MHC Act 2017 Final Version Chandigarh Ready

MHCA, 2017
Pragmatics & Challenges related to its

Implementation
Dr BK Waraich
Dr Suresh Bada Math
Simmi W & Suresh BM, NZ Chandigarh12018

Dr BK Waraich
 MBBS & MD(1995-98) from Govt medical College, Patiala and Senior
Residency from GMCH Sector 32 and PGI, Chandigarh.
 Associated with Distt mental Health program, GMCH Sector 32,
Chandigarh.
 1 year in Australia as Registrar before joining Fortis Hospital in 2005
as Sr Consultant . And Child & Adolescent Clinic, Landmark Hospital,
Chandigarh.
 Numerous newspaper articles where she writes under the name Simmi
Waraich, Lectures and talks on Depression, Stress , Drug Abuse
prevention, Sex education etc.
Simmi W & Suresh BM, NZ Chandigarh 2018

Disclaimer
 Cases discussed in this workshop are purely imaginary, if

they coincide with any person or person’s life it is purely
co-incidental.
 All discussions will be restricted to MHC Act, 2017
 The discussion generated during the workshop are

guidelines only, they are not the law themselves or not
substitutes for opinions from legal luminaries
 There are many grey areas in the law that needs to be

addressed. This workshop is just a first step towards it

Disclaimer
 I am here to discuss and interpret the legislation so that

State Rules can be made easy and implementable
 Clinically correct < Ethically correct < Legally correct

issues are raised but we shall focus on legal correctness
(near to)
 MHC Act, will be interpreted on case by case by the

Mental Health Review Board
 I was involved in drafting rules & regulations (Central)

only

Housekeeping Requests……..
 During the discussion, keep your opinions simple

and crisp
 Please do not discuss your or friend’s past cases

(legal issues)
 No need to become emotionally

Mental Healthcare Act 2017 is drafted
for whom?

Preamble of the Act, Page 1 Simmi W & Suresh BM, NZ Chandigarh 2018
Case Vignette-1
 Miss C, 24 year old female educated up to LLB, practicing law

in High Court of Delhi, married one year back reports with
occasional sadness of mood and easy fatigability since two
months because of marriage related issues. But going to work
regularly.
 She consults a psychiatrist on OPD basis and on assessment
she was suffering from Border Line Personality Disorder.
 She was started on some SSRI medication.
 She developed rashes on her body.
 She wanted to lodged a complaint in Mental Health Review
Board.
 Can she approach the MHRB …………………?
 Should MHRB entertain her case?
Questions
 Does Borderline PD is a mental illness as per

MHCA 2017?
 Should MHRB accept her case?
 What is your argument?

‘Mental Illness’ means
 Sec 2 (1) s. “mental illness” means a substantial disorder

of thinking, mood, perception, orientation or memory that
grossly impairs judgment, behaviour, capacity to
recognize reality or ability to meet the ordinary demands
of life, mental conditions associated with the abuse of
alcohol and drugs, but does not include mental
retardation which is a condition of arrested or incomplete
development of mind of a person, specially characterized
by subnormality of intelligence
Sec 2 (s) Page 4

‘Mental Illness’ means
1) A substantial disorder of thinking, mood,

perception, orientation or memory that
2) Grossly impairs judgment, behaviour, capacity
to recognize reality or
3) Ability to meet the ordinary demands of life
Includes - mental conditions associated with the

abuse of alcohol and drugs
Exclusion – Intellectual Disability (MR)

 The ultimate authority to decide on the ‘definition’
of mental illness (as per MHC Act, 2017) rests
with the MHRB (Case by case)
 Role of psychiatrists is to sensitize the MHRB

members/chairperson that all disorders not
associated with ‘substantial’ impairment
 Clinical Vs Legal definition of ‘Mental Illness’

Case Vignette-2
 Dr P, passed his MD psychiatry recently and

now he is starting his practice in his home town
Lucknow.
 He is consulting in five nursing homes (general

hospital) as a visiting consultant only.
He does not have any designated beds in all these

nursing homes.
He is asking for your expert opinion whether,
questions
 Can he admit cases in medicine ward?

