Medicolegal aspects in the management of mentally ill patients

Dr DG Bagal and  Dr Uttara Agale
Dept.of Repertory
YMTHMC Navi Mumbai

Abstract
Mental illness also called mental health disorders, refers to a wide range of mental health conditions or disorders that affect mood, thinking, and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders, and addictive behaviors.[1]

It is often not permanent, as its effects are not consistent over time and can be treated.

Homoeopathy being owe holistic science has the major scope in treating such patients as compared to modern medicine, which have almost same medicine for every patient of a group of disorders. Homoeopathy treats the patient with individualistic approach.[4]

This article deals with the explanation of psychiatric patients, their rules and regulations to be followed by every physician while treating them along with the measures taken by the physician to safeguard their rights and to make them strengthen their bond in society.

Keywords – Mental illness, Homoeopathy, Mental Health Act

Introduction – Mental illness also called as mental health disorders, refers to a wide range of mental health conditions or disorders that affect mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and additive behaviors.[1]

Patients comes to our OPD are of the three types-

  1. Cooperative
  2. Non cooperative
  3. Violent 
  4. Seriously ill patients unable to understand anything [4]

It is the first and foremost duty of physician to- 

  1. Respect the patients as individuals
  2. Maintaining privacy and confidentiality about the patients information
  3. Seek information about patient from relatives and not to believe blindly on relatives
  4. Patient has right to refuse a therapeutic intervention
  5. A physician should never label as patient as mad or psychic or any such terms which can cause stigma and can cause the patient to feel ashamed or forsaken. 

Legal aspects needed to be done before treating a patient.

  1. Informed consent – Informed written consent from patient is to be taken in English or his vernacular language along with a witness of the patient (Guardian/Parents/Relatives)
  2. Rights to treatment- Every patient ha right to take treatment from the physician as well as patient come during treatment also.
  3. Confidentiality – The physician should maintain the confidentiality of information and should council the patient and relatives separately.
  4. Therapeutic misconception- It means a view or opinion that is incorrect means many times people label a person psychic but he/she is not that. In this many times patients behaves that they will receive a therapy but they are not knowing that they are enrolled for clinical study.
  5. Exploration – These patients generally fall play or victimized of abuse and criminal activity.
  6. Conflict of interest – It means the one who is seeking to treat the mentally ill patient has some sort of legal interest with patient.

So physician need to protect patients rights and safeguard his place.

In India to protect, promote and fulfill the rights of such persons during delivery of mental health care and services an act is amended which is called as 

MENTAL HEALTH ACT 2017.

If we see the prevalence in India about 95-100 are mentally ill in 1000 of 

population.[1]  [2]  [3]

Features of the ACT-

  1. Every person except minor has right to take advance directive by writing.
  2. It empowers the patient to choose his/her treatment and appoint a representative to take decision on behalf of patient.
  3. If patient is minor, his/her parent or care giver will act as representative.
  4. It will not be applicable at the time of emergency.
  5. It is the duty of every physician to plan treatment, keeping advance directive in mind.
  6. It is the right of mentally ill patient to live with dignity.
  7. The patient have right of confidentiality.
  8. Mentally ill patients who require treatment beyond 30 days should reviewed by two psychiatrist.
  9. Professionals conducting research should take sign in informed consent of mentally ill person and from board.

A Mental Health Review Board is comprised of-   

  • District judge
  • Two members (Two members of whom one shall be a psychiatrist and the other shall be a physician. The above two members shall be persons representing organizations of persons with mental illness.)

Unauthorized institutions or which are not registered by government will be punished  5000-50000 for first time, up to 2 lakhs for second time.

  1. This ACT mentions that every patient can get medical insurance provisions and treatment. 
  2. This ACT abolished the ECT for children and made provisions for giving modified ECT.
  3. This ACT also included AYUSH doctors but did not included Mental Health nurse, psychologist as professionals. [1]  [2]  [3]

Homoeopathic therapeutics of mental illness- 

  1. Aconite – Homeopathy practitioners recommend aconite for intense, sudden anxiety, panic, or fear. Panic could be connected to past trauma. Symptoms of this type of panic include dry skin, dry mouth, and fast heart beat.[5]
  2. Argentum nitricum -This is sometimes recommended for people with anxiety that is due to uncertainty. This includes claustrophobia, hypochondria, fear of heights, or fear of everyday things. Uncertainty-based anxiety could be accompanied with digestive disturbance, like diarrhea, and sweets cravings.[5]
  3. Arsenicum album- This is purported to be for anxiety due to fear of loneliness, darkness, or being imperfect. People with this type of anxiety fear being alone and may relieve anxiety through control or criticism of others. They may also feel cold often.[5]
  4. Ignatia – Homeopaths recommend ignatia for those experiencing anxiety from grief or loss. People who fit this description are often very sensitive and prone to mood swings, moving from laughter to tears. Ignatia is also recommended for depression.[5]
  5. Kali arsenicosum- This is for anxiety that is health-based. Conditions include hypochondria, excessive grooming, and even fear of heart attacks. People with health-based anxiety may have racing thoughts and difficulty sleeping. They may also fear death or dying. They can be prone to feeling cold and vulnerable to panic attacks.[5]
  6. Stramonium- This is for anxiety that also includes night terrors, nightmares, or dark thoughts while awake. People with this type of anxiety are often scared of the dark or being alone and are especially scared by thoughts of monsters or mysterious figures. Their imaginations tend to worsen their anxiety.[5]

Bibliography- 

  1. http://www.prsindia.org
  2. http://www.slideshare.net/mobile/Soumyaranjanparida/mental-health-care-act-2017
  3. http://www.healthline.com/health/homeopathy-for-anxiety 
  4. Prof Dr. Shashi Kant Tiwari, Essential of Repertorization, 5th edition, case taking in psychiatric patients
  5. Dr.William Boericke, Boericke’s New Manual Of Homoeopathic Material Medica With Repertory

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