STATE MENTAL HEALTH AUTHORITY, UTTARAKHAND Dehradun, the 05 July

STATE MENTAL HEALTH AUTHORITY, UTTARAKHAND Dehradun, the 05 July, 2022

CHAPTER – I PRELIMINARY

1 Short title and commencement.-

i) These regulations shall be called the Uttarakhand State Mental Healthcare Regulations (State Mental

Health Authority), 2022.

ii) They shall come into force on the date of their publication in the Official Gazette.

2 Definitions. –

i) In these regulations, unless the context otherwise requires, –

a) “Act” means the Mental Healthcare Act, 2017 (10 of 2017).

b) “Board” means the Board referred to in clause (d) of sub-section (1) of section 2 of Act.

c) “Authority” means the State Mental Health Authority, Uttarakhand as defined in section 2(zb) and

established under sections 45 and 46 of the Act.

d) “Chief Executive Officer” means the chief executive of the State Authority referred to in section 52

(1) of the Act.

e) “Form” means a Form appended to these regulations.

f) “Schedule” means the “The Schedule” appended to these regulations.

ii) The words and expressions used herein and not defined but defined in the Act shall have the same meanings as assigned to them in the Act.

Chapter II: Advanced Directive

3 Manner of making an advance directive as defined in chapter III, sections 5 to 13 of the Act shall be as

follows:

i) Any person who desires to apply for a request for advance directive or fresh directive, or change or

revocation, or cancellation of directive, may make an application to the Board in writing in Form A

which shall be provided free of cost in all mental health establishments.

ii) If a nominated representative of a person making an application for advance directive under sub-

regulation (i) of regulation 3 is named in the advance directive, such representative shall sign the request for advance directive stating his willingness to act as the nominated representative.

(Proposed Draft)

2 iii) Every application for an advance directive under sub-regulation (i) of regulation, shall be signed by two

witnesses attesting to the fact that the advance directive has been signed by the person making the

advance directive in their presence.

iv) Every application for an advance directive shall be registered with the Board having jurisdiction at the

place where the person applying for registration resides.

v) No fee shall be charged for registration of an advance directive under sub-regulation (i) of regulation 3

with the Board.

vi) The Board shall make available a copy of the registered advance directive to the applicant and his or

her nominated representative.

4 No person shall release any copy of the advance directive or information in the advance directive to any

unauthorised person or to the media.

5 There shall be no restriction on the number of times an advance directive is changed by the person who

applies for, or whose name appears in the directive, provided that:

i) no person shall apply for change in the advance directive unless a period of three months have been

elapsed from the date of the advance directive issued to him.

ii) Every change under regulation (5) shall comply with the same process as referred to in regulation 3,

sub-regulations (i) to (vi) and the previous advance directive shall become null and void on registration

of a fresh advance directive with the Board.

6 The person who has been issued the advance directive or the nominated representative of such person

shall, as soon as may be possible, inform the treating mental health professional of the new advance

directive.

7 A nominated representative of the person as mentioned in the advance directive may withdraw his

consent, to function as such without giving any reason –

i) by an application in writing addressed to the Board

ii) by giving three months prior notice in writing of such withdrawal to such person.

8 The Board shall, on receipt of the application under sub-section (2) of section 11 of the Act, hold a hearing within a period of fourteen days and decide within a period of seven days thereafter on such application.

Chapter III: State Mental Health Authority

9 The appointment of officers and employees of the Authority shall be governed by recruitment rules made by the State Government.

i) The salary, allowances, leave, joining time, joining time pay, age of superannuation and other

conditions of service of the Chief Executive Officer, other officers and employees of the State

3 Authority, shall be the same as applicable to the officers and employees of the State Government

drawing equivalent pay.

10 The Chairperson of the Authority shall discharge the functions of the Authority, who shall be assisted by a

Secretariat of the Authority headed by the Chief Executive Officer:

11 The Chairperson may delegate all or any of his functions to the Chief Executive Officer.

12 Important policy matters relating to the functioning of the Authority shall be placed before the Authority

in its meeting.

13 Meetings of Authority.-

i) The meeting of the Authority shall generally be held at Dehradun.

ii) Chairperson may select any other place for meeting if the circumstances render it expedient to hold

the meeting at any other place in Uttarakhand.

iii) The Authority shall meet at least twice in a year at such time and place as may be fixed by the

Chairperson.

iv) Chairperson may also call a special meeting at any time to deal with any urgent matter requiring the

attention of the Authority.

v) Every notice calling for a meeting of the Authority shall –

a) specify therein the place, date and time of the meeting.

b) be served upon every member of the Authority not less than seven days prior to the day appointed

for the meeting.

c) Along with the notice for the meeting of the Authority, the Chief Executive Officer shall, prepare

and circulate to the members of the Authority an agenda for such meeting, with the approval of

the Chairperson.

vi) ThequorumofthemeetingoftheAuthorityshallbeinaccordancewithsub-section(2)ofsection76of

the Act.

a) Any member of the State Authority may join the meeting through video conferencing during the

specified time, and he shall have same rights and responsibilities as members attending the

meeting in person.

b) The member attending the meeting through video-conferencing shall also constitute the quorum.

vii) Any business which is to be placed before the State Authority for decision but which cannot wait for the next meeting due to urgent nature, the Chairperson or the member authorised by him shall record such a decision in writing and every such decision shall be ratified in the next meeting of the Authority

viii)The Chief Executive Officer of the Authority shaIl forward the copy of the proceedings of each meeting of the Authority to the State Government.

ix) ConductofMeetings.-

a) A meeting shall be called to order by the Chairperson or, in his absence, by the Member chairing

the meeting.

b) The Chairperson or the member who presides over the meeting shall decide the sequence of the

agenda items for consideration.

c) Save as otherwise provided in these regulations, the Chief Executive Officer may invite a non-

member to the meeting as a special invitee, with the permission of the Chairperson.

d) A meeting shall be called to closure by the Chairperson or the Member chairing the meeting.

x) Attendance and proceedings at Meetings.-

a) The Chief Executive Officer shall record the attendance of members at the meeting in the

attendance register maintained for the purpose by the secretariat of the Authority.

b) The Chief Executive Officer shall record the attendance of non-members in the minutes of the

meeting.

c) The Authority may grant leave of absence to a Member not present in the meeting and the Chief

Executive Officer shall record such leave of absence in the minutes of the meeting.

xi) Minutesofthemeetings.-

a) The Chief Executive Officer shall record the minutes of the meeting of the Authority.

b) The Chairperson or the Member presiding the meeting shall approve the minutes of the meeting recorded by the Chief Executive Officer, and the Chief Executive Officer shall circulate the same to

the members within a fortnight of the meeting.

c) Objections or suggestions or comments to the recorded minutes, if any, submitted by any of the

members after circulation of minutes, will be submitted to Chief Executive Officer within 3 days of

receipt of minutes.

d) Upon receiving the objections or suggestions or comments, if any, the Chief Executive Officer shall

revise the minutes of meeting.

e) It is the duty of the Chief Executive Officer to share revised minutes of meeting with all members

within next 7 days after the time elapsed as mentioned in regulation 13 (xi) (c).

f) The Chief Executive Officer shall cause the approved minutes of the meeting pasted in the Minutes Book and every page of the minutes shall be authenticated by signatures of the Chairperson or the

Member who chaired the meeting.

14 The Chief Executive Officer shall communicate the relevant extracts of the decision of the Authority to all

the members for necessary follow-up action and monitor their compliance by evolving a suitable reporting

system.

15 The Chief Executive Officer shall submit an action taken report on the decisions of the last meeting in the

next meeting.

CHAPTER – IV

MINIMUM STANDARDS OF FACILITIES AND REGISTRATION OF MENTAL HEALTH

ESTABLISHMENTS

16 Minimum standards of facilities .- Every mental health establishment as defined in section 2 (p) of the Act and falling under the control of the Authority, as defined in sections 65 and 66 of the Act, shall maintain the minimum standards specified in the Schedule (vide-infra).

