रजिस्ट्री स.ं डी.एल.- 33004/99

REGD. No. D. L.-33004/99


स.ं 554] No. 554]



भाग III—खण्ड 4 PART III—Section 4

प्राजधकार से प्रकाजित PUBLISHED BY AUTHORITY

नई दिल्ली, िुक्रवार, दिसम्बर 18, 2020/ अग्रहायण 27, 1942


कें द्रीय मानजसक स्ट्वास्ट््य प्राजधकरण अजधसचू ना

नई दिल्ली, 18 दिसम्बर, 2020




फा.स.ं वी.15011/09/2019-पीएच-I.—कें द्रीय मानजसक स्ट्वास्ट््य प्राजधकरण मानजसक स्ट्वास्ट््य िेखरेख अजधजनयम, 2017 (2017 का 10) की धारा 122 द्वारा प्रित्त िजियों का प्रयोग करते हुए, जनम्नजलजखत जवजनयम बनाता ह,ै अर्ाात:-



1. संजिप्त नाम और प्रारंभ- (1) इन जवजनयमों का संजिप्त नाम मानजसक स्ट्वास्ट््य िेख रेख (केंद्रीय मानजसक स्ट्वास्ट््य प्राजधकरण) जवजनयम, 2020 ह।ै

(2) ये रािपत्र में इनके प्रकािन की तारीख को प्रवृत्त होंगे।

2. पररभाषाए-ं (1) इन जवजनयमों म,ें िब तक दक संिभा से अन्यर्ा अपेजित न हो,-

(क) “अजधजनयम” से मानजसक स्ट्वास्ट््य िेखरेख अजधजनयम, 2017 (2017 का 10) अजभप्रेत ह;ै

(ख) “बोडा” से धारा 2 की उप -धारा (1) के खंड (घ) में जनर्िष्टा बोडा अजभप्रेत ह;ै

6198 GI/2020 (1)


िारीररक अवरोध के अधीन व्यजि की जचदकत्सा जस्ट्र्जतयों का समग्र जनधारा ण जिसमें चोि, अगं ों को रि की आपर्ू त,ा रिचाप, पल्स, या कोई अन्य सुसगं त मानिंड सजम्मजलत ह:ैं …………………………………………………………………………………………………………………………….. …………………………………. ……………………………………………………………………………………………………………………………………….. ………………………………………………………………………..

िारीररक अवरोध िाचं के िौरान िी गयी िवाओं की खरु ाक और आवजृ त्त का उल्लखे करें:


खरु ाक

माधय् म आवजृ त्त कुल खरु ाक िष्प्ु प्रभाव (रूि)

मानजसक स्ट्वास्ट््य स्ट्र्ापन के प्रभारी व्यजि का नाम, हस्ट्तािर और मुहर: जविाल चौहान, संयुि सजचव [जवज्ञापन III/4/असा./416/2020]


New Delhi, the 18th December, 2020

F.No.V.15011/09/2019-PH-I.—In exercise of the powers conferred by section 122 of the Mental Healthcare Act, 2017 (10 of 2017), the Central Mental Health Authority hereby makes the following regulations, namely:-



1. Short title and commencement.- (1) These regulations may be called the Mental Healthcare (Central Mental Health Authority) Regulations, 2020

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


(b) (c)

Definitions. – (1) In these regulations, unless the context otherwise requires, – (a) “Act” means the Mental Healthcare Act, 2017 (10 of 2017);

“Board” means the Board referred to in clause (d) of sub-section (1) of section 2; “Central Authority” means the Central Mental Health Authority as defined in clause

(f) of sub-section (1) of section 2 of the Act;

[भाग III—खण्ड 4] भारत का रािपत्र : असाधारण 21

(d) “Chief Executive Officer” means the chief executive of the Authority referred to in sub-section (1) of section 40 of the Act;

(e) (f)


advance directiveor fresh directive, or change or revocation, or cancellation of directive, may make an applicationto the Board in writing in Form A which shall be provided free of cost in all mental health establishments.

(2) If a nominated representative of a person making an application for advance directive under sub- regulation (1) is named in the advance directive, such representative shall sign the request foradvance directive stating his willingness to act as the nominated representative.

(3) Every application foran advance directive under sub-regulation (1), 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.

(4) Every application for an advance directive shall be registered with the Board having jurisdiction at the place where the person applying for registration resides.

(5) No fee shall be charged for registration of an advance directive under sub-rule (1) withthe Board.

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

or her nominated representative.

(7) No person shall release any copy of the advance directive or information in the advance directive to any unauthorised person or to the media.

