🏥📝 Admission and Discharge Procedures
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Mental Health Nursing Exams
🔰 What are Admission and Discharge Procedures?
Admission and discharge refer to the systematic legal and clinical processes followed for admitting and discharging persons with mental illness under the Mental Healthcare Act, 2017.
✅ The Act emphasizes patient rights, informed consent, dignity, and least restrictive care.
🧭 5 Types of Admissions under Mental Healthcare Act, 2017:
🟩 1. Independent (Voluntary) Admission – Section 86
🔹 Client has decision-making capacity
🔸 Admission is done on their own request
🔸 Person can ask for discharge at any time
🔸 Requires examination by a psychiatrist within 24 hours
🟨 2. Admission of Minor – Section 87
🔹 Request by Nominated Representative (NR) (parent/guardian)
🔸 Must be assessed by two mental health professionals (one must be a psychiatrist)
🔸 Facility must provide age-appropriate care
🔸 Reviewed every 30 days
🟧 3. Supported Admission (Short-Term) – Section 89
🔹 For persons without capacity to consent
🔸 Admitted with NR support
🔸 Requires certification by two professionals
🔸 Initial stay: up to 30 days
🔸 Must be reported to MHRB
🟥 4. Supported Admission (Long-Term) – Section 90
🔹 If stay is extended beyond 30 days
🔸 Mandatory Mental Health Review Board (MHRB) approval
🔸 Reviewed every 180 days
🔸 Must be discharged when patient regains capacity
🟦 5. Emergency Admission – Section 94
🔹 For immediate risk to self/others
🔸 Without consent, for up to 72 hours
🔸 Only a registered medical practitioner needed
🔸 Beyond 72 hours → must follow Section 89 admission process
🚪 Discharge Procedures:
✅ 1. Voluntary Discharge
🔹 Independent patients can request discharge anytime
🔸 Discharge granted unless there’s risk of harm
✅ 2. Discharge from Supported Admission
🔹 Happens when:
- Capacity is regained
- Treatment no longer required
🔸 Must be informed to MHRB
✅ 3. Discharge on NR’s Request
🔹 NR can request discharge
🔸 Disallowed only if clinically unsafe
✅ 4. Discharge Planning
🔹 Includes:
- Follow-up appointments
- Medication plans
- Community rehab referrals
🔸 Ensures smooth transition into community care
🎯 Nurse’s Role in Admission & Discharge:
- 🔹 Assist in mental status exam & documentation
- 🔹 Ensure informed consent is obtained
- 🔹 Support patient’s rights & dignity
- 🔹 Coordinate with family, NR, and MHRB
- 🔹 Plan discharge education, referrals, and follow-up
📚 Golden One-Liners for Quick Revision:
- 🟨 Section 86: Voluntary admission
- 🟨 Section 87: Minor admission
- 🟨 Section 89: Supported short-term (30 days)
- 🟨 Section 90: Supported long-term (>30 days)
- 🟨 Section 94: Emergency admission (72 hours max)
- 🟨 MHRB: Mental Health Review Board approves & monitors involuntary admissions
✅ Top 5 MCQs for Practice:
Q1. Admission of a person who has the capacity to make decisions falls under which section?
🅰️ Section 89
🅱️ Section 94
✅ 🅲️ Section 86
🅳️ Section 87
Correct Answer: 🅲️ Section 86
Rationale: Section 86 governs independent (voluntary) admissions.
Q2. What is the maximum period for emergency admission under Section 94?
🅰️ 24 hours
🅱️ 48 hours
✅ 🅲️ 72 hours
🅳️ 1 week
Correct Answer: 🅲️ 72 hours
Rationale: Emergency admission is limited to 72 hours without formal consent.
Q3. Which authority is required for extending supported admission beyond 30 days?
🅰️ Central Government
🅱️ Police
✅ 🅲️ Mental Health Review Board (MHRB)
🅳️ Nurse in charge
Correct Answer: 🅲️ MHRB
Rationale: MHRB ensures legality and safeguards patient rights.
Q4. Admission of minors requires evaluation by how many professionals?
🅰️ One psychiatrist
🅱️ Only a nurse
✅ 🅲️ Two mental health professionals
🅳️ Three social workers
Correct Answer: 🅲️ Two mental health professionals
Rationale: One must be a psychiatrist, and both must assess the need.
Q5. What must be included in discharge planning?
