Summary of interface between Psychiatry and Indian Law

1. PSYCHIATRY AND LAW
SUMMARY

2. LAW AND PSYCHIATRY: CONCEPTS,HISTORY,
APPLICATION & UTILITY
• Law is generally a system of rules which are enforced through
social institutions to govern behavior. There is no universally
accepted definition of law.
• Human being is a civilized social animal.
• Civilization came with certain requirements one of which is
regulation of behavior for security, peaceful coexistence and
maintenance of some order in society.
• Law and governance came into picture to fulfill this
requirement.
• Health was desired for happiness and well-being and that
could happen through prevention and treatment of diseases.
Medicine was invented to fulfill this requirement. The mental
component of health has been there in medicine since
ancient times and the specialty of Psychiatry developed
gradually in the course of time.

3. ASCLEPIUS-GREEK GOD OF
MEDICINE (& PSYCHIATRY)

4. JUSTICE-GREEK GODESS OF LAW

5. PSYCHIATRIST’S OFFICE: COOPERATIVE
THERAPEUTIC PROCESS

6. COURT TRIAL: ADVERSARIAL PROCESS

7. WHEN IT COMES TO REGULATING HUMAN
BEHAVIOR

8. LAW PUNISHES-CONCERNS ITSELF WITH
RIGHT AND WRONG

9. PSYCHIATRY TREATS WITH THE KNOWLEDGE
THAT ABERRANT BEHAVIOUR CAN BE DUE TO
ILLNESS

10. PSYCHIATRY AND LAW-FRIENDS?

11. OR FOES?

12. THEY ARE INTERDEPENDENT FOR TECHNICAL
INFORMATION, YET EACH HAVING THEIR OWN
CONSTRUCTS OF MENTAL ILLNESS

13. PSYCHIATRY AND LAW INTERFACE
• It can be approached in many ways.
• The approach followed in this presentation is mentioned
below:
PSYCHIATRY AND LAW
 Law in psychiatry.
 Psychiatry in civil law.
 Psychiatry in criminal law.
 Law and psychiatric problems of children.
 Certification in psychiatry.
 Psychiatrist as expert witness.
 Ethics and law.
 Human rights and privileges of mentally ill persons.

14. LAW IN PSYCHIATRY: RELEVANT ACTS
• Indian Lunacy Act, Act 4 of 1912.
• Mental Health Act , 1987.
• Central Mental Health Authority Rules, 1990.
• State Mental Health Rules, 1990.
• State Mental Health (Amendment) Rules, 2007.
• Mental Health Care Bill, 2013.
• Narcotic Drugs and Psychotropic Substances Act, Act 61 of
1985 as amended up to Act 2 of 1989.
• Narcotic Drugs and Psychotropic Substances Rules,1985.
• Narcotic Drugs and Psychotropic Substances (Execution of
bond by convicts or addicts) Rules, 1985.
• Prevention of illicit traffic in Narcotic and Psychotropic
Substances Act, Act 46 of 1988.
• Consumer protection act, 1986.

15. PSYCHIATRY IN CIVIL LAW
• If there is a CIVIL LAWSUIT, it’s between a person and another person/s one
or more of whom can be mentally disordered.
• Situations of significance in relation to psychiatry in civil law:
• Contract-It’s validity. Indian contract act(act 9 of 1872).
• Marriage-Nullity, restitution of conjugal rights, judicial separation, divorce.
Special marriage act, 1954 (applicable to all irrespective of religion), different
marriage and divorce acts for different religions: Hindu, Muslim, Parsi,
Christian; Family courts act, 1984; Domestic violence act, 2005.
• Testamentary capacity: Indian succession act,1925; Hindu Succession
Act(amendment 2005); Muslim Personal Laws; Indian Registration Act1908;
Various state amendments of Hindu Succession act.
• Adoption: Hindu Adoption and Maintenance Act(Act 78 of 1956).
• Right to vote and stand for election: Act 326 and act 102 of constitution of
India.
• Witness: Indian evidence act, 1872.
• Torts: Common legal principles are applied.
• Civil proceedings: Regarding civil suits, guardianships etc.
• Driving: Road traffic act and driving license act of India.

16. PSYCHIATRY IN CRIMINAL LAW
‘ACTUS NON FACIT REUM, NISI MENS SIT REA’
(An act does not make a person guilty unless his
mind is guilty).
INDIAN PENAL CODE (ACT 45 OF 1860, IPC):
Nothing is an offence which is done by a person who, at the
time of doing it, by reason of unsoundness of mind, is
incapable of knowing the nature of the act, or that he is doing
what is either wrong or contrary to law.