17 The minimum qualification for the personnel engaged in mental health establishment.-

i) For the ministerial and subordinate staff and any other personnel engaged in a mental health establishment for whom the minimum qualifications are not laid down in the Act, the minimum

qualifications shall be governed by the Schedule.

18 Maintenance of re

19 +3cords and reporting.-

i) The mental health establishments shall keep the medical records in the manner specified in Forms O to

ii) The Authority may call for any medical record on receipt of any complaint.

iii) The medical records shall be kept for the period in accordance with the extant Government

instructions or any other law for the time being in force.

20 Application by the mental health establishment for permanent registration.-

i) A mental health establishment shall apply to the Authority for permanent registration in Form 2 accompanied by a fee of rupees twenty thousand by way of a Demand Draft drawn in favour of the Chairperson, State Mental Health Authority, payable at Dehradun or as may be specified by the State Authority from time to time.

ii) A mental health establishment while submitting an application in Form 2 for permanent registration with the State Authority shall enclose therewith, details of compliance of minimum standards as specified in the Schedule and the documentary proof in support of the claim.

21 Filing of objections against grant of permanent registration to a mental health establishment.-

i) A person may file any objection to the State Authority under sub-section (14) of section 66 of the Act in Form 3 against grant of permanent registration to a mental health establishment in response to

public notice within the time specified in the notice.

CHAPTER – V

MEETINGS OF THE MENTAL HEALTH REVIEW BOARD (MHRB)

22 Meetings and rules of procedure of the Board.-

i) The Board shall meet at least once a month or more frequently as it may consider necessary.

ii) The Board shall meet at such place and at such time as the Chairperson of the Board may decide.

iii) The Chairperson of the board shall give at least five clear days notice for a meeting of the Board,

specifying therein the date, time and place of the meeting.

iv) TheChairpersonoftheboardshallpresideateverymeetingoftheBoardatwhichheispresent,andin

his absence, any other member of the Board as the Chairperson of board may authorise.

v) The quorum of the meeting shall be three members of the Board including its Chairperson.

vi) If the quorum in the meeting is not present within half an hour after the time appointed for the

meeting, the Chairperson of the board may postpone the meeting to another day and the Chairperson

of the board and the members present at the postponed meeting shall constitute the quorum.

vii) All decisions of the Board shall be authenticated by the signature of the Chairperson of the board or

any other member of the Board as the Chairperson of the board may authorize in his behalf.

23 The orders of the Board shall be in writing and contain reasons.

24 The proceedings of the Board shall be conducted in a friendly and barrier free environment.

25 Board may hold an enquiry in a mental health establishment as per sections 82 of the Act.

i) A visit of the Board to a mental health establishment shall be deemed to be a sitting of the Board.

ii) For the purpose of inquiry, the Board shall comply with the basic principles of natural justice and shall ensure the informed participation of the person with mental illness and the nominated representative, or a family member of the person with mental illness and the person with mental illness shall be given

an opportunity to be heard.

iii) The Board shall complete any inquiry or decide on any complaint or request relating to medical

treatment being received by a person with mental illness within three days of the receipt of the application so that treatment is not hampered.

a) Where the Board is not able to reach a decision within three days, the treating psychiatrist shall

continue the treatment planned after taking consent from the nominated representative of the

person with mental illness, if he is available.

b) In absence of nominated representative the treatment shall continue as specified in section 14 of

the Act.

iv) Subject to the provisions of any law for the time being in force, a decision of the Board shall not make

a mental health professional liable to civil or criminal proceedings unless the Board after inquiry in this regard records that act or omission by such mental health professional were mala fide or without reasonable care or illegal under any law for the time being in force.

CHAPTER – VI PSYCHOSURGERY AND RESTRAINTS

26 Restriction on psychosurgery.-

i) The attending psychiatrist may submit an application, with the following papers to the Board, seeking

approval for the psychosurgery procedure, namely:-

a) a certified copy of the written informed consent for psychosurgery duly signed by the person on

whom it is proposed to be performed;

b) a detailed submission by the attending psychiatrist with clinical summary of the case, explaining

and justifying the need, suitability and safety of the proposed psychosurgery;

c) the certified copies of such person’s medical records.

ii) The Board may ask for additional information and documents from the attending psychiatrist, as may be necessary.

27 Restraints.-

i) The mental health professional shall take the following additional preventive measures in a mental

health establishment to contain the use of restraint to the absolute minimum, namely:-

a) He/she shall give periodic training to the staff of the mental health establishment in learning and

adopting alternatives to the use of restraints;

b) He/she shall discuss the option of sedation with the person with mental illness or his nominated

representative in accordance with the provisions of section 89 and section 90 of the Act to manage

the crisis and to avoid restrain;

c) He/she shall submit the monthly report (within the first week of every calendar month) to the

Board, under sub-section (7) of section 97 of the Act, about the restrains used during previous month in MHE. Report should contain details as shown in Form S and signed by the medical officer in-charge of the MHE.

The Schedule

(See Regulations 16 to 20)

Minimum Standards for Mental Health Establishments Uttarakhand

[U/S 122.2.e with 65 (4) (a) of Mental Health Care Act 2017]

The following shall be the minimum standards of facilities and for registration of mental health establishments (MHE) under various categories in Uttarakhand as per MHCA-2017 u/s 65(5). Entities to be considered as MHE are defined in MHCA-2017 act u/s 2(p) and thus, include:

A. Centres/ Premises where persons with mental illness are admitted including addiction for acute care (patients having intoxication or withdrawal symptoms)

B. Centres/ Premises where persons with mental illness are admitted including addiction for long term care (patients not having symptoms of intoxication or withdrawal)

C. Considering that addictions are the mental (medical) disorders as per:

● Definition of mental illness as per MHCA-2017 u/s 2(s)

● International Classification of Diseases 11 edition (ICD-11)

● Diagnostic and Statistical Manual 5th edition (DSM-5)

● Fact that addictive disorders are integral part of postgraduate training MD (Psychiatry) as per

curriculum of National Medical Council, India (May be accessed at https://www.nmc.org.in/wp-

content/uploads/2019/09/MD-Psychiatry.pdf)

● Fact that Institutes of National Importance like AIIMS, New Delhi, PGI Chandigarh and

NIMHANS, Bengaluru are running super-speciality courses (Post doctoral fellowship and DM) in

Addiction Psychiatry

● That National Drug De-Addiction and Treatment Centre, Ghaziabad is managed by Department

of Psychiatry, AIIMS, New Delhi

Hence, all centres providing residential care to patients with addiction shall be considered as MHEs.

D. Centres providing Residential Rehabilitation Services (including residential half-way homes and long stay homes)[as defined in Rehabilitation Council of India Act 1992 u/s 2 (ma): rehabilitation refers to process aimed at enabling persons with disabilities to attain and maintain optimal physical, sensory, intellectual, psychological, environmental or social function levels] for patients with disability arising out of psychiatric disorders [as defined in The Rights of persons with disability act 2016, Schedule specifying disability, clause 3 (mental illness means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life)] will also be considered as MHE as per MHCA-2017 u/s 2(p).

9 All MHEs shall be abided with the MHCA-2017 and The Mental Healthcare (The rights of persons with mental

illness) rules 2018; F No. V.15011/09/2017-PH-I dated 29.05.2018 (to be substituted by the notified rules of the SMHA of Uttarakhand) regarding their day to day functioning.

However,

E. Centers where patients with intellectual disability (not having any symptom of mental illness or if had symptoms in the past, currently stable on psychotropics) are provided rehabilitation services shall be out of purview of these minimum standards.

F. Centers catering to destitute persons and prisons, where persons with history of mental illness are kept (but who are currently asymptomatic as certified by a psychiatrist) shall be out of purview of these minimum standards.

