Capacity for mental healthcare decisions under the Mental Healthcare Act

Namboodiri, Vasudevan

doi:10.4103/psychiatry.indianjpsychiatry_76_19

Cited by 11 publications

(5 citation statements)

References 3 publications

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“…India being a diverse nation makes mental capacity assessment complex, which is further compounded by subjectivity. 13 The present study also found that psychiatrists felt an increased sense of responsibility for maintaining documentation, thereby increasing the burden of work. We found that psychiatrists did not experience any increase or decrease in patients' access to mental health care services, indicating that stigma is still enduring.…”

Section: Original Articlesupporting

confidence: 60%

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Exploring Psychiatrists’ Experiences During Transition from Mental Health Act, 1987 to Mental Healthcare Act, 2017 in Goa, India

Vanagundi,

Pokle,

Walwaikar

et al. 2023

Indian Journal of Psychological Medicine

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Background: Mental Healthcare Act 2017 (MHCA) came into force on 29 May 2018. Goa State Mental Health Authority (GSMHA) notified the Mental Health Review Board on 8 February 2022, completing the important process of implementation of the act. The transition comes with challenges. Methods: A qualitative study was conducted with 18 practicing psychiatrists who had worked under Mental Health Act 1987 as well as MHCA 2017 through purposive sampling across Goa. Data was collected through individual interviews; analysis was done by Braune and Clarke’s framework of Thematic Analysis. Results: Eighteen psychiatrists participated: 4 private, 3 secondary and 11 from tertiary levels. The themes extracted were work during MHA 1987, transition, and after the implementation of MHCA 2017. Some participants reported difficulties, felt an increase in workload, and had negative emotions, while a few were neutral, indicating mixed perceptions. Conclusion: This study highlights the administrative struggles and moral dilemmas faced by psychiatrists in handling the new legislation. It’s imperative that the implementation of new act should be carried out with sufficient resource allocation and monitoring mechanisms.

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Section: Original Articlesupporting

confidence: 60%

“…India being a diverse nation makes mental capacity assessment complex, which is further compounded by subjectivity. 13…”

Section: Discussionmentioning

confidence: 99%

Exploring Psychiatrists’ Experiences During Transition from Mental Health Act, 1987 to Mental Healthcare Act, 2017 in Goa, India

Vanagundi,

Pokle,

Walwaikar

et al. 2023

Indian Journal of Psychological Medicine

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“…Sub-section 5 of Section 86 within IMHCA 2017 strictly prohibits administering psychiatric treatment to an autonomous patient without their informed consent. Many psychiatrists are apprehensive that upholding patients' rights to refuse treatment could potentially amplify dropout rates, subsequently leading to relapses and rehospitalizations (Andrade et al, 2003;Bijal et al, 2019;Harbishettar et al, 2019b;Namboodiri, 2019). Section 5 of IMHCA 2017 outlines the right for every non-minor individual to create a written advance directive, specifying preferences for mental healthcare and treatment.…”

Section: Concerns Related To Clinical Practicementioning

confidence: 99%

“…Section 89 of IMHCA 2017 specifies that supported admission upon a nominated representative’s request must follow an independent assessment by a psychiatrist and a mental health professional or medical practitioner to ascertain immediate risk. Numerous psychiatrists contend that adhering to such stringent criteria could conflict with their patients’ best interests (Bijal et al, 2019 ; Harbishettar et al, 2019b ; Math et al, 2019b ; Namboodiri, 2019 ; Vadlamani and Gowda, 2019 ). They point out that patients with severe mental illnesses or substance use disorders, who may necessitate inpatient care based on psychiatric evaluations, might be ineligible for involuntary admission due to retained capacity or nonthreatening psychiatric symptoms.…”

Section: Concerns Related To Clinical Practicementioning

confidence: 99%

Perceptions regarding the Indian Mental Healthcare Act 2017 among psychiatrists: Review and critical appraisal in the light of CRPD guidelines

