instead of requiring such certificates. From this, it is clear for admissions under this section, reception order is not required. Further, this Section 19 is not under the chapter (Part III) reception order at all.

Another one patient's admission was under the Indian Lunacy Act, 1912, which has become obsolete after The Mental Health Act, 1987.

The acts under which these persons came under the purview of the court were mentioned in some of the reception orders [Table 3].
Table 3: Additional acts

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The above-mentioned table shows the additional acts, apart from MHA, 1987, mentioned in the reception order and the number of patients admitted. Additional acts mentioned in the order for admission inform the medical officer that a criminal issue is pending against the patients. It clarifies the status of such persons, but is not valid for admission in to the hospital. Admissions can be only under Section 27 of the MHA.

In case of eight persons (15.68%) who have a mention of sections from Cr. P. C, Section 328 of code of criminal procedure is about, the procedure in case of accused being lunatic, and Section 329 is about procedure in case of person of unsound mind tried before court, when a magistrate holding an inquiry has reason to believe that the person is of unsound mind and consequently incapable of making his defense, the magistrate enquire into the fact and shall cause such person to be examined by a medical officer and examine him/her as a witness then ordering him/her for treatment. Then, if the magistrate find prima facie, he/she shall postpone the proceedings or the trial and the accused will be dealt with in accordance with Section 330, which deals with further proceedings disposal of a person of unsound mind pending investigation or trial, and clearly states that no order for detention of the accused in a lunatic asylum shall be made otherwise than in accordance with such rules as the State Government may have made under The Mental Health Act, 1987 (act no. 14 of 1987). Again these patients cannot be dealt under Section 24, but have to be under Section 27 of MHA.

When Section 24 is mentioned, there is a possibility of such patients to be treated as mentally ill persons who do not have a criminal issue, but have been apprehended for their mental health issue. Then, they may be sent on leave or discharged erroneously, under Section 40 of MHA, particularly when there is no mention of the provisions of the act under which they are charged for their crimes. Of the 51 patients admitted by the court, 48 (94%) were admitted on provisions other than Section 27 or without any section being mentioned. In case of 31 persons(60.7%), as no act and section was mentioned it puts the medical officer in a quandary, whether to treat them as criminal patients in a special enclosure with attendant management procedures or to house them in other wards meant for civil or voluntary borders. Apart from this, mistakes can be made in the procedures followed while discharging the patients.

In this situation, if the patient is admitted directly from court and if the reception order does not contain the word prisoner, these patients can be discharged as per Se ction 40 of the MHA, which deals with order of discharge by medical officer in charge. The medical officer in charge of a psychiatric hospital or psychiatric nursing home may, on the recommendation of two medical practitioners one of whom shall preferably be a psychiatrist by order in writing, direct the discharge of any person, other than a voluntary patient, and such person there upon be discharged from the psychiatric hospital or psychiatric nursing home. Prisoners will not be dealt with under these provisions or as per Se ction 42 of the MHA, the medical officer may wrongly recommend the discharge of the patient to the court, as the section deals with order of discharge on the undertaking of relatives or friends, etc., for due care of mentally ill persons. In case of any relative or friend of a mentally ill person is detained in a psychiatric hospital or psychiatric nursing home, then Section 22, Section 24, or Section 25 states that such a person shall be delivered over to his/her care and custody, and he/she may make an application to the medical officer in charge who in turn shall forward it together with his/her remarks there on to the authority under whose orders the mentally ill person is detained.

Apart from this, these patients can be sent on leave of absence (Section 45).

  • An application for leave of absence on behalf of any mentally ill person (not being a mentally ill prisoner) undergoing treatment as an inpatient in any psychiatric hospital or psychiatric nursing home may be made to the medical officer in charge (a) in the case of the mentally ill person by the spouse or where by the reason of mental or physical illness, absence from India or otherwise, the spouse is not in a position to make such an application by any other relative of the mentally ill person duly authorized by the spouse or (b) in case of any other person by the person on whose application the mentally ill person was admitted.


Under Subsection 3, on receipt of an application under Subsection 1, the medical officer in charge may grant leave of absence to the mentally ill person for such period as the medical officer in charge may deem necessary and it specifies that the leave of absence should not exceed 60 days.

The Mental Health Act or section was not mentioned for 34 (62.96%) patients admitted by judicial magistrate, it was issued as for medical treatment, observation, admission, or for custodial care.

Then, 19 (26.03%) convicts admitted as per the reference of the jail superintendents. Of this, 18 (94.74%) were male convicts for whom “The Act 3 of 1900” or Section 27 of MHA 1987 for admission at mental hospital have not mentioned for the only (5.26%) female convicts “The Act 3 of 1900” was mentioned but the section was not mentioned. The referral letter from jail superintendent was a requisition for admission without quoting any act or sections or not in the proper format meant for warrant. The Government of Tamil Nadu has delegated the power of sending convicts requiring mental health input to psychiatric facilities, but the format of accompanying order has not been mentioned. In this situation, at least a mention of the prisoners act and Section 27 of MHA will clarify the issue.