G. Old age homes, orphanages, juvenile centers, and other such centers, where persons with history of mental illness are kept/staying (but who are currently asymptomatic as certified by a psychiatrist) shall be out of purview of these minimum standards.

H. Centers providing day-care in the non-restricted environment to the patients suffering from the mental illness (including addiction) that are currently in asymptomatic phase (as certified by a psychiatrist) shall be covered under standard 15.

Standard 1 – Premises

The premises should be safe and preferably with green zone; requisite certificates/No-Objection Certificate (NOC), as applicable, and shall be well maintained and kept in good liveable condition.

a. Structure should be safe and strong enough to withstand heavy rains and moderate natural calamities.

b. The premises and the structure should be disabled friendly.

c. Valid NOC of fire safety should be available.

d. Structure should be safe and hygienic for the patients, caregivers and staff considering the possibility of

harm to self or to others.

e. Common room must have TV, newspapers, magazines and indoor games. Chairs in the common room

must be adequate to provide sitting to patients and caregivers.

f. Separate wards shall be available for the male patients, female patients and children and adolescents.

As specified in the schedule of CMHA regulations vide F.No.V.15011/09/2019-PH-I dated 18.12.2020 standard 8 (a ) (to be substituted by the notified regulations of the SMHA of Uttarakhand) and u/s 87 (4) of MHCA-2017, respectively).

g. A minimum of 60 square feet space per bed with a minimum of 3 feet edge to edge gap between two beds in the wards/rooms.

h. Bunk-beds are not allowed and patient should be accessible from both sides of bed to handle emergencies and to provide optimal medical care.

i. Separate toilets for male and female patients in the ratio not less than 1:5 patients.

j. Separate bathrooms for male and female patients in a ratio not less than 1:10 patients.

k. Number of wash basins not less than 1:12 outside the toilets/bath rooms and in the dining area with

provision of water supply round the clock.

l. Rooms, chambers, wards and corridors must have optimal number of windows for optimal ventilation.

Window panes shall be made of toughened glass with film coating on both sides or transparent

polycarbonate sheets to allow natural lighting.

m. All doors and corridors should have clear space to allow transport of trolley and wheelchairs side by

side simultaneously.

n. All doors must have latches/handle that have provision for unlatching from outside as well as inside.

o. Sufficient illumination during dark, sufficient for reading without causing strain to the eyes.

p. Illuminated passages during Night/ Day leading to toilets and emergency exits. Sign boards with

sufficient illumination should be placed for clear identification of toilets and exits.

q. Power Back-up for emergency lights during power failures and load shedding.

r. Maintenance of the infrastructure as per norms laid down by appropriate authority of the geographical

area where the MHE is situated.

s. Closed circuit TV cameras should be installed in the facility in different areas e.g., corridors, dining room, common room, dorms and wards to ensure the safety of the patients. It must be confirmed that such measures are not defying the rights to live with dignity and privacy of persons with mental illness. Recording for a minimum of two months should be stored.

Standard 2: LIVING CONDITIONS

The living conditions of all MHEs shall be comfortable for the patients, caregivers and staff.

a. Separate cots with mattresses, pillows, bed sheets, drawer sheets and blankets for each patient.

b. Benches, comfortable for both sitting and lying for each patient’s caregiver should be provided.

c. Adequate provision for mosquito/fly/insects repellents or control measures in MHE.

d. There should be provision for maintenance of comfortable level of room temperature in all weathers.

e. Minimum two exits in a dormitory. No sleeping cots in passages, verandas, under staircase or

anywhere else except in dorms/rooms.

f. Provision for warm water for bath to be ensured during all seasons.

Standard 3: HYGIENE, SANITATION AND INFECTION CONTROL

Hygiene, cleanliness and sanitation shall be maintained.

a. Daily sweeping, mopping and dusting of the entire premises.

b. Sanitation maintained in all the areas including toilets and bathrooms using disinfectants.

a. Location of Sewage Treatment Plants and Effluent Treatment Plants, if present in the MHE, shall be far away from Inpatient wards & residential housings, as per CPCB guidelines (2021) for

sewage treatment.

c. Changing of bed linen at least thrice a week and more frequently, if required. Washing of soiled linen

should be done in a clean and hygienic environment.

d. Pest free environment to be ensured all the time in whole MHE.

e. Rubbish bins in rubbish generating areas and daily disposal of rubbish should be ensured.

f. Washing and drying of plates, dishes, cutlery and other soiled vessels/containers after each use should

be ensured.

g. Laundry, if inside MHE, should be equipped with washing, drying and ironing facilities. If, outsourced,

same facilities to be ascertained by the owner or Medical-in-Charge of the MHE.

h. Linen should be decontaminated regularly.

i. Condemnation of linen should be done periodically. Condemned linen should be stored separately

from the usable linen.

j. Optimal measures for the prevention of infections should be ascertained.

Standard 4 : FOOD, WATER & NUTRITION

Wholesome, sumptuous and nutritive food and potable drinking water shall be provided in comfortable settings.

a. Well cooked, fresh, hot and hygienic food, appropriate to local food habits, in sufficient quantities shall be served in each meal.

b. Adequate dinning space with sitting facility to be ensured.

c. Quality of food to be supervised and verified by medical officer in-charge or nominee of the MHE time

to time.

d. Special diet must be served to patients with comorbid other medical disorders on the advice of treating

physician.

e. At least, tea twice a day & three meals must be served at proper timings.

f. Menu must be changed at least thrice a week and the same items other than cereals should not

repeated on the same day or next day, except in exceptional circumstances.

g. Filtered cold water should be provided in summers and filtered room temperature water rest of the

year. Periodic maintenance of filters should be ensured.

Standard 5: STAFF REQUIREMENT & MINIMUM ESSENTIAL STAFF RATIO AS PER SANCTIONED BEDS.

a. MHE (including Deaddiction Centers providing acute care):

i. must have at least one full time Psychiatrist available as defined in MHCA-2017 u/s 2(y) in a

ratio not less than 1:30 beds.

ii. must have, in addition to a full time psychiatrist, as defined above, at least one medical

practitioner for:

a. the supported admissions u/s 89 of MHCA-2017.

b. Providing medical care to patients considering high prevalence of other medical

disorders in persons with mental illness.

iii. must have, in addition to should have at least one mental health professional as defined in

MHCA-2017 u/s 2 (r)] for the supported admissions u/s 89 of MHCA-2017.

iv. in addition to above, must have at least one nurse [as defined in MHCA-2017 u/s 2(q)] for every

10 beds, round the clock.

v. Preferably 25% of the nurses should have received training in psychiatric nursing, and there

should be adequate representation of male nurses.

b. MHE providing long term care (including Deaddiction Centers providing exclusively long term care and

centers providing Residential Rehabilitation Services):

i. must have at least one part-time Psychiatrist as defined in MHCA-2017 u/s 2(y) available in a

ratio not less than 1:50 beds. Psychiatrist should pay at least two visits per week to the MHE.

ii. must have at least one physician available round the clock on call, in a ratio not less than 1:50

beds.

iii. at least one- mental health professional as defined in MHCA-2017 u/s 2(r) or Psychologist (At

least MA in Psychology) or medical social worker, available round the clock in a ratio of not less

than 1:50 beds.

iv. It must have at least one nurse [as defined in MHCA-2017 u/s 2(q)] for every 20 beds, round the

clock.

v. Allied health care professionals, viz., Physiotherapist, occupational therapist and such other

professionals, as defined in National Commission for Allied and Healthcare Professionals Act

2021 dated 28.03.2021, should be available, as per the scope of the services.

vi. Trained rehabilitation specialists as per the Rehabilitation Council of India, as per the scope of the services should be available in a ratio not less than 1:20 patients, as per the scope of

services.

c. All MHEs, irrespective of scope of services, must have following staff in the ratio defined below:

i. Ward aids 1 : 20 for every shift

ii. Sweeper 1 : 30 for every shift

13 iii. Other staff/personnel such as barber, cook, washerman, technicians, pharmacist,

electrician, security personnel, dietician, etc. as per the requirements of the MHE. Their services may be obtained on outsource basis or on contract.

