DELHI STATE MENTAL HEALTH AUTHORITY MINIMUM STANDARDS FOR Mental Health Establishments as per MHA, 2017

DELHI STATE MENTAL HEALTH AUTHORITY

MINIMUM STANDARDS FOR Mental Health Establishments as per MHA, 2017

INTRODUCTION & BACKGROUND

1. In the previous Mental Health Act, 1987 there was no provision for Minimum Standards for Psychiatric Nursing Homes and the norms of the NHRC report of 1999 were the benchmark for providing quality assurance in mental health institutions.

2. The Mental Healthcare Act (MHA) 2017 received the Assent of the President of India on 7th April, 2017 The Draft Rules for implementation of Act were notified by the Govt. of India on 20th September, 2017 and a Gazette Notification of GOI was published on 2nd January, 2018 regarding extension of implementation of MHA, 2017 to 7th July, 2018. The final Rules were suddenly notified on 29th May, 2018 by Govt. of India in the Official Gazette and MHA, 2017 was declared to have ‘come into force’

3. Section 65 (3) of the Mental Health Care Act 2017 empowers existing State Mental Health Authority for provisionally registering all Mental Health Establishments and specify the minimum standards for different mental health establishments.

4. Section 65(5) provides for classifying various mental health establishments by State Mental Health Authority and specify different standards for different categories. The section reads as under :

“The Authority may––

(a) classify mental health establishments into such different categories, as maybe

specified by regulations made by the Central Authority;

(b) specify different standards for different categories of mental health establishments; (c) while specifying the minimum standards for mental health establishments, have

regard to local conditions…”

Mental Health Establishments as per MHA, 2017 will provide one of the following services:

a. Admission and treatment of Persons with Mental Illness

b. Admission and treatment of Persons with Mental Illness and co- existing Substance use disorder

c. Acute Detoxification in Persons with Substance use disorders

d. Non-Pharmacological Interventions for Persons with Mental Illness

e. Vocational Skills and Rehabilitation

f. Long Term Care/Rehabilitation

5. Depending upon the spectrum of services provided and the size of such mental health establishments providing such care, these establishment necessitate to be categorised into the following subcategories for the purpose of prescribing the minimum standards:

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a. Short Term Treatment including detoxification centre for drug abuse (< 1 month): Facility, where patients of substance abuse shall be kept and treated for symptoms of substance withdrawal and/or overdose. For this purpose, detoxification is a set of interventions aimed at managing acute intoxication and withdrawal.

b.Long Term Treatment Rehabilitation Centre (1 month or more) Here the substance use patients can be kept for more than 1 month with the focus on life skills and vocational training.

All these facilities have been further subcategorised keeping in view the number of

c. Treatment Centre for drug abuse and other mental disorders(1 month or more) beds / capacity:

for patients with co-existing psychiatric disorder ( Dual Diagnosis facility):Dual Upto 20 beds

Diagnosis here means Substance Use Disorders present along with Psychiatric

21-50 eds

Diagnoses (not to be confused with medical co morbidities.

d. Short Term Acute Psychiatric Treatment facility: Facility, where patients of psychiatric illness shall stay for short term treatment for around 3-6 months for the purpose of treatment and stabilization of psychiatric condition.

e. Long Term Psychiatric Rehabilitation Centre: Here the patients with psychiatric illness stay for more than 6 months with the focus on life skills and vocational training for their social reintegration and rehabilitation back into the community.

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All these facilities have been further subcategorised keeping in view the number of

beds / capacity:

– Upto 20 beds

– 21-50 beds

– More than 50 beds

6. The present standards have been formulated keeping in mind :

a. Patient Safety

b. Human rights of Patients

c. Medical and psychosocial care standards

d. Ensuring quality care

e. Humane, friendly enabling environment

f. Other contextual local factors.

These facilities are expected to provide a friendly environment, rather than a restrictive atmosphere and are expected to provide facilities for recreation, indoor and outdoor games, outings, family visits, and other recreational tools.

7. These minimum standards will be reviewed periodically every two years.

8. The minimum standards for various subcategories of facilities are depicted in Table 1.The standards have been devised to strike an appropriate balance between respectable quality medico-psycho-social care, safety and optimal functioning of the centres.

9. It is intended that these standards provide essential structure to the functioning of substance use treatment centres. In view of the large need of such services and the treatment gap, these standards have been kept to the minimum and only indicative of

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the basic requirement for these centres in terms of infrastructure and human resource requirements. These minimum standards will be applicable for all government, private and NGO facilities working in the field of drug abuse and detoxification in the State of Delhi.

