INTRODUCTION

Institute of Human Behaviour & Allied Sciences (IHBAS) was established in compliance
with the directives of the Hon'ble Supreme Court in response to a public interest litigation in
1993. The Institute is an autonomous body registered under the Societies Act 1860, funded
jointly by Ministry of Health and Family Welfare, Government of India and Government of
NCT of Delhi. As an autonomous body, the institute has its Memorandum of Association and
Rules and Regulations duly approved under the Societies Act. Minister for Health, Govt. of
NCT of Delhi is the President and Chief Secretary, Govt. of NCT of Delhi is the Chairman of
the Executive Council of the institute. The institute is located in East Delhi at Dilshad garden.
Dr.Prof. Rajindir K Dhamija Director IHBAS. The Institute of Human Behaviour & Allied
Sciences (IHBAS) is a multidisciplinary institute on three major fronts: patient care services
i.e. caring for those with mental and neurological disorders, carrying out research, teaching
and training in psychiatry, neurology, neurosurgery, behavioural and allied sciences. The
Hospital for Mental Diseases (HMD), Shahadara, was established in 1966 in the eastern
outskirts of Delhi across the Yamuna River at a time when custodial care of mentally ill was
order of the day. During this era, the society had lost hopes for recovery of such patients and
kept them far away. It was a virtual dumping ground for society’s unwanted people. The
hospital was in a deplorable condition with inadequate facilities, paucity of trained staff and
often ill-treatment meted out to inmates. It was converted into a multidisciplinary institute
under the Societies Act 1991 and registered as a Society by Supreme Court order in response
to a public interest litigation. Since its inception in 1993, it has served as a good example of
how judicial intervention can bring about changes for the benefit of the patients. At present, it
is functioning as an autonomous body with support from Central and Delhi Governments for
its maintenance and developmental activities.
ORGANIZATION CHART :
VISION

a. The vision of Institute of Human Behaviour and Allied Sciences is to be one of the
leaders in the country and in the world for promoting mental health, neurosciences,
behavioural and allied sciences through multidisciplinary patient care in partnership
with communities, developing future group of professionals and paraprofessional
leaders through formal and semiformal training programmes and expanding scientific
knowledge and its application through frontline research.

MISSION

b. Mission The mission of Institute of Human Behaviour and Allied Sciences is to advance
the mental and neurological health of populations by practicing evidence based
multidisciplinary scientific health care approaches that are novel, adaptive, and ethical,
conduct research of high standard and develop human resource in these fields. The institute
adheres to quality assurance, integrating into practice the prevailing norms for human rights
and diverse value systems of persons and populations while accomplishing this mission.

To accomplish its vision and mission, IHBAS will do the following : -

 Form a strategic Review and planning Group (SRPG) which will include external
group members (expert and people of repute from the field of administration, finance,
research and academia) assisted by IHBAS personnel.
 Ensure that the institute amalgates and synthesises a comprehensive vision document
for the institute based on the vision of all the departments/sections of the institute.
 Work with various Govt., nongovernmental and voluntary health organizations and 2
other interested stakeholders to reduce the discrimination and prejudices associated
with mental illnesses and neurological disorders.
 Promote the visibility and mandate of the institute and its contribution through
effective communication with all sectors of civil society.

Key Objective & Function and Duties:-

 To provide High Quality Super Specialty Health Care using State of Art Technology
in Mental Health, Neuro-Sciences, Behavioural and Allied Sciences.
 To conduct research of High Standards in the field of Mental Health, neurosciences
and Behavioural Sciences.
 To provide comprehensive Training for MD(Psychiatry) , M.Phil (Clinical
Psychology) & DM (Neurology) in field of metal Health, neurosciences and
Behavioural Sciences and Research activities on Current interest.
 To provide High Quality Super Specialty Health Care services using State of Art
Technology in Mental Health, Neuro-Sciences, Behavioural and Allied Sciences to
the patients visiting the hospital (in OPD on all working days.
 To provide specialized care through special clinics in afternoon OPD.