Standard 6: Other Medical Specialists:

Other Medical Specialists & trained manpower resources as per specific requirements of the individual MHE.

a. A qualified Anaesthesiologist as defined by National Medical Council (Erstwhile Medical Council of

India) shall be available during ECT procedure.

b. Considering that persons with mental illness also have comorbid other medical disorders, an in-house

physician should be available. Liaison with other multispecialty centres for such patients is also acceptable. However, in such situation, Memorandum of Understanding or letter of authorization should be submitted along with application of registration.

c. Ambulance should be available round the clock for transfer of patients, whenever required.

d. Trained professionals and measures (equipment / Medicines) to deal with other medical emergencies

must be available in MHE.

Standard 7: Medicines

a. Every MHE should have an in-house pharmacy section.

b. Pharmacy/drug-store of MHE shall procure and use drugs for inpatients as per requirements and

scope of services of individual MHE.

c. Life-saving medications/ medications required for anticipated emergency conditions should be

available in the pharmacy.

Standard 8: Equipment

a. Equipment and articles shall be procured and used for inpatients as per requirements and scope of services of individual MHE.

b. Equipment and inventory should always be kept in a good and usable condition.

c. An examination table with footsteps should be available, in a ratio not less than 1:15 beds.

d. Sufficient sets of basic equipment consisting of blood pressure apparatus, stethoscope,

weighing machine, thermometer, pulse oximeter etc. in the ratio of at least 1:15 beds should be

available in the MHE.

e. If the electro-convulsive-therapy (ECT) procedure falls under the scope of services of the MHE,

in that case, equipment to provide general anesthesia and resuscitation must be available.

f. Oxygen cylinders with flow meter or central supply of oxygen, always in working condition

should be available in a ratio of at least 1:10 beds.

g. First aid box with standard contents must be available in the MHE. A daily check should be done

for replenishments and a log book for the same should be maintained.

Standard 9: Stores

a. All MHEs should have a Hospital Necessity Store (HNS).

b. Hospital Necessity Store will procure and stock all materials other than drugs and linen that are

necessary to efficiently run the MHE viz., cleaning materials, equipment, toiletries etc.

c. At least 30 days’ stock of above consumables should be maintained in HNS.

Standard 10: Documentation

Patient related documentation and record keeping shall be maintained and should be easily retrievable in all MHEs.

a. Documentation of admission, treatment and discharge of patients in accordance to MHCA 2017 as specified u/s 85 to 99 as applicable to the scope of services of the MHE (Forms B to N).

b. Following is the mandatory record to be maintained:

i. All admissions in MHEs shall be registered and a separate column for Minors (admitted

under section 87 of MHCA-2017), Supported admission (admitted under section 89 of MHCA-

2017) shall be maintained

ii. Case record form for OPD patients should have following elements, as applicable

a. Demographic details

b. Advanced Directive

c. Details of nominated representative

d. Presenting complaints and examination findings

e. Diagnosis (Provisional or final) as per ICD-11

f. Prescription

g. Investigations: laboratory investigations as well as Psychological assessment, as

applicable

h. Record of psychosocial interventions with details, as applicable

i. Record of therapy sessions, as applicable

iii. Case record form for in-patients should have following elements:

a. Demographic data

b. Advanced-directive, if available

c. Details of nominated representative

d. Assessment of metal-capacity of the patient

e. Signed consent form or form specifying reasons for supported admission

f. Presenting complaints with details

g. Investigations: laboratory investigations as well as psychological assessment

h. Daily examination charts

i. Record of psychosocial interventions with details, as applicable

j. Record of restrain, if required during stay in MHE

k. Consent, indications, and details of ECT procedure, as applicable

l. Prescription and notes by Psychiatrist/ medical officer/mental health professional,

as applicable to the scope of services of the MHE

iv. Discharge summary: Must contain all the elements as shown in Form P.

Standard 11: Preservation of rights of admitted patients

a. Rights of the persons with mental illness should remain preserved as defined in MHCA-2017 u/s 97 and The Mental Healthcare (The rights of persons with mental illness) rules 2018; F No. V.15011/09/2017-PH-I dated 29.05.2018.

b. Right of persons with mental illness, to be protected according to provisions of MHCA-2017, sections 18 to section 28 as applicable to MHEs.

c. Restrain and seclusion policy in compliance to chapter XII section 97 of MHCA 2017 and section 26 of Uttarakhand State Mental Healthcare Regulations (State Mental Health Authority), 2022 dated … ……. (Whenever notified)

Standard 12: Diagnostic facilities

a. All MHEs should either have in-house diagnostic laboratory services.

b. In case, in-house diagnostic laboratory services are not available, round the clock liaison with a

diagnostic facility must be there. Documentation of the same should be submitted with the

registration form.

c. Facilities for psycho-diagnostic assessment should be available, as per the scope of services of

MHE.

Standard 13: Communication and recreation

a. Facilities shall be provided for social, cultural, leisure and recreational activities.

b. Facilities for entertainment and social interaction must be available.

c. Furnished visitors’ room for families coming to meet patients should be available.

d. Facilities must be made available to inpatients for free and independent internal and external

communications including freedom to receive visitors as per daily visiting hours of the MHE, use

16 mobiles/telephone, send and receive mails or through any other conventional mode of communication

as per MHCA-2017 u/s 18-28 and The Mental Healthcare (The rights of persons with mental illness)

rules 2018; F No. V.15011/09/2017-PH-I dated 29.05.2018.

Standard 14: Services to be made available in residential rehabilitation Centres including deaddiction centres providing long term care:

a. Residential rehabilitation centres means the places where persons with mental illness who do not require hospitalization or residential care are staying and they are provided with psychosocial rehabilitation services by qualified and trained personnel.

b. Requirement of staff for such centres is spelled in Standard 5 (b) and 5 (c) of the schedule.

c. Occupational and vocational therapy activities should be made available and should be locally and

culturally relevant.

d. Availability of various types of local resources and marketability of materials to be produced in the

rehabilitation section should be taken into consideration while planning activities.

e. Vocational and occupational rehabilitation should be provided considering the patient’s job profile,

needs and free-will.

f. Daily record of rehabilitation measures provided to persons with mental illness should be

maintained along with the progress chart.

Standard 15- Non-residential rehabilitation centres including Day care centres, vocational training centres and other such centres

c. i.

ii. iii.

Non-residential rehabilitation centres means the places where persons with mental illness who do not require hospitalization or residential care are provided psycho social rehabilitation services by qualified and trained personnel during daytime.

Visit to the centre is entirely voluntary or on the recommendation of the treating Psychiatrist. In- charge of the centre shall maintain basic medical record and produce when asked. (Form O)

Staff:

There must be a visiting psychiatrist in a ratio not less than to be 1:30 with at least one day visit every week. Responsibility of maintenance of detailed notes of visiting Psychiatrist is the responsibility of the owner or the in-charge of the centre.

Scope of the services of non-residential rehabilitation centre needs to be clearly defined in the application for the registration.

Allied health care professionals, viz., Physiotherapist, occupational therapist and such other professionals, as defined in National Commission for Allied and Healthcare Professionals Act

17 2021 dated 28.03.2021, should be available, as per the scope of the services of the non-

residential rehabilitation centre.

iv. Trained rehabilitation specialists as per the Rehabilitation Council of India, as per the scope of

the services should be available in a ratio not less than 1:20 patients.

v. At least one mental health professional, as specified in MHCA-2017 u/s 2 (r) should be available

in the centre in a ratio not less than 1:50 patients.