10. For the purpose of these standards the Counsellor shall be defined as under:

‘A Counsellor is a person trained to give guidance on personal or psychological problems, with minimum qualification being graduate in Clinical Psychology/Psychology or Social Work and with 6 month experience in De-addiction services.’

11. Psychiatric Nursing Homes/Hospitals licensed under Mental Health Act 2017providing detoxification facilities shall also maintain the prescribed minimum standards.

12. Standards of MoSJE 2009, AIIMS Deaddiction Centre Guidelines and Draft of SMHA Minimum Standards were consulted and deliberated for drafting the minimum standards keeping in view the local requirements.

Table 1: Minimum Standards of various subcategories of Mental Health Establishments as per MHA, 2017

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Type of Facility

Requirement 

Short Term Treatment including detoxification centre for drug abuse (< 1 month)

Long Term Treatment Rehabilitation Centre (1 month or more )

Treatment Centre for drug abuse and other mental disorders

Short Term Treatment including acute hospitalisation (< 6 months)

Long Term Treatment Rehabilitation Centre/Halfway Home (>6 months)

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Physical Infrastructure

A1. Living and Physical space

(situated at an easily accessible place ensuring safety and security of patients with proper ventilation and sanitation facility)

Minimum patient /Ward area of 60 sq. feet per bed including

adequate area for recreational facilities, therapies, counselling, follow-up/OPD etc. Minimum facility built up of 2000 Sq Feet for 20 patients

Children and adolescents are to be segregated from Adult patients

Facility for safe keep of personal belongings of patients

60 Sq. Feet per bed Including adequate area for recreational facilities, therapies, counselling etc.

Children and adolescents are to be segregated from Adult patients

Facility for safe keep of personal belongings of patients

Minimum patient / Ward area of 60 sq. feet per bed including adequate area for recreational facilities, therapies, counselling, follow-up/ OPD etc.

Children and adolescents are to be segregated from Adult patients

Facility for safe keep of personal belongings of patients

Minimum patient /Ward area of 60 sq. feet per bed including adequate area for recreational facilities, therapies, counselling, follow-up/OPD etc. Minimum facility built up of 2000 Sq Feet for 20 patients

Children and adolescents are to be segregated from Adult patients

Facility for safe keep of personal belongings of patients

Minimum patient /Ward area of 60 sq. feet per bed including adequate area for recreational facilities, therapies, counselling, follow-up/OPD etc.

Facility for safe keep of personal belongings of patients

Human Resources

B1. Trained Physician/

Medical care*

*Minimum qualification – Graduate degree (as per the system

Part time and available on call

If patients with overdose are admitted, the doctor has to be available round the clock.

Part time and available on call

Gynaecologist on Call for facilities admitting Females

Part time and available on call

Gynaecologist on Call for facilities admitting Females

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Type of Facility

Requirement 

Short Term Treatment including detoxification centre for drug abuse (< 1 month)

Long Term Treatment Rehabilitation Centre (1 month or more )

Treatment Centre for drug abuse and other mental disorders

Short Term Treatment including acute hospitalisation (< 6 months)

Long Term Treatment Rehabilitation Centre/Halfway Home (>6 months)

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of allopathic/AYUSH medicine) along with registration with the concerned Medical Council

Gynaecologist on Call for facilities admitting Females

Paediatrician on Call for facilities admitting Minors

B2. Psychiatrist

Minimum Qualification – Diploma / MD / equivalent in Psychiatry/Psychologic al Medicine along with registration with the Medical council.

Part time and available on call

Access to Psychiatrist on call

Visiting Psychiatrist with daily visits

Full Time

Visiting Psychiatrist

B3. Counsellors

Minimum qualification – graduate in Clinical Psychology / Psychology / Social Work Experience of working for 6 months in De- addiction services

Full time

1 for every 30 beds or part thereof

Full time

1 for every 30 beds or part thereof

Full time

1 for every 30 beds or part thereof

Part time

1 for every 20 beds or part thereof

Part time

1 for every 20 beds or part thereof

B4. Social workers & Not Mandatory Regular Not Mandatory Not Mandatory Regular 5 of 7 | P a g e

Type of Facility

Requirement 

Short Term Treatment including detoxification centre for drug abuse (< 1 month)

Long Term Treatment Rehabilitation Centre (1 month or more )

Treatment Centre for drug abuse and other mental disorders

Short Term Treatment including acute hospitalisation (< 6 months)

Long Term Treatment Rehabilitation Centre/Halfway Home (>6 months)