 Can he see patients referred inpatient suicidal
attempted cases/delirium cases in medical ICU?
 Does all five hospitals needs to register under
MHC Act, 2017 for admitting psychiatric patients?
 Can he give modified ECT on opd basis without
registration of the nursing home?
 What are penalty for practicing in unregistered
establishments?

Registration under which Act?
 MHC Act, 2017

 RPWD Act, 2016
 NDPS Act, 1985
 Clinical Establishment Act,
 Which Act??????????

OPD and Mental Health
Establishment
 OPD is not considered as the MHE. The
definition of ‘Mental health establishment’ (MHE) is
mainly for registration only
OPD basis treatment clinics are exempted from

registration but ‘Rights Violation of persons with
mental illnesses’ will be taken by the MHRB’
irrespective of the OP / IP Basis / Faith-healer /
any place/ any person for that matter

GH Referrals
 Referral forms made appropriately mentioning

the day, time of visit and on OPD basis
 Avoid inpatient unless registered
 Sec 94 can be utilized
 If psychiatrist is examining the patients ‘who do

not qualify the definition of mental illness of MHC
Act need not require registration’

 To admit patients qualifying the definition of
‘mental illness’ as per Sec 2 (1)s of MHC Act,
2017 the hospital needs registration.
 If psychiatrist is admitting patients under sec 89

or 90 (Supported / Involuntary)

Mental Health Establishment
 2 (1) (p) “mental health establishment” means 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, organisation 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, organisation 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
Sec 2 (p) Page 3 Registration Simmi W & Suresh BM, NZ Chandigarh 2018
Mental Health Establishment
 Anything apart from residential place with family needs

registration
 Registration process is made simple, easy and
transparent (Sec 65, Page 31)
 No need for inquiry in case of provisional reg (sec 66,
Page 32)
Provisional registration (within 10days and valid for

12months)
Permanent registration (within 30days)
 If no communication – it is deemed to be registered

 Appeal to high-court (30days)
What are the penalty for serving in a
unregistered mental health
establishment?

Penalty for
 107 (2) Whoever knowingly serves in the capacity as a

mental health professional in a mental health
establishment which is not registered under this Act, shall
be liable to a penalty which may extend to twenty-five
thousand rupees
 108 First contravention be punishable with imprisonment

for six months, or with a fine of ten thousand rupees or
with both
 Subsequent contravention with imprisonment for two

years or with fine extending upto to five lakh rupees or
with both
Sec 107 & 108 Page 43 Simmi W & Suresh BM, NZ Chandigarh 2018
Case Vignette-3
 Dr Y, 26yrs unmarried girl was brought to your hospital

by her family members with history of violent behavior,
abusive, assaultive, dancing, disrobing, singing, smiling
to self and wandering behavior. She had past history of
two episodes of mania and had received 7 ECTs
 She is brought to your poly-clinic, which is registered
under MHC Act, 2017.
 She has written AD that, she should be given only
Ayurvedic treatment for her BPAD.
 She has denied ECT in her AD
 Family members are insisting for admission and
treatment under allopathy
 Will you admit her in your hospital? Which
clause?
 Will you treat her in your hospital? Which
clause?
 She does not want family members interacting
with the treating team, what will you do?
 If you want to give ECT, what will you do?

Regarding Admission
 Articulation is clear and almost similar to MHA

1987
 Only reporting to board is added
 Care giver for adolescents
 Amending Advance directives
 ECT is prohibited – Emergency treatment

Mental Health Care Act, 2017
Independent Admission Supported Admission

(Voluntary admission) (Involuntary Admission)
Adult (S 86) Minor (S 87) Supported Admission up to Supported Admission beyond

30days (Sec 89) 30days up to 90days (Sec 90)
Request for Request for Request for admission by nominated

admission by admission by representative
himself Nominated Rep
Patient will be Patient will be Patient will be Patient will be

admitted if a admitted if 2 admitted if a admitted if two
medical psychiatrist or medical psychiatrist examine
officer/mental medical officer + officer/mental
health professional Psy / mental health health professional
is satisfied professional+ psy has examines
examined
Intimation to the concerned board within Intimation to the concerned board within
72 hrs for women and children 7days for adult male

Case Vignette-4
 Mr Z, 56yrs married was brought to your hospital by her

family members with history of suspicious, abusive,
assaultive, damaged house hold articles, talking to self,
smiling to self, poor personal care, disrobing and
wandering behavior since past ten years. Never received
any treatment for mental illness. Mr Z feels that he is
completely alright and denies of any mental illness. He
has not written AD or NR. Today, he is brought to a
nearest nursing home, which is not registered.
 What will you do? Will you admit him?

