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LETTERS TO EDITOR  
Year : 2019  |  Volume : 61  |  Issue : 4  |  Page : 423
Comments on “Mental Healthcare Act, 2017, and addiction treatment: Potential pitfalls and trepidations”


Department of Psychiatry, St. Thomas Hospital, Changanacherry, Kerala, India

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Date of Web Publication16-Jul-2019
 

How to cite this article:
Ameen S. Comments on “Mental Healthcare Act, 2017, and addiction treatment: Potential pitfalls and trepidations”. Indian J Psychiatry 2019;61:423

How to cite this URL:
Ameen S. Comments on “Mental Healthcare Act, 2017, and addiction treatment: Potential pitfalls and trepidations”. Indian J Psychiatry [serial online] 2019 [cited 2019 Dec 8];61:423. Available from: http://www.indianjpsychiatry.org/text.asp?2019/61/4/423/262795




Sir,

In a first article of its kind, Rao et al.[1] deliberated on the advantages and limitations of Mental Healthcare Act (MHCA) 2017 with respect to addiction management. The authors correctly pointed out the mistake made by the drafters of MHCA in using the term “abuse” in the Act's definition of mental illness and also elaborated some of the positive aspects of the Act such as its emphasis on humane treatment.

A hypothetical case scenario is presented in the article. A person drinks on alternate days, indulges in physical violence, has deranged liver function tests but drinks despite that, has not appointed any nominated representative (NR) or made an advanced directive, and is brought by the family to a mental health establishment for admission. The article opines that the person fulfills the International Classification of Diseases-10 criteria for one mental illness (harmful use of alcohol), his wife fears bodily harm from him, and he is showing an “inability to care for himself to a degree that places him at risk of harm (liver derangement) to himself.” Based on the above, and as “the wife becomes the NR in this scenario,” the authors conclude that “the various requirements of Section 89 of the MHCA, 2017, are met” and that hence, he can be admitted under the section.

However, the authors did not take into account the requirement stipulated in Section 89(1)c, i.e., “the person is ineligible to receive care and treatment as an independent patient because the person is unable to make mental healthcare and treatment decisions independently and needs very high support from his nominated representative in making decisions.”[2] In other words, admission under Section 89 can be made only if the patient lacks sufficient ability or capacity to make independent decisions regarding mental healthcare and treatment. Although the proposed guidelines for capacity assessment are yet to be published, one can safely assume that a patient with harmful use of alcohol would have the necessary capacity to make relevant decisions (except maybe during periods of intoxication). The authors themselves subsequently say that “The capacity for taking decisions is preserved in most cases of SUD [Substance Use Disorders], even in those with dependence syndrome, except for periods of intoxication or during severe withdrawals.” Thus, it would not be possible to admit the described patient under Section 89. Hence, the authors' conclusion that “a literal interpretation of the MHCA, 2017, seems to indicate that involuntary admission is possible for most individuals suffering from SUD” is invalid. Also, their apprehension that “the Act, which was brought in force precisely for protecting the rights of people with mental illness, may be used to violate the rights of this individual” is unfounded.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Rao R, Varshney M, Singh S, Agrawal A, Ambekar A. Mental Healthcare Act, 2017, and addiction treatment: Potential pitfalls and trepidations. Indian J Psychiatry 2019;61:208-12.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
The Mental Healthcare Act; 2017. Available from: https://www.prsindia.org/uploads/media/Mental%20Health/Mental%20Healthcare%20Act,%202017.pdf. [Last accessed on 2019 Mar 24].  Back to cited text no. 2
    

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DOI: 10.4103/psychiatry.IndianJPsychiatry_206_19

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