What is MENTAL HEALTH?

Mental health comprises of psychological, emotional, and social well-being. Our mental health influences the way we think, act and feel. The patterns of handling stress, ability to relate to others, to make choices, etc. make up mental health. It is essential at every stage of our life. Mental health determines our nature and temperament from childhood and adolescence throughout adult life.

What is MENTAL ILLNESS?

If we experience mental health problems at any point in life- the way of thinking, speaking, eating, sleeping, socializing, mood, etc. show changes. If a person has a mental illness, he/she shows conditions involving changes in emotion, thinking, or behavior, or a combination of these. Many factors contribute to mental health problems, such as biological factors like gene or brain chemistry, experiences related to trauma or abuse, mental health problems or family history. It is crucial to provide mental health support for nurses to help them manage these challenges effectively, given their demanding roles and the impact their mental health has on their ability to care for others.

Many people who have a mental illness do not wish to speak up or talk about the issue. Mental health problems can affect anyone regardless of their gender, geography, income, social stature race/ethnicity religion/spirituality, sexual orientation, social background, or other aspect of cultural identity.  Signs and symptoms of mental illness can vary, depending on the type of disorder, the circumstances that lead to it, and other factors. The symptoms show changes in emotions, thoughts and behaviors. Few examples of signs and symptoms of mental illness include: the feeling of sadness or feeling down/upset, the confused state of thinking, losing concentration, fearing or worrying intensively, extreme sense of guiltiness, the sudden and impetuous mood changes varying from high and low, isolating oneself from friends family and activities, sleep disorder, delusions paranoia or hallucinations, unable to cope with stress and daily routine, difficulty in understanding people and relating to situations, alcohol and drug abuse, sudden significant changes in eating habits, changes in sexual drive, spontaneous or excessive anger and violence, suicidal or self-harm thoughts. Sometimes mental illness symptoms can manifest as physical problems like stomach pain, back pain, headaches, unexpected and unexplained aches, pains, and difficulties.

The Mental Health Care Act 2017:

“The mental health care act is defined as an Act to provide for mental health care and services for persons with mental illness and to protect, promote and fulfill the rights of such persons during delivery of mental health care and services and for matters connected therewith or incidental thereto (Mental health care Act, 2017)”.

The mental health care act explicitly talks about patients’ rights with mental illness and lays down the ethical and legal responsibilities of mental health professionals and the government. The rights of people with mental illness are at par with the fundamental rights of human beings. They need to be clearly discussed as they belong to vulnerable groups from the evaluation, treatment, and research perspective. These rights are interpreted into the ethics of psychiatric care that relate to respect for autonomy, the principle of non-maleficence, beneficence, and justice, informed consent, boundary violations, confidentiality, etc.

Medico Legal Aspects:

The moral principles that guide medical practices are beneficence and non-maleficence, autonomy, justice, value and sanctity of human life, truth and integrity. To regulate the functioning of the hospitals assuming that their implementation will remove the inadequacies and malpractices, laws on various healthcare aspects have been enacted from time to time. Each hospital administrator must know his/her lawful rights and responsibilities concerning the hospital staff, employees, patients and visitors. One must have sufficient background and legal knowledge of hospital care in order to know when to seek professional legal advice. The medical legal experts should have basic knowledge on injury/accidents, negligence related to civil and criminal cases, malpractices, professional incompetency, ethical issues in human experimentation, organ transplants, sex determination and genetic counselling, euthanasia, ethical issues in sexually transmittable diseases etc. The medical legal experts should be aware of laws such as; Medical termination of Pregnancy Act, Pre-conception and Prenatal Diagnostic Technique Act, Registration of birth and Death, Medical Council of India Act, Organ Transplantation Act, Bombay Nursing Home Registration Act, Clinical Establishment Act, Labour Laws and the Medical Establishment, Shop and Establishment Act, Bio Medical Waste Management Act, Consumer Protection Act, Indian Penal Code.

Medico Legal Case:

A medico legal case is defined as a case of injury or illness where some investigation by law enforcement agencies is essential to establish and fix responsibility for the case by the law of the land. It is simply explained as a medical case with legal implications or a legal case that requires medical expertise. The causality doctor who attends the case, the doctor who has the first contact with the patient should prepare a Medico-Legal Case report. In rape cases, the rape victim is examined and the female doctor prepares the MLC. Indoor doctors can also make the report in cases where they think the case report was not made. The patient or their respective relatives request to tag a case MLC or not shall have no effect on the doctor’s decision. The cases that are treated as MLC are: all the cases related to trauma and burns concerning the circumstances, commission of an offence by somebody irrespective of suspicion of foul play, all vehicular and industrial accidents or other unnatural accident cases, especially when there is a chance of patients death or grievous hurt, electrocution cases, suspected or evident sexual assault or criminal abortion cases, the instances where unconsciousness cause is not natural or not clear, suspected or apparent poisoning or intoxication cases, referred from the court or otherwise for age estimation medical examination, someone brought dead with the wrong suspicion of an offence, the cases where comas cause could not be determined, suspected self-infliction of injuries or attempted suicide cases, starvation cases including hunger strike, the cases of unclaimed newly born, medical malpractice cases.

Mental Capacity and the Civil Law:

For a will to be legal an individual must be able to primarily understand what a will is, recollect nature and extent of own property, to remember and recognize relationship to living posterities and others who will be affected by will. Testimonial capacity comes into play when an impaired person appears in court to testify. The court may decide whether the individual lacks testimonial capacity. An individual’s capacity to sign a contract is to understand what a contract is and its consequences. To give proper consent, an individual must have the mental capacity to enter into a contract, to understand the transaction, to act voluntarily – free from threat or force. Concerning divorce and child custody, spouses of mentally ill patients may require a psychiatrist’s evidence in the matter of divorce for questioning the competence of mentally-ill parents to care for their children. A need for guardianships is required when basic civil rights are removed, when we loss function in multiple arenas- making very poor decisions and lack of insight into deficits, if there is no expectation to recover, if they have clear and convincing evidence, beyond reasonable doubt, if it is considered as the last resort.

We need to be fearful yet cautious while evaluating and treating them and should be aware of the legal angle, ultimately boiling down to the ethical aspects. It is vital that the fear of being accused of “violation of rights” should not prevent us from providing sound and ethical psychiatric care in the best interest of the PWMI responding to the caregivers’ concerns, especially the parents who bear the brunt of a patient’s illness.  All the medical ethics approaches are that they are empirical, legal, sociological, theological, or philosophical. It should all aim at being practically useful. The value of good medical ethics is to inform and guide those who are directly involved in moral issues in medicine and healthcare. This means that good medical ethics is clinically relevant. The medical ethics must not become archaic impractical laws, but scientifically sound and implementable guidelines considering the ethos, and they should always be updated.

REFERENCES:

sedky, mohammed. (2017). medico legal approach of the psychiatric patients. https://www.slideshare.net/mohamedsedky39/medico-legal-approach-of-the-psychiatric-patient.

sharma, dr. loveleen. (2013). MEDICO LEGAL ASPECTS OF HEALTH CARE. https://www.slideshare.net/loveleenS/medicolegal-aspects-of-healthcare.

parekh, ranna. (2018). What Is Mental Illness? https://www.psychiatry.org/patients-families/what-is-mental-illness.

bipeta, rajshekar. (2019). Legal and Ethical Aspects of Mental Health Care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436399/.

guttmacher, manfred s. (1941). The Medicolegal Aspects of Mental Disease.