act 010 of 2017 : Minimum Standards of Care for Centres etc. Rehabilitation, 2018

Section 1. Short title and commencement

(1) These regulations will be called Minimum Standards of Care for Centres Providing Substance use Disorder Treatment and Rehabilitation, 2018

(2) They will come into force on the date of the publication in Official Gazette.

Section 2. Definition

(1) In these regulations unless the context otherwise requires,

(a) Act means Mental Healthcare Act, 2017 .

(b) Forms as prescribed in The Mental Healthcare Act, 2017

(c) Section means section of The Mental Healthcare Act, 2017

(d) Counselor is a person trained to give guidance on personal or psychological problems, with minimum qualification being graduate in Clinical Psychology/Psychology or Social Work and with 6 month experience in De-addiction services.

(2) The words and expression used herein and not defined, but defined in the Act or as the case may be, in the Mental Healthcare Act, 2017, in so far as they are not inconsistent with the provisions of the Act, shall have the meanings as assigned to them in the Act or, as a case may be in those enactments.

Chapter II

INTRODUCTION AND BACKGROUND

Section 3.

3. Centres providing substance use disorder treatment and rehabilitation, commonly known as Deaddiction Centres , range from Acute Detoxification centres to long term care/Rehabilitation centres, and as per MHA, 2017 are Mental Health Establishment's (MHE's) mandatorily requiring registration. These MHE's offering deaddiction services need to maintain the minimum standards prescribed by the State Mental Health Authority (SMHA).

Section 4.

4. Section 65(3) of the Mental Health Care Act, 2017 empowers existing State Mental Health Authority for provisionally registering all Mental Health Establishments and specify the minimum standards for different mental health establishments.

Section 5.

5. Section 65(5) of the said Act, provides for classifying various mental health establishments by State Mental Health Authority and specify different standards for different categories.

Chapter III

Section 6. Categorisation of Substance Use Disorders Treatment and Rehabilitation Centres

(1) The substance use disorders treatment and rehabilitation centres provide one or more of the following services:

a. Acute Detoxification

b. Treatment of existing mental disorders and other co-morbidities

c. Counselling and Motivational Enhancement

d. Awareness and Patient Education

e. Vocational Skills and Rehabilitation

f. Long Term Care/Rehabilitation

(2) Depending upon the spectrum of services provided and the size of such mental health establishments providing such care, these establishment necessitate to be categorised into the following sub-categories for the purpose of prescribing the minimum standards:

a) Short Term Treatment including detoxification centre for drug abuse (< 1 month): Facility, where patients of substance abuse shall be kept and treated for symptoms of substance withdrawal and/or overdose. For this purpose, detoxification is a set of interventions aimed at managing acute intoxication and withdrawal.

b) Long Term Treatment Rehabilitation Centre (1 month or more) Here the substance use patients can be kept for more than 1 month with the focus on life skills and vocational training.

c) Treatment Centre for drug abuse and other mental disorders for patients with co-existing psychiatric disorder (Dual Diagnosis facility): Dual Diagnosis here means Substance Use Disorders present along with Psychiatric Diagnoses (not to be confused with medical co morbidities)

(3) All these facilities have been further subcategorised keeping in view the number of beds/capacity:

- Upto 20 beds

- 21-50 beds

- More than 50 beds

(4) The present standards have been formulated keeping in mind:

a. Patient Safety

b. Human rights of Patients

c. Medical and psychosocial care standards

d. Ensuring quality care

e. Humane, friendly enabling environment

f. Other contextual local factors.

(5) These facilities are expected to provide a friendly environment, rather than a restrictive atmosphere and are expected to provide facilities for recreation, indoor and outdoor games, outings, family visits, and other recreational tools.

(6) These minimum standards will be reviewed periodically every two years.

Chapter IV

Section 7. Minimum Standards of Care for Substance Use Disorders Treatment and Rehabilitation Centres

(1) The minimum standards for various sub-categories of facilities are depicted in Annexure 1. The standards have been devised to strike an appropriate balance between respectable quality medico-psycho-social care, safety and optimal functioning of the centres.

(2) It is intended that these standards shall provide essential structure to the functioning of substance use treatment centres. In view of the large need of such services and the treatment gap, these standards have been kept to the minimum and only indicative of the basic requirement for these centres in terms of infrastructure and human resource requirements. These minimum standards will be applicable for all government, private and Non Governmental Organization (NGO) facilities working in the field of drug abuse and detoxification in the State of Delhi.