17. PSYCHIATRY IN CRIMINAL LAW
• If there is a CRIMINAL TRIAL, the legal matter is between the State and a
person who can be mentally disordered.
 Situations of significance in relation to psychiatry in criminal law:
• Criminal responsibility for serious crimes (e.g. murder): IPC(Act 45 of 1860; IPC);
‘Partial insanity’: Section 84, IPC; Section 335 CPC; Intoxication (forced or without
knowledge): Sections 85 and 86 IPC. Competency to stand trial and subsequent
procedure: Act 2 of 1974: CPC.
• Consent: Section 90 IPC, Section 89 IPC
.
• Suicide: Section 309 IPC, Section 84 IPC.
• Miscellaneous crimes:
• Unnatural sex offences-IPC, Section 377.
• Paraphilias- e.g. exhibitionism -IPC Section 294
• Affrays- Disturbances caused by fighting etc. in public places- IPC, Section
159.
• Misconduct in public while drunk-IPC, Section 510.

18. LAW IN RELATION TO CHILDREN AND
THEIR PSYCHIATIC PROBLEMS
• Rights of Children clearly mentioned in Convention on the same
by General Assembly of United Nations, Resolution 44/25 of 20
November 1989.
Relevant Indian Laws:
• The persons with disabilities(equal opportunities, protection of
rights and full participation) act, 1995. Provides for prevention
and detection of disabilities, education, employment, non-discrimination,
research and manpower development, affirmative
action, social security and grievance redress of people with
disabilities.
• Juvenile justice (care and protection of children) act, 2000.
Enacted by the parliament for to provide for the care, protection,
development, rehabilitation and social integration of delinquent
juveniles and for the adjudication of certain matters relating to,
and disposition of , delinquent juveniles.
• The national trust for the welfare of persons with autism,
cerebral palsy, mental retardation and multiple disabilities act,
1999.

19. LAW IN RELATION TO ORGAN TRANSPLANTATION &
ROLE OF PSYCHIATRIST
• Transplantation of human organs act, 1994.
• Transplantation of human organs rules, 1995.
• Transplantation of human organs (amendment) act, 2011.
• Transplantation of human organs and tissues rules, 2013.
The acts and rules make it mandatory for every proposed
live voluntary donor to undergo psychiatric evaluation by a
psychiatrist appointed by authorization committees at hospital,
district and state levels. The authorization committee has to
mention reasons for approval/rejection of application of every
voluntary donor in a prescribed form. One of the conditions
mentioned for approval is:
‘psychiatric clearance is mandatory to certify the applicant’s
mental condition, awareness, absence of any overt or latent
psychiatric disease and ability to give free consent.’

20. CERTIFICATION IN PSYCHIATRY
• Medical certificate for Involuntary
Hospitalization.
• Certificate for invalidation from service
(Unfitness).
• Treatment certificate.
• Mental fitness certificate.
• Certificate for leave and fitness to resume
duties.
• Certification for mental illness for Government
benefits.
• Certification for disability.

21. INDIAN LAWS RELATED TO DISABILITY
• Mental health act, 1987. Mentions provision for rehabilitation
activities in psychiatric hospitals and about licensing of
convalescent homes for mentally ill persons.
• Rehabilitation Council Act of India, 1992. Deals with
development of manpower for providing rehabilitation services.
Handicapped in this act means a person who is visually
handicapped, hearing handicapped, suffering from locomotor
disability or suffering from mental retardation.
• Persons with Disability (Equal Opportunities, Protection of
Rights and Full Participation) (PWD) Act, 1995. Came into force
in 1995 with the purpose of providing equal rights to disabled
persons and to protect their rights and full participation. Seven
conditions recognized by this act: blindness, low vision, leprosy-cured
person, hearing impairment, locomotor disability, mental
retardation, mental illness.
• National Trust for welfare of persons with autism, cerebral palsy,
mental retardation and multiple disabilities act, 1999. Has
provisions for legal guardianship.