Physical Features-

i. Infrastructure: As per standards 1,3,4

ii. Adequate facilities to ensure safety of the patient should be provided.

iii. Adequate facilities should be provided for dining, recreation and entertainment.

iv. At least one Psychiatric Emergency room- 10 X 12ft (2 beds).

d. Pro-forma of case record for each patient must be maintained (Form O). Detailed record of all

Facility to refer of a General Hospital/Psychiatric centres when needed. interventions shall be maintained (Forms Q and R, as applicable).

Standard 16: Inspection of rehabilitation centres-

SMHA or the nominee of the SMHA can visit MHEs and non-residential rehabilitation centres as specified above in various standards. It is the duty of the in-charge of such centre to provide all documents desired by inspectors at the time of inspection. Inspectors may also take the feed-back from the clients/patients directly at the time of inspection.

Standard 17: Administrative changes, reforms and recommendations

a. Medical superintendents/ In-charge of MHEs must be a Psychiatrist or a medical practitioner as per MHCA – 2017 u/s 2 (m).

b. If person having MD/ DNB/ DPM or equivalent degree is not available, State Government may recognise doctors having Diploma in Primary Care Psychiatry from NIMHANS, Bengaluru or AIIMS Rishikesh as Psychiatrist till the time they are serving the Government.

c. The administration shall be responsible for the ensuring optimal medical care to persons with mental illness, preservation of their rights, necessary documentation, confirming the minimum standards, day to day cleanliness, upkeep, utilization and maintenance of all amenities and services such as water supply, electricity, sewage system etc in the facility.

d. Staff at all levels should undergo periodic in service training and should be given continuous professional development inputs, aimed at enhancing motivation, commitment and increased professional competence.

Standard 18: Outpatient settings

Minimum standards for Mental health establishments providing outpatient services {as per section

18 – sub section 5 (b) of MHCA 2017} are as follows:

a. Outpatient services should be organised in a separate area from the in-patient block.

b. Outpatient setting should be easily approachable and accessible to the public.

c. Minimum facilities should consist of :

(i) Waiting space with sitting arrangements

(ii) Reception, inquiry and registration counters

(iii) Cubicles or rooms for consultation with facilities for physical examination

(iv) Drinking water facilities

(v) Toilet facilities

d. Minimum documentation in case records should be maintained for all outpatients as per Form O. For efficient follow up of patients, records should be easily retrievable. When patients are admitted there should be continuity of records from out-patient to in-patient.

e. If the MHE is providing non-pharmacological therapies like psychotherapy, behaviour therapy, counselling etc, there should be separate adequate space available for the same. Records for the same should be kept as per Forms R and S.

f. Mental health educational material (e.g. posters) should be prominently displayed at strategic points in the out-patient block. Patient and Family Information pamphlets, handouts and other educational materials in vernacular should be made freely available for the public.

Standard 19. Miscellaneous

1. Every MHE should have written booklet stating in details, facilities and privileges available in the same; various areas like boarding, entertainment, occupational training, and participation in religious activities etc., which are open to various categories of patients. A copy of the above said booklet shall accompany the application for the license to the authority.

2. Every MHE as well as premises providing non-residential rehabilitation services to the persons with mental illness should prominently display the following information, as applicable, in such manner that it can be clearly read even from a distance of 6 meters in common places like reception, visitors room and dinng room etc.:

a. Scope of services available in the facility

b. Menu of the kitchen of the MHE in the day and meal wise manner

19 c. Fee and charges for various services provided in the premise in such clear fashion that the patient

and/or caregiver may make a close estimate regarding expenses incurred towards the medical

care and rehabilitation, as the case may be

d. Name and contact numbers of the Medical officer In-charge and owner of the MHE

e. Details (Name, qualification, registration with the respective professional council) of medical and

mental health professionals working in the premise

f. Registration certificate of the MHE with the SMHA

g. Contact details (Phone Number, e-mail and postal address) of Mental Health Review Board of the

district where the facility is situated and State Mental Health Authority of Uttarakhand.

3. For restriction to discharge functions by professionals not covered by the field of his profession, provision of

MHCA- 2017 chapter XIV (Section- 106) shall be applicable.

4. For offences and penalties, provisions of chapter XV (section-107, 108, 109) shall be applicable.

FORM – A

[See regulation 3]

FORM FOR MAKING, AMENDING/ REVOKING AND CANCELLING ADVANCE DIRECTIVE

1. Name (Attach copy of photo identity document proof): __________________

2. Age (Attach copy of age proof for being above 18 years of age):___________

3. Father’s/ Mother’s Name:_________________________________________

4. Address (Attach copy of proof):____________________________________

Note.- Any valid identity proof like Birth Certificate, Driving License, Voter’s Card, Passport, Aadhaar card, etc. shall be admissible as address proof and age proof.

5. Contact number(s):______________________________________________

6. Registration no. of previous advance directive (to be filled in case of amendment/ revocation/ cancellation of advance directive):______________

7. I wish to be cared for and treated as under (not to be filled in case of revocation/ cancellation of advance directive):

_________________________________________________________________________

_______________________________________

8. I wish not be cared for and treated as under (not to be filled in case of revocation/ cancellation of advance directive):

_________________________________________________________________________

____________________________________________

9. Any history of allergies, known side effects, or other medicalproblems _________________________________________________________________________ _________________________________________

10. I have appointed the following persons in order of precedence(Enclosed photo ID and age proof), who are above 18 years of age to act as my nominated representatives to make decisions about my mental illness treatment, when I am incapable to do so (not to be filled in case of revocation/ cancellation of advance directive):

(a) Name: _______________________________________Age______________ Father’s/Mother’s name: __________________________________________

Address: ______________________________________________________ Contact number(s): ______________________________________________ Signature: …………………………………………. Date_________________

(b) Name: _______________________________________Age______________ Father’s/Mother’s name: __________________________________________ Address: ______________________________________________________ Contact number(s): ______________________________________________ Signature: …………………………………………. Date_________________

[Any number of nominated representatives can be added]

11. Signature of applicant…………………………….Date_______________

12. Signature of witnesses:

13. Mr./ Ms. ________________ has the mental capacity to make/ amend/ revoke/ cancel an advance directive at the time of signing this form and has signed it in our presence of his/ her own free will.

o Witness 1: (Name)……………….(Signature)………….Date……… o Witness 2: (Name)……………….(Signature)………….Date……..

Enclosure(s):

Note.- Please strike off those which are not required.

Form B

Assessment of Capacity to Make Mental Healthcare Decisions

Name: Age: Gender: UHID:

Definitions: (As per Mental Healthcare Act, 2017): Mental Healthcare: “Mental healthcare” includes analysis and diagnosis of a person’s mental condition and treatment as well as care and rehabilitation of such person for his mental illness or suspected mental illness (Chapter I, Section 2, subsection O), Capacity: (Chapter II, Section 3): Capacity here refers to “capacity to make decisions regarding his/her mental healthcare or treatment”, past treatment or hospitalization in a Mental Health Establishment though relevant, shall not by itself justify any present or future determination of the person’s mental illness, the determination of a person’s mental illness shall alone not imply or be taken to mean that the person is of unsound mind unless he/she has been declared as such by a competent Court

If YES: Please proceed as below

A) The person is able to understand the information in the following domains:

Reasons for doubting Mental Healthcare Capacity: a.

c. d.

Is there an impairment or disturbance in the functioning of mind or brain?

Altered sensorium Substance Use Dementia Learning Disorder Mental Illness/Suspected Mental Illness

Others(pl. specify)

YES NO

Record symptoms and/or behavior, any relevant diagnosis

Permanent Temporary

If NO: The person is deemed to have capacity therefore Assessment has been completed and no further action is needed

Person understands that he/she is ill

Person understands that he/she requires treatment

Person understands that the treatment would be best administered during in-hospitalization setting

Person understands that there is significant risk in taking treatment on outpatient (OPD) basis

C) The person is able to retain the information long enough YES to make a decision.

