RECENT ADVANCES IN INDIAN LAW IN

RELATION TO PSYCHIATRY
Chairperson : Dr. K.V. Rami Reddy MD
Professor, Department of Psychiatry, AMC
Presenter : Dr. Ch.S.V.Krishna Vasan,
(MD Postgraduate)
Scheme of presentation
 Introduction
 Mental Health Care Act 2017
 The Rights of Persons with Disability Act 2016
 The Protection of Children from Sexual Offences (POCSO) Act, 2012
 Narcotic Drugs and Psychotropic Substances Act 1985 (2014 amendment)
 Transplantation of Human Organs Act 1994 (Amendment 2014)
 The Rights of Transgender Persons Bill 2014
Introduction
 The beginning of forensic psychiatry in India in mid 19th century with drafting of Indian
Penal Code by Thomas Babington Macaulay.
 S. 84 and S.85 which deal with Criminal responsibility were added in Indian Penal Code.
 Later developed concern among public about possible harm that they may face from
lunatics, which made British Government to bring The Indian Lunatic Asylum Act 1858
to protect people from lunatics.
 The ILA Act emphasized on Custodial care of lunatics thus legalizing Custodial Care.
 Various Lunatic Asylums were established across India under this act
 Cont…

 The Custodial Care in Lunatic Asylums was delivered by Prison Authorities.

 During the first decade of 20th century, people came to know about the grave conditions of
people residing in Asylums and started to criticize the care given to lunatics and after
continuous inputs from various stake holders, British Government brought The Indian Lunatic
Act in1912.
 Indian Lunacy Act 1912 – this act guided the destiny of psychiatry in India. The name ‘’lunatic
asylum’’ is changed to ‘’mental hospitals’’
 This act first defined the procedure of admission and certification.
 Cont…

 Subsequently the administration of Mental hospital is given to medical personel from prison
authorities in 1920.
 After Independence, Indian Psychiatric Society was established in 1948.
 Indian Psychiatric Society had suggested various changes in Indian Lunacy Act and proposed
Mental health bill in1949.
 After a long gap of 40years, Mental Health Act was passed in Parliament in 1987 and came into
effect in all states in April,1993.
 Such long gap is due to delay in the formation of rules by various state governments.
Mental Health Act 1987
 It contains 10 chapters with 98 sections.
 It defined mentally ill person as a person who is in need of treatment by reason of any
mental illness other than mental retardation
 Hence excluded mental retardation from the definition of mental illness.
 Stressed upon treatment rather than custodial care but continues with the practice of
admission under reception order.
 It emphasized on the protection of human rights of the mentally ill without addressing the
fundamental rights of the patient i.e ‘’right to life and liberty’’ enshrined in Constitution
under Article 21.
 Demerits of MHAct 1987
 MH Act 1987 only covered psychiatric hospitals/nursing homes and excluded other
places like places where persons will mental illness are kept on the name of de-addiction,
rehabilitation or religious healing, leaving them to follow unstandardized practices.
 Just focussed on hospital-based custodial care, ignoring community care.
 Failed to give prominence to choices of persons with mental illness as individual or
regarding range of treatment.
 Failure to provide provision for emergency care for helping families of mentally ill
 Human rights activists have questioned about the MHA 1987 regarding its constitutional
validity
 Hence with the continuous inputs from Social Welfare Organizations, NGOs and human
rights activists, Government of India drafted Mental health care bill in 2013.
 The Mental Health Care Act, 2017
The Mental health care bill was passed in Rajya Sabha on 8th august, 2016 and in Lok Sabha on 27th march 2017.
The MHC act came into force from 7th July 2018 repealing the MHA 1987
It spreads in 16 chapters with 126 sections
Need for a new law :
The Convention on Rights of Persons with Disabilities and its Optional Protocol was adopted on the 13th December, 2006
at United Nations Headquarters in New York and came into force on the 3rd May, 2008.
India has signed and ratified the said Convention on the 1st day of October, 2007. Hence it is necessary to align and
harmonize the existing laws with the said Convention.