 Mr Z is refusing to take treatment, what will you do?
Emergency treatment (Sec 94)
 Any medical treatment may be provided subject to

 Informed consent of the nominated representative,
 If it is immediately necessary to prevent - danger to

self or to others or the person causing serious damage
to property belonging to self or to others where such
behavior is believed to flow directly from the person’s
mental illness.
 The treatment referred shall be limited to 72 hours only.

 It includes transportation of the patient
 AD & ECT is not applicable during the emergency
Sec 94 Page 38 Simmi W & Suresh BM, NZ Chandigarh 2018

Case Vignette-5
 Mrs X, 35yrs married from urban middle class is

treated for depression by you since past 5years
(X - Corporate hospital). She had revealed her
pre-marriage affair. Now, she has improved and
doing well. She has nominated her husband has
NR.
 Now her husband is requesting for medical
record of his wife’s treatment.
 What will you do?

 Irrespective of the status of ‘NR’ – If, she has
capacity do not give any records without her
consent
 An advance directive or nominated

representative made under section 5(3), shall be
invoked only when such person ceases to have
capacity to make mental healthcare or treatment
decisions and shall remain effective until such
person regains capacity to make mental
healthcare or treatment decisions
Requesting for medical records
 25. (1) All persons with mental illness shall have

the right to access their basic medical records as
may be prescribed
 (2) The mental health professional in charge of

such records may withhold specific information in
the medical records if disclosure would result in,–
(a) serious mental harm to the person with
mental illness; or
(b) likelihood of harm to other persons
Right to Information vs
Basic Medical Records
22. (1) A person with mental illness and his

nominated representative shall have the rights to
the following information, namely
 the criteria for admission and right to review the

admission
 diagnosis and the proposed treatment plan
(NR will take over only when patient is

incapacitated)
Modification in your medical records
 Don’t document unnecessary details such as

fantasy, pre-marital affair, extra-marital affair,
masturbatory practices, sexual abuse, child
sexual abuse and other graphical details
 Document collateral information in a separate

page (file)
 Document only the requirement as per the Basic

Medical Record

Case Vignette-6
 Mr Y approached the family court for divorce on

the basis of his wife Mrs X is suffering from
mental illness.
 The court wants to know, whether she has illness

or not?
 Court is asking for medical records / documents,

What will you do?

Dispute on proof of Mental Illness
 105. If during any judicial process before any

competent court, proof of mental illness is
produced and is challenged by the other party,
the court shall refer the same for further scrutiny
to the concerned Board and the Board shall,
after examination of the person alleged to have a
mental illness either by itself or through a
committee of experts, submit its opinion to the
court.

Right to confidentiality
 23(2)f - release of information upon an order by

concerned Board or the Central Authority or High
Court or Supreme Court or any other statutory
authority competent to do so; and
 Suggestion – do not withhold any information if

there is any cognizable offences is committed

CASE VIGNETTE 7
 A 28 yr old lady was brought to the hospital by

her husband and mother. She is pregnant and
talking to herself. She reports auditory
hallucinations, has decreased self care. Insight is
absent. She is 5 months pregnant and the
husband does not want treatment as he fears it
may harm the unborn child. The mother wants
treatment.

 Husband is the legal NR if the person has not
nominated an NR. However, if the patient has
capacity admit.
 If not Mother can write to the MHRB or Treating
Psychiatrist can write to the MHRB after she is
examined by Psychiatrist and another Medical
practitioner and it is found that it is against her
best interests to let her go untreated.
 NR shall consider the current &past wishes, life
history, values, cultural values and the BEST
INTERESTS of PWMI.
(Sec14 &17 Page 7 & 8) Simmi W & Suresh BM, NZ Chandigarh 2018
Case Vignette-8
 Mr Z, 25 year male admitted in a rehabilitation

under Sec 90 wants to exercise his right to
personal contacts and communication. He wants
to make a phone call. He is demanding for phone
call facility, since it is ‘ Right to personal contacts
and communication’
 How will you facilitate the right to personal

contacts and communication?

