FORENSIC PSYCHIATRY

~Forensic Psychiatry is a combination of Law and Psychiatric practice, which deals with issues like criminal responsibility and civil responsibility.

~Forensic psychiatrists assess individuals involved in legal proceedings, such as criminals, victims and witnesses, and determine their mental condition, competence and responsibility. They often testify in court cases related to mental health problems.

CRIMINAL RESPONSIBILITY

~According to Section 84 (Indian Penal Code 1860) no crime is a crime which is committed by a person at a time when that person is mentally ill.

1. Mcnaughton Rule’s

~Daniel MacNaughton A 29-year-old Scotsman, acting under a delusion, shot and killed Edward Drummond, British Prime Minister Sir Robert Peel’s secretary.

McNaughten was a paranoid schizophrenic and had delusions that Sir Robert Peel was conspiring against him. He intended to kill Sir Robert Peel but mistakenly killed Drummond.

A committee, after hearing the medical advice of 9 physicians, found McNaughten not guilty by reason of mental illness.

2. Durham Rule`s

~A person is not criminally responsible for his conduct if his unlawful act is the result of a mental illness or mental defect.

3.American Law Institute (ALI) Test

~A person is not responsible for criminal conduct if, at the time of such conduct, he lacked the capacity, as a result of mental disease or mental defect, to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law.

The ALI test is a combination of McNaughton’s rule and the inevitable impulse test. This rule does not apply to psychopaths. This popular test is now used by all courts in the USA.

CIVIL RESPONSIBILITY

•Property Management

~Mentally ill person is not able to manage their property. He can give authority to another person to act for him during his illness until he recovers from mental illness. If a certificate proves a severe degree of mental illness, the court can appoint a manager to look after his property.

•Marriage

~Hindu Marriage Act (Act 25 of 1955) provides conditions for Hindu marriage. Based on that, if a person is mentally ill or mentally retarded at the time of marriage, it can be declared null or void (without any legal force). Spouse can also appeal for divorce.

•Testamentary Capacity

~Testamentary capacity is the ability of a person to make a WILL (a document of disposal of one’s own property). Only a person with a healthy mind can WILL. If a person is suffering from mental illness at the time of making the WILL, then the will is considered invalid due to mental disturbance.

•Right To Vote

~ mental ill person cannot contest election and do not exercise the right of voting.

•Contrast

~If it is proved that at the time of making the contract, the person is not fit enough to contract and is not capable of understanding the contract, then the contract is invalid. A person with mental illness is also not allowed to enter into any business contract.

•Guardianship

A mentally ill person cannot act as a legal guardian of a minor (under 18 years of age).

INDIAN LUNACY ACT-1912

~Indian Lunacy Act 1912 is derived from English Lunacy Act 1890. It has 8 chapters.

In this Act, care of Lunatic (mentally ill person) and management of his property and mental illness related laws have been made and amended.

After the implementation of this Act, many asylums (psychiatric hospitals) were opened.

•Chapter-1 :

~This chapter includes some definitions. In which Asylum, district court, criminal lunatic etc.

Asylum: A mental hospital licensed by the Central Government or the State Government is called an asylum, in which mental patients are kept.

~Cost Of Maintenance : This includes all expenses incurred for accommodation, maintenance, medicine, cloth and monitoring of patients with mental condition and removal from asylum.

~Criminal Lunatic : This means any person removed or detained from asylum, jail or safe custody.

•Chapter-2 :

~According to this section, criminal lunatics are released or admitted as per the order of someone else due to the petition or due to the petition of the neighboring state.

•Chapter-3 :

~This section is related to providing care and treatment, including appointments of visitors, monthly inspection by visitors, discharge of lunatics and parole (permission for a maximum of 90 days to attend any family function or religious function). is

Chapter-4:

High court has the power to investigate Lunacy related judicial matters.

In this the district court has the power to order inquiry in some cases.

~Court can order investigation for a person who is Lunatic.

~Makes time and space for judicial inquiry.

Chapter-5:

~Related to the investigation by the District Court and its judgment.

~ Power to direct the collector

The District Court has the power to appoint guardians and managers.

~If the court finds that there is no mental illness, it also has the power to close or set aside the related ongoing proceedings.

Chapter 6:

~State Government can establish or license asylum

~Can also cancel the license if curative treatment is not provided properly.

Chapter 7:

~Related to expenses incurred with Lunatics.

To bear the cost of the asylum licensed by the State Government.

~ Application in civil court for order of payment of maintenance expenses.

Chapter 8:

State Government has the power to make rules.

Publication of ~Rules.

Also protects individuals according to ~Rules.

Power to make rules for admitting lunatics from outside India.

