Mentally sick patients admitted in a hospital are highly vulnerable patients as they are exposed to a lot of hazards which the normal patients may not be exposed to.
Apart from the hazards due to disease process or medical/nursing errors, they are exposed to peculiar hazards due to disturbed mental condition and inability to know what is right and what is wrong.
Some of them suffering from psychotic conditions may be in danger of violent behavior, suicidal tendencies or self inflicted injuries.
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Because of lack of understanding, they may be highly vulnerable to sexual abuse/exploitation such as molestation, rape or sodomy.
During the past few years there has been an increasing focus on the safety of mentally ill patients in the mental health institutions, all over the world.
In Australia, The National Safety Priorities in Mental Health: A national plan for reducing harm was published in 2005. The goal of the plan was to identify, avoid, or reduce, actual or potential harm from mental health care delivery. The strategy emphasized four priority areas:
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i. Reducing suicide and deliberate self harm in mental health services,
ii. Reducing use of and where possible eliminating restraint and seclusion,
iii. Reducing adverse drug events in mental health services, and
iv. Safe transport of people experiencing mental disorders.
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In India, for protection of interests and ensuring the safety of mentally sick patients The Mental Health Act, 1987 was enacted. Salient provisions of the Act are discussed below.
1. Licensing of Psychiatric Hospitals/Nursing Homes. (Section 5, 6 and 9):
If the hospital/nursing home is headed by a psychiatrist, can provide the prescribed facilities for admission, treatment and care of mentally ill persons and is maintained in accordance with prescribed conditions (Section 10) a license may be granted for five years.
The licensing authority may revoke the license if the provisions of this Act or the Rules made there under are not being complied with or the maintenance is in a manner detrimental to the moral, mental or physical well-being of the in-patients (Section 11). To monitor and inspect their functioning there is a provision for appointment of inspectors (Section 13) and visitors.
2. Treatment Facilities (Section 14):
a. Admission/Discharge of Voluntary Patients:
On request by a major (who considers himself to be mentally ill) for admission as voluntary patient (Section 15) or by guardian of a mentally ill minor (Section 16), to the medical officer in charge of the hospital, for admission and treatment as a voluntary patient.
Such voluntary patients are to be discharged from the hospital within 24 hours of receipt of a valid application (Section 18) from the patient/guardian of the patient, unless the medical officer in-charge/board of two medical officers, find him unfit for discharge.
b. Admission of Mentally Ill Persons under certain Special Circumstances (Section 19):
Any mentally ill persons who does not, or is unable to, express his willingness for admission as a voluntary patient, may be admitted on an application made in that behalf by a relative or friend of the mentally ill person.
c. Application for Reception Order (Section 20):
The husband, wife or any other relative of a mentally ill person may apply to the area magistrate (for issue of a reception order) on a prescribed form accompanied by medical certificates from two independent medical practitioners, of whom one shall be a government official, both having independently examined the patient and formed the opinion, that the alleged mentally ill person is suffering from mental disorder of such a nature and degree as to warrant the detention of such person in a psychiatric hospital/nursing home and that such detention is necessary in the interests of the health and personal safety of that person or for the protection of others.
3. Ill Treatment of Patient:
If the area Magistrate comes to know that a mentally ill person is being ill treated, neglected or cruelly treated, he is empowered (Section 25) to pass orders requiring the relative or other person to take proper care of such mentally ill person. Non compliance of such orders would be punishable.
4. Appointment of Visitors:
Section 37 makes provision for appointment of visitors for every psychiatric hospital/nursing home.
The number of visitors should not be less than five, of whom at least one should be a psychiatrist or at least a medical officer, and two social workers. Section 38 deals with the monthly joint inspection of the hospital/nursing home by the visitors.
5. Discharge:
A psychiatric patient admitted in the hospital/nursing home may be discharged by order of the Medical Officer in charge (Section 40) or on the undertaking of relatives or friends, etc. for due care of the patient, or on request of the patient himself (Section 43).
6. Protection of Human Rights of Mentally Ill Persons:
No mentally ill person shall be subjected, during treatment, to any indignity (whether physical or mental) or cruelty or be used for purposes of research.
7. Penalties:
a. Penalty for establishment or maintenance of psychiatric hospital or psychiatric nursing home in contravention of Chapter III (Section 82):
Imprisonment for a term up to three months and/or fine up to two hundred rupees and in the case of a subsequent offence, with imprisonment up to six months and/or fine up to one thousand rupees
b. Penalty for improper reception of mentally ill person (Section 83):
Imprisonment up to two years and/or fine up to one thousand rupees
c. General provision for punishment of other offences (Section 85):
Any person who contravenes any of the provisions of this Act or of any Rule or Regulation made there under, for the contravention of which no penalty is expressly provided in this Act, shall, on conviction, be punishable with imprisonment for a term up to six months and/ or fine up to five hundred rupees.