Why Are There No Mental Health Review Boards Yet, Asks Delhi HC

The Delhi High Court has asked the state mental health services authority to explain why review boards for mental health patients have not been constituted yet as mandated under the law.

The issue cropped up before metropolitan magistrate Abhilash Malhotra while hearing a plea moved by an NGO for the mental health assessment of a homeless woman, who identified herself as an MBBS graduate and has been residing in their shelter home and had refused her medical examination without a court order or in absence of a lawyer.

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Calling it a peculiar situation, the judge said the jurisdiction of allowing a person with mental illness to be admitted and treated without her consent vested with the district mental health review board and the court of metropolitan magistrate has no domain or jurisdiction to deal with the same.

It is informed that the District Mental Health Review Boards are yet to be constituted. Section 73 of Mental Health Care Act, 2017 mandates that the state authority shall by notification constitutes the Mental Health Review Boards at all districts.

"Notice be issued to the state authority of mental health services concerned to file a detailed report before the court as to why review boards for mental health patients have not been constituted so far in compliance of the legislative mandate," it said.

Under the Act, the District Mental Health Review Boards would address public grievances related to violation of its provisions.

The court directed the secretary of Delhi State Legal Services Authority (Central district) to provide legal aid counsel to the woman and placed the matter before the Delhi state authority for Mental Health Services for considering her admission in a hospital for treatment as sought by the NGO.

"In view of the peculiar situation, it will be prudent to place the matter before the State Authority for Mental Health Services, Delhi for considering the admission sought by the NGO under section 89 of the Act and pass appropriate directions. Accordingly, the matter shall be placed before the state authority for mental health services, Delhi and status of the proceedings be apprised to this court," it said.

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Centre for Equity Studies, an NGO that provided facility of recovery services to rescued homeless patients, has sought in its application directions for assessment and possible emergency admission of the woman who was residing at its shelter home since August 2018. It has claimed that she suffered from mental ill health which required urgent treatment.

Mental Health to Be Assessed After a Valid Court Order Only

The woman has refused to cooperate for her mental health assessment citing her right to be examined only after a valid court order and in the presence of a lawyer.

She had identified herself as an MBBS graduate who was staying in the city since 1989. She did not get any work to sustain herself and hence she was living in another women's shelter home since December 2017. When she came to the Centre for Equity Studies she was asked to get a medical checkup done to which she refused, the NGO has said in its plea.

The plea read, “Since her transfer to the shelter, the counsellor and the rest of our team has tried repeatedly to request her to see a doctor for a medical psychological assessment and if recommended, take medication based on her symptoms of delusional thinking as well as anger which manifests unexpectedly, as well as attributing mal intent to others.”

"But she has refused to go out of the shelter home for an assessment or take medication for the mental ill health as per suggestion of the visiting psychiatrist based on her symptoms, and spends her days usually sitting with all her clothes in the sun for the full day. Over the time, she has become less willing to engage with others and shows a lot of irritation. We think her symptoms are becoming worse over time." It further claimed that the woman had violent episodes in the past where she beat up her fellow residents and its staff members.

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The NGO in its plea said:

"“The shelter currently houses 66 residents, out of which 17 are children of the women residents and the remaining are women in need of safe and secure shelter above the age of 18. We cannot use force to control her, and recognise that she needed urgent care and treatment for her mental ill-health otherwise she was likely to deteriorate further.”"

It said when the NGO contacted her brother, he did not give any response in providing support in her treatment.

The NGO urged the court to direct the Institute of Human Behaviour and Allied Sciences (IHBAS) to send an emergency van with trained professionals to facilitate the process of sending the woman to the hospital for getting psychiatric treatment.

IHBAS told the court that the woman had actively refused to cooperate for her mental health assessment.

The State Mental Health Authority told the court that it was not feasible to admit a person who has been actively refusing for her assessment and with apparent intact capacity to make mental health care and treatment decisions.

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