MENTAL HEALTH ACT-1987

A draft of the Mental Health Act was prepared by the Parliament in 1987.

~ Came into force in April 1993 in all the States and Union Territories (UTs) of India.

~This act replaces the Indian lunacy act -1912.

~This Act is passed to strengthen and amend the laws relating to the treatment and care of mentally ill persons, their property and to make better provision for matters connected with or incidental thereto.

OBJECTIVES OF ACT

1. To establish central and state authorities for licensing and supervision of psychiatric hospitals.
2. To establish psychiatric hospitals and nursing homes.
3. To provide inspection of the working of these hospitals.
4. To provide custody of mentally ill person

Those who are not capable of caring for themselves, and are dangerous to themselves and/or others.

5. To protect society from dangerous manifestation of mentally ill person.
6. To regulate the process of admission and discharge of mentally ill persons.
7. To protect the rights of the detained persons.
8. To protect citizens from being unnecessarily detained.
9. To provide the cost of maintenance of mentally ill person.
10. To provide legal aid to mentally ill criminals at state expense.

SALEINT FEATURES

~Mental Health Act is divided into total 10 chapters.

•Chapter-1 :

~This section includes some terminology.

Gives definition of mentally ill person, psychiatrist, medical officer etc.

~ There are some old terms, today new terms are used.

~Lunatic = Mentally ill person

~Lunatic Asylum = Psychiatric hospital

~Criminal lunatic = Mentally ill prisoner

Chapter-2:

This section relates to the establishment of mental health authorities at the central and state levels.

Chapter-3:

~Deals with establishment and maintenance of psychiatric hospitals and nursing homes.

Chapter-4:

~ Mentally ill is associated with the process of admitting and detaining people in psychiatric hospitals.

Chapter-5:

~ It works with supervision, discharge, leave of absence and removal of mentally ill persons

Chapter-6: It deals with judicial inquiry into mentally ill persons owning property and its management.

Chapter-7:

It deals with the maintenance of mentally ill persons in a psychiatric hospital or psychiatric nursing home.

Chapter-8:

It is concerned with the protection of human rights of mentally ill persons.

Chapter-9:

~It deals with the guidelines of the Act and penalties and proceedings for violation.

Chapter-10:

~It deals with miscellaneous matters not covered by other acts.

NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCE(NDPS) ACT-1985

The Narcotic Drugs and Psychotropic Substances Act-1985, commonly known as the NDPS Act, is an Act of the Parliament of India which prohibits a person from consuming or producing, cultivating, possessing, selling, purchasing, transporting, storing, or consuming narcotic drugs or psychotropic substances. is

OBJECTIVES OF NDPS ACT

~To consolidate and amend existing laws relating to narcotic drugs.

Making strict provision for control and regulation of operations related to narcotic drugs and psychotropic substances.

~Significantly increasing penalties especially for trafficking offences.

~ Making provisions for the implementation of the International Convention on Narcotic Drugs and Psychotropic Substances to which India is a party.

CONTENTS

~This ACT includes some narcotic drugs including Opium, Poppy, Cannabis, Cocaine and Marijuana etc.

~Psychotropic Substances: Includes 76 drugs including pentazocine and barbiturates.

PRELIMINARY

~This Act is known as the Narcotic Drugs and Psychotropic Substances Act, 1985.

~It extends all over India.

~It applies to all citizens of India outside India

~ This Act applies to all persons on board ships and aircraft registered in India, wherever they may be.

PUNISHMENT

Cultivation of opium, cannabis and coca plants without a license can lead to a jail term of up to 10 years and a fine of more than 1 lakh.

Embazzlement of opium by licensed farmers is punishable by rigorous imprisonment up to 10-20 years and a fine of 1-2 lakh rupees.

~ Import/export or production, cultivation, ownership, sale, purchase, transport of narcotic drugs or psychotropic substances in small quantities shall be punishable with rigorous imprisonment for 6 months or a fine of 10,000 rupees or both.

~If in commercial quantity, 10-20 years of rigorous imprisonment and a fine of 1-2 lakhs.

STANDARD OF PSYCHIATRIC NURSING PRACTICE

~Standards of mental health nursing practice include providing comprehensive care to individuals with mental health problems, including assessment, diagnosis, planning, intervention, and evaluation.

The standard is the minimul professional practice expected for any nurse in any setting or role, approved by a council or otherwise within the nursing profession (Registered Nurses Act, 2006).

PROFESSIONAL PRACTICE STANDARD

Standard-1 (Theory)

~Psychiatric mental health nursing is the application of relevant theory to nurses to explain phenomena of concern and provide a basis for intervention.

Standard-2 (Data Collection)

The nurse continuously collects data that is comprehensive, accurate and systematic.

