instance), before arrangements are made to provide treatment under the aegis of the mental health act. If treatment is not required on an urgent basis, then it can only be given under statutory orders of a mental health act. Whether unmodified ECT should be pursued is a matter for the Indian psychiatric fraternity to deliberate upon. Whilst there are short term gains for the individual who is in need of urgent ECT treatment, the fear and stigma that forcible treatment of this nature can create will in the longer run deter all but the most courageous of patients to approach psychiatrists in future for treatment. The above guidelines seek to ensure proper legal and ethical checks whilst allowing necessary treatments to be provided. Hence, whilst a tribunal acts as the legal checkpoint to test the validity of detention, second opinion and consent to treatment acts as a clinical checkpoint to ensure the delivery of high quality treatment, whilst simultaneously respecting the patient’s autonomy (to refuse treatment). As additional guideline to practicing psychiatrists, the various mental health authorities can specify treatments for which sufficient and rigorous data exists, and one that a reasonable body of medical opinion skilled in the particular form of treatment in question would use under the circumstance (Re F 1990). Thus if a majority (more than half) of Indian psychiatrists favour the use of unmodified ECT then that position should be steadfastly adhered to, only if rigorous data of the highest order can demonstrate that there is no significant disadvantages in unmodified over modified ECT. Equally relevant to this debate is the view of the patients and their families and a proper balance must be sought. For instance, tubal ligation and/or vasectomy are effective ways to control an ever burgeoning population such as India’s but to achieve population control one cannot forcibly use these procedures on non-consenting subjects even if the outcome would be beneficial to them and the society at large. Similar arguments can be made in relation to the use of unmodified ECT for those deemed to be in need of it. A New Mental Act for India of insight, can be relatively resistant to treatment and demonstrate probably higher rates of violence directed towards self and/or others. They constitute the most severely ill and therefore in need of assertive follow-up when discharged from hospitals. Whilst provision of any community care is worthwhile, these patients (and their families) can ethically demand in a compensatory manner a higher quality of follow-up than what may be routinely provided. Such demands, were they to be made, would be just as under a principle of reciprocity, one ought to provide better standards of care than usual to those whose liberties have been stripped. It would be desirable for the new act to specify that all those who have been detained must be provided compulsory community care under the provisions of the National Mental Health Programme [NMHP] (Department of Health and Family Welfare 1982). Failure to provide such care can highlight deficiencies in service availability and put pressure on government agencies to fill such lacunae in health care delivery. Community care can be made a reality in India by means such as exploration of the role of NGOs, local self governments institutions (Panchayati Raj Institutions) and the potential for partnerships between the public and private sectors in delivery of mental health services (Lal and Vashisht 2002). The right to have access to treatment in community under the NMHP and National Health Policy can be interwoven into a new mental health act such that the act does not stand in isolation but is intricately interlinked with government policies. One of the many drawbacks of MHA ’87 is its relative isolation from governmental health strategies and policies. Reversing this trend will not only help provide seamless and continuous health care services to patients (including support and information to their families) but also seek to make the act more a relevant and powerful tool for its users (primarily mental health professionals) and its intended beneficiaries (the patients), not least through its ability to destigmatise the pursuit of mental healthcare. Integration with government’s health policies Conclusions The treatment of a person does not end when he leaves the safety of hospital. The lack of meaningful community health services for psychiatric patients in developing countries (WHO 2001) means that they become non- compliant relatively quickly and hasten rapidly towards relapse, whereupon they may be brought back to hospitals under detention again. We have a special duty towards patients who have been detained, more so than others. Those that have required involuntary detention suffer from a more virulent form of disorder, have greater disturbance There is a need for a new mental health act for India. There are multiple deficiencies in the current act of 1987. These deficits are primarily due to the act being court and judiciary centered with the attendant problems of bureaucracy, delays and complications due to the enormous pressure on Indian judiciary. The current act gives little or no recognition to the ethical principles of autonomy and reciprocity (providing as good care as possible for persons whose liberty has been curtailed) and appears to prioritise custody over any meaningful treatment of the patient. 113