(8) There shall be no restriction on the number of times an advance directive is changed by the person who applies for, or whose name is appeared in the directive:

Provided that 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.

(9) Every change under sub-regulation (8) shall comply with the same process as referred to in sub- regulations (1) to (6) and the previous advance directive shall become null and void onregistration ofa fresh advance directive with the Board.

(10) 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.

(11) A nominated representative of the person as mentioned in the advance directive may withdraw his consent, to function as such without giving any reason –

(a) by an application in writing addressed to the Board;

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

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


“Form” means a Form appended to these regulations; “Schedule” means the Schedule appended to these regulations.

The words and expressions used herein andnot defined but defined in the Act shall have the same meanings as assigned to them in the Act.


Manner of making an advance directive.- (1) Any person who desires to apply for a request for




4. Officers and other employees of the Central Authority.-(1) The appointment of employees of the Authority shall be governed by recruitment rules made by the Central Government.

(2)The salary, allowances, leave, joining time, joining time pay, age of superannuation and other conditions of service of the Chief Executive Officer and other employees of the Central Authority, shall be the same as applicable to the officers and employees of the Central Government drawing equivalent pay.

5. The functions of the chairperson of Authority.- (1)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:

Provided that the Chairperson may delegate all or any of his functions to the Chief Executive Officer.

(2). Important policy matters relating to the functioning of the Authority shall be placed before the Authority in its meeting.

6. Meetings of Central Authority.- (1) The meeting of the Central Authority shall generally be held at New Delhi:

Provided that the Chairperson may select any other place for meeting if the circumstances render it expedient to hold the meeting at any other place in India.

(2) The Central Authority shall meet at least twice in a year at such time and place as may be fixed by the Chairperson:

Provided that the Chairperson may also call a special meeting at any time to deal with any urgent matter requiring the attention of the Authority.

(3) (i)

Every notice calling for a meeting of the Central Authority shall – specify therein the place, date and time of the meeting;

(ii) be served upon every member of the Central Authority not less than seven days prior to the day appointed for the meeting:

Provided that the Chairperson may call a special meeting at any time.


prepare and circulate to the members of the Central Authority an agenda for such meeting, with the approval of the Chairperson.

Along with the notice for the meeting of the Central Authority, the Chief Executive Officer shall,

(5) The quorum of the meeting of the Central Authority shall be in accordance with sub-section (2) of section 76 of the Act.

(6) (a)Any member of the Central 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.

(7) Any business which is to be placed before the Central 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

(8) The Chief Executive Officer of the Central Authority shaIl forward the copy of the proceedings of each meeting of the Authority to the Central Government.

7. Conduct of Meetings.- (1) A meeting shall be called to order by the Chairperson or, in his absence, by the Member chairing the meeting.

(2) The Chairperson or the member who presides over the meeting shall decide the sequence of the agenda items for consideration.

[भाग III—खण्ड 4] भारत का रािपत्र : असाधारण 23 (3) 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.

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

8. Attendance and proceedings at Meetings.- (1) 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.

(2) The Chief Executive Officer shall record the attendance of non-members in the minutes of the meeting.

(3) 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.

9. Minutes of the meetings.- (1) The Chief Executive Officer shall record the minutes of the meeting of the Authority.

(2) 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.

(3) 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.

(4) 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.

(5) The Chief Executive Officer shall submit an action taken report on the decisions of the last meeting in the next meeting.



10. Minimum standards of facilities .- Every mental health establishment under the control of the Central Government shall maintain the minimum standards specified in the Schedule.

11. The minimum qualification for the personnel engaged in mental health establishment.- (1) 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 recruitment rules applicable to the respective mental health establishment.

12. Maintenance of records and reporting.-(1) The mental health establishments under the Central Government shall keep the medical records in the manner specified in Form-B.

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

(3) 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.

13. Application by the mental health establishment for permanent registration.- A mental health establishment shall apply to the Central Authority for permanent registration in Form-C accompanied by a fee of rupees twenty five thousand by way of a Demand Draft drawn in favour of the Chairperson, Central Mental Health Authority, payable at New Delhi or as may be specified by the Central Authority from time to time.

14. Manner of submitting application.- A mental health establishment while submitting an application in Form-C for permanent registration with the Central Authority shall enclose therewith, details of


compliance of minimum standards as specified in the Schedule and the documentary proof in support of the claim.

15. Filing of objections against grant of permanent registration to a mental health establishment.- A person may file any objection to the Central Authority under sub-section (14) of section 66 of the Act in Form-D against grant of permanent registration to a mental health establishment in response to public notice within the time specified in the notice.