Uvais,

Joag

2024

Camb. prisms Glob. ment. health

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Background: Informed by the UN Convention on the Rights of Persons with Disabilities, the Indian government replaced the 1987 Mental Health Act with the transformative "Indian Mental Healthcare Act, 2017" (IMHCA 2017), which gained presidential approval on April 7, 2017. While the new act aligns with CRPD guidelines, emphasizing the promotion, protection and realization of complete and equitable human rights, legal capacity, equality and dignity for persons with mental illness, it has faced diverse criticism from various stakeholders, particularly psychiatrists. This study systematically explores the critiques and apprehensions expressed by psychiatrists regarding the IMHCA 2017 using available published resources and assesses these criticisms within the context of CRPD guidelines. Methodology: We conducted a scoping review of the literature, using two search engines like PubMed and Scopus. The review covered academic publications, reports and documents from both national and international sources, authored by psychiatrists and psychiatric organizations, related to the IMHCA 2017. The primary search term "IMHCA 2017" was used without temporal restrictions. Publications authored by mental health professionals from India and around the world were included in the final analysis. Through qualitative analysis, key themes reflecting psychiatrists' viewpoints were identified. These themes, marked by substantial criticism, were then assessed in accordance with the guiding principles of the CRPD, including its optional protocol and general comments. Results: The study analyzed 33 manuscripts discussing criticisms and concerns about IMHCA 2017. Manuscript types included opinion papers (60.6%), original research articles (21.21%), review articles (9.09%), editorials (6.06%) and comments (3.03%). All but one article were authored by psychiatrists, with five by non-Indian authors and the rest by Indian psychiatrists. Most articles were published in the Indian Journal of Psychiatry (75.76%), with some in other journals. About 54.55% critically scrutinized act provisions, while 45.45% highlighted positive aspects. The analysis identified seven prominent criticism themes: clinical apprehensions, lack of clarity and comprehensiveness, feasibility challenges, neglect of caregivers, mistrust toward psychiatrists, crises in general hospital psychiatry units and ideological reservations. Conclusions: Each theme was critically assessed in the context of CRPD guidelines, and corresponding recommendations were formulated. Impact statementThis article carries significant implications for mental health policy and practice. By elucidating psychiatrists' multifaceted criticisms through the lens of Convention on the Rights of Persons with Disabilities (CRPD) guidelines, the study facilitates a nuanced understanding of challenges in implementing the Indian Mental Healthcare Act (IMHCA) 2017. The identified themes provide policymakers with targeted insights, offering a roadmap for refining mental health legislation and addressing concerns rais...

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“…in the time frame of the last 30 days (Wallace et al, 2000). Standardized capacity assessment checklist: Capacity Assessment for Treatment decisions including Admission will be used to assess capacity for decisions regarding mental healthcare (mental healthcare under the Act includes analysis, admission, treatment, and rehabilitation of mental illnesses (Namboodiri, 2019). A Capacity the checklist will be used for screening and documenting decisional capacity in people participating in different types of clinical research (Jeste et al, 2007) 6.…”

Section: Quality Of Lifementioning

confidence: 99%

“Development and Feasibility Testing of Supported Housing Programme on Independent Living Skills of Homeless Women with Severe Mental Illness: A Prospective Study”

Lydia.V,

Jagannathan,

Thirthalli

et al. 2024

Preprint

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Homelessness and mental illness are inextricably linked and this bidirectional phenomenon forms a vicious circle from which an escape seems complicated. One of the most pertinent needs of the HWSMI when they recover from mental illness is to return to their families. However, catering to this need has been challenging due to several reasons. HWSMI, when institutionalized get trapped in a system that reduces access to normative resources and solidifies social withdrawal. In this context, we aim to develop a supported housing program (SHP) for HWSMI & examine the effect of SHP on their Independent Living Skills.

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Capacity for mental healthcare decisions under the Mental Healthcare Act

Cited by 11 publications

References 3 publications

Exploring Psychiatrists’ Experiences During Transition from Mental Health Act, 1987 to Mental Healthcare Act, 2017 in Goa, India

Exploring Psychiatrists’ Experiences During Transition from Mental Health Act, 1987 to Mental Healthcare Act, 2017 in Goa, India

Perceptions regarding the Indian Mental Healthcare Act 2017 among psychiatrists: Review and critical appraisal in the light of CRPD guidelines

“Development and Feasibility Testing of Supported Housing Programme on Independent Living Skills of Homeless Women with Severe Mental Illness: A Prospective Study”

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