YES NO YES NO YES NO

YES NO

NO (Record views/evidence to show they understand it)

B) State what help and support was provided to make the person understand the decision? (Such as information has been given using simple language, which he/she understands or in sign language or visual aids or any other means to enable him/her to understand the information or information has been explained to the patient in a safe and comfortable environment/setting)

D) Does the person have the ability to weigh the YES NO (Record views/evidence to show they understand it) information as part of the decision-making process?

Does he/she understand the consequences of making or

not making the decision including the risks?

E) The person is able to communicate the decision. Document words/gestures/actions

FLUCTUATING CAPACITY – Always consider whether the person has fluctuating capacity and if the decision can wait until capacity returns. If this is the case, explain and enter a reassessment date in the outcome below.

Signature, Name & Designation of Psychiatrist

References: 1) https://www.scie.org.uk/files/mca/directory/mca-tailored-for-you/health/pan-london-commissioner-toolkit/beh-capacity-assessment- toolguidance.pdf?res=true. Retrieved on 27th June,2017, 2) http://www.prsindia.org/uploads/media/Mental Health/Mental Healthcare Act,2017.pdf. Retrieved on 27th June,2017, 3) https://www.surreyandsussex.nhs.uk/wp-content/uploads/2014/03/FOI-2144-Attachment-2-ASSESSMENT-FOR-CAPACITY-CHECKLIST-June-2012.pdf. Retrieved on 27th June,201

Outcome:

Has Mental Healthcare capacity Lacks Mental Healthcare capacity

To,

The Medical Officer in-charge AIIMS

Rishikesh

Sir/Madam,

I, Mr. /Mrs. , residing at age son/daughter of

establishment for treatment of mental illness

The following papers regarding my illness are enclosed: 1.

, request for my admission in your

I have the following symptoms since

FORM C

REQUEST FOR INDEPENDENT ADMISSION

Kindly admit me in your establishment as an independent admission. A self- attested copy of my Identity Proof is enclosed (optional).

Address

Date Signature Mobile and E-mail Name

N.B.: – Please strike off those which are not required.

To,

The Medical Officer in-charge

FORM D

REQUEST FOR ADMISSION OF A MINOR

Sir/Madam,

I, Mr. /Mrs.

nominated representative (being legal guardian) of Master/Miss

admit Master/Miss aged son/daughter of

illness: He/she is having the following symptoms since

The following papers related to my being the nominated representative and his/her illness are enclosed: 1.

Kindly admit him/her in your establishment as minor patient.

Address

Date Signature Mobile and E-mail Name

N.B.: – Please strike off those which are not required.

residing at

, who is the request you to treatment of mental

, for

FORM E

REQUEST FOR ADMISSION WITH HIGH SUPPORT NEEDS

To,

The Medical Officer in-charge

Sir/Madam,

I, Mr. /Mrs. residing at

/Mrs. , aged son/daughter of

in your establishment for treatment of mental illness.

Mr. /Mrs. is having the following symptoms since .

The following papers regarding my appointment as nominated representative and related to his/her illness are enclosed:

Kindly admit him/her in your establishment as patient with high support needs.

Address

Date Signature Mobile and E-mail Name

N.B.: – Please strike off those which are not required.

, nominated representative of Mr. request for his/her admission

FORM F

REQUEST FOR CONTINUOUS ADMISSION WITH HIGH SUPPORT NEEDS

To,

The Medical Officer in- charge AIIMS Rishikesh Sir/Madam,

I, Mr. /Mrs.

/Mrs.

category, requests for his/her continued admission beyond thirty days/readmission within seven days of discharge for the reasons stated below:

1. 2. 3.

Kindly continue his/her admission/readmit him/her in your establishment as patient with high support needs

Address Signature Date Name

N.B.: – Please strike off those which are not required.

, residing at nominated representative of Mr. , who is/was an inpatient in your establishment under supported admission

FORM G

REQUEST FOR DISCHARGE BY INDEPENDENT PATIENT

To,

The Medical Officer in-charge AIIMS

Rishikesh

Sir/Madam,

Subject: – Request for discharge.

I, Mr/Ms/Mrs at

Address Signature & Date Mobile/ email Name

N.B.: – Please strike off those which are not required.

son/daughter of

the condition has improved and wish discharge with immediate effect.

aged

your mental health establishment as n Independent admission on

residing

, (who) was admitted in . I now feel

To,

The Medical Officer in-charge …………….

Sir/Madam,

Subject: – Request for discharge.

FORM H

REQUEST FOR DISCHARGE FOR A MINOR PATIENT

I, Mr/Ms/Mrs… … … … . . residing

Ms/Master…………………….. Aged……., son/daughter of………………. who was admitted in your mental health establishment as a minor patient on . I now feel his/her condition has improved and wish his/her discharge with immediate effect.

Address Signature & Date Mobile/ email Name

N.B.: – Please strike off those which are not required.

at……………………………………………..is the legal guardian of

The Medical Officer in-charge

Sir/Madam,

Subject: Request for leave of absence Mr. / MS residing at

to your mental health establishment. I, as nominated representative of Mr. /MS

aged years was admitted on request that he/she be granted leave of absence from

FORM I

REQUEST FOR LEAVE OF ABSENCE

(By Nominated Representative)

to , for the reason stated below:

The proof of my appointment as nominated representative is enclosed.

I will be responsible for care and treatment of while he/she is on leave of absence from the mental health establishment.

Address

Date

Mobile and E-mail:

N.B.: – Please strike off those which are not required.

Signature Name

FORM J

Assessment for Independent Admission Under Section 85 & 86 of Mental Healthcare Act, 2017

N.B.: – Please strike off those which are not required.

Nominated Representative (if any)/Legal Guardian details:

Based on the available history and the preliminary examination he/she suffers from the following symptoms and signs:

1. 2. 3. 4. 5.

His/her condition is such that he/she requires to be kept under observation or inpatient evaluation and treatment at AIIMS, Rishikesh under section 85 & 86 (Admission of Person with Mental Illness as Independent Patient in Mental Health Establishment), Mental Healthcare Act, 2017 and is likely to benefit from admission and treatment. The person has understood the nature and purpose of admission and has made the request for admission of his own free will, without any duress or undue influence and has the capacity to make mental health care and treatment decisions without support or requires minimal support from others in making such decisions.

Signature of Psychiatrist

Name of Patient: S/o/D/o/W/o: Address:

Mobile No.: UHID:

Advance Directive: Yes (attach copy) / No Identification Marks: 1.

2. Photo ID Card No.:

Age (DOB):

Gender: Date:

FORM K

Assessment for Admission of Minor Under Section 87 of Mental Healthcare Act, 2017

Name of Patient: DOB: S/o/D/o/:

Address:

Mobile No.:

UHID:

Advance Directive: Yes (attach copy) / No Guardian details:

Identification Marks: 1. 2.

Photo ID Card No:

Age: Gender: Date:

Based on the available history and the preliminary examination he/she suffers from the following symptoms and signs:

1. 2. 3. 4. 5.

His/her condition is such that he/she requires to be kept under observation or inpatient evaluation and treatment at AIIMS, Rishikesh under section 87 (Admission of Minor in Mental Health Establishment), Mental Healthcare Act, 2017. The admission shall be in the best interests of the minor, with regard to his/her health, well-being or safety. The mental healthcare needs of the minor cannot be fulfilled unless he/she is admitted; and most of the community-based alternatives to admission have been shown to have failed or are demonstrably unsuitable for the needs of the minor.

Signature of a Psychiatrist

Nominated

Representative

(if any)/Legal

FORM L-1

Assessment for Supported Admission Under Section 89 of Mental Healthcare Act, 2017

(In a case, a person with the mental illness admitted under this section has been discharged, such person shall not be readmitted under this section within a period of seven days from the date of his discharge).