16. Meetings and rules of procedure of the Board.-(1)The Board shall meet at least once a month or more frequently as it may consider necessary.

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

(3) The Chairperson shall give at least five clear days notice for a meeting of the Board, specifying therein the date, time and place of the meeting.

(4) The Chairperson shall preside at every meeting of the Board at which he is present, and in his absence, any other member of the Board as the Chairperson may authorise.

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

(6) If the quorum in the meeting is not present within half an hour after the time appointed for the meeting, the Chairperson may postpone the meeting to another day and the Chairperson and the members present at the postponed meeting shall constitute the quorum.

(7) All decisions of the Board shall be authenticated by the signature of the Chairperson or any other member of the Board as the Chairperson may authorize in his behalf.

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

(9) 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.

(10) The orders of the Board shall be in writing and contain reasons.

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

(12) 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 and 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.

(13) 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.



17. Restriction on psychosurgery.- (1) 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;

[भाग III—खण्ड 4] भारत का रािपत्र : असाधारण 25 (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.

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


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

Restraints.- The mental health professional shall take the following additional preventive measures

(a) he shall give periodic training to the staff of the mental health establishment in learning and adopting alternatives to the use of restraints;

(b) he 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 shall submit the monthly report to the Board, under sub-section (7) of section 97 of the Act, which shall be a calendar month report and shall contain the details in Form-E which shall be signed by the person in-charge of the mental health establishment;

(d) he shall forward the restraint report to the respective Board on monthly basis within the first week of the next month.


[See regulations 10 and 14]

Minimum Standards for Registration of Mental Health Establishments

Standard 1. The premises shall –

(a) be a pucca structure;

(b) be equipped with functional windows and doors with strong and intact vertical grills and wire

meshes to avoid attempts for suicide or self-harm;

(c) have lift with generator or power backup for areas having more than four floors;

(d) have sufficient ventilation and natural light;

(e) have sufficient illumination after sunset for reading without causing strain to the eyes;

(f) have illuminated passages leading to toilets and emergency exits during the night;

(g) have inverters or power back-up for emergency lights during power failures;

(h) have periodic maintenance of the mental health establishment; and

(i) have heaters and coolers subject to safety and health of residents, according to seasons.

Standard 2. The living conditions shall be comfortable with –

(a) separate cots, mattresses, pillow and blanket (with due regard to the season) for each patient placed in a manner that there is sufficient space between each bed;

(b) residents must not be made to sleep on the floor;

(c) hygiene; and

(d) adequate fans.

Standard 3. Hygiene, cleanliness and sanitation shall be maintained by –

(a) daily sweeping, swabbing and dusting of the entire premises;

(b) sanitation maintained in all the areas including toilets and bathrooms using disinfectants;




(c) adequate number of toilets and bathrooms and separate toilets and bathrooms for male and female inpatients, and disposal facilities for sanitary napkins; and

(d) adequate availability of water in wash basins, bathrooms and toilets;

(e) periodic fumigation, pest control and fixing of wire meshes on all doors and windows to keep out pests;

(f) cleaningandchangingthelinenregularly;

(g) providing in every Institution automated laundry service, or a separate area for washing and drying clothes, with adequate manpower, so that the laundry is collected, washed, dried and returned to the residents the same day or by out-sourcing the laundry service; and

adequate arrangements for safe disposal of biomedical waste.

Standard 4. Wholesome, sumptuous and nutritive food and potable drinking water shall be provided in comfortable settings and –

(a) (b) (c)

(d) (e)

food shall be served in a respectable and comfortable manner; hygienic and nutritious food shall be served;

cooks and persons involved in preparation and serving of food must undergo mandatory health check-ups periodically; aprons, masks and headgears must be provided to all;

food must be served at frequent intervals under the supervision of sufficient number of attendants so that there shall be no long gap between meal times;

the food served to each patient must meet their unique dietary requirements; meal plans and diet charts must be prepared by a dietician; and

special diet based on special nutritional requirements must be given to women who are elderly,


pregnant, lactating, or have recently undergone abortion or miscarriage.

Standard 5. Facilities shall be provided for social, cultural, leisure and recreational activities including –

(a) entertainment programs, socials and excursions for inpatients; and

(b) furnished visitors’ room for families coming to meet the inpatients.

Standard 6. Adequate number of health professionals shall be employed to provide proper treatment and –


(a) (b) (c)

the inpatients seen on a regular basis by a mental health professional;

a medical officer shall be available on call twenty-four hours to meet the emergencies:

the trained human resources in mental health shall be made available to provide mental health services:

human resources requirement shall be specified by the respective Government as per the availability of local resources; and

provisions must be made for emergency treatment; ambulances equipped with necessary medical


equipment must be kept ready at all times in the mental health establishments.

