A Person cannot be Admitted to a Mental Hospital in order to determine whether such admission is Required; HC

The Delhi High Court on Wednesday 18th April 2018 in Dr. Sangamitra Acharya Vs. State (NCT of Delhi) has held that a person cannot be admitted to a mental health institution in order to determine whether she requires such admission. The determination that she requires admission should be prior to her admission and not later.

A bench comprising of Justice Dr. S. Muralidhar and Justice C. Hari Shankar observed that the procedure for involuntary admission under Section 19 of the Mental Health Act, 1987 (MHA) is only applicable when the person has been found to be mentally ill as required by law and a satisfaction has been reached to that end. Admitting a person under Section 19 MHA merely for observation cannot be countenanced as doing so would be in violation of a person‘s rights to life, liberty, and dignity granted under Article 21 of the Constitution of India.

The Judgment authored by Justice Dr. S. Muralidhar also found that Section 19 (1) read with Section 19 (2) of the MHA mandates that the medical officer in-charge has to record two kinds of satisfaction – first, in terms of Section 19 (1) of the MHA, the satisfaction that it is in the interest of the medically ill person that they necessarily be admitted to a mental health institution; and second, the satisfaction in terms of the proviso to Section 19 (2) of the MHA that it is proper to cause such mentally ill person to be examined by two medical practitioners working in the hospital itself instead of requiring the two certificates as provided under Section 19 (2) of the MHA. The medical officer in-charge cannot delegate this crucial function of the recording of the satisfaction of two separate kinds to some other person.

The chief protagonist in this petition is a 23 year old woman, Z (name withheld for reasons of privacy).

In the present case, the satisfaction for the purposes of Section 19 (1) MHA could not have been arrived at by Dr. Sunil Mittal by just listening to his colleagues on the phone (or by a WhatsApp message). Such satisfaction could have been arrived at by Dr. Sunil Mittal only after interacting with Z. Clearly that interaction did not take place in the present case.

the Judgment said.

Important questions of law arise for determination in this petition under Article 226 of the Constitution of India filed by a teacher of classical music, and his wife (Petitioners 2 and 1 respectively), seeking a writ of habeas corpus. These questions involve interpretation of the relevant provisions of the Mental Health Act, 1987 (MHA) in light of the right to life, liberty, dignity and in light of the right to privacy and autonomy of an adult female, as guaranteed in the Constitution of India. 

The Cosmos Institute of Mental Health and Behavioural Sciences (CIMBS), Delhi Psychiatry Centre, the private mental health facility at 35, Defence Enclave in Preet Vihar, Delhi, its Director Dr. Sunil Mittal, and the other mental health professionals associated with CIMBS - Dr. Sameer Kalani and Dr. Raj Mishra – participated in the hearings by filing their respective affidavits and producing the relevant record.

Summary of conclusions and directions

The actions of Z‘s parents in removing her forcibly from the Petitioners‘ residence and getting her admitted without her consent to the CIMBS on 11th June 2017, with the aid of the local police, the staff of Almas, and the staff of CIMBS, was in clear violation of Z‘s fundamental rights to life, liberty and the right to dignity enshrined in Article 21 of the Constitution. This violation of her rights was triggered by her exercising her freedom of choice as a female adult by choosing to leave her home, and deciding where she would like to reside. The Court rejects the plea of Z‘s parents that they acted in the larger interests of their daughter and in consideration of her well-being since their actions indicate the opposite.

A person cannot be admitted to a mental health institution in order to determine whether she requires such admission. The determination that she requires admission should be prior to her admission and not later. The involuntary admission of Z to the CIMBS at 7.55 pm on 11th June 2017 was, therefore, in clear violation of the requirement of Section 19 (1) MHA read with Section 19 (2) MHA.

A professional psychiatrist requires personal interaction with a person before making a diagnosis of such person‘s mental condition. A psychiatrist cannot determine a mental state of a person by merely discussing the symptoms and conditions with another fellow psychiatrist over the telephone. To do so is illegal and unconstitutional.

The Medical Council of India (MCI) should formulate a separate code of ethics for psychiatrists to follow, which will reinforce the law.

The practice adopted in the present case by Dr. Sunil Mittal, Dr. Raj Mishra, and Dr. Sameer Kalani was in breach of the law, professional medical ethics and norms. The question as to what action is to be taken against them is left to the MCI to decide. MCI will take note of this being the second known instance in twenty years of violation of the law and ethics by Dr. Sunil Mittal and the Delhi Psychiatry Centre. 

Z is permitted to file a formal complaint with the MCI relying upon the affidavits and records submitted by CIMBS in this matter. If such complaint is filed, it is expected that the MCI will deal with it promptly and render a decision not later than six months from the date of receiving such complaint. 

The Almas ambulance staff grossly neglected the duty of care owed to Z. They proceeded to abet the abduction of Z and administered drugs to her by injection in the absence of any medical records and on the mere say so of Z‘s family. This is a fit case for revocation of the registration of Almas as an ambulance company if it is so registered and stopping their further functions.

Almas and its team have been party to depriving Z of her liberty and virtually rendering her into the custody of the hospital without her consent. Almas has to be restrained from offering any type of ambulance services. A peremptory direction is issued to the Government of NCT of Delhi to take action in regard to Almas and other ambulances, on being checked, which have been registered in states outside the NCT of Delhi but are operating in Delhi with impunity and in violation of the applicable guidelines.

The police has abetted the flagrant violation of Z‘s fundamental rights to life, liberty, privacy and dignity under Article 21 of the Constitution. A full-fledged inquiry be conducted by the police into the roles of SI Yogesh Kumar and HC Praveen in this entire matter.

Further, on the aspect of violations of the MHA, the Delhi Police appears to have left it to the Secretary (Health) Government of National Capital Territory of Delhi (GNCTD) who is apparently enquiring into the matter. The Court directs the Secretary (Health) GNCTD to share with the Delhi Police within four weeks the report of such enquiry and for the Delhi Police to take further action in accordance with law in terms of such report.

The Delhi Police shall prepare a manual detailing how to deal with cases under the MHA and, after 8th July 2018, the Mental Healthcare Act 2017. It must prepare a protocol in consultation with legal experts as well as experts in mental healthcare and spread awareness on the issue of mental health.

The Central and State Mental Health Authorities must, in collaboration with the Delhi Judicial Academy, hold programmes on periodic basis with civil society groups, Resident‘s Welfare Associations, Police Officers, lawyers and Judges to sensitize them about the various compliances under the MHA and its successor the Mental Healthcare Act 2017 and how to treat persons who are sought to be governed by the said legislation.

Z will be paid compensation as follows: Rs. 3 lakhs by CIMBS; Rs. 1 lakh each by Almas and the State and Rs. 3 lakhs by her parents. The compensation amounts will be paid by demand draft in Z‘s name (which has been withheld in this judgment for reasons of privacy) within four weeks from today and will be deposited by Z in her own account. Z will be free to utilize the amount in whichever way she deems fit. This will not preclude Z from seeking appropriate remedies in other proceedings in accordance with law.

Z‘s parents and brother will be continued to be bound down by their affidavits of undertaking to this Court that they will not come in the way of Z‘s peaceful existence and choices.

The criminal case arising out of FIR No. 231/2017 registered at PS Malviya Nagar will be decided by the concerned Courts in accordance with law uninfluenced by anything said in this order.