22. DISABILITY ASSESSMENT
• Disability has been defined as any restriction or lack of
ability to perform an activity in the manner within the range
considered normal for a human being. Disability can be
temporary or permanent and can be certified accordingly.
• Disability assessment using IDEAS(Indian Disability
Evaluation and Assessment Scale) developed by the
Rehabilitation Committee of Indian Psychiatric Society,
December 2000:
Items in IDEAS: self-care, interpersonal activities(social
relationships), communication and understanding, work.
It categorizes disabilities from no disability to profound
disability. It can be used for evaluation of four mental
illnesses: schizophrenia, bipolar disorder, OCD, dementia.
• Disability assessment schedule(WHO-DAS, 1988) is a well
validated but research oriented instrument for assessment of
disability.

23. ASSESSMENT OF DISABILITY IN PERSONS WITH
MENTAL RETARDATION (ADPMR)
• Developed for assessment of disability in mentally retarded
children.
• Items-Perceptual motor, self-care, communication and social,
academic, occupational.
• Categorizes disability from no disability to profound
disability.
• For the purposes of welfare benefit, cut-off of disability is
40%.

24. PSYCHIATRIST AS EXPERT
WITNESS
• Indian Evidence Act, 1872: Common witness, expert witness.
• Psychiatrist in Court-as a common witness, as a professional
witness, as an expert witness, as a defendant.
• Expert witness may be summoned by: Prosecution, defense,
judge or tribunal.
• Non-testifying expert versus testifying expert.
• Summons is issued by Registrar of the Court to appear as
witness.
• Attending Court is mandatory except in rare specific
circumstances.
• Courts rely on oral evidence by the witness and documental
evidence.
• Preparation of testimony.

25. CONTINUED
• Appearance in court: Aim-to assist Court in dispensation of
justice.
• Order of examination of witness: Examination in chief, cross
examination by opposing lawyer, re-examination by first
party.
• Court verdict is not bound by expert’s testimony.
• Expert witness is liable for negligence and perjury.
• There is a presumption in favor of sanity and the contrary
has to be proved to the satisfaction of the court.
• There is a presumption of continuity of sanity as well as
insanity. The return of soundness of mind, as well as lucid
interval , must be proved to the satisfaction of the court.

26. ETHICS AND LAW
• The word ethics is derived from the Greek term ethikos, which
stands for rules of conduct that govern natural disposition in
human beings. Encyclopedia Britannica defines ethics as
systematic study of the ultimate problems of human conduct.
These ultimate problems are concerned with the concepts of
right and wrong, morality and similar other issues. Ethics
usually represents a system of internal control and is usually
voluntary. In contrast, law represents a mechanism for external
control and it’s enforced by the state. Ethics is guided by moral
principles whereas law is guided by reality principles. They
supplement and complement each other.
• Medical ethics is as old as the art of healing itself and the
earliest code of medical ethics was formed by Hippocrates in 5th
century BC.
• Psychiatric ethics is rather of a recent origin. The APA appointed
a committee to develop a code of ethics. Subsequently , in 1977,
the WPA developed a code of ethics which is known as the
‘DECLARATION OF HAWAII’. IPS adopted its ethical code in
1985.

27. CONTINUED
Main objectives of professional ethics are as under:
 To provide guidelines of conduct among the professionals
themselves. It includes area like referral from one therapist to
another, giving comments on the opinion of another
professional, and charging consultation fee from
coprofessionals and their families.
 To formulate guidelines in dealing with patients, their
relatives and third parties. The areas to which these
guidelines relate are mainly the following:
• Psychiatric diagnosis.
• Informed consent.
• Voluntary and involuntary treatment and hospitalization.
• Confidentiality.

28. CONTINUED
• Respect for the patient and his human rights.
• Third party responsibility.
• Psychiatric research.
A committee comprising of Professors J S Neki, D N Nandi,
P K Agarwal, V N Vahia and J K Trivedi was requested to
prepare the recommendations for a code of ethics for
psychiatrists in India. The draft recommendations prepared
by the committee were approved by IPS at its annual
conference held at Cuttack, Orissa in1989. It has mentioned
principles and recommendations.

29. CONTINUED
PRINCIPLES:
• Responsibility
• Competence
• Benevolence
• Moral standards
• Patient welfare
• Confidentiality
RECOMMENDATIONS
It’s proposed that ethical committees may be formed at central
and zonal levels. These are supposed to consider complaints
either from the public or from fellow professionals and then
carefully investigate them.