Standard 7. Medical and para-medical staff shall be engaged in accordance with the specified requirements and –


(a) (b) (c)

there shall be regular visits by a qualified medical practitioner, in accordance with the norms fixed by the appropriate government, for checkup and treatment;

nurses engaged for shift duty shall be in conformity with the norms made by the Indian Nursing Council from time to time;

multipurpose workers, one for every ten beds or part thereof shall be employed; and multipurpose workers shall be engaged after an adequate induction training programme.

[भाग III—खण्ड 4] भारत का रािपत्र : असाधारण 27 Standard 8. The premises shall have adequate floor space having –

(a) (b) (c) (d) (e)

separate wards for mentally ill female inpatients and mentally ill male inpatients;

adequate space between beds;

adequate dimension to ensure comfortable passage and safe evacuation in case of emergencies;

ward bed and surrounding space not less than one metre on all sides;

common room, where possible, which has television, newspapers, magazines and indoor games and the chairs provided is 1:4 ratio; and

outpatient department and inpatient facilities shall have sitting arrangements for patients and


accompanying family members, registration, help and cash counters, drinking water facilities and separate toilets for males and females.

Standard 9. Equipment and articles shall be procured and used for inpatients in accordance with the requirements in mental health establishment having –


(a) (b)

(c) (d)

(e) (f)

medical equipment and instruments, commensurate with the scope of services and the number of beds;

anesthesia equipment and oxygen cylinders with flow meter for establishments providing electro convulsive therapy services in acute care services;

equipment and inventory kept in a good usable condition;

sufficient sets of basic equipment such as blood pressure apparatus, stethoscope, weighing machine, thermometer and like other equipments:

sufficient stock of drugs, medical devices and consumables;

first aid box with standard contents; a daily check done for replenishments; and an examination table with foot step.

Standard 10. Alternate methods shall be used in place of restraint to de-escalate crises situations and


(a) physical restraints to be used only to prevent inpatients from hurting themselves or others, with the permission of the medical practitioner on duty or consultant psychiatrist and the circumstances shall be recorded in a separate register kept for this purpose;

(b) nursing staff shall be trained to use de-escalation techniques to prevent patients from harming themselves and others; and

adequate number of security staff must be hired, with an equal number of female guards.

Standard 11. There shall be protection of privacy, dignity, safety and security of patients especially of women and their confidentiality and –

(a) no discrimination on the grounds of religion, race, caste, sex, creed, place of birth and economic condition or on any other ground in the matter of admission or treatment of patients;

(b) reasonable freedom and facility for pursuing religious beliefs;

(c) physical examination or treatment of female patients done shall be in the presence of a female attendant or female nursing staff, if conducted by male medical staff inside the hospital and vice versa;

(d) independent lockers provided to patients to keep their personal belongings;

(e) necessary procedures exist to meet fire and non-fire emergencies and safe exit of inpatients and others;

(f) appropriate display of directional fire exit signage, at least in two languages, one of which is local;

(g) all fire safety measures taken including fire prevention, detection, mitigation, evacuation, containment and mock drills;





firefighting equipment to be periodically inspected, chemicals replenished and shall be kept in usable condition;

residents must be provided with adequate number of clean undergarments and disposable sanitary napkins that are marked for personal use in public mental health establishments; and



basic cosmetics such as powder, cream, bindis and kumkum and other items should be provided in sufficient quantity.

each individual resident must be provided with basic hygiene articles such as slippers, towels and bathing and washing soap on a fortnightly basis, and at least two shampoo sachets every week;

Standard 12. Every mental health establishment shall comply with the provisions of the Right of Persons with Disabilities Act, 2016 (49 of 2016).


[See regulation 3]


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 medical problems _______________________________________________________________________________ _________________________________________

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: __________________________________________

[भाग III—खण्ड 4] भारत का रािपत्र : असाधारण 29 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……..


Basic Medical Records:

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


[See rule 12(1)]

The mental health establishment shall maintain specific minimum records at their level for various types of patients they are dealing with. The requirement of records to be maintained for in-patients, out patients and community outreach may vary and is accordingly specified below. A graded approach in minimum records to be maintained may be followed:

Community outreach register shall consist of information from (a) to (h) of the basic medical record of outpatient specified in paragraph 1 below.


The mental health establishments shall maintain and provide on demand the following basic medical record to the person with mental illness or his nominated representative.