 ;
 Capacity Assessment (Chapter I)
 Defined mental health professionals as a professional who was registered in state mental
health authority / a psychiatrist / a professional with postgraduate degree in Ayurveda,
Unani, Sidda, Homoeopathy
 Defined mental health establishments as any health establishment, including
Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy establishment, by
whatever name called, either wholly or partly, meant for the care of persons with mental
illness, established, owned, controlled or maintained by the appropriate Government, local
authority, trust, whether private or public, corporation, co-operative society, organization or
any other entity or person, where persons with mental illness are admitted and reside at, or
kept in, for care, treatment, convalescence and rehabilitation, either temporarily or
otherwise; and includes any general hospital or general nursing home established or
maintained by the appropriate Government, local authority, trust, whether private or public,
corporation, co-operative society, organization or any other entity or person; but does not
include a family residential place where a person with mental illness resides with his
relatives or friends
 Capacity assessment (Chapter II)
 Capacity to make mental healthcare and treatment decisions
 As with any other person, a person with mental illness shall be deemed to have capacity to make
decisions regarding his mental healthcare or treatment if such person has ability to understand the
information that is relevant to take a decision on the treatment or admission or personal assistance; or
appreciate any reasonably foreseeable consequence of a decision or lack of decision on the treatment or
admission or personal assistance communicate the decision by means of speech, expression, gesture or
any other means
 Where a person makes a decision regarding his mental healthcare or treatment which is perceived by
others as inappropriate or wrong, that by itself, shall not mean that the person does not have the
capacity to make mental healthcare or treatment decision, so long as the person has the capacity to
make mental healthcare or treatment decision.
 Advance directive (chapter III):
 Every person, who is not a minor, shall have a right to make an advance directive in
writing, specifying any or all of the following, namely:––
(a) the way the person wishes to be cared for and treated for a mental illness;
(b) the way the person wishes not to be cared for and treated for a mental illness
(c) the individual or individuals, in order of precedence, he wants to appoint as
his nominated representative.
 The legal guardian shall have right to make an advance directive in writing in respect of a
minor and all the provisions related to advance directive, shall apply to such minor till he
attains majority.
Cont…
 It can be override if he lacks capacity to make a decision or has inadequate information or
if made contrary to any existing law.
 It remain effective till the person regains capacity and can be changed any number of
times according to the decision of person with mental illness.
 Advance directive doesn’t apply to emergency treatment.
 The person writing advance directive and his nominated representative shall have a duty
to ensure that the treating Medical Officer in charge of mental health establishment has
access to advance directive when required
 Every board shall maintain online register of all advance directives registered with it and
make them available to concerned MHP as required
Cont…
 It shall be the duty of every medical officer or a psychiatrist in charge of a person’s
treatment to propose and give treatment to a person with mental illness, in accordance with
his valid advance directive.
 A mental health professional or a relative or a caregiver 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.
 Liability of MHP/MHE in relation to advance directive :
 A medical practitioner or a mental health professional shall not be held liable for any unforeseen
consequences on following a valid advance directive.
 A medical practitioner or a mental health professional shall not be held liable for not following a
valid advance directive, if he has not been given a copy of the valid advance directive.
Nominated Representative (Chapter IV)
 Appointment and revocation of nominated representative
a. every person who is not a minor, shall have a right to appoint a nominated representative
b. the nominated representative shall not be a minor
c. order of preference – person who was appointed by the PMI as stated in Advance Directive.
Followed by a relative followed by a care giver who is concerned in the interest of PMI or
any suitable person appointed by the concerned board. If no one is present, then The Director
of Department of Social welfare acts as a nominated representative.
 Nominated representative of a minor
The Legal guardian shall be the nominated representative in case of a minor , unless the
concerned Board orders
i. when the legal guardian is not acting in best interest of the minor or
ii. when the legal guardian is not otherwise fit to act as a nominated representative.
 Cont…
 Revocation or alteration of nominated representative by board
 Duties of a nominated representative
 Consider current, and past wishes and life events of PWMI.
 To give particular credence to views of PWMI and to make them understand the consequences of decisions
made.
 Help the PWMI in making treatment related decisions.
 To ensure the right of PWMI to seek information on diagnosis and treatment related decision are met.
 Involvement in discharge planning and to apply to concerned board on behalf of PWMI for admission,
discharge and when violation of rights of PWMI if any.
 Rights of persons with mental illness (Chapter V)