(3) Psychiatric Nursing Homes/Hospitals licensed under Mental Health Act, 2017 providing detoxification facilities shall also maintain the prescribed minimum standards.

(4) Standards of Ministry of Social Justice and Empowerment 2009, AIIMS Deaddiction Centre Guidelines and Draft of SMHA Minimum Standards were consulted and deliberated for drafting the minimum standards keeping in view the local requirements.

Annexure 1

Minimum Standards of various subcategories of Substance use disorder Treatment and Rehabilitation Facilities

Type of Facility	Short Term Treatment including detoxification centre for drug abuse (< 1 month)	Long Term Treatment Rehabilitation Centre (1 month or more)	Treatment Centre for drug abuse and other mental disorders
Requirement
1	2	3	4
A. Physical Infrastructure
A1. Living and Physical space (situated at an easily accessible place ensuring safety and security of patients with proper ventilation and sanitation facility)	Minimum patient/Ward area of 60 sq. feet per bed including adequate area for recreational facilities, therapies, counselling, follow-up/OPD etc. Minimum facility built up of 2000 Sq Feet for 20 patients	60 Sq. Feet per bed Including adequate area for recreational facilities therapies, counselling etc.	Minimum patient/Ward area of 60 sq. feet per bed including adequate area for recreational facilities, therapies, counselling, follow-up/OPD etc.
	Children and adolescents are to be segregated from Adult patients	Children and adolescents are to be segregated from Adult patients	Children and adolescents are to be segregated from Adult patients
	Facility for safe keep of personal belongings of patients	Facility for safe keep of personal belongings of patients	Facility for safe keep of personal belongings of patients
B. Human Resources
B1. Trained Physician/Medical care*	Part time and available on call	Part time and available on call	Part time and available on call
*Minimum qualification Graduate degree (as per the system of allopathic/AYUSH medicine) along with registration with the concerned Medical Council	If patients with overdose are admitted, the doctor has to be available round the clock.
	Gynaecologist on Call for facilities admitting Females Paediatrician on Call for facilities admitting Minors
B2. Psychiatrist Minimum Qualification Diploma/MD/equivalent in Psychiatry/Psychological Medicine along with registration with the Medical Council.	Part time and available on call	Access to Psychiatrist on call	Visiting Psychiatrist with daily visits
B3. Counsellors Minimum qualification graduate in Clinical Psychology/Psychology/Social Work Experience of working for 6 months in De-addiction services	Full time 1 for every 30 beds or part thereof	Full time 1 for every 30 beds or part thereof	Full time 1 for every 30 beds or part thereof
B4. Social workers & Persons in Recovery	Not Mandatory	Regular 1 for upto 20 beds 2 for 21-50 beds 3 for 51 beds or more	Not Mandatory
B5. Nursing staff Nos. (To be as per Nursing Council norms)	At least 1 nursing staff to be available round the clock	As per requirement	At least 1 nursing staff to be available round the clock
Minimum qualification	GNM	GNM	GNM
B6A. Vocational trainers	Not Mandatory for facility for Adults Mandatory for facilities for Minors	Preferable as per requirement	As per requirement
B6B. Yoga trainers	Not Mandatory	Preferable as per requirement	As per requirement
B7. Support Services/Staff (Sanitation, Security, attendants. Clerical and managerial staff etc.)	As per requirement, In-house or outsourcing arrangement Female attendants to be available around the clock for facilities admitting Females and/or Minors	As per requirement, In-house or outsourcing arrangement	As per requirement, In-house or outsourcing arrangement
B8. Laboratory services	Essential either in house/outsourcing arrangement	Not mandatory	Essential either in house/outsourcing arrangement
C. Services
C1. Registration	Essential Every patients' details to be recorded and each patient to get a unique ID	Essential Every patients' details to be recorded and each patient to get a unique ID	Essential Every patients' details to be recorded and each patient to get a unique ID
C2. Inpatient Treatment	Every patient to be seen by the doctor every day of the stay at least once and on SOS basis. Availability of isolation facility to reduce transmission of communicable diseases/infection	Every patient to be seen by the doctor at least once per week during the stay or on SOS basis.	Every patient to be seen by the doctor every day of the stay at least once or on SOS basis.
C3. Emergency services	Linkage/network with a hospital with 24 hour emergency medical facilities	Linkage/network with a hospital with 24 hour emergency medical facilities	Linkage/network with a hospital with 24 hour emergency medical facilities