1. Basic Medical Record of all out-patients (at hospitals, nursing homes, private clinics, camps, mobile clinics, primary health care centers and other community outreach programmes, and the like matters):

(In hard copy format)

(a) Name of the mental health establishment/doctor____________

(b) Date___________________

(c) Hospital registration number___________________

(d) Advance Directive YES/NO

(e) Patient’s Name _____________________________

(f) Age ________Sex __________

(g) Father’s/Mother’s name_________________________________

Address _____________________Mobile No________________

(h) Chief complaints _____________________

(i) Provisional diagnosis ________________

(j) Treatment advised and follow-up recommendations._____________

2. Basic Medical Record of In-Patient

(a) Name of the hospital/nursing home____________

(b) Date________________

(c) Patient’s name ___________

(d) Father’s/Mother’s name_________________________________

(e) Age ________Sex ________

(f) Address _____________________

(g) Patient accompanied by (Name, age and nature of relationship) __________

(h) Hospital registration number__________________

(i) Identification marks _______________

(j) Nominated representative __________________________

(k) Advanced Directive – Yes or No; If yes salient features of the content

(l) Date of admission___________Date of discharge ____________

(m) Mode of admission (section of the Mental Healthcare Act, 2017): Independent/ Supported

(n) Chief complaints

(o) Summary of Medical Examination Laboratory investigations

(p) Provisional/differential/ final diagnosis

(q) Course in the hospital (Treatment and Progress)

(r) Condition at discharge or discharge at request or leave against medical advice or person with mental illness absconding or others

(s) Treatmentadviceatdischarge

(t) Follow-up recommendations

[भाग III—खण्ड 4] भारत का रािपत्र : असाधारण 31 3. Basic Psychological Assessment Report (facilities where persons with mental illness undergoes

psychological assessment):

Clinic Record no. ————————————-

Name: Education: Referred by:

Reason for referral:

Age: Occupation:


Date of testing:

Language tested in:

Neuropsychological assessment (Specify domain if the assessment is domain specific)

IQ Specific learning assessment disability


Personality Psychopathology assessment assessment

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):

Informant: Self

Others Specify

Salient behavioral 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: Further assessment Therapy

Any other

Specify Specify Specify




Assessed by


Date: Qualification:


Verified/ supervised by (if applicable)


Date: Qualification:


4. Basic Minimum Standard Guidelines for Recording of Therapy Report (facilities where persons with mental illness are provided with therapy for any mental health problem)

Minimum Basic Standard Guidelines for Recording of Therapy (Name of the Institute/Hospital/Centre with address)

Clinic record no._____________

Psychiatric diagnosis:


Patient name: Age:


Session number and date:

Duration of session:

Session Participants:

Therapy method:

Individual Couple/Family Group

Other _______

Objectives of the session: 1.




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

Therapy techniques used:

Therapist observations and reflections:

Plan for next session: Date for next session: Therapist Supervised by (if applicable)

[भाग III—खण्ड 4]


Date: Qualification:


भारत का रािपत्र : असाधारण 33


Date: Qualification:



[See regulation 14]


1. Name of the establishment:

2. Postal address:

3. Category:

4. Name, qualifications and experience of the in charge of the establishment:

5. Number of beds:

6. 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)

7. Services provided (tick what is provided)

(a) Out-patient

(b) In-patient

(c) Emergency

(d) Day Care

(e) Electro convulsive therapy (f) Imaging

(g) Psychological testing

(h) Investigation and laboratory (i) Anyother(Specify)

8. Staff (Numbers):

(a) Medical officers and specialists

(b) Para-medical/ para-clinical staff

(c) Attenders

(d) Health educators

(e) Multi-purpose workers

(f) Others (Specify)

Details of registration fee paid:



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.


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.


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





[See regulation 15]


The Chairperson,

Central Mental Health Authority……………………….

It is in my knowledge that the Mental Health Establishment (name) …………………………………… situated at …………………………………… does not fulfill 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.

Signed by the authorized signatory (Name and designation of the signatory)

Stamp of the mental health establishment

[भाग III—खण्ड 4] भारत का रािपत्र : असाधारण 35 1. ________________________________________________

2. ________________________________________________ 3. ________________________________________________

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

1. 2. 3.

Please take necessary action accordingly Address:

Mobile number:


Date: Enclosure:

Name of the Patient: Sex:


File No:

Provisional Diagnosis: Date of Admission:

Signature:……………………… Name:…………………………


(See regulation 18)

Physical Restraint Monitoring and Reporting Form Date:

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:





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:

Medication Dose Route Frequency Total dose Side-effects

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

VISHAL CHAUHAN, Jt. Secy. [ADVT.-III/4/Exty./416/2020]

Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.

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