Chennai: Nine years after the Mental Healthcare Act, 2017, Tamil Nadu has framed regulations for enforceable standards for psychiatric hospitals, de-addiction centres and rehabilitation homes, with safeguards to prevent critically ill patients from being admitted to facilities incapable of managing medical emergencies.The Tamil Nadu State Mental Healthcare Regulations, 2026, notified by the State Mental Health Authority under the central law, classify facilities into five categories — standalone mental health establishments, psychiatry departments in medical colleges, psychiatric wards in multi-speciality hospitals, standalone de-addiction centres, and centres for psychosocial rehabilitation. They prescribe minimum norms for staffing, patient care, building safety, hygiene, records and protection of rights.A key safeguard concerns admission to standalone de-addiction centres, IMH director Dr M Maalaiappan said. Before admission, a psychiatrist must assess every person and decide whether the patient is fit for care at the centre or needs acute treatment elsewhere. People with severe mental illness, violent behaviour, suicidal tendencies or serious medical illness cannot be admitted to standalone de-addiction or psychosocial rehabilitation centres, according to the regulations. They must be referred to a registered clinical establishment or a mental health facility equipped for acute care.“The provision addresses a potentially dangerous gap in addiction care. Severe alcohol withdrawal, including delirium tremens, acute drug overdoses and extreme behavioural agitation are now medical as well as psychiatric emergencies,” he said.Such conditions can lead to seizures, aspiration, severe electrolyte imbalances and cardiovascular collapse. “Standalone de-addiction centres, especially those oriented towards counselling, psychosocial rehabilitation and long-term recovery, may not have the 24-hour intensive-care infrastructure, emergency crash carts, continuous multi-parameter monitoring or immediate access to acute medical specialists needed to handle life-threatening withdrawal,” he said.Acute stabilisation should happen at a general hospital or a multi-speciality medical facility with a psychiatry department, he added. Families, however, often approach the closest facility displaying a de-addiction sign without knowing whether it is equipped for emergency medical care.The regulations also mandate safe living conditions in all facilities, including adequate ventilation, lighting, bedding, drinking water, nutritious food, sanitation and fire-safety arrangements. Wards must provide at least six square metres per bed, while facilities must have one toilet for every eight patients and one bathroom for every 10.They need facilities to display registration certificates, treatment tariffs and a charter of patients’ rights in Tamil and English. Facilities must also provide a gender-neutral ward or dormitory for inpatients who do not wish to be placed in either male or female wards.Physical restraint may be used only when it is the sole means of preventing immediate harm. It requires psychiatric approval, documentation and intimation to the patient’s family member or nominated representative within 24 hours.All mental health establishments, except those under the Union government, must obtain permanent registration from the State Authority. The authority will also maintain a digital register of practising mental health professionals and update it every month.
