Dr Prachi Chivate, Psychiatrist, Masina Hospital
My introductory remarks are that in an attempt to give rights to the citizens with mental illness on par with those available in the western world, we have not taken into account the societal taboos that prevent persons from seeking treatment for mental illness. Also, the shortage of facilities and psychiatrists and the absence of strong regulatory laws make the seeking and availability of appropriate intervention even more difficult than before.
Advance Directive made in the rights of the patient has over-privileged them. Patients or their caregivers are given the right to frame their treatment. So, the mental health professional that is an authority figure becomes a secondary figure. Where a mental health professional or a relative or a care-giver of a person desires not to follow an advance directive while treating a person with mental illness, such mental health professional or the relative or the care-giver of the person shall make an application to the concerned Board to review, alter, modify or cancel the advance directive.
Notwithstanding anything contained in clause (c) of sub-section (1) of section 5, every person who is not a minor, shall have a right to appoint a nominated representative. The idea of nominated representative reduces treatment burden on mental health professionals and increases differences of opinions. So the treating professional does not have chance to exercise own clinical skills at the maximum.
For the purposes of this Act, “independent patient or an independent admission” refers to the admission of person with mental illness, to a mental health establishment, who has the capacity to make mental healthcare and treatment decisions or requires minimal support in making decisions. However, independent admissions always have the risk of malingering.
The medical officer or mental health professional in charge of a mental health establishment shall discharge from the mental health establishment any person admitted as an independent patient immediately on request made by such person or if the person disagrees with his admission subject to the provisions of sub-section (3). But a psychiatric patient has reality testing impaired, so they are not in a position to think what is best for them.