~Effective interviews, behavioral observations, physical and mental health assessments enable the nurse to reach appropriate conclusions and formulate appropriate intervention plans with the client.

Standard-3 (Diagnosis)

~Includes identification of actual and potential health problems. Psychiatrist-Mental Health Registered Nurse analyzes assessment data to determine diagnosis or problems, including level of risk.

Standard-4 (Planning)

The nurse develops a nursing care plan with specific goals and interventions that describe unique nursing actions for each client’s needs.

Standard-5 (Intervention)

~ Psychotherapeutic intervention, health education, daily life activities, somatic therapy,

The nurse plays an important role in the therapeutic environment, psychotherapy

Standard-6 (Counseling)

~ Psychiatric mental health nurses use counseling interventions to help clients improve or regain their previous coping skills, promote mental health, and prevent mental illness and disability.

Standard-7 (Millieu Therapy)

~Mental health nurses collaborate with clients and other health care providers to provide structures and maintain a therapeutic environment.

Standard-8 (Psycho-Biological Intervention)

~Psychiatric mental health nurses use psychobiologic interventions and clinical skills to restore clients’ health and prevent disability.

Standard-9 (Health Teaching)

Mental health nurses, through health education, help clients achieve satisfying, productive and healthy lifestyles.

Standard-10 (Case Management)

~Mental health nurses coordinate comprehensive health services and provide case management to ensure continuity of care.

STANDARD OF PROFESSIONALS PERFORMANCE

Standard-1 (Quality Of Care)

~Psychiatric mental health nurses systematically evaluate the quality of care and the effectiveness of psychiatric mental health nursing practice.

Standard-2 (Education)

~Psychiatric mental health nurses acquire and maintain current knowledge in nursing practice.

Standard-3 (Collegiality) Collegiality:

Psychiatric mental health nurses interact with and contribute to the professional development of others as colleagues, health care clinicians, and collegians.

Standard-4 (Ethics)

~ The psychiatric mental health nurse’s assessment, actions and recommendations on behalf of the client are determined and implemented in ethical manners.

Standard-5 (Collaboration)

~Psychiatric mental health nurses collaborate with clients, others, and health care providers.

Standard-6 (Research)

~Psychiatric mental health nurses make contributions to nursing and mental health through the use of research methods and findings.

ADMISSION DISCHARGE PROCEDURES OF MENTALLY ILL PATIENT

•ADMISSION PROCEDURES

A patient with mental illness can be admitted like a patient with physical illness. Psychiatric patients can be admitted by the medical officer and in-charge of the hospital on request even without application by the patient.

•VOLUNTARY ADMISSION

~Any person (above 18 years of age) who considers himself mentally ill and desires to be admitted to any psychiatric hospital or psychiatric nursing home, may request the Medical Officer.

A patient below ~18 years of age can be admitted on the request of his parents. The patient is admitted till 24 after which the team of medical officer decides the further treatment. A patient should not be admitted for more than 90 days.

•INVOLUNTARY ADMISSION

~They are called Formal Admission means they are admitted to the hospital under the section of the Mental Health Act.

~Even if they do not want to receive treatment for a certain period of time, they must remain in the hospital.

• ADMISSION UNDER SPECIAL CIRCUMSTANCES

~Any mentally ill person who does not or cannot express his desire for voluntary admission, is admitted or kept in a psychiatric hospital or psychiatric nursing home on application made by his relatives or friends. The in-charge medical officer assesses the condition of the mentally ill patient for treatment and if satisfied, the patient is admitted to a psychiatric hospital.

• ADMISSION BY THE POLICE AND MAGISTRATE

~ Under Section 23 of the Indian Mental Health Act, 1987, a police officer can protect any person found within the limits of his station. The officer must have reason to believe that the person is mentally ill and unable to care for himself. He can become dangerous due to his mental illness. Such patients are produced before the nearest Magistrate within 24 hours of being detained.

•EMERGENCY ADMISSION

Can be admitted for 72 hours without the consent of the patient or guardian if a mental health doctor says that emergency admission is necessary.

• ADMISSION OF CRIMINAL LUNATICS

~1) Prisoners Act III, 1900:- mentally ill Prisoner who became mentally ill during his imprisonment.

~2)Criminal Procedure Code Section 330:– A person who has committed a crime but is not fit to stand trial due to mental illness.

~3) Criminal Procedure Code Section 335:– A person who has committed a crime and is guilty of his act but is not punished due to mental illness but is admitted to a mental hospital for treatment.

