Consent to treatment for mental illness sparks debate

Pressure is mounting on health practitioners and police to obtain consent, respect and protect the rights of patients with mental disorders as they are enrolled into care or go through the justice system.
The prevalence of any mental disorders in Uganda was 23 percent in children and 24 percent in adults, according to a 2021 Analysis Report by John Nelson Opio and other researchers from the University of Adelaide, Australia. 

In an interview with the Monitor last Friday, ahead of World Mental Health Day celebrations today, Mr Arthur Nsereko, the head of the Network of Public Interest Lawyers, questioned methods used to arrive at involuntary treatment (hospitalisation) and the way people with mental health challenges are handled. 

“We make a case for a human rights-based approach in which we acknowledge the right of the patient as a human being, not necessarily as a patient. But also, the duties of the duty bearer in respect to the patient, and also, the call for accountability in case the rights of this patient with mental health disability have been violated or abused,” Mr Nsereko said.

Dr Hafsa Luswata, the assistant commissioner for Mental Health at the Ministry of Health, said this year’s World Mental Health Day celebrations will be held under the theme: “Mental health is a fundamental human right.”

“This means that we as human beings have a right to good mental health and we need to pay attention to our mental health but also ensure that we don’t break other people’s mental health,” she said.
Mr Nsereko, on the other hand, said their biggest concern is that many people in Uganda want to handle or view everyone with mental health issues the same way.

“We need to appreciate that not all mental health challenges present at the same level. That even when somebody shows signs of a relapse, it does not mean they have hit rock bottom in that they are not in position to make consent in their best interest,” he said.
“Our challenge as a community is thinking that all cases are the same –requiring a rope, a chain or police intervention. We acknowledge circumstances where the person is under crisis and it is at the extreme,” he added.
Mr Nsereko argued that even in a situation like this, the person should be given a chance to decide. 
“When it comes to treatment, it is in the hands of medical practitioners to determine or advise on the best course of treatment to take. They should advise but not dictate the mode of treatment. This takes us back to the need to involve this person in arriving at the decision of which type of treatment they are going to undertake,” he said.

The social justice advocate highlighted some modes of handling the patients such as seclusion (containment of a patient in a room or place where a patient has no means to leave freely), and the use of electroconvulsive therapy which involves sending electricity into the brain to relieve some symptoms of mental health problems.
However, Dr Harriet Birabwa-Oketcho, a senior consultant psychiatrist at Butabika Hospital, while recognising the need to uphold the rights of all patients, said it is tough balance. She said they sometimes undertake involuntary hospitalisation because of the danger the patient poses and clinical impression.

“Involuntary treatment types are preventive, temporary, [or] court authorised. People can be hospitalised against their will when they are a danger to themselves, to others, or unable to look after themselves,” she said.

“Sometimes people think that maybe we depend on past behaviour and need for care, inability to make their own decision, strange behaviour that are bothering people; many times people can be brought because of many of those and our work is to assess and determine whether to admit or not,” she added.
The senior consultant, however admitted that involuntary treatment is “highly distressing to a patient”.