 Right to access to mental health

 Right to protection from cruel, inhuman and degrading treatment
 Right to equality and non-discrimination
 Right to information
 Right to confidentiality
 Right to restriction on release of information in respect to mental illness
 Right to access medical records.
 Right to personal contacts and communication
 Right to legal aid
 Right to make complaint about deficiencies in provision of services.
 Central Mental Health Authorities
( chapters VII )

 This is the administrative body required to

 Register, supervise and maintain a register of all mental health establishments.
 Develop quality and service provision norms for such establishments.
 Maintain a register of mental health professionals.
 Train law enforcement officials and mental health professionals on the provisions of the act.
 Receive complaints about deficiencies of the services.
 Advice Central Government on matters related to mental health
 The Central Authority shall meet at such times (not less than twice in a year)
and places and shall observe such rules of procedure in regard to the transaction of business at its meetings
(including quorum at such meetings) as may be specified by regulations made by the Central Authority.
 State Mental Health Authorities
( chapters VIII )

 This is the administrative body required to

 Register, supervise and maintain a register of all mental health establishments.
 Develop quality and service provision norms for such establishments.
 Maintain a register of mental health professionals.
 Train law enforcement officials and mental health professionals on the provisions of the act.
 Receive complaints about deficiencies of the services.
 Advice State Government on matters related to mental health
 The State Authority shall meet at such times (not less than four times in a year) and places and shall observe
such rules of procedure in regard to the transaction of business at its meetings (including quorum at such
meetings) as may be specified by regulations made by the State Authority.
 Mental Health Review Commission and Board
( chapter X )
 A quasi judicial body which periodically review the use of and the procedure for making an advance
directive, advise the Govt. on protection of rights of the PWMI.
 MHR commission in concurrence with state governments constitute MHRB in the districts of a state.
 Composition of a MHRB :
 District judge / retired district judge
 Representative of district collector / district magistrate / deputy commissioner of districts
 2 members ( 1 psychiatrist & 1 medical practitioner )
 2 members ( 1 PWMI or a care giver of PWMI & 1 person representing organizations of PWMI or NGOs).
 Procedings of MHRB
 The Board shall dispose of an application––
(a) for appointment of nominated representative
(b) challenging admission of a minor
(c) challenging supported admission within a period of seven days from the date of receipt of such
applications.
(3) The Board shall dispose of an application challenging supported admission within a period of
twenty-one days from the date of receipt of the application.
 There shall be no fee or charge levied for making such an application.
 All proceedings before the Board shall be deemed to be judicial proceedings
within the meaning of sections 193, 219 and 228 of the Indian Penal Code.
 The proceeding of the Board shall be held in camera.
 In respect of any application concerning a person with mental illness, the Board
shall hold the hearings and conduct the proceedings at the mental health establishment where such
person is admitted.
 Powers and Functions of MHRB
 (a) to register, review, alter, modify or cancel an advance directive;
(b) to appoint a nominated representative;
(c) to receive and decide application from a person with mental illness or his
nominated representative or any other interested person against the decision of medical officer or
mental health professional in charge of mental health establishment or mental health establishment , to
receive and decide applications in respect non-disclosure of information specified , to adjudicate
complaints regarding deficiencies in care and services specified , to visit and inspect prison or jails and
seek clarifications from the medical officer in-charge of health services in such prison or jail.
 If the mental health establishment does not comply with the orders or directions of
the Authority or the Board or wilfully neglects such order or direction, the Authority or the Board, as
the case may be, may impose penalty which may extend up to five lakh rupees on such mental health
establishment and the Authority on its own or on the recommendations of the Board may also cancel
the registration of such mental health establishment after giving an opportunity of being heard.
 ADMISSION

