A New Mental Act for India ‘best interest’ principle must be the minimum effective intervention. Assessment orders should not be renewable and must be either followed by a treatment order or by discharge from hospital. MHA ’87 does not appear to make a distinction between assessment and treatment orders. Section 21 order for ‘admission under special circumstances’ comes closest to an assessment order but allows treatment under clause 2 (Mental Health Act 1987, p 15). necessary for members of hospital staff for brief periods of time as senior psychiatrists can often be unavailable (during nights, for instance). A time period of 48-72 hours is a reasonable time frame within which arrangements must be made by the treating hospital for statutory assessment to determine further detainability. Nursing powers must be less than that of junior doctors in terms of the length of time that a patients can be detained for so as to reflect the differences in legal responsibility of the two professions. Treatment orders for civil patients: Orders for mentally disordered offenders: Treatment orders must extend for periods longer than that of assessment orders. In many countries the initial order is for a period of 6 months and is renewable thereafter; six months in the first instance and then for periods of one year (Jones 2003). A separate order must be available to cover for contingencies where patients need swift admission from the community and insufficient time is available to arrange a proper assessment. Such an order (an emergency order) can be made by any doctor (not necessarily a psychiatrist in recognition of the necessary expediency) and a relative/social worker but should not exceed for more than 48-72 hours. This would allow the necessary time to convey the patient to hospital and arrangements to be made for conversion into an assessment order (if still felt to be necessary). The emergency order will allow rapid institution of treatment for patients who require swift removal from the community. The equivalent of a treatment order in the Indian MHA ’87 is a ‘reception order’ although there is no specific time frame for it, the order tending to run indefinitely, until a decision to discharge is made (Mental Health Act 1987, p 19). There is no equivalent to an emergency order in the MHA ’87. Holding powers: There are occasions when patients having agreed to voluntary admission initially, refuse to remain in hospital, against professional opinion. In such cases it has most often been the case in India that patients are discharged against medical advice (DAMA), a term that many would be familiar with. This practice is unethical and often allows a vulnerable, needy (of appropriate treatment), and potentially dangerous patient to be at large in the community. A decision to DAMA can only be legally defensible if the patient does not meet the statutory criteria for detention at point of discharge. If he does, then either the duty doctor or the nurse in charge of the ward must have powers to hold the patients until such time that a detailed assessment under the act is possible. Such holding powers are 111 There are two categories of patients that are involved in the criminal justice system, those who have been convicted, and the undertrials. Whilst the former have been tried and found guilty, the latter must be considered innocent until proven guilty. Different orders for transfer to a psychiatric facility must be available to reflect this difference in legal status. Due to the involvement in the criminal justice process orders for transfers to psychiatric hospitals must be made by judges trying their cases in courts and not anybody else. Similar types of orders as exist for civil patients,like assessment, treatment and urgent treatment can be created for this category of patients. In view of the security that such patients would require, certain hospitals can be identified in advance so that the judge can direct the patient there, rather than to a general hospital psychiatric ward with little or no security, for instance. The security of such places can either be provided by the police or nursing staff. The former option allows therapeutic relationship between staff and the patient to develop and hopefully flourish, but brings with it the presence of policemen in a clinical setting with obvious implications for privacy, stigma and inadvertent anxiety to other patients. The latter option does not carry these disadvantages but requires training nursing staff in security measures and providing secure wards. Experience within maximum secure hospitals in England seems to favour the later option. However, any parole outside of locked wards or discharge from hospital must be decisions that are made by the judiciary or nominated substitutes of the judiciary, e.g. the state home ministry. Any unreasonable delay in making such decisions can also be a subject for scrutiny by an independent tribunal in order to minimize the effects of bureaucratic red-tape. Consent to treatment While detaining a patient under a mental health act will allow treatment to be provided to him under the aegis of