Section 14 in The Mental Healthcare Act, 2017
Title: Appointment and revocation of nominated representative
(1) 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.
(2) The nomination under sub-section (1) shall be made in writing on plain paper with the person's signature or thumb impression of the person referred to in that sub-section.
(3) The person appointed as the nominated representative shall not be a minor, be competent to discharge the duties or perform the functions assigned to him under this Act, and give his consent in writing to the mental health professional to discharge his duties and perform the functions assigned to him under this Act.
(4) Where no nominated representative is appointed by a person under sub-section (1), the following persons for the purposes of this Act in the order of precedence shall be deemed to be the nominated representative of a person with mental illness, namely:—
(a) the individual appointed as the nominated representative in the advance directive under clause (c) of sub-section (1) of section 5; or
(b) a relative, or if not available or not willing to be the nominated representative of such person; or
(c) a care-giver, or if not available or not willing to be the nominated representative of such person; or
(d) a suitable person appointed as such by the concerned Board; or
(e) if no such person is available to be appointed as a nominated representative, the Board shall appoint the Director, Department of Social Welfare, or his designated representative, as the nominated representative of the person with mental illness:
Provided that a person representing an organisation registered under the Societies Registration Act, 1860 (21 of 1860) or any other law for the time being in force, working for persons with mental illness, may temporarily be engaged by the mental health professional to discharge the duties of a nominated representative pending appointment of a nominated representative by the concerned Board.
(5) The representative of the organisation, referred to in the proviso to sub-section (4), may make a written application to the medical officer in-charge of the mental health establishment or the psychiatrist in-charge of the person's treatment, and such medical officer or psychiatrist, as the case may be, shall accept him as the temporary nominated representative, pending appointment of a nominated representative by the concerned Board.
(6) A person who has appointed any person as his nominated representative under this section may revoke or alter such appointment at any time in accordance with the procedure laid down for making an appointment of nominated representative under sub-section (1).
(7) The Board may, if it is of the opinion that it is in the interest of the person with mental illness to do so, revoke an appointment made by it under this section, and appoint a different representative under this section.
(8) The appointment of a nominated representative, or the inability of a person with mental illness to appoint a nominated representative, shall not be construed as the lack of capacity of the person to take decisions about his mental healthcare or treatment.
(9) All persons with mental illness shall have capacity to make mental healthcare or treatment decisions but may require varying levels of support from their nominated representative to make decisions.
Title: Nominated representative of minor
(1) Notwithstanding anything contained in section 14, in case of minors, the legal guardian shall be their nominated representative, unless the concerned Board orders otherwise under sub-section (2).
(2) Where on an application made to the concerned Board, by a mental health professional or any other person acting in the best interest of the minor, and on evidence presented before it, the concerned Board is of the opinion that,—
(a) the legal guardian is not acting in the best interests of the minor; or
(b) the legal guardian is otherwise not fit to act as the nominated representative of the minor,
it may appoint, any suitable individual who is willing to act as such, the nominated representative of the minor with mental illness:
Provided that in case no individual is available for appointment as a nominated representative, the Board shall appoint the Director in the Department of Social Welfare of the State in which such Board is located, or his nominee, as the nominated representative of the minor with mental illness..
Title: Revocation, alteration, etc, of nominated representative by Board
The Board, on an application made to it by the person with mental illness, or by a relative of such person, or by the psychiatrist responsible for the care of such person, or by the medical officer in-charge of the mental health establishment where the individual is admitted or proposed to be admitted, may revoke, alter or modify the order made under clause (e) of sub-section (4) of section 14 or under sub-section (2) of section 15.
Title: Duties of nominated representative
While fulfilling his duties under this Act, the nominated representative shall—
(a) consider the current and past wishes, the life history, values, cultural background and the best interests of the person with mental illness;
(b) give particular credence to the views of the person with mental illness to the extent that the person understands the nature of the decisions under consideration;
(c) provide support to the person with mental illness in making treatment decisions under section 89 or section 90;
(d) have right to seek information on diagnosis and treatment to provide adequate support to the person with mental illness;
(e) have access to the family or home based rehabilitation services as provided under clause (c) of sub-section (4) of section 18 on behalf of and for the benefit of the person with mental illness;
(f) be involved in discharge planning under section 98;
(g) apply to the mental health establishment for admission under section 87 or section 89 or section 90;
(h) apply to the concerned Board on behalf of the person with mental illness for discharge under section 87 or section 89 or section 90;
(i) apply to the concerned Board against violation of rights of the person with mental illness in a mental health establishment;
(j) appoint a suitable attendant under sub-section (5) or sub-section (6) of section 87;
(k) have the right to give or withhold consent for research under circumstances mentioned under sub-section (3) of section 99.