Independent admission Admission of minor Supported admission Supported admission

under 30 days beyond 30 days

Not a minor Application by nominated Application by Application by nominated

Self requests for admission representative of minor nominated representative beyond 30 days or
representative readmission within 7 days of
such discharge
Independent examination by 1 psychiatrist & Independent examination by 2 psychiatrists or 1 psychiatrist & 1
1 mental health professional/medical practitioner mental health professional / medical practitioner

Harm to himself or others

Severity of illness Severity of illness

PMI benefits Harm to himself or others

In best interests of minor Inability to care for himself
Capacity to make decisions to a degree
MHC needs of minor cant be fulfilled unless
Own free will admitted Inability to care for himself
to a degree that places
that places individual at risk individual at risk of harm to
Community based alternatives to admission have of harm to himself or others
been shown to be failed himself
Important concepts for inpatient care
 Emergency treatment (Chapter XII, section 94): Any medical treatment, including treatment for mental illness, may be
provided by any registered medical practitioner to a person with mental illness either at a health establishment or in the
community, subject to the informed consent of the nominated representative, where the nominated representative is
available, and where it is immediately necessary to prevent—
(a) death or irreversible harm to the health of the person; or
(b) the person inflicting serious harm to himself or to others; or
(c) the person causing serious damage to property belonging to himself or to
others where such behavior is believed to flow directly from the person’s mental ill
 Electroconvulsive therapy shouldn’t be used as a form of emergency treatment.
 Emergency treatment refers to first 72 hours or till the person with mental illness has been assessed at a mental health
establishment, whichever is earlier.
 Provided that during a disaster or emergency declared by the appropriate Government, the period of emergency treatment
referred to in this sub-section may extend up to seven days.
 Prohibited treatment (Chapter XII, Section 95)
The following treatments shall not be performed on any person with mental illness —
(a) electro-convulsive therapy without the use of muscle relaxants and anesthesia;
(b) electro-convulsive therapy for minors;
(c) sterilization of men or women, when such sterilization is intended as a treatment for
mental illness;
(d) chained in any manner or form
If, in the opinion of psychiatrist in charge of a minor’s treatment, electro-convulsive
therapy is required, then, such treatment shall be done with the informed consent of the
guardian and prior permission of the concerned Board.
Restriction of psychosurgery for patients with mental illness (Chapter XII, Section 96) :
consent should be taken from PWMI and his NR. Should Apply and permission should
be taken from concerned MHRB before performing psychosurgery.
Use of Restraints and Seclusion (Chapter XII, Sec 96)

 A person with mental illness shall not be subjected to seclusion or solitary

confinement, and, where necessary, physical restraint may only be used when,—
(a) it is the only means available to prevent imminent and immediate harm to
person concerned or to others;
(b) it is authorized by the psychiatrist in charge of the person’s treatment at the
mental health establishment
 Physical restraint shall not be used for a period longer than it is absolutely necessary to prevent the
immediate risk of significant harm
 Cont…
 The medical officer or mental health professional in charge of the mental health establishment
shall be responsible for ensuring that the method, nature of restraint, justification for its
imposition and the duration of the restraint are immediately recorded in the person’s medical
notes.
 The nominated representative of the person with mental illness shall be informed
about every instance of restraint within a period of twenty-four hours
 A person who is placed under restraint shall be kept in a place where he can cause no harm to
himself or others and under regular ongoing supervision of the medical personnel at the mental
health establishment
 DISCHARGE