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Persons in Recovery

1 for upto 20 beds

2 for 21-50 beds

3 for 51 beds or more

1 for upto 20 beds

2 for 21-50 beds

3 for 51 beds or more

B5. Nursing staff

Nos. (To be as per Nursing Council norms)

Minimum qualification –

At least 1 nursing staff to be available round the clock

GNM

As per requirement

GNM

At least 1 nursing staff to be available round the clock

GNM

At least 1 nursing staff to be available round the clock

1 for upto 20 beds

2 for 21-50 beds

3 for 51 beds or more

GNM

At least 1 nursing staff to be available round the clock

1 for upto 20 beds

2 for 21-50 beds

3 for 51 beds or more

GNM

B6A. Vocational trainers

Not Mandatory for facility for Adults

Mandatory for facilities for Minors

Preferable as per requirement

As per requirement

Not Mandatory for facility for Adults Mandatory for facilities for Minors

Preferable as per requirement

B6B. Yoga trainers Not Mandatory Preferable as per As per requirement Not Mandatory Preferable as per requirement requirement

B7. Support Services/Staff

(Sanitation, Security, attendants. Clerical and managerial staff etc.)

As per requirement, In- house or outsourcing arrangement

Female attendants to be available around the clock for facilities admitting Females and/or Minors

As per requirement, In- house or outsourcing arrangement

As per requirement, In-house or outsourcing arrangement

Female attendants to be available around the clock for facilities admitting Females and/or Minors

As per requirement, In-house or outsourcing arrangement

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Type of Facility

Requirement 

Short Term Treatment including detoxification centre for drug abuse (< 1 month)

Long Term Treatment Rehabilitation Centre (1 month or more )

Treatment Centre for drug abuse and other mental disorders

Short Term Treatment including acute hospitalisation (< 6 months)

Long Term Treatment Rehabilitation Centre/Halfway Home (>6 months)

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B8. Laboratory services

Essential – either in house/ outsourcing arrangement

Not mandatory

Essential – either in house/ outsourcing arrangement

Not mandatory

A. Services

C1. Registration

Essential

Every patients’ details to be recorded and each patient to get a unique ID

Essential

Every patients’ details

to be recorded and each patient to get a unique ID

Essential

Every patients’ details

to be recorded and each patient to get a unique ID

Essential

Every patients’ details

to be recorded and each patient to get a unique ID

Essential

Every patients’ details

to be recorded and each patient to get a unique ID

C2. Inpatient Treatment

Every patient to be seen by the doctor every day of the stay at least once and on SOS basis.

Availability of isolation facility to reduce transmission of communicable diseases/ infection

Every patient to be seen by the doctor at least once per week during the stay or on SOS basis.

Every patient to be seen by the doctor every day of the stay at least once or on SOS basis.

Every patient to be seen by the doctor every day of the stay at least once and on SOS basis.

Availability of isolation facility to reduce

transmission communicable diseases/ infection

Every patient to be seen by the doctor at least once per week during the stay or on SOS basis.

C3. Emergency services

Linkage/network with a hospital with 24 hour emergency medical facilities

C4. Dispensing of medications

(Pharmacotherapy )

Only on prescription by the doctor and by the staff authorized to dispense

Only on prescription by the doctor and by the staff authorized to dispense.

Only on prescription by the doctor and by the staff authorized to dispense

Only on prescription by the doctor and by the staff authorized to dispense.

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Type of Facility

Requirement 

Short Term Treatment including detoxification centre for drug abuse (< 1 month)

Long Term Treatment Rehabilitation Centre (1 month or more )

Treatment Centre for drug abuse and other mental disorders

Short Term Treatment including acute hospitalisation (< 6 months)

Long Term Treatment Rehabilitation Centre/Halfway Home (>6 months)

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C5. Psychosocial interventions

As per requirement, to be delivered by the qualified personnel

C6. Referral / Consultation /

Liaison/Legal/Amb ulance Services

Formal arrangements with concerned agencies/ organisations/ professionals

C7. Diet / food

Patients should have access to wholesome food and daily dietary requirements

(If an in-house kitchen is maintained, appropriate regulatory norms must be followed)

Special Nutritional needs to be assessed by Paediatrician/Dietician in case of Facilities admitting Minors.

Patients should have access to wholesome food and daily dietary requirements

(If an in-house kitchen is maintained, appropriate regulatory norms must be followed)

Special Nutritional needs to be assessed by Paediatrician/ Dietician in case of Facilities admitting Minors.

Patients should have access to wholesome food and daily dietary requirements

(If an in-house kitchen is maintained, appropriate regulatory norms must be followed)

Patients should have access to wholesome food and daily dietary requirements

(If an in-house kitchen is maintained, appropriate regulatory norms must be followed)

Special Nutritional needs to be assessed by paediatrician/Dietician in case of Facilities admitting Minors.

