MEDICAL TREATMENT OF MENTAL ILLNESS Mentally sick persons (insane) have no insight into their illness. They neither have the ability to consent nor to refuse medical treatment Till the middle of 19th century, they were considered moon-struck, thus called lunatics. The only measure considered appropriate for them was to restrain them in lunatic asylums in accordance with Lunatic Asylum Act 1858

Further research and understanding of the subject has necessitated the replacement of this law by Lunacy Act 1912 amended number of times, last being in 1973 Promulgation of Mental Health Ordinance 2001 has brought number of structural changes in this law. MEDICAL TREATMENT OF MENTAL ILLNESS

The statues of the law: 1.Prescribe instructions to open psychiatric ward in all Government hospitals for care and treatment of insane 2.Describe admission procedures into mental hospitals 3.Provides guide lines for maintenance and management of estate and affairs of mentally sick person

1.Voluntary reception 2.Temporary reception 3.Reception order 4.Arrest of dangerous / wandering lunatic Admission procedures in mental hospitals

Voluntary reception sec 4 Written application by an insane person who desire treatment to in charge of asylum Admission will be subject to the condition of notification to at least two visitors of the asylum (one to be RMP) within 24 hours Period — open, if recovers and desire to leave – can leave, if not recovers and desire to leave -- cannot be retained for more than 24 hours so that temporary reception can be arranged

Temporary reception sec 4A Written application by relatives on prescribe form explaining condition and circumstances necessitating admission Two medical certificates on prescribe forms subject to the conditions: 1.One medical practitioner is not his usual medical attendant 2.Examination in conjunction or separately indicating date and time, with maximum interval of 5 days 3.Recommendations valid for 14 days

In charge after accepting the application will notify the reception of the lunatic to two visitors, one of whom has to be a RMP, before the expiry of 2nd day Period of stay —maximum 6 months, If not recovered, can be detained for a period of another 28 days for arranging reception order

Reception order sec 5-11 Obtained from the court of area magistrate by making a petition explaining besides circumstances necessitating admission any previous petition and whether it was accepted or not Two medical certificates from RMP subject to conditions 1.One from Government medical officer 2.Both examine independently and separately and 3.If one MP is related to the examinee, do indicate

Magistrate, subject to his own satisfaction regarding 1.Genuineness of the petition 2.Relatives, ready to pay for treatment / maintenance 3.In charge of the asylum, willing to accept the lunatic May issue reception order or dismiss the petition after recording in writing, the reasons for its dismissal Period of stay –Open, subject to the permission of court

Arrest of dangerous / wandering lunatic sec13-15 In charge police station may arrest dangerous, wandering or cruelly treated lunatic and produce him before the magistrate, who in turn 1.Orders examination by Government medical officer and / or 2.Make other inquiries like whereabouts of his relatives or 3.Make him over to relatives who undertake to take care or 4.Pending reception order, authorize detention for 10 days; three such orders; maximum 30 days The idea behind this exercise is to locate relatives and give them reasonable time to arrange admission

Care and treatment of insane sec28-36 Appointment of visitors (maximum 3, one to be RMP) Visitors inspect the institution at least once in a month and record their observations / remarks in the register Inspection by IG Prison of criminal lunatic once in every 6 months and report about their mental health to relevant authorities Discharge of lunatic from asylum by in charge of the asylum on undertaking by relatives to take care (not for dangerous lunatics)

Maintenance / management of estate / affairs of mentally sick person sec Appointment of manager for estate (relative) Appointment of court of ward / guardian (non heir, non relative) Authorization to collector / provincial Government over estate of lunatic Duties / remuneration of the manager / relative Account / audit of inventory etc. etc.