Mohan Ashwin, Math Suresh Bada
Euzen Mental Health Clinic, Chandigarh, India.
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Indian J Psychiatry. 2019 Apr;61(Suppl 4):S744-S749. doi: 10.4103/psychiatry.IndianJPsychiatry_114_19.
The Mental Healthcare Act (MHCA) 2017 has been recently enacted with the objectives of providing mental health services and securing of rights of the persons with mental illness. Mental conditions due to abuse of alcohol or drugs have been included in the definition of mental illness. However, these conditions present some unique and difficult problems due to their very nature. Despite being an integral part of psychiatry, these disorders have traditionally been dealt with separately and even treated in dedicated facilities such as deaddiction centers and rehabilitation centers. In fact, some states have separate rules for treatment delivery of these disorders. Addiction also has major legal ramifications that are dealt with other acts such as the Narcotic Drugs and Psychotropic Substances Act (NDPSA). With this background, this article focuses on the issues of capacity and informed consent specific to addiction, addresses the admission issues in addiction including the issue of coerced treatment, and the treatment facilities, and deals with the some of the discordance and inconsistency between the NDPSA and the MHCA 2017. We believe that addiction-related provisions have not been addressed adequately in the MHCA 2017, and detailed procedures specific to addiction and its treatment will be required if the MHCA 2017 has to be implemented both in letter and in spirit.
2017年《精神卫生保健法》(MHCA)最近已颁布,其目标是提供精神卫生服务并保障精神疾病患者的权利。因酗酒或吸毒导致的精神状况已被纳入精神疾病的定义。然而,由于其本质,这些状况存在一些独特且棘手的问题。尽管这些疾病是精神病学的一个组成部分,但传统上它们是分开处理的,甚至在戒毒中心和康复中心等专门机构进行治疗。事实上,一些邦对这些疾病的治疗有单独的规定。成瘾还具有重大的法律后果,需依据《麻醉药品和精神药物法》(NDPSA)等其他法律来处理。在此背景下,本文重点关注成瘾特有的行为能力和知情同意问题,探讨成瘾治疗中的收治问题,包括强制治疗问题以及治疗机构,并处理NDPSA与2017年MHCA之间的一些不一致和不协调之处。我们认为,2017年MHCA中与成瘾相关的条款未得到充分阐述,如果要全面落实2017年MHCA,将需要制定成瘾及其治疗的详细程序。