Title: Right to access mental healthcare
(1) Every person shall have a right to access mental healthcare and treatment from mental health services run or funded by the appropriate Government.
(2) The right to access mental healthcare and treatment shall mean mental health services of affordable cost, of good quality, available in sufficient quantity, accessible geographically, without discrimination on the basis of gender, sex, sexual orientation, religion, culture, caste, social or political beliefs, class, disability or any other basis and provided in a manner that is acceptable to persons with mental illness and their families and care-givers.
(3) The appropriate Government shall make sufficient provision as may be necessary, for a range of services required by persons with mental illness.
(4) Without prejudice to the generality of range of services under sub-section (3), such services shall include—
(a) provision of acute mental healthcare services such as outpatient and inpatient services;
(b) provision of half-way homes, sheltered accommodation, supported accommodation as may be prescribed;
(c) provision for mental health services to support family of person with mental illness or home based rehabilitation;
(d) hospital and community based rehabilitation establishments and services as may be prescribed;
(e) provision for child mental health services and old age mental health services.
(5) The appropriate Government shall,—
(a) integrate mental health services into general healthcare services at all levels of healthcare including primary, secondary and tertiary healthcare and in all health programmes run by the appropriate Government;
(b) provide treatment in a manner, which supports persons with mental illness to live in the community and with their families;
(c) ensure that the long term care in a mental health establishment for treatment of mental illness shall be used only in exceptional circumstances, for as short a duration as possible, and only as a last resort when appropriate community based treatment has been tried and shown to have failed;
(d) ensure that no person with mental illness (including children and older persons) shall be required to travel long distances to access mental health services and such services shall be available close to a place where a person with mental illness resides;
(e) ensure that as a minimum, mental health services run or funded by Government shall be available in each district;
(f) ensure, if minimum mental health services specified under sub-clause (e) of sub-section are not available in the district where a person with mental illness resides, that the person with mental illness is entitled to access any other mental health service in the district and the costs of treatment at such establishments in that district will be borne by the appropriate Government:
Provided that till such time the services under this sub-section are made available in a health establishment run or funded by the appropriate Government, the appropriate Government shall make rules regarding reimbursement of costs of treatment at such mental health establishment.
(6) The appropriate Government shall make available a range of appropriate mental health services specified under sub-section (4) of section 18 at all general hospitals run or funded by such Government and basic and emergency mental healthcare services shall be available at all community health centres and upwards in the public health system run or funded by such Government.
(7) Persons with mental illness living below the poverty line whether or not in possession of a below poverty line card, or who are destitute or homeless shall be entitled to mental health treatment and services free of any charge and at no financial cost at all mental health establishments run or funded by the appropriate Government and at other mental health establishments designated by it.
(8) The appropriate Government shall ensure that the mental health services shall be of equal quality to other general health services and no discrimination be made in quality of services provided to persons with mental illness.
(9) The minimum quality standards of mental health services shall be as specified by regulations made by the State Authority.
(10) Without prejudice to the generality of range of services under sub-section (3) of section 18, the appropriate Government shall notify Essential Drug List and all medicines on the Essential Drug List shall be made available free of cost to all persons with mental illness at all times at health establishments run or funded by the appropriate Government starting from Community Health Centres and upwards in the public health system:
Provided that where the health professional of ayurveda, yoga, unani, siddha, homoeopathy or naturopathy systems recognised by the Central Government are available in any health establishment, the essential medicines from any similar list relating to the appropriate ayurveda, yoga, unani, siddha, homoeopathy or naturopathy systems shall also be made available free of cost to all persons with mental illness.
(11) The appropriate Government shall take measures to ensure that necessary budgetary provisions in terms of adequacy, priority, progress and equity are made for effective implementation of the provisions of this section.
Explanation.—For the purposes of sub-section (11), the expressions—
(i) "adequacy" means in terms of how much is enough to offset inflation;
(ii) "priority" means in terms of compared to other budget heads;
(iii) "equity" means in terms of fair allocation of resources taking into account the health, social and economic burden of mental illness on individuals, their families and care-givers;
(iv) "progress" means in terms of indicating an improvement in the State's response.