IHBAS Provides Emergency Services 24 hour and 7 days.

 The Institute offers 24 hours Emergency services in Psychiatry, Neurology and
Neurosurgery.
 A 10 bedded Short Observation Facility(SOF) is available for patients of psychiatry
and neurology. There is an emergency laboratory providing routine investigations
facility.
 As IHBAS is not General Hospital so these services are not available at IHBAS.
 To provide indoor services to the patients admitted to this hospital.

NORMS OF IHBAS
The patients are housed in spacious wards. Recreational facilities are provided.
Family members are encouraged to stay with the patients. Private room (AC/Non-AC)
facility is also available.

1. In-patient admission
Admissions to the hospital can be done on a voluntary or involuntary basis as per
mental health laws and regulations of the country.
The duration of stay can vary depending on an individual patient’s need.
In-patient admission to psychiatry wards are done only when another relative/ family
member or a close confidant is available to stay with the patient around the clock.
Once you/ your relative’s treating doctor decides to admit you, you will be sent to the
admission counter to provide details and for payment, if required.
Thereafter, you will be accompanied by an attender to the ward / room and received
by nursing staff for further care.

2. Hospital Stay
A team of psychiatrists, clinical psychologists, psychiatric social workers and
psychiatric nurses will take care of you when you are admitted.
The consulting psychiatrist treating will see you on Consultant Rounds.
You will be seen by a senior resident and junior resident on a daily basis. Any
clarifications can be held with the nursing staff or the junior resident. The Senior
Resident (SR) directly supervises the junior resident. The Consultant is aware of all
your details through the Junior Resident (JR) and Senior Resident.
Required physiotherapist and counselors will also be seeing you if required on a daily
basis.
You may also be referred to various other departments and therapies depending on
your need.

3. Discharge process
The discharge date is intimated by the treating doctor well in advance.
You/ your relative will be given a discharge summary with all your treatment details
and prescribed medications with follow up date and schedule.
Any other therapies that require follow up on an out-patient basis will be intimated to
you by the respective therapist.
 Emergency Services:
IHBAS Provides Emergency Services 24 hour and 7 days.The Institute offers 24
hours Emergency services in Psychiatry and Neurology . A 10 bedded Short
Observation Facility(SOF) is available for patients of psychiatry and neurology. There
is an emergency laboratory providing routine investigations facility.

Mental Health, Neurosciences & Allied sciences services are available at IHBAS. As IHBAS
is not General Hospital so these services are not available at IHBAS.

 Road Traffic accident, polu-trauma & emergency neurosurgery services.

 Gynecology, maternity care and general pediatric services.
 General medical, general surgical conditions TB & chest illnesses.
 Super specialty care in Cardiology, urology and endocrinology diseases.
 Eye, ENT, Skin, Dental and Orthopedic care.
 Mortuary services.
General Logistics

At present in IHBAS three departments are functioning i.e Psychiatry,

Neurology & Neurosurgery. All the departments functions in the model of
multidisciplinary care for the patients with mental & neurological disorders.
The departments have emergency outpatient and inpatient services.

 When an individual with or without family members visits the hospital he or

she first guided by the security to approach the reception counter of
registration as a new patient. The staff at the registration counter inquire about
patient’s medical complaints.
 Accordingly, given a white card for psychiatry and green card for neurology &
yellow card for senior citizen. The patient is then sent to the respective OPDs
which are located in the main OPD block. Then the patient is examined by the
qualified specialist and given medical treatment and further advise to come for
detailed evaluation.
 Patient who are acutely disturbed are directly seen by the doctors and offered
immediate medical treatment, while the relatives sent to the reception counter
for registration. Patient requiring treatments beyond OPD hours seen by the
qualified doctors in emergency.
 Patient requiring both neurology and psychiatry care are referred for necessary
consultation within the hospital. Those requiring help of psychologists and
Social Workers are sent within the hospital for the required consultation.
Those requiring other medical help are sent to GTB hospital or SDN hospital
(both are within 1 km distance from IHBAS) for the necessary consultation.

