Mental Healthcare Act 2017: what your hospital ERP must handle for psychiatry

Advance directives, nominated representatives, admission categories and treatment consent under the Mental Healthcare Act, 2017 — and the specific records a hospital system needs to keep for each.

By L.K. Monu Borkala, Founder, OneCity Technologies Pvt Ltd

The Mental Healthcare Act, 2017 reorganised how Indian hospitals treat patients with mental illness, shifting the default from institutional decision-making to patient autonomy wherever the patient retains capacity. For a hospital running general medical software, the Act introduces record-keeping obligations that a standard EMR simply wasn't built for — an Advance Directive that must be checked before treatment, a Nominated Representative whose authority is legally bounded, and an admission classification that determines whether external review is triggered at all.

Advance Directives: a legal document your EMR has to surface, not just store

Under Section 5 of the Act, any person can make an Advance Directive stating how they wish to be treated — or not treated — for a mental illness, and naming who should make decisions if they later lose capacity. The directive is registered with the Mental Health Review Board. The obligation on a hospital is specific: a treating psychiatrist must consult a patient's Advance Directive before treatment, and can only deviate from it with a documented reason reviewable by the Board.

Storing a PDF of the directive in a patient's file satisfies almost nothing here. The practical requirement is that the directive surfaces automatically at the point a treatment decision is made — before a prescription is written or a procedure is scheduled — not filed away where a busy resident has to remember to look for it.

Nominated Representatives: bounded authority, not a blank proxy

A Nominated Representative is a person the patient designates (or, in the absence of a designation, a relative or caregiver by statutory default) to receive information and participate in decisions during periods of reduced capacity. Their authority is not unlimited — it operates within whatever the patient's own Advance Directive already specifies, and does not override a patient's expressed wishes when that patient currently has capacity to decide.

Software needs to record who the Nominated Representative is, their relationship to the patient, and — critically — flag when a decision being recorded is being made by the representative rather than the patient directly, since that distinction has legal weight if the treatment is later reviewed.

Admission categories: most patients need no Board review at all

The Act is often assumed to require a Mental Health Review Board process for every psychiatric admission. It doesn't. There are three categories, and the review burden differs sharply:

• Voluntary admission — the patient consents directly. No Board involvement is required.
• Supported admission — for a patient unable to consent but not actively objecting. This requires independent medical assessment within a defined window and notification to the Board, but not prior approval.
• Admission the patient objects to — this is where full Board review applies before the admission can continue, precisely because the Act is designed to minimise coercive process rather than route every psychiatric admission through the same heavy mechanism.

A hospital system needs to capture which category applies at the point of admission, because that choice determines what deadline — if any — the record has to meet, and missing a supported-admission review window is a compliance gap even though no patient ever objected.

Restraint and seclusion: a separate, more restrictive log

The Act specifically restricts the use of restraint and seclusion and requires documentation distinct from ordinary clinical notes — the reason for the intervention, its duration, and the review that ended it. Treating this as just another nursing note loses the audit trail the Act expects a facility to be able to produce if the intervention is ever questioned.

Where OneCity fits

OneCity's patient registration and consent module supports Advance Directive storage with a treatment-time surfacing flag, Nominated Representative records tied to the decision log, and an admission-category field that tracks the review deadline each category triggers. The IPD module keeps restraint and seclusion entries as a distinct, separately-reportable log rather than folding them into general nursing notes.

None of this substitutes for a hospital's own psychiatric care protocols or its State Mental Health Authority registration — the Act's substantive obligations sit with the treating clinicians and the facility's governance. What the software can do is make sure the record a Board or an inspector asks for already exists in the right shape, rather than being reconstructed after the fact.