26 Right to personal contacts and
communication
 You will not stop him from communicating (at

reasonable times subject to the norms of such
mental health establishment) Sec 26 (1)
 State shall provide the (reasonable) facilities for

communication. The requisition has to go to the
board
 Let the family can decide about the mobile
 Signal Jammer (area / ward)

Notice Board Display
 MHRB members phone number

 Legal Aid phone number
 State Mental Health Authority number
 State Human Rights Commission number
 Women / Child Commission
 Local Police Number

Case Vignette-9
 Mrs X, 59yrs widow comes to your hospital, where her

son is taking treatment for BPAD and Borderline PD since
past 9years
 He had multiple episodes and each episode is
precipitated by drug default
 Mother reports that her son had relapsed since past one
week and refusing to come for consultation. He is
refusing to take medicines.
 She is requesting for prescription.
 She is reporting that she will give covert medication

Proxy care consultation
 Proxy consultations should be avoided

 It is a risk you are taking
 Take permission from MHRB (families to approach
the MHRB)
 Preauthorization letter???????????
 Tele-medicine facility can be leveraged
 Avoid covert medication and proxy consultation
Sec 4 (Page 5)

Case Vignette-10
 Mr 24 year old male suffering from Mania

without psychotic symptoms was admitted to
your hospital three days back under sec 89.
 But now, he has escaped from your hospital.

 Sec 92 – If any person to whom section 103 (prisoner
with mental illness) applies absents himself without leave
or without discharge from the mental health
establishment, he shall be taken into protection by any
Police Officer at the request of the medical officer or
mental health professional in-charge of the mental health
establishment and shall be sent back to the mental health
establishment immediately.
 Law is silent – need to evolve local policy or professional

body stand
 Best practice - to facilitate missing complaint & issue
certificate
FIR for searching family members
 100 (7) In case of a person with mental illness

who is homeless or found wandering in the
community, a First Information Report of a
missing person shall be lodged at the concerned
police station and the station house officer shall
have a duty to trace the family of such person
and inform the family about the whereabouts of
the person
Sec 100(7) Page 41 Simmi W & Suresh BM, NZ Chandigarh 2018

Case Vignette-11
 Mrs V, a 35 yr old with a 4 yr old daughter comes

to a pediatric OPD. It is noticed by the Doctor
that child was sexually abused by someone –
What needs to be done? The mother seems to
be having a mental illness. There is no husband
or other caregiver.

POCSO and Who Will be the NR in case of
no relative
 Under POCSO, Child Helpline and District CPO/ State

Child Welfare Committee informed
 Chapter IV section 14 (4)- Where no NR is appointed by

the person under sub section (!) , the following persons
for the purposes of this Act shall be deemed to be the NR
of a person with Mental illness-
 …..If no person is available to be appointed as a

nominated representative the board shall appoint the
Director, Department of Social Welfare or his/her
designated representative as the NR.
Sec 14 (4)e Page 7 Simmi W & Suresh BM, NZ Chandigarh 2018
Case Vignette-12
 Family is requesting to keep Mr. P, 35yrs,

unmarried, diagnosed to be suffering from a
chronic schizophrenia patient in your half way
home for long duration (5 years)

Admission
(i) has consistently over time threatened or

attempted to cause bodily harm to himself; or
(ii) has consistently over time behaved violently

towards another person or has consistently over
time caused another person to fear bodily harm
from him; or
(iii) has consistently over time shown an inability to

care for himself to a degree that places the
individual at risk of harm to himself;
Sec 89 Page 34, Sec 90 (1) Page 36 Simmi W & Suresh BM, NZ Chandigarh 2018
Admission
 Information to the MHRB with in 7 days

 MHRB has to provide, with in 21 days, shall
permit/deny such admission
 If MHRB doesn’t respond, reminder letters until
they respond
 Continue to treat
 If MHRB does not exist in your jurisdiction, inform
Chair person of the state mental health authority
and state legal services authority (legal aid)

Case Vignette-13
 Ms L, 26 years old unmarried advocate diagnosed to be

suffering from P Schiz since past 8years. Recently, she
had stopped medicine and became violent. She was
admitted against her wish for few days in a registered
Mental health establishment.
 After her discharge, she has approached various forums
like SHRC, NHRC, IMC/SMC, PVT hospital/clinical
establishment act, Information commissioner, Civil Court
and District Consumer forum challenging the decision of
psychiatrist to admit against her consent.
 Is she authorized to do so?