Name of Patient: S/o/D/o/: Address:

Mobile No.: UHID:

Age:

Gender: Date:

Aadhar/ Voter ID Card No.:

Nominated Representative: Yes (give details) / No 2.

Advance Directive: Yes (attach copy) / No Identification Marks: 1.

Based on the available history and the preliminary examination he/she suffers from the following symptoms and signs: 1. 2.

I, Dr am of the opinion that you are required to be kept under observation or inpatient treatment at AIIMS, Rishikesh. Hence, I request you to sign your Independent Admission under section 85, 86 of MHA, 2017.

Signature of the Patient: (To the extent possible)

The undersigned have seen that the doctors have offered independent admission to my patient, however, the patient has refused to sign above. Hence, I Mr/Mrs/Ms , relationship with the patient

nominated representative / family member / relative / caregiver / any other (please mention), is of the opinion that my patient is in need of supported admission. Hence, I request the Medical Officer In-Charge of the hospital to admit and treat my patient under section 89 (Admission of person with mental illness with high support needs in mental health establishment, up to thirty days) of Mental Healthcare Act, 2017.

Signature:

Name: _ Relationship with patient:

The patient Mr/Mrs/Ms , his/her condition is such that he/she requires to be kept under observation or inpatient evaluation and treatment at AIIMS, Rishikesh under section 89 (Admission of person with mental illness with high support needs in mental health establishment, up to thirty days) of Mental Healthcare Act, 2017. I have satisfied myself that the patient’s illness is of such severity that the person (strike if not applicable):

1. has recently threatened or attempted or is threatening or attempting to cause bodily harm to himself/herself; or

2. has recently behaved or is behaving violently towards another person or has caused or is causing another person to fear

bodily harm from him/her; or

3. has recently shown or is showing an inability to care for himself/herself to a degree that places the individual at risk of

harm to himself/herself.

The person is currently ineligible to receive care and treatment as an independent patient as he/she is unable to make mental health care and treatment decisions independently and needs very high support from his caregiver/nominated representative in making decisions. Hence, he/she requires to be in the hospital for his/her treatment and/or safety of self or others and would be a least restrictive care option possible in the circumstances.

Signature of Psychiatrist

FORM L-2

Assessment for Supported Admission Under Section 89 of Mental Healthcare Act, 2017

Name of Patient: S/o/D/o/: Address:

Mobile No.: UHID:

Age:

Gender: Date:

Aadhar/ Voter ID Card No.:

Nominated Representative: Yes (give details) / No 2.

Advance Directive: Yes (attach copy) / No Identification Marks: 1.

Based on the available history and the preliminary examination he/she suffers from the following symptoms and signs: 1. 2.

Signature of the Patient: (To the extent possible)

The undersigned have seen that the doctors have offered independent admission to my patient, however, the patient has refused to sign above. Hence, I Mr/Mrs/Ms , relationship with the patient

Signature:

Name: _ Relationship with patient:

4. has recently threatened or attempted or is threatening or attempting to cause bodily harm to himself/herself; or

5. has recently behaved or is behaving violently towards another person or has caused or is causing another person to fear

bodily harm from him/her; or

6. has recently shown or is showing an inability to care for himself/herself to a degree that places the individual at risk of

harm to himself/herself.

Signature of another Psychiatrist/ Medical practitioner Mental Health Professional

FORM M-1

Assessment for Supported Admission Under Section 90 of Mental Healthcare Act, 2017

Name of Patient: Age: S/o/D/o/:

Address:

Mobile No.:

UHID:

Nominated Representative: Yes (give details) / No Identification Marks: 1.

Gender: Date:

Photo ID Card No.:

Valid Advance Directive: Yes (attach copy) / No 2.

Based on the available history and the preliminary examination he/she suffers from the following symptoms and signs: 5. 6.

Signature of the Patient: (To the extent possible)

The undersigned have seen that the doctors have offered independent admission to my patient, however, the patient has refused to sign above. Hence, I Mr/Mrs/Ms , relationship with the patient

Signature: Name:

The patient Mr/Mrs/Ms , his/her condition is such that he/she requires to be kept under observation or inpatient evaluation and treatment at AIIMS, Rishikesh under section 90 (Admission of person with mental illness with high support needs in mental health establishment, beyond thirty days) of Mental Healthcare Act, 2017. I have satisfied myself that the patient’s illness is of such severity that the person (strike if not applicable):

1. has consistently over time threatened or attempted to cause bodily harm to himself; or

2. has consistently over time behaved violently towards another person or has consistently over time caused another

person to fear bodily harm from him; or

3. has consistently over time shown an inability to care for himself to a degree that places the individual at risk of harm to

himself;

Signature of Psychiatrist

FORM M-2

Assessment for Supported Admission Under Section 90 of Mental Healthcare Act, 2017

Name of Patient: Age: S/o/D/o/:

Address:

Mobile No.:

UHID:

Nominated Representative: Yes (give details) / No Identification Marks: 1.

Gender: Date:

Photo ID Card No.:

Valid Advance Directive: Yes (attach copy) / No 2.

Based on the available history and the preliminary examination he/she suffers from the following symptoms and signs: 1

Signature of the Patient: (To the extent possible)

The undersigned have seen that the doctors have offered independent admission to my patient, however, the patient has refused to sign above. Hence, I Mr/Mrs/Ms , relationship with the patient

Signature: Name:

4. has consistently over time threatened or attempted to cause bodily harm to himself; or

5. has consistently over time behaved violently towards another person or has consistently over time caused another

person to fear bodily harm from him; or

6. has consistently over time shown an inability to care for himself to a degree that places the individual at risk of harm to

himself;

Signature of another Psychiatrist

FORM N

Assessment for Emergency Treatment Under Section 94 of Mental Healthcare Act, 2017

(For the purpose of Emergency treatment; up to 72 hours only)

Based on the available history and the preliminary examination he/she suffers from the following symptoms and signs:

3. 4.

I have satisfied myself after adequate assessment that the patient needs emergency treatment (as defined in Section 94 of MHCA, 2017). I, , Nominated Representative of the patient , has been explained by the doctors that my patient after assessment needs emergency treatment in

view of the abovementioned conditions. I was explained the treatment options available and the consequences of denying emergency treatment. Hence, I herewith provide consent for administering emergency treatment for my patient.

Signature:

Name & Relationship with patient:

Provisional Diagnosis (As per ICD-11):

Other comorbid medical disorders (As per ICD-11): Treatment Given:

Nominated

details)

Name of Patient: S/o/D/o/: Address:

Mobile No.: UHID:

Advance Directive: Yes (attach copy) / No Identification Marks: 1.

Age:

Gender:

Photo ID Card No.:

Representative: Yes / No

Date:

(give

Medications 1.

4. 5.