SOP FOR PATIENT STAFF GROUP MEETING

The department of psychiatry at IHBAS has been conducting regular patient
staff group meetings in all the psychiatric wards. These meetings are held on
monthly basis and the schedule of each ward is prefixed, that has been
circulated in other communication. This standard operating procedure (SOP)
handout is aimed to orient the new members joining in the team so that they
understand what it is, why it is being conducted and how.
Objectives
In departmental staff meeting of department of psychiatry three main
objectives were identified for PSGM. These are:
1. Issues related with day- to-day problems and their solution.
2. To explain the treatment related issues to the patients and their family
members.
3. To utilize this opportunity in making after discharge follow-up plan.
Composition of Group : For each ward one senior resident is identified who is
responsible to conduct the PSGM in that ward. The following constitutes the
group:
Essential components
(1) All patients of the wards who are fit to participate.
(2) Family members/care takers of the patients admitted in the ward.
(3) Treating team, SR, JR, staff nurse, PSW
(4) Dietician, civil and electrical engineer.
(5) House keeping supervisor
(6) Security Officer (supervisor) {Male C & DATRC ward only}

Desirable components
(1) Ward consultants
(2) Clinical psychologist assigned to the ward
Schedule ;
The meeting is scheduled to be conducted for about one hour. A convenient
schedule for each ward is provided. All the participants of the meetings are
requested to assemble in the ward without any separate intimation at the
scheduled time and date.If the meeting is not held on scheduled date due to
some unavoidable problem a contingency plan is provided for most of the
wards according to which the PSGM should be conducted on a later day.
Process of the meeting:
SR in-charge and psychiatric social worker will conduct the meeting as group
leaders. After explaining the purpose of the group meeting to the participant
they must encourage the group to participate actively. Initially the day-to-day
problems of wards must be addressed quickly and their on the spot solution is
sought with the help of the supporting staff. Problems that requires the
intervention of higher administration are identified. The group leader should
direct the group to discuss the treatment related issues, such as
psychoeducation involvement of family members in the management plan and
to discuss the after discharge plans in details.
Records and reporting: The minutes of the meetings will be recorded in the
PSGM register of the ward. A copy of the minutes is to be submitted to the
PSGM coordinator. A performa for recording the minutes is suggested below
for the purpose of uniformity and convenience both in recording and
interpretation.
A. Issues related to wards
B. Issues related to persons
C. Recurring issues
D. Issues requiring consideration by higher authority
E. Points of psycho-education stressed eg: Nature of illness, compliance need
F. Plan agreed to involve the family in treatment process.
G. After discharge plan discussed in the meeting.

