Admission Pattern After Half a Decade of Implementation of MHCA, 2017: Experience from a Tertiary Care Hospital in Southern India.

Abstract

Background: Many laws and acts related to mental health play a vital role in delivery of mental health services for persons with mental illness (PMI). In India, the Mental Health Act of 1987 (MHA, 1987) was replaced with the Mental Healthcare Act, 2017 (MHCA, 2017). However, there were numerous barriers and challenges in the proper implementation of the Act, and there is a paucity of research on the extent of implementation of the new Act. This study assessed the admission patterns of PMI admitted during the transition phase from MHA, 1987 to MHCA, 2017.

Methods: A retrospective chart review was done on admissions through the Hon'ble Magistrate's orders and mentally ill prisoners at a tertiary care psychiatric hospital in first four years (2018-2022) after MHCA enactment. Details regarding the admission, legal variables, and clinical variables were taken from case records.

Results: Our study included 354 patients, including 222 (62.7%) admissions through the Hon'ble Magistrate's orders and 132 (37.3%) mentally ill prisoners. Paranoid schizophrenia (n = 162, 52.9%) was the most common diagnosis and modified electroconvulsive therapy was given to 36% (n = 120) of patients. Total 115 (52%) patients were admitted under MHA, 1987, and 38 (17%) were admitted under MHCA, 2017, and no Act was mentioned in the case of 68 patients (30.6%).

Conclusions: This study highlights the extent of change in admissions of PMI after MHCA, 2017 enactment and sheds light on probable barriers for delay in the proper implementation of the Act. Our study emphasized the need for awareness about MHCA for all stakeholders as adherence to the proper procedure is necessary while admitting patients in closed wards and prison wards of the psychiatric facility.