C4. Dispensing of medications (Pharmacotherapy)	Only on prescription by the doctor and by the staff authorized to dispense	Only on prescription by the doctor and by the staff authorized to dispense.	Only on prescription by the doctor and by the staff authorized to dispense
C5. Psychosocial interventions	As per requirement, to be delivered by the qualified personnel	As per requirement, to be delivered by the qualified personnel	As per requirement, to be delivered by the qualified personnel
C6. Referral/Consultation/Liaison/Legal/Ambulance Services	Formal arrangements with concerned agencies/organisations/professionals	Formal arrangements with concerned agencies/organisations/professionals	Formal arrangements with concerned agencies/organisations/professionals
C7. Diet/food	Patients should have access to wholesome food and daily dietary requirements (If an in-house kitchen is maintained, appropriate regulatory norms must be followed) Special Nutritional needs to be assessed by Paediatrician/Dietician in case of Facilities admitting Minors.	Patients should have access to wholesome food and daily dietary requirements (If an in-house kitchen is maintained, appropriate regulatory norms must be followed) Special Nutritional needs to be assessed by Paediatrician/Dietician in case of Facilities admitting Minors.	Patients should have access to wholesome food and daily dietary requirements (If an in-house kitchen is maintained, appropriate regulatory norms must be followed)
C8. Record maintenance A. Mode of Records	Manual or digital ensuring confidentiality as per provisions of MHA 2017	Manual or digital ensuring confidentiality as per provisions of MHA 2017	Manual or digital ensuring confidentiality as per provisions of MHA 2017
B. Institutional Policy for confidentiality and record keeping	In place	In place	In place
C. Mandatory records to be maintained	i. Patient register	i. Patient register	i. Patient register
	ii. Patients assessment formats.	ii. Patients assessment formats	ii. Patients assessment formats
	iii. Signed Consent forms	iii. Signed Consent forms	iii. Signed Consent forms
	iv. Doctors' Prescription	iv. Doctors' Prescription	iv. Doctors' Prescription
	v. Medication related records	v. Medication related records	v. Medication related records
	vi. Records of psychosocial intervention	vi. Records of psychosocial intervention	vi. Records of psychosocial intervention
	vii. Discharge slip/summary	vii. Discharge slip/summary	vii. Discharge slip/summary
	viii. Medication related records as per the Drugs and Cosmetics Act, 1938 and Rules thereunder	viii. Medication related records as per the Drugs and Cosmetics Act, 1938 and Rules thereunder	viii. Medicationrelated records as per the Drugs and Cosmetics Act, 1938 and Rules thereunder
	ix. Records to be maintained as per other applicable Acts such as JJ Act/POCSO etc. in case of Minors.	ix. Records to be maintained as per other applicable Acts such as JJ Act/POCSO etc. in case of Minors.	ix. Records to be maintained as per other applicable Acts such as JJ Act/POCSO etc. in case of Minors.
Other Common minimum standards	D1. As per the MHA 2017, maintenance of minimum standards is the responsibility of the organization seeking registration.
	D2. The critical issue of informed written consent for admission will be as per the provisions of MHA, 2017 and the Rules thereof.
	D3. Patients should be given adequate information about the patient rights, services, rules, charges, grievance redressal systems etc. at the time of admission and relevant information in this regard should be prominently displayed at the location of registration/intake.
	D4. Services should be addressed to the needs of the special/socially vulnerable population groups (Children, Women, Senior Citizens, Transgenders) incorporating gender and age sensitivities in addiction and related stress management.
	D5. In case the facility provide services to children in need of care and protection, the services should be in consonance with the facility illustrated in the Juvenile Justice Rules, 2016 and guidelines issued by the Government from time to time.
	D6. The facility shall submit periodical returns as may be prescribed from time to time by Government/SMHA.
	D7. Provisions of all other applicable Acts/Rules for operating the facility shall be applicable.

1. Deptt. of Health and Family Welfare, Noti. No. F. No. 10/51/SMHA/IHBAS/2018/255, dated September 18, 2018, and published in the Delhi Gazette, Extra., Part IV, dated 19th September, 2018, pp. 7-12, No. 188.

Minimum Standards of Care for Centres etc. Rehabilitation, 2018