DISCHARGE PROCEDURES

~The Medical Officer in charge of a psychiatric hospital or psychiatric nursing home may, on the recommendation of two medical practitioners, one of whom shall be a psychiatrist, by order in writing, or order to discharge any person other than an involuntary patient under treatment. The patient should then be discharged from the mental hospital or physical nursing home, unless there is an order from some other authority such as the Superintendent of Jails.

Discharge procedures are also done like admission procedures.

~Voluntary Discharge

~Involuntary Discharge

~Discharge Under Special Circumstances

ROLE OF NURSE IN ADMISSION AND DISCHARGE PROCEDURES

~Approach the client in a warm and accepting manner.

~Should have proper knowledge about admission and discharge of patients.

~Consent of patient or family members for various processes in the client.

~Nurses should protect the patient’s basic human rights.

~Privacy of patient data should be maintained.

~All records must be kept strictly private.

~Inform relatives if client runs away from unit.

~ Keep dangerous objects away from the patient.

~ Ensuring that hospital policies do not violate patient rights.

BASIC RIGHTS OF MENTALLY ILL PATIENTS

~The right to communicate with people outside the hospital by correspondence, telephone and personal visits.

~Religious freedom (religious freedom) right.

~ Right to wear Hospital Cloth.

~ Right to do job if possible.

Right to manage and dispose of ~property.

~Right to be in a contractual relationship.

~Right to Education.

Right to independent psychiatric examination.

~The right to retain a license or permit established by law, such as a driver’s or professional license.

~Right to civil service status.

~Right to sue or be sued.

~Right to marry and take devorce.

~Right to buy.

~Right to hygienic condition.

~Right not to be subjected to unnecessary mechanical restraints.

Right to periodic review of ~Condition

~Legal representative (legal representation) right.

~Right to Privacy.

Right to informed consent

~Right to Treatment.

~Right not to receive treatment.

~The right to treatment in the least restrictive setting.

LEGAL ISSUES AND LEGAL RESPONSIBILITIES IN THE CARE OF MENTALLY ILL PATIENT

Legal issues in psychiatric nursing may include issues related to patient privacy, informed consent, involuntary commitment, medication management, restraint and seclusion, patient right, and duty to warn or protect. When providing care to individuals with mental illness, psychiatry Nurses should look at this legal concern. Patients’ rights should be respected.

CONFIDENTIALITY/PRIVACY

~ Privacy is a fundamental right, and especially in psychiatry. There are laws protecting the privacy of client records and client-related communications.

~ All the data or information that the psychiatric mental health nurse collects from the mentally ill patient should be kept private. Data can be disclosed without consent in life threatening conditions.

RECORD KEEPING

~Nursing notes and progress records constitute legal documents and should therefore be carefully maintained.

~Mental health nurses play the role of record keeping in the psychiatric setting. Only those persons who have the right to observe the client or obtain medical information are involved in his medical care.

INFORMED CONSENT

~Informed Consent is about giving knowledge to the patient which makes the patient capable of making a decision. Informed consent is the permission given by the client to the physician to perform a therapeutic procedure. In which the client is given the benefits, harms and all related information of the procedure before the procedure.

~ Client has the right to allow the procedure or not.

~ Mentally incompetent client who is not capable of taking decision to save life or emergency condition and client is minor (less than 18 years) in certain conditions such treatment can be started without the consent of the client.

• RESTRAINT AND SECLUSION*

~ Restraint and seclusion may be used only if the psychiatrist gives permission for the individual’s treatment in a mental health organization.

The client also has the right to be freed from restraint and seclusion but they do not have this right in emergency conditions.

~Restraint: Clients are restrained when their behavior is out of control.

~Seclusion: In this the client is kept alone in the room. Not allowed to go out.

MALPRACTICE

In Malpractice, professionals fail to provide appropriate and competent care that is provided by their professional members, resulting in harm to the patient. Examples of malpractice include not following a physician’s order or not giving medication to a patient.

NEGLIGENCE

~* Negligence is when a person does not do the work as it should be done, normal precautions are not taken and unintentionally harming the patient is called negligence.

~If the nursing assistant does not monitor the patient’s vital sign at the time it is called negligence.

LEGAL ROLES OF THE NURSE

~Know the laws of your state.

~Keep accurate and concise records.

~ Maintaining patient privacy

The nurse should protect the basic human rights of the mentally ill patient.

~ Should maintain privacy of records or data collected from him or family members.

Special care should be taken to avoid malpractice and negligence.

~Should have proper knowledge about admission and discharge of patients.

~Consent of patient or family members for various processes in the client.

~Beware of mentally ill criminals.

~Inform relatives if client runs away from unit.

~ Keep dangerous objects away from the patient.

~ Ensuring that hospital policies do not violate patient rights.

If any questions arise, a lawyer should be consulted.

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