Bar of jurisdiction
 116. No civil court shall have jurisdiction to

entertain any suit or proceeding in respect of any
matter which the Authority or the Board is
empowered by or under this Act to determine,
and no injunction shall be granted by any court
or other authority in respect of any action taken
or to be taken in pursuance of any power
conferred by or under this Act.

82. Power & Function of the board
 to register/review/alter/modify or cancel an advance

directive and NR;
 matter related to section 87 or section 89 or section 90;
 diagnosis of illness (sec 105)
 non-disclosure of information
 to complain regarding deficiencies in provision of care,
treatment and services in a mental health establishment
 the Board, in consultation with the Authority, may take
measures to protect the rights of persons with mental
illness

Act to have overriding effect.
 120. The provisions of this Act shall have

overriding effect notwithstanding anything
inconsistent therewith contained in any other law
for the time being in force or in any instrument
having effect by virtue of any law other than this
Act.

Case Vignette-14
 Ms R, 23 yrs old married female is admitted in

your hospital under sec 90.
 She is refusing to give consent for treatment.

Capacity to make mental healthcare
and treatment decisions
 4. (1) Every person, including a person with

mental illness shall be deemed to have
capacity to make decisions regarding his mental
healthcare or treatment
(onus of proving is on PSYCHIATRIST / remote

possibility is family members / others)

Capacity to make mental healthcare
and treatment decisions.
 4. (1) Every person, including 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—
 (a) understand the information that is relevant to take a decision on

the treatment or admission or personal assistance; or (and)
 (b) appreciate any reasonably foreseeable consequence of a

decision or lack of decision on the treatment or admission or
personal assistance; or (and)
 (c) communicate the decision under sub-clause (a) by means of

speech, expression, gesture or any other means

Capacity to consent for treatment
(a) understand the information that is relevant to

take a decision on the treatment or admission or
personal assistance; (Comprehension)
(b) appreciate any reasonably foreseeable

consequence of a decision or lack of decision on
the treatment or admission or personal assistance;
(weighing the risk)
(c) communicate the decision

 Admission is clear
 For treatment – one needs to assess the

capacity
 Mental Capacity is Specific to task –

Admission / Treatment / Research / ECT
 Competence is a broad categorical legal term of

Loss of Personhood (Person before the law)
Expert Committee
 81. (1) The Central Authority shall appoint an

Expert Committee to prepare a guidance
document for medical practitioners and mental
health professionals, containing procedures for
assessing, when necessary or the capacity of
persons to make mental health care or treatment
decisions.

Case Vignette-15
 Ms S was brought to your hospital with history of

suicidal attempt by consuming sleeping pills 24
hours back.

De-criminalizing suicide
 Section 115 of the Act provides for

decriminalizing suicidal attempts (Sec 309 IPC).
A person who attempts suicide shall be
presumed to be suffering from mental illness
(stress) at that time and will not be punished
under the Indian Penal Code
 General Medical Condition - treat

 Any doubt make it MLC
 Let the police investigate for abetment of suicide
Case Vignette-16
 What are the utmost precautions you should take

under MHCA 2017?

Keep an eye on Prohibitions and
Restrictions
a) Psychosurgery only after consent & Board clearance

b) Restraint
 If it is the only way to prevent imminent and immediate harm
to self or others
 Authorized by the psychiatrist in-charge
 As less a time as is permissible
c) Unmodified electro-convulsive therapy-totally prohibited
d) Sterilization- totally prohibited
e) Chaining/seclusion/solitary confinement - prohibited
f) ECT is prohibited in minors (except with prior clearance
from the board)

Case Vignette -17
 You are working in a medical college/hospital

with 2MD/2DNB students per year. You have
taken registration for your hospital.
 Your MD students are doing thesis.
 What are the steps to be taken to do or to
facilitate research in your medical college?

Sec 99
 Ethics committee
 Informed consent from PWMI
 If doing research on PWMI, who are unable to

give consent …..
NR consent (Proxy Consent)
State Mental Health Authority

Role of Magistrate
 What is the role of Magistrate under MHC Act,

2017?