PSGM Coordinator: One SR of the department is given the responsibility to

coordinate the functioning of PSGM in all the wards. The PSGM coordinator
will keep record of all the meetings held in the wards and ensure the
implementation of any decision taken in departmental staff meeting in
reference to PSGM. In case of any practical difficulty in conducting the
PSGM the SR incharges are suggested to contact the coordinator or the head,
department of psychiatry .
STANDARD OPERATING PROCEDURE FOR THE MEDICAL
BOARD IHBAS
A Neuropsychiatric Institute and several patients are refereed from the
Jail/Court and other Dept. with request to examine the patient from Medical
Board, which is a highly sensitive case. So, it is necessary to modify the
current system/formalities of medical board which is being done. In view of
the above, it has been decided that the following guidelines may be followed
in the Institute before putting up such type of cases to the medical board:-
1. The request letter should be clear for which, the board is to be conducted, if
required may request to concerned authority for clarification.
a) Fitness to Stand Trial
b) Fitness for job
c) Ability to take care of person and property
d) Current mental State and its implication
e) Any other (specified)
2. All cases coming for medical board be registered at the institute and worked
up in detail as per the standard procedure. The consultation for the case should
be done preferably by a consultant.
3. If a senior resident has provided initial consultation and then he should
discuss the case with a consultant and record the discussion on the patients
file.
4. Psychometric assessment of the case should be done until considered
otherwise due to any specific reasons.
 5. 2-3 cross consultations within the unit should be completed for the case
before proceeding further.
6. Notes of the consulting doctors of the case clearly mention the following
information:
 Referring agency
 Intent/purpose of the 1,2&3 etc. referral to the medical board expressed by the
referring agency.
 Diagnosis of the patient’s condition
 Report of the psychometric assessment if considered necessary
 Discussion with consultant (in case of SR)
 Opinion of the consulting doctor regarding the purpose of the referral
 7. SR in room No. 6 (OPD) or consulting SR should coordinate arranging for
date of medical board and any other formalities specific to the case, with the
reception.
 8. Request for Medical Board to be entertainment for court or other institution
or employer.
 9. In instances of Jail case (under trial on convict) the patient should first be
admitted in the ward along with escort, for observation (minimum 10 days).
All such admission should only be done after getting appropriate reception
orders for the same. Formalities of admission are direct responsibilities of the
consulting doctor.
 10. All formalities for correspondence assigning dates, gathering photographs
and board fees etc. are direct responsibilities of the Reception.
 11. The Medical Board Performa of all cases assigned date of the medical
board should be completed by the concerned SR of the case. The opinion of
the treating team for mentioned in the Performa.
 12. The SR in-charge of the case would present the case to the medical board
and would write the final report and get it signed by the Board members.
 13. Reception is responsible for printing of the final report, getting it duly
signed and sending it with forwarding letter to respective referring agency as
soon as possible.
 14. Reception is responsible for calling & informing board member and the
concerned SR about the cases to be examined.
STANDARD OPERATING PROCEDURE FOR THE DISABILITY
BOARD IHBAS

A Neuropsychiatric Institute & many patients are request to issue the

disability certificate for getting the facility provided by the Govt. So it is
necessary to complete the file and examine the patient in details. In this
connection it has been decided that the following Standard Operating
Procedure may be adopted by the Institute before any such case is reffered to
the Disability Board.
 1. A written request should be made from the Patient, Patent’s relative or any
Guardian address to the M.S. / Director IHBAS.
2. All cases coming for Disability Certificate should be registered at the
institute and worked up in details as per the standard procedure. A consultant
should do the consultation for the case.
3. If a senior resident has provided initial consultation then the he should
discuss the case with a consultant and record the discussion on the patient life.
4. Disabilities of the patient should be determined as per IDEAS- Senior
Resident concerned and non-faculty Psychiatry Social Worker to do the
assessment as per IDEAS format.
5. Psychometric evaluation including Neuropsychological assessment of the
case should be done if required.
6. Notes of consulting doctors of the case should be clearly mentioned in the
file.
a. Referring agency.
b. Diagnosis of the patient’s condition.
c. Report of the psychometric assessment if considered necessary.
d. Discussion with consultant (in case of SR).
e. Psychological Assessment testing done if required
7. Concerned SR should coordinate arranging for disability board and any
other formalities specific of the case, with reception.
8. All formalities for correspondence, assigning dates, gathering photographs
and certificate fees etc are the direct responsibilities of the Reception.
9. The Disability assessment should preferably be done one OPD basis in all
cases. The opinion of the treating team for inpatients and OPD patients
regarding the purpose of referral should be clearly mentioned in the Proforma.
10. The SR in charge of the case would present the case the disability board
and would write the final report and get it signed by the appropriate authority.
11. Reception is responsible for issuing the final certificate, getting it duly
signed by the board members. 12. Reception is responsible for calling &
informing board member and the concerned SR about the cases to be
examined.

