Mental Healthcare Act 2017 for clinic doctors Registration, confidentiality under section 23, advance directives and emergency treatment, read for a general OPD.

The Mental Healthcare Act, 2017 (No. 10 of 2017) is mostly about psychiatric services, but parts of it reach any doctor who sees a patient with mental illness. A general clinic needs to know whether it counts as a mental health establishment that must register, what the confidentiality duty in section 23 requires of the doctor and the desk, how to handle an advance directive, and what emergency treatment section 94 allows. Clinical questions about diagnosis and treatment are outside this post.

Does a general clinic need to register as a mental health establishment?

Only if it fits the definition. Section 2(1)(p) defines a mental health establishment as any health establishment, including AYUSH establishments, "either wholly or partly, meant for the care of persons with mental illness" where such persons "are admitted and reside at, or kept in, for care, treatment, convalescence and rehabilitation, either temporarily or otherwise". It "includes any general hospital or general nursing home", whoever runs it, and excludes "a family residential place where a person with mental illness resides with his relatives or friends".

On a plain reading, a consulting-only OPD that admits no one is not a place where patients are admitted or kept. A nursing home with beds, or a clinic that keeps patients for observation or de-addiction care, is in a different position, because the definition names general nursing homes and covers places "partly" meant for such care. This is our reading of the text; if your clinic has beds, write to your State Mental Health Authority and ask whether it must register.

For the general clinical establishment licence that most states require of every clinic, see our clinical establishments list by state.

What does section 23 require of a GP?

Section 23(1) gives a person with mental illness "the right to confidentiality in respect of his mental health, mental healthcare, treatment and physical healthcare". Section 23(2) puts the duty on "all health professionals providing care or treatment to a person with mental illness", not only psychiatrists, to keep confidential all information obtained during care or treatment. The exceptions are:

1. To the patient's nominated representative, so they can fulfil their duties under the Act.
2. To other mental health professionals and health professionals, so they can provide care and treatment.
3. If necessary to protect any other person from harm or violence.
4. Only such information as is necessary to protect against the harm identified.
5. Only such information as is necessary to prevent a threat to life.
6. On an order of the Mental Health Review Board, the Central Authority, a High Court, the Supreme Court or another competent statutory authority.
7. In the interests of public safety and security.

Section 24(2) adds that the right "shall also apply to all information stored in electronic or digital format in real or virtual space". For a clinic, the practical points are: the diagnosis does not go on a token slip, a waiting-room screen or a staff WhatsApp group; referral letters go to the doctor receiving the patient; and a family member who is not the nominated representative is not automatically entitled to the notes. A relative or employer asking for information gets a polite refusal and a request for the patient's written consent. Our posts on patient record requests and the DPDP Act for clinics cover the general rules.

What if a patient brings an advance directive?

Under section 5, any adult may make an advance directive in writing stating how they wish, and do not wish, to be cared for and treated for a mental illness, and who should be their nominated representative. It "shall be invoked only when such person ceases to have capacity to make mental healthcare or treatment decisions", and a decision made while the person has capacity overrides it. The manner of making one is set by regulations of the Central Mental Health Authority (section 6), and each Mental Health Review Board keeps an online register of directives registered with it (section 7).

• The duty to follow it falls on the medical officer in charge of a mental health establishment and the psychiatrist in charge of the person's treatment (section 10). A GP who is neither should still record that one exists and pass it on when referring.
• The person and their nominated representative must ensure that "a medical practitioner or a mental health professional" has access to it when required (section 11(3)).
• A doctor "shall not be held liable for any unforeseen consequences on following a valid advance directive", and is not liable for not following one "if he has not been given a copy" (section 13).
• Anyone who wants to depart from it applies to the Board (section 11(1)). It does not apply to emergency treatment (section 9).

At the desk, scan or photocopy any directive or nomination the patient hands over, file it with the patient's record, and flag the record so the doctor sees it. The nomination itself can be "in writing on plain paper" (section 14(2)).

What emergency treatment may a registered medical practitioner give?

Section 94 allows "any registered medical practitioner" to give medical treatment, at a health establishment or in the community, where it is "immediately necessary to prevent" death or irreversible harm, serious harm to the person or others, or serious damage to property believed to flow directly from the mental illness. It is subject to the informed consent of the nominated representative where one is available. It includes transporting the person to the nearest mental health establishment for assessment, and it is limited to 72 hours or until the person is assessed at such an establishment, whichever is earlier. The section rules out treatment not directly related to the emergency. Read section 94 in full before relying on it, and record the reasons and the time in the notes.