 Sec 100 - Role of police (Wandering or
Dangerous to self or others)
 Sec 101 – To produce in front of the court
 Sec 102 – Magistrate will commit into a public
mental health establishment for 10days only.
The medical officer or mental health professional
in charge of the mental health establishment
shall submit a report to the Magistrate and the
person shall be dealt with in accordance with the
provisions of this Act
Sec 100, 101, 102 Page 41, 42 Simmi W & Suresh BM, NZ Chandigarh 2018
Summary and conclusions
 Defensive practice is going to increase

 Non hospitals – will refuse
 Advance directives / Nominated representative are going
to increase litigation and our paper work
 Need to have more work force for documentation which
will increase Mental Health Care costs
 Manpower issues needs to be addressed (UG training)
 Indemnity insurance is essential
 Risk management is the first and the treatment comes
next
 Documentation needs to short and crisp (basic minimum
record)
Dr Suresh Bada Math, MD, DNB, PGDMLE, PGDHRL, PhD in Law
Professor of Psychiatry
NIMHANS, Bangalore
Mob: 9845141918
sureshbm@gmail.com

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MHCA, 2017

Pragmatics & Challenges related to its

Dr Suresh Bada Math

Simmi W & Suresh BM, NZ Chandigarh12018

Simmi W & Suresh BM, NZ Chandigarh 2018

 Cases discussed in this workshop are purely imaginary, if

 All discussions will be restricted to MHC Act, 2017

 The discussion generated during the workshop are

 There are many grey areas in the law that needs to be

Simmi W & Suresh BM, NZ Chandigarh 2018

 I am here to discuss and interpret the legislation so that

 Clinically correct < Ethically correct < Legally correct

 MHC Act, will be interpreted on case by case by the

 I was involved in drafting rules & regulations (Central)

Simmi W & Suresh BM, NZ Chandigarh 2018

 During the discussion, keep your opinions simple

 Please do not discuss your or friend’s past cases

 No need to become emotionally

Simmi W & Suresh BM, NZ Chandigarh 2018

Simmi W & Suresh BM, NZ Chandigarh 2018

 Miss C, 24 year old female educated up to LLB, practicing law

 Does Borderline PD is a mental illness as per

 Should MHRB accept her case?

 What is your argument?

Simmi W & Suresh BM, NZ Chandigarh 2018

 Sec 2 (1) s. “mental illness” means a substantial disorder

Sec 2 (s) Page 4

Simmi W & Suresh BM, NZ Chandigarh 2018

1) A substantial disorder of thinking, mood,

Includes - mental conditions associated with the

Simmi W & Suresh BM, NZ Chandigarh 2018

 Role of psychiatrists is to sensitize the MHRB

 Clinical Vs Legal definition of ‘Mental Illness’

Simmi W & Suresh BM, NZ Chandigarh 2018

 Dr P, passed his MD psychiatry recently and

 He is consulting in five nursing homes (general

He does not have any designated beds in all these

 Can he admit cases in medicine ward?

Simmi W & Suresh BM, NZ Chandigarh 2018

 MHC Act, 2017

Simmi W & Suresh BM, NZ Chandigarh 2018

OPD basis treatment clinics are exempted from

Simmi W & Suresh BM, NZ Chandigarh 2018

 Referral forms made appropriately mentioning

 Avoid inpatient unless registered

 Sec 94 can be utilized

 If psychiatrist is examining the patients ‘who do

Simmi W & Suresh BM, NZ Chandigarh 2018

 If psychiatrist is admitting patients under sec 89

Simmi W & Suresh BM, NZ Chandigarh 2018

 2 (1) (p) “mental health establishment” means any health

 Anything apart from residential place with family needs

Provisional registration (within 10days and valid for

 If no communication – it is deemed to be registered

Simmi W & Suresh BM, NZ Chandigarh 2018

 107 (2) Whoever knowingly serves in the capacity as a

 108 First contravention be punishable with imprisonment

 Subsequent contravention with imprisonment for two

 Dr Y, 26yrs unmarried girl was brought to your hospital

Simmi W & Suresh BM, NZ Chandigarh 2018

 Articulation is clear and almost similar to MHA

 Care giver for adolescents

 Amending Advance directives