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Int J Ment Health Syst. 2019 Oct 24;13:67. doi: 10.1186/s13033-019-0322-7. eCollection 2019.

Comparing legislation for involuntary admission and treatment of mental illness in four South Asian countries.

Author information

1Waikato Hospital, Waikato District Health Board, 222 Pembroke Street, Hamilton, 3240 New Zealand.
2Waikato Clinical Campus Waikato DHB, Auckland University, Auckland, New Zealand.
3Auckland University of Technology, Auckland, New Zealand.
District General Hospital, Matara, Sri Lanka.
5Teaching Hospital, Galle, Sri Lanka.
Psychiatric Nursing Home Trust, Kolkata, West Bengal India.
7School of Public Health, Independent University, Dhaka, Bangladesh.
Department of Child, Adolescent and Family Psychiatry, National Institute of Mental Health, Agargaon, Dhaka, Bangladesh.
9Waikato Hospital, Hamilton, New Zealand.
10Al Nafees Medical College, ISRA University, Islamabad, Pakistan.



Involuntary admission or treatment for the management of mental illness is a relatively common practice worldwide. Enabling legislation exists in most developed and high-income countries. A few of these countries have attempted to align their legislation with the United Nations Convention on the Rights of Persons with Disabilities. This review examined legislation and associated issues from four diverse South Asian countries (Bangladesh, India, Pakistan and Sri Lanka) that all have a British colonial past and initially adopted the Lunacy Act of 1845.


A questionnaire based on two previous studies and the World Health Organization checklist for mental health legislation was developed requesting information on the criteria and process for involuntary detention of patients with mental illness for assessment and treatment. The questionnaire was completed by psychiatrists (key informants) from each of the four countries. The questionnaire also sought participants' comments or concerns regarding the legislation or related issues.


The results showed that relevant legislation has evolved differently in each of the four countries. Each country has faced challenges when reforming or implementing their mental health laws. Barriers included legal safeguards, human rights protections, funding, resources, absence of a robust wider health system, political support and sub-optimal mental health literacy.


Clinicians in these countries face dilemmas that are less frequently encountered by their counterparts in relatively more advantaged countries. These dilemmas require attention when implementing and reforming mental health legislation in South Asia.


Comparison; Law; Mental health legislation; South Asia; Trend

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

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