Independent Admission Admission of minor Supported

Supported admission
admission Supported
Supported admission
admission
under
under 30
30 days
days beyond
beyond 30
30 days
days

On request Nominated representative At end of 30 days no Nominated

longer meet criteria for representative
admission

Minor becoming major On becoming an adult Nominated Mental health review

under inpatient care and representative board
can decide as independent

Psychiatrist in charge Psychiatrist in charge Psychiatrist in-charge Psychiatrist in-charge

 Legal status of attempted suicide in India
 According to Article 21 of Indian Constitution, ‘’No person shall be deprived of his life or
personal liberty except according to procedure established by the law’’
 The attempts at taking ones own life was not considered to fall under purview of constitutional
right to life.
 However , on 9th March 2018, while legalizing euthanasia, the Supreme court of India said that
right to life includes right to die.
 Section 309 of Indian Penal Code states that : ‘’ whoever attempts to commit suicide and does
any act towards the commission of such offence, shall be punished with simple imprisonment for
a term which may extend to one year or with fine or both’’
 Abetting of commission of suicide is covered under section 306 IPC and abetment of suicide of a
child is covered under section 305 of IPC
 Cont…

 PROVISIONS FOR DECRIMINALIZATION OF SUICIDE IN CHAPTER XII OF MENTAL HEALTH

CARE ACT, 2017 :
Section 115: ‘’Presumption of severe stress in case of attempt to commit suicide.’’
(1) Notwithstanding anything contained in section 309 of the Indian Penal Code
any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe
stress and shall not be tried and punished under the said Code.
(2) The appropriate Government shall have a duty to provide care, treatment and
rehabilitation to a person, having severe stress and who attempted to commit suicide, to reduce the risk of
recurrence of attempt to commit suicide.
 Repealing of Section 309, per se, would not affect or impact the sections on abetment of completed
suicide i.e. section 305 and section 306 of IPC.
 The Rights of Persons with disability act
 This act repealed Persons with Disability act,1995.
 It came into force from April 19th , 2017.
 Spread in 17 chapters and 102 sections.
 Principles :
1) Respect for inherent dignity, individual autonomy including freedom to make one’s choices
2) Non discrimination
3) Full and effective participation and inclusion in the society
4) Respect for difference and acceptance of persons with disabilities as a part of human diversity and humanity
5) Equality of opportunity
6) Accessibility
7) Equality between men and woman
8) Respect for evolving capacities of children with disabilities and respect for the right of children with
disabilities to preserve their identities.
 Cont…
 The types of disabilities have been increased from 7 (in existing PWD act 1995 – blindness,low vision,leprosy-
cured,hearing impairement,locomotor disability,mental retardation and mental illness) to 21.
 Disability conditions of relevance for mental health include :
a. Intellectual Disability
b. Mental Illness
c. Autism Spectrum Disorder
d. Specific Learning Disabilities
 Persons with ‘’benchmark disabilities’’ are defined as those certified to have at least 40% of the disabilities specified
in the act.
 Rights and entitlements provided under the rights of persons with disabilities act, 2016
1. Government responsibility to take measures ensuring PWD enjoy their rights.
2. Reservation – 5% in higher education and 4% in Government jobs.
3. Right of education – free education from 6 to 18 years.
4. Inclusive government funded education
 Cont…
5. No discrimination against women and children with disabilities
6. Right to live in community – not to be forced to live in shelter homes.
7. Right to protect from cruelty and inhuman treatment – consent made mandatory before any
research targeted on PWD. Prior permission should be taken from commity on research on disability.
8. Protection against abuse, violence and exploitation
9. Right to home and family – not to be separated from family. If parents cant afford to take care of
the PWD, the duty is given to any of the relatives on a voluntary basis or to NGOs.
10. Reproductive rights – right to seek information on reproductive health, and on various
sterilization procedures.
 Cont…
11. Accessibility in voting – establishment of separate poling booths for PWD.
12. Access to justice – NLSA & DLSA Should ensure that PWD should get access to legal aids, schemes and
services.
13. Right to exercise equal legal capacity – in financial affairs and in inheritance of the property.
14. Provision for guardianship – from limited guardianship to total guardianship as per the severity of disability.
15. Reservation in job – 1% each for visual, hearing and loco-motor disabilities and 1% for Persons with
intellectual disabilities and mental illness.
16. Penalties for offences –
a. Any person who doesn’t follow the provisions of the act are punishable with up to 6months imprisonment/ ₹10,000
fine or both
b. Second violation – up to 2 years imprisonment / ₹50,000-5lakhs fine or both.
c. Any person who intentionally insults/threatens/exploit a PWD, is punished with 6months-5years imprisonment &
fine or both.
 Strengths and limitations of the Rights of Persons with Disability act