SOP FOR INPATIENTS MODE OF ADMISSION OPD ADMISSION

From Walk-in clinic or follow up clinic Admission recommended by SR or
Consultant referred to DMO who on the basis of the bed availability and
indication for the admission decides on admission as in patient or keep in SOF
Preadmission counseling by PSW ADMISSION FROM EMERGENCY
Admission Advised by SR DMO or Consultant Pre admission counseling done
by SR/ JR DMO SECTIONS OF MHA UNDER WHICH PATIENTS
ARE ADMITTED
 Voluntary 15/17
 Special circumstances 19
 Magistrate order 24
 Jail Suptd. Order 26
Indications for Admission
▪ Suicidal/ Homicidal attempt
▪ Requiring acute symptomatic management
▪ Diagnostic Clarification
▪ Complicated withdrawal in SUD
▪ Dual Diagnosis
Other specific clinical or management Issues Protocol following admission
 Admission note including brief history and examination details by SR & JR on
the same day .
 Review by consultant on post OPD evening rounds to check on Immediate
medical management issues
 Detailed work up by JR the next day
 Detailed work up to be discussed with SR and consultant in service rounds.
Final diagnosis and management plan discussed.
 Psychological interventions as well as psychosocial interventions initiated
where indicated
 Ward Observations and noting the progress with daily assessments by SR &
JR with periodic assessment by consultant.
 Selected cases with diagnostic dilemma or difficulties in management or
medico-legal issues to be discussed in Grand Rounds.
 Duration of inpatient stay on an average is one month.
 Once patient is clinically stable and does not require further inpatient stay
discharge is planned
 Pre discharge counseling including psycho educative session on nature &
course of illness, need for treatment & regular follow up with treating team
 Follow up plan discussed with the patient and relatives.

Mode of Discharge
 Voluntary
 MM order under Section “ 40 after relatives have traced or through been court
order
 Discharge on request
 LAMA if discharge sought against medical advice Chart Meeting Discussion
of silent aspects of cases e.g. to discuss course of illness during ward stay,
revising post discharge management plan.

PRE-ADMISSION COUNSELLING (PAC) FOR FAMILYIES OF

INPATIENTS CLINICAL / SCIENTIFIC ASPECTS
Expected duration of the treatment/ hospitalization, preamble of the type of
the illness. Concept of interdisciplinary and interdisciplinary team functioning.
Component / various modes of treatment. Importance of family member’s
active participation in the hospitalization, specially during initial stages like,
providing adequate history and other information. Briefing about available
medicines/ other investigation facility. Admission and discharge is entirely
decided by the team.
ADMINISTRTATIVE/ ORGANIZATIONAL ASPECTS
Briefing about unit functioning, OPD days, ward rounds including availability
of Residents, Senior Residents and Consultants. Approximate hospital
expenses, relatives/ care giver’s stay in general wards/ private wards,
depositing amount time to time and getting receipt for the payment, visiting
hours, visiting pass. To involve family members actively in the treatment
process and to motivate them for dialogue with administration or clinical staff,
to brief about PSGM, to make them aware about Right of the information etc.
To make them aware about existing rule for the common people, like security,
keeping the hospital clean, no smoking zone, prohibition on drugs etc.
MUTUAL EXPECTATION
To understand about their concern for admission and expectation from the
hospital. To brief about their required stay in the hospital in consultation with
the doctors like in acute/ stabilization state and it’s needful intervention. For
voluntary patients, to brief the relatives for providing essential items to the
patient like soap, oil, tooth paste, brush, towel and clothes. Encourage family
members in the hospital treatment process and to brief about important things
about aftercare.
PRE ADMISSION COUNSELLING PROFORMA FOR FAMILY’S OF
INPATIENTS
Who so ever fills this Proforma, please ensure that they should not leave any
gaps in filling this Proforma. Kindly note your observation under the
following heads :
I. Clinical / scientific aspects
II. Administration and organizational aspects
III. Mutual expectations
IV. Any other information
V. Suggestions for further counselling and remarks