Examining the ethical issues surrounding compulsory hospitalizations
In the realm of mental health care, the concept of involuntary admission, or commitment, is a critical yet sensitive topic. This article aims to provide a clear and informative overview of this process, focusing on the Mental Health Act of 2022 in Kenya.
The Mental Health Act of 2022 emphasizes rights-based care, ensuring that each patient is treated with dignity and respect. This Act establishes the Kenya Board of Mental Health Review Board, which plays a crucial role in hearings and approving longer stays.
The legal definition of involuntary admission is the hospitalization and treatment of an individual with a diagnosed mental illness without their consent, when they pose a serious risk of harm to themselves or others, or are unable or unwilling to seek treatment voluntarily.
The process and criteria for involuntary admission typically require a diagnosed mental illness or mental disturbance that necessitates treatment, a serious risk of harm to the individual, others, or property, or a substantial risk of serious mental or physical deterioration without treatment. The individual must also be unable or refuse to consent to treatment, and less restrictive alternatives to hospitalization are not available or appropriate.
In Kenya, involuntary admission can be triggered by myths and stigma associated with mental health. Relatives, guardians, police officers, community health volunteers, or medical officers can apply for an involuntary admission, accompanied by a medical report. In emergency cases, police or a chief may take a person directly to a mental health facility for assessment.
The initial evaluation involves mental health professionals or sometimes law enforcement performing an emergency assessment if the person is considered a danger. This leads to a temporary psychiatric hold, such as California’s 5150 hold, allowing for 72 hours for evaluation and treatment without consent.
If the criteria are met, the individual can be detained involuntarily at an approved treatment facility for further evaluation and treatment. Most jurisdictions require a court hearing within a specified timeframe to review the justification for continued involuntary hospitalization, ensuring protection of the individual's rights.
During admission, the patient receives mental health treatment as mandated, with ongoing evaluations regarding the necessity of continued involuntary care. Depending on progress and legal findings, the patient may be discharged, continue treatment voluntarily, or be subjected to extended involuntary commitment under legal supervision.
It is important to note that informed consent is usually the norm, and involuntary treatment is a last resort. After involuntary admission and sedation, close monitoring by qualified nursing and medical staff is mandatory to ensure the patient's safety, manage potential side effects of medication, and prevent harm to the patients or others.
Dr Mutisya, a psychiatrist and former head of Substance Abuse Management at the Ministry of Health, and head of clinical services at Mathari National Teaching and Referral Hospital, underscores the importance of upholding the rights of individuals with mental health conditions while ensuring public safety and clinical needs are balanced.
The Kenya Board of Mental Health provides overall oversight and policy direction for mental health services, ensuring that the rights of individuals with mental health conditions are protected. This Act serves as a significant step towards ensuring that those in need of mental health care receive it, regardless of their ability to consent.
[1] New Jersey Civil Commitment Statutes (N.J.S.A. 30:4-27.1 et seq.) and court rules. [2] Northern Territory (Australia) criteria. [3] Voluntary psychiatric hold. [5] Balancing public safety, patient rights, and clinical needs.
The Mental Health Act of 2022 in Kenya insists on rights-based care for patients with mental health conditions, ensuring they are treated with dignity and respect. In cases of involuntary admission, when an individual poses a risk to themselves or others, or refuses to seek voluntary treatment, less restrictive alternatives are first considered before hospitalization.
The Kenya Board of Mental Health Review Board plays a crucial role in hearings and approving longer hospital stays in cases of involuntary admission. Their primary objective is to balance the rights of individuals with mental health conditions, public safety, and clinical needs.
