Final Adoption of ‘Mental Patients Law’ is a Welcome Step, Further Steps are Needed to Uphold Mental Health Rights
The Egyptian Initiative for Personal Rights (EIPR) today welcomed the adoption by the People’s Assembly of the “Law for the Care of Mental Patients” on 26 April 2009, following six months of parliamentary debates. The organization said the new law represents a milestone in the protection of the rights of persons with mental disorders, but added that the law can only succeed through further steps by the government to ensure its effective implementation as part of a comprehensive policy of rights-based reforms to Egypt’s mental health sector.
“The adoption of the new law is a positive step that is long overdue,” said Dr. Ragia Elgerzawy, the EIPR’s Health and Discrimination Officer. “We congratulate lawmakers for choosing to place the protection of the rights of people with mental disorders over the objections by some private practitioners who, in their attempts to maintain the status quo, have resisted any measure to bring increased oversight and regulation of conditions in mental health institutions.”
The EIPR commended the parliamentary Committee on Legislative and Constitutional Affairs for introducing a number of last-minute changes to the bill shortly before the vote in parliament. One of these important changes addressed the EIPR’s recommendation for increased safeguards on involuntary admission to mental health facilities. According to the final version of the law, involuntary admission orders must be reviewed by the Public Prosecutor’s Office within 24 hours of their issuance, and the patient and/or “other interested parties” have the right to appeal the order before local courts and other review mechanisms established by the law.
Another positive amendment stipulates that outdated terminology in other laws—such as “imbecility” or “insanity”—be replaced with the neutral clinical term “psychiatric or mental disorder.” The EIPR regrets, however, that the name of the bill as originally drafted by the government, the Mental Health Bill, was changed to become the Law for the Care of Mental Patients. The EIPR noted that the original title sought to reduce the social stigma associated with mental disorders and address the needs of mental health care from a comprehensive perspective that goes beyond the narrow scope of illness.
The EIPR urged officials in the Ministry of Health to ensure that the Implementing Regulations of the law include specific measures and safeguards that were not made explicit in the text of the law itself, despite repeated calls from the EIPR. These include strict guarantees related to compulsory treatment, the prohibition of any irreversible treatments without adequate protections, and an explicit ban on the use of sterilization as a method of treatment for any mental disorder. In addition, the Implementing Regulations should stress the conflict-of-interest principle for members of the mental health councils that will be entrusted with monitoring the enforcement of the law and measures to protect certain classes of patients, such as children and minors. The regulations should also specify in detail the procedural guarantees given to patients or their representative when appealing involuntary admission or treatment orders. These guarantees should include the patient’s right to a lawyer of their choice or have one provided by the state, to access copies of all records and documents pertaining to the patient’s condition, and to participate in appeal hearings, call witnesses, and introduce independent reports and testimonies.
EIPR stressed, however, that for the law to be effective, the state must commit to a sustainable budget increase for mental health services and health care more generally.
“While we certainly welcome the new law and the qualitative change it represents for people with mental disorders,” Dr. Elgerzawy said, “the law will not be a success unless the state guarantees the provision of mental health services as part of its system of primary health care and provides community treatment services such as outpatient clinics, supervised home-based care, and rehabilitation for people after being discharged from mental health facilities. It also must work to integrate persons with mental disabilities into society by ensuring access to employment, housing and social welfare.”
The General Secretariat for Mental Health at the Ministry of Health began drafting the law in 2006 with the active participation of the EIPR and other civil society groups. The new law defines the situations in which persons with mental disorders may be involuntarily admitted to mental health facilities in accordance with internationally-accepted professional standards. The law also upholds the patient’s right to informed consent to treatment and requires doctors to document and periodically review treatment plans. The law creates a system for the treatment of patients outside hospitals and prohibits solitary confinement or physical restrictions on patients except in exceptional cases. Most importantly, the law includes a bill of rights for patients inside mental health facilities and states that both the patient and all care providers must be informed of these rights; it also stipulates punitive measures if these rights are violated. The law creates a patients’ rights committee in every facility and explicitly stipulates the participation of civil society organizations in these committees.
For further information, please see Egypt’s New Mental Health Bill: a First Step on the Right Path, a study issued by EIPR in English in January 2009. The study includes a comparative analysis of the bill and the previously enforced 1944 law (the Law for the Institutionalization of Those with Mental Illnesses). It also introduces detailed recommendations to make the new law more compatible with the state’s legal obligation to guarantee to citizens the highest attainable standard of mental health. The study cited research and statistics showing that Egypt faces severe shortcomings in mental health services and the financial and human resources devoted to them, particularly outside large urban centers.