30. HUMAN RIGHTS AND PREVILEGES OF
MENTALLY ILL PERSONS
• The term human rights in a broad sense means “those claims
which every individual has or should have upon the society in
which he/she lives.” According Richard Wasserstorm, it
means ones that ought to be claimed as entitlements –those
minimal things without which it is impossible to develop
one’s capabilities and to live life as a human being.
• First human rights legal resolutions: Declaration of Human
Rights, 1948. It did not specifically address rights of the
mentally ill.
• Later resolutions: Declaration on the Rights of Mentally
Retarded Persons,1979 and Declaration on the Rights of the
Disabled Persons, 1975; began the process of establishment
of minimum international standards for the treatment of
persons with mental disabilities.

31. CONTINUED
• Right to health in constitution of India: Mentally ill have
fundamental/ human right to receive mental health care and
to humane living conditions in the mental hospitals.
• Declaration of Hawaii, 1992 by the General Assembly of
World Psychiatric Association also talks about rights of the
mentally ill.
MAJOR HUMAN RIGHTS STANDARDS APPLICABLE TO
MENTAL HEALTH:
• UN Principles for the protection of persons with mental
illness and the improvement of mental health care, 1991.
• Standard rules on the equalization of opportunities for
persons with disabilities (Standard Rules, 1993).

32. CONTINUED
• WHO TECHNICAL STANDARDS:
In 1996, WHO developed the Mental Health Care Law:
Ten Basic Principles and the Guidelines for Promotion of
Human Rights of Persons with Mental Disorders, which is a
tool to help understand and interpret the principles
mentioned by it and to evaluate human rights conditions in
institutions.
TEN BASIC PRINCIPLES:
• Promotion of mental health and prevention of mental
disorders.
• Access to basic mental health care.
• Mental health assessments in accordance with
internationally accepted principles.

33. CONTINUED
• Provision of least restrictive type of mental health care.
• Self-determination.
• Right to be assisted in the exercise of self-determination.
• Availability of review procedure.
• Automatic period review mechanism Qualified decision maker.
• Respect to the rule of law.
Chapter VIII of Mental Health Act, 1987 contains explicit provision
of protection of human rights of mentally ill persons. But it does
not spell out any enforceable right of the mentally ill to a
minimum standard of care and treatment. Besides it does not
spell out much on human rights and fails to cover neglect or
cruelty to mentally ill persons sustained in families or alternate
systems of care like faith healers. It does not mention anything
about protection of rights of the mentally ill in areas such as
employment, education and housing.

34. CONTINUED
IMPORTANT RIGHTS OF THE MENTALLY ILL:
• Informed consent
• Confidentiality.
• Access to information.
• Rights when admitted in mental health facilities.
• Voluntary and involuntary mental health care.
• Rights during emergency situations.
• Rights related to special treatment.
• Rights related to competence, capacity and guardianship.
• Rights related to seclusion and restraint.
• Rights related to clinical and experimental research.

35. FUTURE: BETTER UNDERSTADING AND
COOPERATION BETWEEN LAW & PSYCHIATRY AND
CONTINUED EFFORTS FOR IMPROVEMENT

36. TRANSCENDENCE
We often talk of right and justice,
but we find that in the world right and
justice are mere baby’s talk. There are two
things that guide people’s conduct: might
and mercy.
The exercise of might is
invariably the exercise of selfishness. All
men and women try to make most of
whatever power or advantage they have.
Mercy is heaven itself. To be
good, we have all to be merciful. Even
justice and right should stand on mercy.
SWAMI VIVEKANANDA

37. HINDU DEITIES OF MEDICINE & LAW
VAIDYANATH PARVATI

38. CONSCIOUSNESS

39. PROJECTION
judge love
MOTHER
TERESA

40. UNITY

41. HARMONY

42. REFERENCES AND ACKNOWLEDGEMENT
• Textbook of postgraduate psychiatry, second
edition. Editors: J N Vyas, Niraj Ahuja. JAYPEE
Publications, 1999.
• Forensic psychiatry: Clinical Practice Guidelines
for Psychiatrists in India. Editors: Prof. Shiv
Gautam, Prof. Ajit Avasthi. Published by Indian
Psychiatric Society, 2009.
• Dr. Nambi, for article on legal aspects of psychiatry
in IPS publication for young psychiatrists.
• Wikipedia and wikimedia for images and
information.
• www.digitalcomposting.files.wordpress.com.
• Other websites on internet for free pictures.

43. FEEDBACK AND SUGGESTIONS
Feedback and suggestions from the
audience are welcome.

44. ERRORS AND SHORTCOMINGS
REGRETTED

45. THANK YOU