1. We have heard learned Additional Solicitor General Mr. Altaf Ahmed and counsel for the parties.
2. In continuation of our order dated 5th February, 2002 and considering various provisions of the Mental Health Act, 1987, particularly S. 5 which inter alia provides that Central Government may in any part of India or State Government may within the ^limits of its jurisdiction establish or maintain psychiatric hospital or psychiatric nursing homes for the admission, treatment and care of mentally ill persons at such places as it thinks fit. It is directed as under :
1. Every State and Union Territory (UT) shall undertake a comprehensive need assessment survey and file the report thereof on the following aspects ;
(a) Estimated availability of Mental Health Resource personnel in the State, including psychiatrists, psychologists, psychiatric social workers and psychiatric nurses in both the public and private (licensed) sector;
(b) Type of Mental Health Delivery System available in the State, including the available bed strength, outpatient services and rehabilitation services in the public and private (licensed) sector;
(c) An estimate of the Mental Health Services (including personnel and facilities) that would be required having regard to the population of the State and the incidence of mental illness.
2. The Chief Secretary of each State and Administrator/Commissioner of every UT shall file an affidavit stating clearly;
(i) Whether any minimum standards have been prescribed for licensing of Mental Health Institutions in the State/UT and in case such minimum standards have been prescribed, full details thereof;
(ii) Whether each of the existing registered Mental Health Institutions in the State/UT, whether private or run by the State, meet such minimum prescribed standards as on date of passing this order and if not, what steps have been taken to ensure compliance of licensing conditions and/or withdrawal of the licence.
(iii) How many unregistered bodies, by whatsoever name called, purporting to offer psychiatric/mental health care exist in the State on date of this order and whether any of them comply with minimum standards and are entitled to grant of licence and if not, whether steps have been taken to close down the same;
(iv) Whether any mentally challenged person has been found to be chained in any part of the State/UT;
(v) Conclusions on the basis of the Need Assessment Survey undertaken in terms of direction (1) above.
It is made clear that each affidavit must specifically and comprehensively deal with each of the queries set out above.
3. The report of Need Assessment Survey and affidavit as set out in directions (1) and (2) above shall be submitted to the Health Secretary, Union of India so as to reach him latest by 1st July, 2002. The Health Secretary, Union of India shall thereafter compile and collate the information as above and present the same in the form of a self-explanatory note/chart to this Court along with his conclusions. The affidavits filed by the States/UTs shall be annexed to the note/ chart. The Health Secretary, Union of India shall file the said note/chart in this Court by 15th July, 2002.
It is further directed that the Chief Secretaries of all States and Commissioners of all UTs who fail to file such affidavit with the Health Secretary, Union of India by 1st July, 2002 shall have to personally remain present on the next date of hearing and explain the default.
4. Further Union of India is directed-
a) To frame a policy and initiate steps for establishment of at least one Central Government run Mental Health Hospital in each State (as provided under Section 5 of the Act);
b) To examine the feasibility of formulating uniform rules regarding standard of services for both public and private sector Mental Health Institutes;
c) To constitute a committee to give recommendations on the Issue of care of mentally challenged persons who have no Immediate relatives or who have been abandoned by relatives;
d) To frame norms for n on-Government Organisations working in the field-of Mental Health and to ensure that the services rendered by them are supervised by qualified/trained persons.
5. All State Governments are also directed to frame policy and initiate steps for establishment of at least one State Government run Mental Health Hospital in each State. It is clarified that a Mental Health Hospital as stated above means a full-fledged Hospital catering only to mentally challenged persons and does not include a separate psychiatric ward in a Medical College or Government Hospital.
6. LEGAL AID Under Section 43 of the Mental Health Act (MHA), a patient is required to apply to the Magistrate in order to be discharged. The procedure prescribed under the section, on occasions causes difficulties to the patients inasmuch as many patients may not be in a position to make the requisite applications before a Magistrate, nor would they be aware of their rights, and the procedure to seek discharge.
Hence it is directed that two members of the Legal Aid Board of each State be appointed to make monthly visit to such Institutions, so as to assist the patients and their relatives in applying for discharge from the Institutions If they have fully recovered, and do not require institutional assistance any longer or to find out whether as a matter of fact they require any such treatment as indoor patients,
7. RIGHTS
1. INFORMING PATIENTS OF THEIR RIGHTS Patients and their guardians shall be explained their rights by a team of 2 members of the Legal Aid and a Judicial Officer, under the Mental Health Act, in a language known to them, at the time of the admission to any Institute. They should also be informed whom to approach in case their rights are being infringed.
2. INSPECTION BY THE BOARD OF VISITORS Section 37 provides for inspection of psychiatric hospital and psychiatric nursing home. In view of the said section a Board of Visitors must be formed by the State Mental Health Authority in every State within a time bound period, and a compliance report be filed to this Court. The Board of Visitors shall be required to visit every State or Private Institution for the time being at least once every month. The membership of the Board of Visitors is contained in Section 37 of the Mental Health Act, 1987, which includes :--
a) Not less than 5 members
b) At least one psychiatrist
c) Two social workers preferably with knowledge of the issues in the hospital and may be from the NGO Sector.
d) Head of Medical Services or their nominees (preferably a psychiatrist) as ex-officio member of Board of Visitors in the State;
The Board of Visitors should also include :--
1. The Additional District Judge, and/or Chief Judicial Magistrate, and/or the President of the Bar Association of the area;
2. State Disability Commissioner or his/ her nominee.
A monthly record of visits of the Board of Visitors and a quarterly report should be filed with the State Mental Health Authority.
Further it has been suggested by the learned counsel for the parties that appropriate norms be prescribed for maintenance of Mental Hospitals and Institutions for which various suggestions are made by the learned counsel for the parties but are not discussed at present as it is for the concerned authorities to first frame such norms.
8. A Scheme may be envisaged for rehabilitation process for those who are not having any backing or lack of support in the community. The Scheme may be on the basis of quarter-way homes (Supported Shared Home Like Accommodation) for all patients ready to be discharged, but are not being discharged due to family not taking them back, or lack of support in the community, should be placed in a home like accommodation created on the hospital campus itself. This accommodation could be an existing ward converted to have a home like environment, with patients being taught housekeeping skills, cooking, shopping and also encouraged to take up responsibilities in the hospital for which they should be paid for and then gradually encouraged to go to the community for work.
3. Learned Amicus Curiae Dr. Singhvi rightly submitted that If any suggestions are made by any interested parties, the same may be submitted through Mr. Pranab Kumar Mullick, Advocate (Amfcus Curiae) and we order accordingly.