these conditions. Any definition of mental disorder in a new MHA in India must also recognise and reflect the different categories of mental disorder and the differing thresholds for treatment. This would not amount to merely emulating what exists elsewhere but would be a reflection of the reality of psychiatric practice. Difficulties with procedural rules in Indian MHA ‘87 India has a long tradition of families carrying out many of the responsibilities and duties that in a developed country would properly be the role of the social services. The primacy of family (and indeed friends) has been recognized in the MHA ’87 where except for patients who are detained by the police (Section 25) and prisoners who are diverted into the mental health system by court rulings (Sec 27, 29), most other applications for involuntary hospitalization become the responsibility of the family or friends of the patient. Despite the ready availability of the family to share the burden of caring for the mentally ill, the process of seeking and receiving treatment under the MHA ’87 is exceedingly arduous, appears to be more penal and less therapeutic, and can lead not only to isolation of patients and professional alike, but also stigmatize them (Trivedi 2002). Conversely, it is also not unknown for families/relatives to abandon patients in psychiatric institutions and never to take them back again (Trivedi, 2001). An MHA, by implicitly discouraging mentally ill patients’ and their families from using it due to procedural difficulties that it poses for users, will lead to increasing stigma for the patients and their families, thereby encourage the pursuit of alternative and dubious forms of ‘cures’ and may lead to desertion of the patients by their families. Recommendations for change a) A court based system: One of the many requirements of the new act should be the relative ease of navigation through it by patients, their carers and professionals. One of the major difficulties for relatives is accessing the judicial system, particularly if they are from rural backgrounds, ensuring in the process that the appropriate court having jurisdiction for the area where the patients hails from must be the one to be approached. Should a new act persevere with the legal-heavy approach of its predecessors, a major innovation could at least pave the way for a simplified process of admission. This could be achieved to a substantial degree by ensuring easy 109 A New Mental Act for India availability of the judiciary when it is needed. Just as there exists ‘lokadalats’ (although the rough and ready translation is ‘public courts’, the real meaning of the term is courts that are readily accessible by members of the public) for certain kinds of disputes, a similar arrangement could be made for mental health purposes. The experience of one non-governmental organization (NGO) suggests that such an innovation is possible within existing resources. This particular NGO, with unprecedented support from the local judicial system, was able to provide a magistrate on its premises, and more recently the chief justice of the Madras High Court inaugurated the world’s first permanent and continuous ‘lokadalat’ for mentally challenged persons at this site (Sridhar 2003). b) A doctor based system (quasi-legal model): An alternative strategy to the above and one that seeks to i) incorporate safeguards into the act, and ii) recognizes the special expertise of psychiatrists in the treatment of people with mental disorders, could form the basis of a new act, one that dramatically shifts the locus and focus of the act from courts and judges to hospitals and doctors respectively. Such an act would be accessible by patients and their families, easy to use, responsive to their needs, and involve handing powers to those professionals who actually treat the patients so that they can make applications (and indeed recommendations for eventual detention) should family members be unavailable or unwilling to do so. Such an approach will not only prevent any potential for abuse or desertion of patient by relatives, either during admission and/or discharge, but also make the decision making process much more transparent and clinically expedient. Psychiatrists are especially trained and skilled in the assessment and treatment of the mentally disordered. Beyond pandering to a school of thought that may apprehend abuse of powers, should certain members of the society be bestowed with legal authority to detain other members of public, there seems little logic and propriety that a judge make an order for admission (and discharge) when s/he is usually entirely dependent upon doctors, in order to arrive at this conclusion. The only exceptions must be cases where the patient is involved in the criminal justice system, either as an undertrial or convicted prisoner, and when he is a person of no known abode and has been detained by police. Such changes will attempt to reverse the tone of the current MHA being archaic, seemingly rooted in spirit to the asylum acts of the previous centuries, anachronistic and appearing to implicitly prioritise detention and custody over treatment.