Strengths :
 It is very client centred act, inclined towards making persons with disability in possession of requisite rights
to exercise their true potential in all walks of life than just providing social welfare measures.
 Term mental retardation has been replaced by intellectual disability.
 A stepwise guideline first time for intellectual disabilities (ID), SLD, and other disabilities and stressed on
the assessment of disorder severity.
Limitations :
 No mention about certification for autism in entire rules.
 Policy-makers and expert committee members for the guidelines overlooked the fact that, SLD is also
disorder under neurodevelopmental disorders and just based on the nosological status, pediatricians and
pediatric neurologists are included, and Psychiatrists are ignored in the certifying medical board team of
SLD.
 The Protection of Children from Sexual Offences (POCSO) Act, 2012

 A comprehensive law to provide for the protection of children from the offences of sexual assault, sexual
harassment and pornography, while safeguarding the interests of the child at every stage of the judicial
process by incorporating child-friendly mechanisms for reporting, recording of evidence, investigation and
speedy trial of offences through designated Special Courts.
 Defines a child as any person below eighteen years of age
 Defines different forms of sexual abuse, including penetrative and non-penetrative assault, as well as sexual
harassment and pornography, and deems a sexual assault to be “aggravated” under certain circumstances,
such as when the abused child is mentally ill or when the abuse is committed by a person in a position of
trust or authority vis-à-vis the child, like a family member, police officer, teacher, or doctor.
 People who traffic children for sexual purposes are also punishable under the provisions relating to
abetment in the said Act.
 Cont…
 Prescribes stringent punishment graded as per the gravity of the offence, with a maximum term of
rigorous imprisonment for life, and fine.
 Section 21(1) of the POCSO Act 2012 requires Mandatory reporting of cases of sexual abuse to
the law enforcement authorities and applies to all individuals who has awareness about the
possibility of act including doctors.
 The purpose of reporting is to identify children suspected to be victims of sexual abuse and to
prevent further harm.
 Interview setting should be child friendly with toys & art material.
 Avoid unnecessary touching of the child during interview & respect child’s dignity.
 There is no obligation to inform child/parents/caregivers for reporting but it will be a good
practice to do so.
 Cont…
 Whom to report and what to report – to report any suspected physical/sexual violence/exploitation
with physical or circumstantial evidence to special protection units (SPUs) / child helpline number
1098 / local police station.
 Legal sanctions of not reporting or falsely reporting – failure to report/record an offence under
Section 2(1) is punishable with imprisonment is up to 6months or with fine or both. False reporting
of the offence is punishable with imprisonment upto 1year of fine or both.
 Ethical dilemma in reporting – family concerns and health professional concerns
 Family concerns – humiliation / facing long judicial process/ family members may not bring the child back to
treatment or assault may be aggravated if the penetrator is a family member.
 Health professional concerns – overriding confidentiality / victim may seek treatment from quacks for fear of
reporting.
 Narcotic Drugs and Psychotropic Substances Act
1994 (2014 amendment)
 National policy on narcotic drugs and psychotropic substances is based on the directive principles contained in
Article 47 of Indian Constitution, which direct the state to endeavour to bring about prohibition of the consumption,
except for medical purposes, of intoxicating drugs injurious to health.
 The Narcotic Drugs and Psychotropic Substances act 1985 (w.e.f. 14-11-1985) :
Purpose of act :
 It is an Act to consolidate and amend the law relating to narcotic drugs, to make stringent
provisions for the control and regulation of operations relating to narcotic drugs and
psychotropic substances.
 Provide for the forfeiture of property derived from, or used in, illicit traffic in narcotic drugs and psychotropic
substances
 Implement the provisions of the International Convention on Narcotic Drugs (1961) and Psychotropic Substances
(1971).
 Cont…
 The NDPS act spreads in eight chapters and 83 sections. It enlists punishments for production, possession,
transportation, trading, purchase and use of any of the listed substances.
 The NDPS act also provides immunity from punishment to persons using small quantities for personal