🅰️ Police report
🅱️ Termination of all treatment
✅ 🅲️ Follow-up, medication, and referrals
🅳️ Transfer to jail
Correct Answer: 🅲️ Follow-up, medication, and referrals
Rationale: Effective discharge includes community reintegration support
📘 Admission and Discharge Procedures in Mental Healthcare Act 2017
(Implemented from May 2018, Replacing Mental Health Act 1987)
✅ 1. Introduction:
- The Mental Healthcare Act 2017 ensures rights-based, patient-centric admission and discharge processes.
- Admissions are divided into voluntary, supported, and emergency based on patient capacity and mental condition.
- The Act emphasizes informed consent, minimal restriction, and rehabilitation-based care.
✅ 2. Types of Admissions:
🔹 A. Independent Admission (Section 86)
- Applies to: Persons with mental illness who have capacity to make decisions.
- Admission is based on voluntary request.
- Consent is given by the person themself.
- Discharge can be requested at any time by the person.
🔹 B. Supported Admission (Sections 89 & 90)
- Applies to: Persons who lack decision-making capacity.
- Admitted with the support of a Nominated Representative (NR).
- Requires assessment and certification by:
- Two mental health professionals (Psychiatrist + one more)
- Initial admission is for 30 days (Section 89).
- Extended admission requires review by Mental Health Review Board (Section 90).
🔹 C. Emergency Treatment and Admission (Section 94)
- Immediate care allowed for up to 72 hours.
- To prevent harm to self/others or serious health deterioration.
- Treatment can begin without consent.
- Admission must be reported to the Mental Health Review Board if extended.
🔹 D. Admission of Minor (Section 87)
- Requires application by Nominated Representative (usually parent/guardian).
- Must be evaluated by two professionals, one of whom must be a psychiatrist.
- Separate facilities required for minors.
- Continuous review required for every 30 days.
✅ 3. Discharge Procedures:
🔹 A. For Independent Admissions
- Patient can request discharge anytime.
- Facility must honor the request unless:
- Patient turns aggressive/dangerous, in which case admission may shift to supported.
🔹 B. For Supported Admissions
- Discharge when:
- Patient regains decision-making capacity.
- No longer meets criteria for inpatient care.
- MHRB review ensures fair discharge.
🔹 C. On Request by Nominated Representative (NR)
- NR may request discharge unless:
- It poses significant risk to patient or public.
🔹 D. Post-Discharge Planning
- Discharge must include:
- Rehabilitation plan
- Follow-up care
- Community integration support
✅ 4. Safeguards and Patient Rights:
- Every patient has the right to legal aid and to appeal decisions.
- MHRB ensures that no person is admitted against their will without review.
- Admission and discharge must be documented and reported as per law.
🟨 Golden One-Liners for Revision:
- 🔹 Section 86 – Voluntary/Independent admission.
- 🔹 Section 89 & 90 – Supported admissions with MHRB review.
- 🔹 Section 94 – Emergency admission for max 72 hours.
- 🔹 Section 87 – Admission of minors with dual assessment.
- 🔹 Discharge is a right, especially for voluntary patients.
✅ Top 5 MCQs for Practice:
1. Which section of Mental Healthcare Act 2017 deals with voluntary admission?
a) Section 90
b) Section 89
c) Section 86
d) Section 87
Answer: c) Section 86
Rationale: Section 86 is for independent (voluntary) admission.
2. What is the maximum initial duration of supported admission under Section 89?
a) 15 days
b) 30 days
c) 60 days
d) 72 hours
Answer: b) 30 days
Rationale: Section 89 allows up to 30 days for supported admission initially.
3. Which authority must be informed during extended supported admission beyond 30 days?
a) NIMHANS
b) Mental Health Review Board
c) Chief Minister
d) Central Mental Authority
Answer: b) Mental Health Review Board
Rationale: MHRB must review continued admission.
4. Who can authorize the admission of a minor in a mental health facility?
a) Nurse and Social Worker
b) Local Police
c) Nominated Representative with two doctors’ assessment
d) Any adult family member
Answer: c) Nominated Representative with two doctors’ assessment
Rationale: One psychiatrist + another professional must certify admission.
5. Emergency admission without consent is valid up to how many hours?
a) 24 hours
b) 48 hours
c) 72 hours
d) 7 days
Answer: c) 72 hours
Rationale: Section 94 allows emergency admission for 72 hours.