From the above discussions, it is evident that most of the reception orders issued by the magistrates and all the prisoners referred by jail superintendents except one do not mention the proper act or sections. However, all these patients were admitted to the Institute of Mental Health as MHA itself has provided remedial measure in Section 34, which is about amendment of order or document. Section 34 states that, “the order under which he was admitted or detained or any of the documents on the basis of which such order was made is defective or incorrect, the same may, at any time thereafter, be amended with the permission of the magistrate or the district court, by the person or persons who signed the same and upon such amendment being made.” In addition to this, a judicial magistrate being a member of the monthly visitors committee, which evaluates all the admission and discharge of the patients can clarify and guide the hospital authorities when such situations arise.

Hence, due to incorrect reception order, the treatment or rights of the patients are not affected, but the problem is more of treatment and care, especially when they are referred to general hospital for physical ailments. When the prisoner develops physical illness, they must be accompanied by armed reserve escorts when sent to general hospital for specialist opinion as outpatient or for admission, whereas it is not required for civil patients. In addition, if the reception order is not proper, the prisoner may be mistakenly treated as civil patient or admitted as involuntary patient and can be discharged or sent on leave of absence.

To ensure proper reception orders, model forms may be designed on the lines of such forms available in the criminal procedure code for other eventualities such as warrant and bonds. This will result in clarity for the court, police, and medical officers of the psychiatric facility.

The Mental Hospital Code, 1961,[15] the manual that describes the governance of the mental hospital, issued by the authority of the Government of Madras, contains a model Form B [Annexure I] for reception (under Sections 8,16, and 23 of Indian Lunacy Act, 1912) and detention of mental patient (or an alleged mental patient). This is under the heading Section III - Rules for the admission and discharge of civil insane; further, it has a model of the warrant [Annexure II] for referring the convicts by the government to jail superintendent and to the superintendent of mental hospital. A model form for persons who are to be admitted for mental health issues without criminal issue and a separate form for those with criminal issues will ease the burden and help in managing these patients in a better manner.[Additional file 1][Additional file 2]

Limitations of the study

This study was carried out in a single center, a larger sample involving multiple centers across the nation may give a better idea about this problem, based on which corrective measures can be planned.


   Conclusions Top


Of the 54 patients admitted, only three had proper reception order. The rest were under various other provisions or without mention of the act at all. This will lead to complications in the management of such patients. Adherence of proper procedure while admitting patients in criminal ward of psychiatric facility will prevent unwanted issues, for this the reception order must contain the act and appropriate subsection, which will facilitate smooth functioning and avoid complications while discharging the mentally ill criminal patients. The reception orders can be made easier by interdisciplinary discussions between judiciary, police, and mental health professionals, and compilation of forms will help to resolve this kind of procedural lapses.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
The Gazette of India Extraordinary. The Mental Health Act 1987 (act no. 14 of 1987). New Delhi: Ministry of Law and Justice (Legislative Department); May 22nd, 1987.  Back to cited text no. 1
    
2.
Government of India. The Code of Criminal Procedure; 1973 (Act 2 of 1974). Law ministry, Govt. of India 1974.  Back to cited text no. 2
    
3.
Government of India. 1888 (amended), Powers of the city commissioner, The Chennai City Police Act 1888 (Madras act no III of 1888).  Back to cited text no. 3
    
4.
Power of Superintendent to send a prisoner to hospital or Asylum for special treatment, ch.8, 39A, Prisons Act 1894. The Prisoners Act,1900 (3 of 1900).  Back to cited text no. 4
    
5.
Kandrakunda S, Angnthu H, Vanapalli VP, Sunrinedu R. Discharge of patients with mental illness into the community following involuntary admission versus voluntary admission: Factor analysis. AP JPsychol Med 2014;15:222-7.  Back to cited text no. 5
    
6.
Kumar D, Viiswanath B, Sebastian A, Holla B, Konduru R, Chandrashekar CR, et al. Profile of male forensic psychiatric inpatients in South India. Int J Soc Psychiatry 2014;60:55-62.  Back to cited text no. 6
    
7.
Government of India. Ministry of Law. The Indian lunacy act, 1912 (IV of 1912). Delhi: Manager of Publications; 1951.  Back to cited text no. 7
    
8.
Government of India. Ministry of Law. The Foreigners Act, 1946, November 23rd, 1946.  Back to cited text no. 8
    
9.
Government of India. Penalty for drunkenness or indecent behavior in public place. The Chennai City Police Act 1888 (Madras act no III of 1888). 1888 (amended).  Back to cited text no. 9
    
10.
Gazette of India extraordinary. The Criminal Law (Amendment) Act, 2013, Ministry of Law and Justice 2nd April, 2013.  Back to cited text no. 10
    
11.
Tamil Nadu gazette extraordinary. Tamil Nadu Prohibition of Harassment of Women Act, 1998. Govt. of Tamil Nadu Act 44 of 1998.  Back to cited text no. 11
    
12.
Ministry of Law and Justice 1923, Act No 19 of 1923, Official Secrets Act, 1923.  Back to cited text no. 12
    
13.
Gazette of India extraordinary Pt II, Sec.1, No 34, dt 20th June, 2012. The Protection of Children from Sexual Offences Act, 2012. Ministry of Law and Justice 2012.  Back to cited text no. 13
    
14.
Council of Governor General of India. The Indian penal code, 1860 (Act 45 of 1860) Government of India.  Back to cited text no. 14
    
15.
Government of Madras. The Mental Hospital Code, Revised Edition, 1961, controller of Stationary and printing, Madras.  Back to cited text no. 15
    

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Correspondence Address:
Dr. Nakkeerar Subramanian
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DOI: 10.4103/0019-5545.183787

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