consumption by giving them option for availing for de-addiction services at nearest designated mental health
facility.
 The offences are non-bailable and non-cognizable.
 If drugs fall under NDPS act, a symbol of NRx on the left hand corner of the drug’s name should be
mentioned.
 The NDPS act was amended in 1989, 2001 and in 2014.
 Punishment for possessing small quantities of substances is punishable with rigorous imprisonment up to 1
year or fine of ₹10,000 or both.
 Punishment for possessing commercial quantities of substances is punishable with rigorous imprisonment up
to 10 years or fine of ₹1 to 2 lakhs or both.
 Repeat offenders with possession of commercial quantities of substances is punishable with rigorous
imprisonment up to 30 years
 NDPS Act amendment 2014 (w.e.f. 01-05-2014)
 Basis for NDPS act amendment 2014 :
Need to facilitate and improve access to opioids for medical use while maintaining, strengthening
and integrating programmes to control misuse and diversion.
 The amendment expanded the scope of the act include medical and scientific use.
 Notified list of Essential Narcotic Drugs (ENDs) i.e. the opioids identified for medical use,
approved by the Drug Controller General of India.
 The notified list of ENDs currently includes – Morphine, methadone, codeine, hydrocodone,
oxycodone, tramadol (recently added from 26th april 2018) and Fentanyl.
 Defined ‘Recognized Medical Institutions’ with criteria for stocking and dispensing opioids for
medical use.
 Conferred the powers for authorizing medical institutions as RMIs, for stocking and dispensing
ENDs, to a single state agency.
 Cont…
 Those institutions fulfilling the criteria to be RMIs, may apply to the State drug controller –
SDC / Commissioner, FDA, to procure and dispense ENDs.
 The authorization of RMIs is for a period of 3 years and renewable from the same agency.
Prescribing ENDs :
 Prescriptions must be in capital letters, dated and signed by the RMP with full name, address and
his/her registration number.
 Prescription must specify name and address of the person to whom prescription is given.
 Prescription must mention the total quantity of END, daily dose and the duration of the
prescription.
 Home care treatment shall not be provided for treatment of opioid dependence, it can be given for
narcotic analgesia.
 Laws and rules government organ transplantation in
India
 Legislation dealing with donation and transplantation of organs in our country is Transplantation of
Human Organs Act (THOA).
 Passed in 1994 amended twice in 2009 and 2011, gazette notified in 2014.
 Aim of the act : To provide for the regulation of removal, storage and transplantation of human
organs for therapeutic purposes and for the prevention of commercial dealings in human organs.
 Essential features of THOAct :
 The act mandates that organ donation has to be for therapeutic purposes only.
 It mandates all transplant centers to update their details periodically on government’s concerned website.
 Emphasized Psychiatrist’s role in transplantation process.
 Role of mental health proessional in transplantation
process
 Psychiatrist plays a dual role as a transplant team member as well as assessing and serving needs of
transplant patients, donors and carers.
 Psychiatrist’s clearance is deemed mandatory to certify the donor’s mental condition, awareness, absence
of any overt or latent psychiatric disease, and ability to give free consent
 Pre transplant psychosocial evaluation – this include assessment of any pre-existing mental illness/
anxiety regarding procedure/ fear of death or organ rejection or exacerbation/recurrence of mental illness
and treatment for the same. To assess side effects of the medication and treatment for the same.
 Cont…
 Pre transplant assessment of living donors and certification – this include assessment of donor’s ability
to give consent, screening of donors for mental illness and assessment of their higher mental functions
and treatment for the same. To assess donor’s capacity to understand the transplantation process &
ability to express their feelings/emotions/motivation for process of donation and post transplantion
treatment.
 Pre transplant psychosocial assessment of family – this include assessment of the ability to understand
the process, ability to support the person who undergoes transplantation post operatively in the form of
financial assistance and emotional/social support that they can offer to the patient and their
expectations, fears and clarification of doubts if any.
 Post-transplant psychosocial assessment – to assess the emergence of any new psychiatric illness due
to medications or drug interactions/exacerbation of previous mental illness and their treatment and
counselling related to life style modifications post transplantation.
 The Rights of Transgender Persons Bill 2014