Dose Route of Administration Time

Signature of Psychiatrist

FORM O

Format for Basic Medical Record for the OPD

1. Name of the mental health establishment:

2. Name of Psychiatrist:

3. Hospital Registration Number:

4. Date:

5. Advanced directive: Yes/No

6. Patients Name:

7. Age:

8. Sex:

9. Father/Mother’s name:

10. Address:

11. Mobile Number:

12. Chief Complaints

a. ………..

b. ………………………….. c. …………………………… d. …………………………….. e. ………………………………

13. Provisional Diagnosis (As per ICD-11):

14. Comorbid Other medical disorders (As per ICD-11):

15. Treatment advised and follow up recommendations:

FORM P

Format for Basic Medical Record for inpatients

1. Name of the mental health establishment:

2. Name of Psychiatrist:

3. Hospital Registration Number:

4. Date of admission:

5. Date of discharge:

6. Patients Name:

7. Age:

8. Sex:

9. Father/Mother’s name:

10. Address:

11. Mobile Number:

12. Identification marks: 1. 2.

13. Patient accompanied by (Name, age and nature of relationship)

14. Advanced directive: Yes/No (if yes, salient features of the content)

15. Nominated Representative (details)

16. Mode of admission ( u/s…….. of MHCA-2017)

17. Chief Complaints

a. ………..

b. ………………………….. c. …………………………… d. …………………………….. e. ………………………………

18. Summary of medical and laboratory examinations

19. Provisional/differential/final Diagnosis (As per ICD-11):

20. Comorbid Other medical disorders As per ICD-11):

21. Course in the hospital (treatment given with day to day progress)

22. Condition at discharge:

23. Mode of discharge: Discharge on request/ Left against medical advice/Person with mental illness

absconded

24. Treatment advised and follow up recommendations:

Form Q

Format for Basic Psychological Assessment Report

(Facilities where persons with mental illness undergoes psychological assessment)

Clinic Record/Hospital Registration Number: ————————————-

Name:

Education: Referred by: Reason for referral:

Occupation:

Age: Gender:

Date of testing:

Language tested in:

o IQ Assessment

o Specific Learning disability Assessment o Neuropsychological Assessment

o Personality Assessment

o Psychopathology assessment

o Any other (Mention the specific domain such as interpersonal relationship)

Comments if any (may give brief detail of the referral purpose; e.g., ‘the individual has mental illness and he has been referred for current psychopathology assessment as well as to ascertain the level of disability’)

Brief background information (e.g., the nature of the problem, when it started, any previous assessments and like details):

Informants: Self/ Others (Specify)

Salient behavioural observations (Comment on alertness, attention, cooperativeness, affect,

comprehension and any other relevant information) Tests/ Scales administered (Standardized tests/ scales):

Salient scores (if applicable such as Intelligence Quotient, scores obtained on cognitive function tests, severity rating on psychopathology scales, disability percentage and like details)

Impression:

Recommendations: Please specify o Further assessment

o Therapy

o Any other

Assessed by

Name:

Date: Qualification:

Signature:

Verified/ supervised by (if applicable)

Name: Date: Qualification:

Signature:

1. 2. 3.

Form R

Basic Minimum Standard Guidelines for Recording of Therapy Report

(Facilities where persons with mental illness are provided with therapy for any mental health problem)

Name of the Institute/Hospital/Centre with address) Clinic/Hospital record no._____________ THERAPIST SESSION NOTES

Patient name:

Psychiatric diagnosis (As per ICD-11):

b. Age:

c. Gender:

Therapy method:

Individual Couple/Family Group

Other _______

Session number and date:

Duration of session:

Session Participants:

Objectives of the session: 1.

2. 3. 4.

Key issues/themes discussed: (Psychosocial stressors/Interpersonal problems/Intra psychic conflicts/Crisis situations/Conduct difficulties/Behavioural difficulties/ Emotional difficulties/ Developmental difficulties/ Adjustment issues/ Addictive behaviours/ Others).

Therapy techniques used:

Therapist observations and reflections: Plan for next session: Therapist Date for next session:

Supervised by (if applicable)

Name of the Patient: Sex:

Age:

File No:

FORM – S

Physical Restraint Monitoring and Reporting Form

Date:

Provisional Diagnosis (As per ICD-11):

Date of Admission:

Indication for Physical Restraint (encircle):

(1) Violence (2) Agitation (3) Aggression (4) Self-harm (5) Suicidal attempt (6) Other (specify)…………………………………

Informed Consent of the Nominated Representative taken: Yes/ No Name and Signature of the Nominated Representative: If informed If Consent not taken, mention the reason:

Date and Time of Physical Restraint:

Date Time Indication From To

Overall assessment of medical conditions of the person under physical restraint including injuries, blood supply to limbs, blood pressure, pulse, etc. or any other relevant parameter:………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………………… …………………………………………………………………..

Mention the dose and frequency of medications administered during the Physical Restraint:

Date and Time

Medication Dose Route Frequency Total dose Side-effects

Name, Signature and Seal of the person in-charge of the mental health establishment:

FORM – 1

APPLICATION FOR GRANT/RENEWAL OF PROVISIONAL REGISTRATION OF A MENTAL HEALTH

ESTABLISHMENT

1. Name of applicant:

2. Age of applicant

3. Permanent address of applicant:

4. Qualifications and experience of the in charge of the establishment:

5. Name of the establishment:

6. Postal address of establishment:

7. Details of establishment:

8. Services provided: Acute care/ Long term care / Both

9. Number of beds:

10. Number of Rooms

11. Past/ Current Registration No………………………………….(Attach a copy)

(In case registration was under the Clinical Establishments (Registration and Regulation) Act, 2010 (23 of 2010) or any other law, such Registration No with a copy of Registration Certificate be enclosed with this application)

12. Services provided (tick what is provided)

(a) Out-patient

(b) In-patient

(d) DayCare

(e) Electroconvulsivetherapy

(f) Imaging

(g) Psychological testing

(h) Investigationandlaboratory

(i) Any other (Specify)

13. Staff (Name, qualifications, registration numbers, as applicable):

(a) Medical officers and other medical specialists

(b) MentalHealthProfessionals

(d) Para-medicalandrehabilitationstaff

(e) Attenders

(f) Health educators

(g) Multi-purpose workers

(h) Others(Specify)

Details of registration fee paid:

DECLARATION

We hereby undertake to abide fully by the provisions of the Mental Health Care Act, 2017 (10 of 2017) and rules and the regulations made thereunder.

PRAYER

We request for registration of our mental health establishment with the Authority.

Date

Place

Signed by the authorized signatory

Enclosure:

(Name and signatory)

Stamp of establishment

designation the mental

of the health

FORM – 2

APPLICATION FOR PERMANENT REGISTRATION OF A MENTAL HEALTH ESTABLISHMENT

1. Name of applicant:

2. Age of applicant

3. Permanent address of applicant:

4. Qualifications and experience of the in charge of the establishment:

5. Name of the establishment:

6. Postal address of establishment:

7. Details of establishment:

8. Services provided: Acute care/ Long term care / Both

9. Number of beds:

10. Number of Rooms

11. Details of provisional registration with Authority:

12. Past/ Current Registration No………………………………….(Attach a copy)

13. Services provided (tick what is provided)

(a) Out-patient

(b) In-patient

(d) DayCare

(e) Electroconvulsivetherapy

(f) Imaging

(g) Psychological testing

(h) Investigationandlaboratory

(i) Any other (Specify)

14. Staff (Name, qualifications, registration numbers, as applicable):

(a) Medical officers and other medical specialists

(b) MentalHealthProfessionals

(d) Para-medicalandrehabilitationstaff

(e) Attenders

(f) Health educators

(g) Multi-purpose workers

(h) Others(Specify)

DECLARATION

We hereby undertake to abide fully by the provisions of the Mental Health Care Act, 2017 (10 of 2017) and rules and the regulations made thereunder.

CONFIRMATION

We confirm that our establishment complies with the minimum standards specified under the Central Mental Health Authority Regulations, 2020 under which we are seeking registration.

PRAYER

We request for registration of our mental health establishment with the Authority.

Date

Place

Signed by the authorized signatory

Enclosure:

(Name and signatory)

Stamp of establishment

designation the mental

of the health

FORM 3

FILING OBJECTIONS AGAINST GRANT OF PERMANENT REGISTRATION TO A STATE

MENTAL HEALTH ESTABLISHMENT

The Chairperson,

State Mental Health Authority, Dehradun

It is in my knowledge that the Mental Health Establishment (name) …………………………………… situated at …………………………………… does not fulfil the following requirements for registration under section 65 (4) of the Mental Health Care Act, 2017 (10 of 2017) and the rules and regulations made thereunder.

1. ________________________________________________ 2. ________________________________________________ 3. ________________________________________________

I enclose the following in support of what is stated above: 1.

Please take necessary action accordingly

Address: Mobile number: E-mail:

Date: Enclosure:

Signature:……………………… Name:…………………………