Supported Admission and Discharge

The supported mode of admission and discharge means that the person being admitted does not have the capacity to make mental health care decisions, or requires very high support. All admissions in a mental health care establishment should be independent, except when supported admission is necessary¹.

Supported Admission for 1 month

Criteria and Procedure for Admission

The nominated representative must make an application to the mental health professional in-charge of the establishment. The criteria is as follows:².

• A psychiatrist and a mental health professional/medical practitioner have examined the person within the last 7 days. Additionally, both must conclude that the mental illness is severe enough that they have recently:
  • Attempted/threatened to cause physical harm to themselves
  • Behaved violently towards someone else or have caused someone else to fear physical harm
  • Shown an inability to care for themselves to the extent that they pose a harm to themselves
• The professional certifies (after considering the advance directive) that admission to the establishment is the least restrictive care option possible
• The person is ineligible to be an independent patient due to inability to make treatment decisions independently and requirement of a very high support from their nominated representative.

Treatment

Before treatment, the following is considered:³

• An advance directive, if any
• Informed consent (i.e. permission given after complete knowledge of the treatment and its consequences). If the person is not able to give informed consent, the nominated representative may do so on their behalf⁴. In such a case, the consent must be recorded in the medical records by the professional in-charge. Additionally, the professional must review the person’s capacity to give consent every 7 days⁵.

Discharge 

Once the person stops meeting the criteria mentioned above, they may be discharged from the establishment. The professional must inform them/their nominated representative⁶.

For the next 7 days after discharge, they cannot be readmitted⁷. If these conditions are not met, they may remain in the establishment as a patient.⁶

Supported Admission for more than 1 month

Criteria and Procedure for Admission

If the person requires continuous treatment beyond 30 days or has to be readmitted within 7 days of discharge, the nominated representative must make an application to the professional in-charge. The professional will continue admission of the person if⁸:

• Two psychiatrists have examined them independently within the last 7 days. Additionally, both conclude that the mental illness is severe enough that the person has consistently over time:
  • Attempted/threatened to cause physical harm to themselves
  • Behaved violently towards someone else or caused  someone else to fear physical harm
  • Shown an inability to care for themselves to the extent that they poses a harm to themselves
• Both the psychiatrists certify (after considering the advance directive) that admission to the establishment is the least restrictive care option possible.
• The person is ineligible to be an independent patient due to inability to make treatment decisions independently and requirement of a very high support from their nominated representative.

The Mental Health Review Board must review and permit such an admission⁹. The admission is for 90 days¹⁰. It can be extended to 120 days at the first instance, and after that, to 180 days at every instance, as required, with the Mental Health Review Board’s permission¹¹.

Treatment 

Before treatment, the following is considered:¹²

• The advance directive, if any
• Informed consent (i.e. permission given after complete knowledge of the treatment and its consequences). If the person is not able to give informed consent, their nominated representative may do so on their behalf¹³, and in such a case, the consent must be recorded in the medical records by the professional, who must also review the person’s capacity to give consent every 15 days¹⁴.

Discharge 

Once the professional believes that the person has stopped meeting the criteria mentioned above, they will be discharged from the establishment, and the person and their nominated representative must be informed¹⁵. However, they may remain in the establishment as an independent patient.¹⁶

1. Section 85(2), the Mental Healthcare Act, 2017. [↩]
2. Section 89(1), the Mental Healthcare Act, 2017. [↩]
3. Section 89(6), the Mental Healthcare Act, 2017. [↩]
4. Section 89(7), the Mental Healthcare Act, 2017. [↩]
5. Section 89(8), the Mental Healthcare Act, 2017. [↩]
6. Section 89(5), the Mental Healthcare Act, 2017. [↩] [↩]
7. Section 89(15), the Mental Healthcare Act, 2017. [↩]
8. Section 90(2), the Mental Healthcare Act, 2017. [↩]
9. Section 90(4), the Mental Healthcare Act, 2017. [↩]
10. Section 90(8), the Mental Healthcare Act, 2017. [↩]
11. Section 90(9), the Mental Healthcare Act, 2017. [↩]
12. Section 90(11), the Mental Healthcare Act, 2017. [↩]
13. Section 90(12), the Mental Healthcare Act, 2017. [↩]
14. Section 90(13), the Mental Healthcare Act, 2017. [↩]
15. Section 90(15), the Mental Healthcare Act, 2017. [↩]
16. Section 90(16), the Mental Healthcare Act, 2017. [↩]