 It is spread in 10 chapters with 58 sections.

 Passed in the Rajya Sabha on April 24, 2015 and It is currently before the Lok Sabha.
 Guarantees many rights for Transgender Indians, including access to education, employment,
housing, medical care, and freedom from discrimination.
 It includes consideration about the need for curriculum review and enhanced medical education,
to equip the workforce with the competency required to meet the needs of this population.
 Highlights the familial bond and the primacy of a sense of self-identity.
 Formation of national and state commissions for transgenders and to establish separate
transgender courts.
 Cont…
 It also mentions the pivotal role that a psychiatrist may play in decision making in gender
reassignment surgery and rehabilitation.
 Section 377 of IPC : The 2012 Delhi High Court challenge to S 377 of IPC through Naz
Foundation v Government of National Capital Territory of Delhi found that this section was a
violation of fundamental rights provided by the Indian Constitution, but this decision was
reviewed and effectively reversed. Thus IPC 377 S thus remained in place until 2018.
 The Supreme Court decided to finally overturn Section 377 (in Navtej Singh Johar and Ors
versus Union of India, The Secretary Ministry of Law and Justice) on September 6, 2018.
Duffy RM, Narayan CL, Goyal N, Kelly BD. New legislation, new
frontiers: Indian psychiatrists’ perspective of the mental healthcare act
2017 prior to
implementation. Indian J Psychiatry 2018;60:351-4
 References
1. Jolitha RC, Prerna Kukreti, Dinesh Kataria. Forensic Psychiatry an Indian Perspective. Jaypee publications
2018
2. The Rights of Persons with Disabilities Act, 2016, Gazette of India
(Extra‑Ordinary); 28 December, 2016
3. Duffy RM, Narayan CL, Goyal N, Kelly BD. New legislation, new frontiers: Indian psychiatrists’
perspective of the mental healthcare act 2017 prior to implementation. Indian J Psychiatry 2018;60:351-4
4. Narayan CL, John T. The Rights of Persons with Disabilities Act, 2016: Does it address the needs
of the persons with mental illness and their families. Indian J Psychiatry 2017;59:17-20 .
5. John T, Subramanyam AA, Sagar R. Strength and weakness of the guidelines of Rights of Persons
with Disabilities Act, 2016 (dated January 5, 2018): With respect to the persons with neurodevelopmental
disorders. Indian J Psychiatry 2018;60:261-4
6. Kealy-Bateman W. The possible role of the psychiatrist: The lesbian, gay, bisexual, and transgender
population in India. Indian J Psychiatry 2018;60:489-93
THANK YOU