Patients should have access to wholesome food and daily dietary requirements

(If an in-house kitchen is maintained, appropriate regulatory norms must be followed

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Type of Facility

Requirement 

Short Term Treatment including detoxification centre for drug abuse (< 1 month)

Long Term Treatment Rehabilitation Centre (1 month or more )

Treatment Centre for drug abuse and other mental disorders

Short Term Treatment including acute hospitalisation (< 6 months)

Long Term Treatment Rehabilitation Centre/Halfway Home (>6 months)

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C8.Record maintenance

A. Mode of Records

B. Institutional Policy

for confidentiality and record keeping

C. Mandatory records to be maintained

Manual or digital ensuring confidentiality as per provisions of MHA 2017

In place

i. Patient register

ii. Patients assessment

formats ii

iii. Signed Consent forms

iv. Doctors’ prescription

v. Medication related records

vi. Records of psychosocial intervention

vii. Discharge slip / summary

iii. Medication related records as per The Drugs and Cosmetics Act 1938 and Rules thereunder

ix. Records to be maintained as per other applicable Acts such as JJ Act/ POCSO etc. in case of Minors

v vi vii

Manual or digital ensuring confidentiality

as per provisions of MHA 2017

In place

i. Patient register

i. Patients assessment

formats

i. Signed Consent forms

v. Doctors’ prescription v. Medication related

records

i. Records of psychosocial

intervention

i. Discharge slip /

summary

i. Medication related

records as per The Drugs and Cosmetics Act 1938 and Rules there

x. under

. Records to be

maintained as per other applicable Acts such as JJ Act/ POCSO etc. in case of Minors.

Manual or digital ensuring confidentiality as per provisions of MHA 2017

In place

i. Patient register

ii. Patients assessment

formats i

iii. Signed Consent

forms ii

iv. Doctors’ prescription i

v. Medication related records

vi. Records of v psychosocial

intervention

vii. Discharge slip /

summary

viii. Medication related vii

records as per The Drugs and Cosmetics Act 1938 and Rules thereunder.

ix. Records to be i maintained as per other applicable Acts such as JJ Act/ POCSO etc. in case

of Minors

Manual or digital ensuring confidentiality as per provisions of MHA 2017

In place

i. Patient register

i. Patients assessment

formats

i. Signed Consent forms

v. Doctors’ prescription v. Medication related

records

i. Records of

psychosocial

intervention

i. Discharge slip /

summary

i. Medication related

records as per The Drugs and Cosmetics Act 1938 and Rules there under

. Records to be maintained as per other applicable Acts such as JJ Act/ POCSO etc. in case of Minors

Manual or digital ensuring

confidentiality as per provisions of MHA 2017

In place

i. Patient register

ii. Patients assessment

formats

iii. Signed Consent

forms

iv. Doctors’

prescription

v. Medication related

records

vi. Records of

psychosocial

intervention

vii. Discharge slip /

summary

viii. Medication related

records as per The Drugs and Cosmetics Act 1938 and Rules there under

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Type of Facility

Requirement 

Short Term Treatment including detoxification centre for drug abuse (< 1 month)

Long Term Treatment Rehabilitation Centre (1 month or more )

Treatment Centre for drug abuse and other mental disorders

Short Term Treatment including acute hospitalisation (< 6 months)

Long Term Treatment Rehabilitation Centre/Halfway Home (>6 months)

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Other Common minimum standards

D1. As per the MHA 2017, maintenance of minimum standards is the responsibility of the organization seeking registration. D2. The critical issue of “informed written consent’ for admission will be as per the provisions of MHA, 2017 and the Rules

thereof.

D2. Patients should be given adequate information about the patient rights, services, rules, charges, grievance redressal

systems etc. at the time of admission and relevant information in this regard should be prominently displayed at the

location of registration / intake.

D3. Services should be addressed to the needs of the special /socially vulnerable population groups (Children, Women, Senior

Citizens, Transgenders) incorporating gender and age sensitivities in addiction and related stress management.

D4. In case the facility provide services to children in need of care and protection, the services should be in consonance with

the facility illustrated in the Juvenile Justice Rules 2016 and guidelines issued by the Government from time to time. D5. The facility shall submit periodical returns as may be prescribed from time to time by Government/SMHA.

D6. Provisions of all other applicable Acts/Rules for operating the facility shall be applicable.

(Dr. Nimesh G Desai) Director, IHBAS & Member Secretary/CEO, SMHA

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