Despite facing criticism, the parliamentary committee of Health Affairs insists on amendments for the mental health care law, despite rejections from the World Health Organisation (WHO), the World Federation for Mental Health, and the World Psychiatric Association.
Secretary of the Health Affairs Committee in Parliament, Samy Al-Mashd said to Daily News Egypt that the committee does not see criticism to the law as urgent, but unfounded, noting that as of now, there is no information on when parliament will discuss these amendments.
Al-Mashad strongly believes that the law guarantees the rights of mental illness patients, allowing, for the first time, for low–income citizens to be treated in any private hospital at the state’s expense and to be protected from health care providers’ exploitation. The law will set in place penalties for those that are practicing health care without a proper licence.
Last week, the committee approved an amendment to the law of 2009 and forwarded it to parliament’s administration to discuss during a plenary session. In November, the government presented a draft to amend some articles to the law and Parliament approved it in principle.
In late December, a number of prominent psychiatric professors such as the former director of the mental health programme at the WHO and the president of the World Psychiatric Association expressed their deep concern about these amendments, explaining their reasons in a letter addressed to the head of parliament’s health committee.
Coordinator of the Defence Front for the Abbasiya Mental Health Hospital Ahmed Hussein said in press statement last Tuesday that the demanded amendments would set back years of mental health care policies in Egypt.
Hussein expressed his objection to the amendments of the law, saying “There are complete deficiencies in many provisions and the reason for this is that the health committee only meets with the government and then passes serious decisions that seriously harm psychiatric patients without hearing the perspective of the concerned entities.” He pointed out that none of the members of the health committee are psychiatrists, meaning that they don’t fully understand the implications of amendments like these.
Hussien said: “unfortunately these amendments give beneficiaries to famous psychiatrists to exploit patients and their families, and will harm Egypt’s reputation, as we received strong-worded letters by the international organisations on these illegal changes.”
The critics mainly rejected the usage of electrotherapy to regulate the rhythm of the brain, saying that this practice is “misleading, a wrong medical action, and unethical.” Al-Mashad commented that countries all over the world use this type of treatment and it is necessary to improve the conditions of patients.
One of the amendments’ biggest opponents is the Al-Abbasiya Defense Front, an independent group consisting of psychiatrists that defend the rights of doctors working in the Al-Abbisiya Mental Health Governmental Hospital, as well as protect proper health treatment for mental illness patients. The Front rejected these amendments and prepared a petition to collect signatures to be presented to Parliament, the Doctor’s Syndicate, as well as other relevant authorities, to assume all responsibility for these amendments, and to call for its cancelation.
The Front said that the amendments’ approval will exacerbate mental illness in Egypt as more doctors will exploit their patients as well as parliamentary legislation in all forums.
It further requested changing the term electrotherapy to brain rhythm sessions, saying that that term did not have any scientific basis and did not express the nature of the treatment, which results in misleading patients and their families.
The amendments will allow doctors to administer two electrotherapy sessions even without the consent of the patient, which is already a violation of the law that stipulates that the patient must agree to services or an overruling decision based on the evaluation from National Council for Mental Health.
The Egyptian Human Rights Initiative said in a report on the amendments that “The most dangerous of these amendments is the article that regulates the rules of compulsory treatment, including electrotherapy, as it stipulates neglecting independent evaluation, and authorises when necessary, the patient to be given two sessions to regulate the rhythm of the brain, until the evaluation provided for them is carried out in accordance with the controls determined by the executive regulations of the law.”
Under the current law, it is not necessary to provide the psychiatric patient any type of treatment before conducting an independent evaluation within 24 hours to review the opinions of the treating physician. The law continues that the physician must be registered with the mental health council, while giving the patient emergency treatment until the evaluation’s completion in order to reduce the chances of error and to protect the doctor from suspicions of abuse of power.
Ragia Al-Garazawy, head of health affairs in EIPR, the largest hospital in Cairo that specialises in mental health, said the proposed law lacks proper protocol and severely against the interests of the patient and the recommendations of the WHO already state that any sort emergency treatment may not include “the use of electrotherapy.”
Electrotherapy, such as surgical intervention, is carried out under complete and simplified muscle anesthesia. Hospital records include many cases of complications and sometimes death when using it, she explained.
Al-Garazawy, who is also a doctor, said that proposed amendments used a term not agreed upon in the medical community, which is “controlling the rhythm of the brain” instead of electrotherapy or electric shock therapy, a term that experts described as false and therefore misleading.
She also added that it is unfortunate that the government is preoccupied with these methods and with proposing amendments that violate Egypt’s international norms, principles, and obligations, allowing the government to implement such obsolete provisions that are out of date and allow the misuse of influence. She suggested, instead, that the government should focus on projects that protect the rights of the mentally ill, upgrade mental health services, and improve the conditions of public hospitals that are already suffering from a severe shortage of doctors, nursing, financing, and equipment.
WHO regulations relating to human rights and legislation in mental health stipulate that “emergency treatment may not include the use of electrotherapy, or any of the therapies that cannot be reversed, such as psychological surgeries,” and that the decades-old medical tradition confirms restricting the use of compulsory electrotherapy to a minimum, and only after approval of an independent doctor.
The initiative said that hospital records include many cases of complications, and sometimes death, when using electroconvulsive therapy, and that electrotherapy is an intrusive treatment that is carried out under the influence of general anesthetic and extensor to muscles such as surgeries, and it is first to fortify controls that ensure the safety of its use with minimal risks, it is not the opening of loopholes that weaken these controls.
In their comments, the organisations also objected the absence of any representatives of patients and their families from the formation of the National Council for Mental Health, as well as the inclusion of a licence to practice therapy under the law.
About the amendments
Al-Mashad said that law aims to regulate the profession of psychological treatment, and penalise those who practice the profession without a licence, and it also aim at protecting the patient while under the supervision of non-specialists.
He referred that several individuals now are taking on the title of psychiatrist while not having a degree or licence, so the amendments determines controls for practicing and stipulates that whoever violates it will be subject to punishment.
The amendments include penalty of imprisonment for a period of up to two years maximum, and a fine of up to EGP 50,000. Before, it was only an EGP 5,000 fine to deter punishment, he added.
The draft law aims to bridge the gaps that resulted from the application of the current law, and emphasise the importance of academic and clinical specialisation in the practice of psychotherapy, Al-Mashad said, adding that it will also ensure holding an exam for psychiatric medical students, and the importance of continuing education, and confirms renewing the licence.
The draft law provides for more guarantees of the patient’s psychological rights by providing adequate protection for the patient against abuse and exploitation, and the draft law is also keen to provide clear legal mechanisms for legal accountability in case of violation.
The new amendments dictates the establishment of a National Mental Health Council, but after a decision from the Prime Minister. The council will include the health minister or his representative, the head of the Central Department of the Technical Secretariat of the National Mental Health Council, and the Ministry of Finance to determine what will be allocated to the fund from the state budget.
The health minister issues executive regulations for this law within three months from the date of its application. The ministry previously estimated 25% of Egyptians suffer from mental health disorders.
The law was issued in 2009 to replace the law that was called “Mental Illness Detention Law” issued in 1944, when mental illness was considered a permanent disorder.
This law has been enforced in Egypt for over 60 years now despite scientific revolution the world has experienced in the field of medicine in the previous century. Electric shock therapy has a dark history that has caused international organisations to call for the ending of its practice. It is important that governments continue to upgrade and enhance policies that ensure the safety and wellbeing of patients while allowing for the safe use of dangerous medical procedures.