Your rights in mental-health care in India

Can I disagree with a recommendation?

Yes. You can disagree, ask why and ask about other choices. Section 4 of the Mental Healthcare Act, 2017 is about capacity. It says a choice that others think is wrong does not, by itself, mean you lack capacity.

Capacity means being able to understand a decision and make it. Information should be given in simple words you understand.

Consent should be for a specific treatment. It should come after you hear the risks, benefits and other choices, without force or pressure.

The limit: in a serious crisis, the law allows some care without your consent. This is covered below, under hospital care.

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What information can I ask for?

You can ask about your condition, the treatment plan and its known side effects. Section 22 of the Act says this should be in a language and form you understand.

If you are admitted to hospital, you can ask which law it is under and how to ask for a review.

The limit: if you cannot take in full information at the start, it must be given as soon as you can. In that case, your nominated representative is told straight away.

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Does my family have to know?

No. Your mental health, treatment and records are confidential. Section 23 of the Act gives you this right. It covers digital records too. Whoever pays for your care does not get a right to your information because of that.

The limits: the law lets a doctor share information in some cases:

• with your nominated representative, so they can do their legal role
• with other health workers who are caring for you
• to protect someone from harm or violence, or to prevent a threat to life
• on the order of a court, a Mental Health Review Board or another legal authority
• for public safety and security

Only what is needed should be shared.

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What is a nominated representative?

It is a person you choose to support you with care decisions. Section 14 of the Act lets any adult name one, in writing, on plain paper.

The person must be an adult, able to do the role, and must agree in writing. You can change or cancel your choice at any time.

Having a nominated representative does not mean you lack capacity. Under section 17, they must think about your wishes and values, and support you to decide.

The limit: if you name no one, the law lists who acts instead. A relative or a carer usually comes first.

Can I write down my wishes in advance?

Yes. An adult can make an advance directive under section 5 of the Act. It can say how you want to be treated and how you do not. It can also name your nominated representative.

The limits: a formal advance directive has legal steps, set by regulations. It is used only when you cannot make the decision yourself. A choice you make while you can decide counts over an older directive. Emergency rules can also affect it.

A crisis plan made with your doctor is useful. But it is not automatically a legal advance directive. Ask a lawyer or the Mental Health Review Board about the current steps.

Can someone make me go into hospital?

Most hospital stays should be your own choice. The Act says admissions should be voluntary as far as possible. An adult can ask to be admitted.

The limits: under section 89, a "supported admission" is possible without your consent. It needs two separate examinations and strict conditions.

There must be a recent risk of serious harm to yourself or others. Or you must be at risk because you cannot care for yourself. The person must also be unable to make treatment decisions alone, and need very high support to make them.

The hospital stay must also be the least restrictive choice that fits the situation. It is limited to 30 days, with more safeguards for any longer stay. A family disagreement alone does not meet these conditions.

In an emergency, section 94 allows treatment to prevent death or serious harm. It must relate to the emergency.

Section 94 also requires your nominated representative's informed consent, where they are available. It lasts up to 72 hours, or until an assessment at a mental health establishment, whichever is sooner.

Can I get my records or another opinion?

You can ask for your basic medical records. Section 25 of the Act gives you this right.

The limit: a doctor can hold back specific parts. This is allowed if sharing them could cause you serious mental harm, or put others at risk. If that happens, you must be told that you can ask the Mental Health Review Board to release them.

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You can also ask another psychiatrist for an opinion. Agree who will prescribe and review your medicines in the meantime.

Are the rules the same for children?

No. Under the Act, a minor is anyone under 18. For a minor, the legal guardian is usually the nominated representative, unless a Board decides otherwise. Only adults can make an advance directive.

For a child, a parent or guardian gives consent to care. The child's views are heard in a way that fits their age. Child protection law can require a doctor to act if a child is being harmed. Ask the doctor how this works.

What can I do if a concern is not resolved?

First, ask the service to explain the decision and its reasons. Keep copies of what you ask and what you are told.

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Section 27 of the Act gives you a right to free legal services to use these rights. For care in a mental health establishment, section 28 sets a route.

You complain to the person in charge, then to the Mental Health Review Board, then to the State Mental Health Authority. You can still go to court.

Can I be punished for attempting suicide?

In most cases, no. Section 115 of the Mental Healthcare Act, 2017 says a person who attempts suicide is presumed to be under severe stress, unless shown otherwise. Such a person is not to be tried or punished for it.

The government also has a duty to offer care and support to lower the chance of it happening again.

If you are thinking about suicide, get help now. The crisis lines below say how.