CAIRO: The draft law on mental health currently before parliament is a positive move forward but there remain areas which must be addressed, speakers said Wednesday, during a press conference held by the Egyptian Initiative for Personal Rights (EIPR).
EIPR presented its report, “The Draft Law on Mental Health: a First Step on the Correct Path.
The report analyzes the draft law from the perspective of international mental health standards and Egypt’s human rights obligations, and presents criticism of the existing law regulating mental health treatment, Law 141 on the detention of individuals suffering from mental illnesses, passed in 1944.
The draft law was approved by cabinet this month and is tabled to be presented to the People’s Assembly during the current parliamentary session.
EIPR director Hossam Bahgat told the press conference he is hopeful the law will be passed either before the end of 2008 or in early 2009.
Aida Seif El Dawla, a professor of psychiatry at Ain Shams University and a psychiatrist with the Nadim Center for the Rehabilitation of the Victims of Violence, described problems in the current regime of mental health treatment.
“The current law refers to patients with mental health disorders as if they are criminals, Seif El Dawla said.
“Doctors are regarded as the sole decision-makers. Power is concentrated in their hands and three quarters of what happens in hospitals occurs without patients’ consent, she continued.
She criticized doctors’ reluctance to involve patients in their treatment.
“I once heard a university professor of psychiatry say ‘the majority of the [Egyptian] people are ignorant and illiterate and out of respect for the culture of Egyptian society we must respect this ignorance and illiteracy [and not involve patients in their treatment].
“This is a university professor who graduates generations of doctors who will go on to deal with people’s brains, minds and feelings. Seif El Dawla criticized the absence of patient autonomy within the Egyptian mental health system, pointing to the use of experimental drugs to illustrate this.
“Patients are used in drug trials without even being informed of this – in other countries, not only are they asked for their consent to take part in such trials but patients receive payment in return for taking part, Seif El Dawla explained.
“In addition, there is no follow-up to ensure that the patient will continue to have access to the drugs afterwards.
EIPR’s report quotes a 2004 study which found that 17 percent of adult Egyptians suffer from mental illnesses. It also refers to a 2005 study that found that 50 percent of university students display symptoms of mental illnesses.
Ragia El Gerzawy, EIPR health and discrimination program officer and the author of the report, said that people with mental illnesses in Egypt face the dual challenges of discrimination within Egyptian society and a chronically under-funded mental health service.
“Spending on the mental health sector accounts for only 2 percent of the government’s total spending on health, El Gerzawy said.
“Mental health services are also concentrated in cities – people in rural areas are deprived of services meaning that they have to travel to receive treatment.
The EIPR report states that there are some 6,000 beds in Egypt’s 15 psychiatric hospitals, and a further 600 beds in psychiatric units within general public hospitals.
University teaching hospitals offer a total of roughly 200 beds to psychiatric patients.
While these and all public and private hospitals and medical centers dedicated to the treatment of mental illness fall within the ambit of the draft law, several important medical treatment centers fall outside the purview of the law.
Patients in private clinics that offer psychiatric treatment, emergency rooms and rehabilitation centers are not covered by the law.
EIPR is strongly critical of their exclusion from it, pointing to the fact that some of these private clinics treat their patients with electric shock treatment.
In addition, individuals in these medical centers do not benefit from the rights of patients receiving mental health treatment listed in the fifth section of the draft law.
While EIPR praises the inclusion of this list of rights, it criticizes the absence of an obligation to inform patients admitted involuntarily into hospital of the reasons why they are being admitted, and what channels exist for challenging this hospitalization.
El-Gerzawy pointed out during the press conference that some patients of psychiatric hospitals are detained there for reasons entirely unconnected to their mental health – for example because a family member wishes to keep them there.
Daily News Egypt spoke to Magdy, who has been in Abbaseyya psychiatric hospital since 2004.
“My brother is a consultant in the Egyptian foreign ministry. He raised a case against me after which I was admitted involuntarily into hospital. When I went to Abbaseyya hospital the people there told me that I needn’t be there, but my brother has possession of my apartment, I don’t have access to my money because of the case he’s raised against me and so I can’t leave, I have nowhere to go.
Magdy is currently working in IT within the hospital.
El-Gerzawy stressed the importance of moving towards a culture of treatment within the community – rather than in psychiatric institutions – saying that hospitalization itself either induces illness or aggravates pre-existing conditions because of the patient’s isolation and separation from his or her family.
She rejected fears that the planned and managed release of individuals with mental illnesses from psychiatric institutions poses a threat either to them or to the community, pointing out that many people living within Egyptian society have undiagnosed mental disorders for which they never receive treatment.
Seif El Dawla contrasted the trend towards institutionalization in Egyptian mental health treatment with other approaches through reference to John Nash, a Nobel prize winner who suffered from Schizophrenia and whose life was portrayed in “A Beautiful Mind.
“In 1996 I attended a conference on psychiatry during which Nash – who continued to suffer from hallucinations until the end of his life – gave a lecture. It was one of the best lectures I have ever heard, Seif El Dawla said.
“If Nash had been in Egypt he would have been labeled insane, locked up in Abbaseyya hospital and never let out.
