New law protects rights of persons with mental illness


By Charles Bukuwa

For a long time, persons with mental illness have been all generalised as mad in the Ugandan and largely, African setting. In Uganda, they have all been stereotyped in vernacular as ‘mulalu or balalu’.

In most cases, they have been denied their basic rights and needs. Families have abandoned them. In other extreme cases, families keep them home but chained to trees or poles.

In the streets of Kampala, some are forcefully taken to the only psychiatric hospital in Butabika and left there without family support.
There is hope though. Parliament last year passed the Mental Health Act. The Act provides for mental health treatment at primary health centres, emergency admission and treatment, involuntary admission and treatment and for voluntary and assisted admission and treatment among others.

The law also provides for the patient’s consent to treatment; the protection of the rights of patients and also provides for the right to appoint personal representatives and for orders for custody, management and guardianship. The new law also provides for mental health treatment for prisoners and other offenders.

Clause 20(2) of the Act states that ‘Treatment for mental illness at a primary health centre shall only be administered on a person with mental illness after that person gives informed consent to the treatment’.

There have been tales of persons rushed to Butabika or other health facilities and treatment administered basing on the information provided by the relatives or whoever has taken them there.

The law also provides for assisted care and treatment where the person is willing to have treatment but may not be in position to give consent.

The exemption in this case is provided for in clause 22 that states that a person with mental illness qualifies for emergency admission and treatment if that person is likely to inflict serious harm on themselves or on another person, cause financial loss to him or herself and damage property among others.

This law also addresses the issue of confinement. Persons with mental illness have been locked up in bedrooms, stores, car garages and in cages in extreme cases. This has in most cases caused more trauma and pain on the patients leading to physical injuries and sometimes, death.

The Act in clause 48, sub-section 1 prohibits the seclusion of a patient in a facility that is not a mental health unit and if they have to be kept in seclusion, it must be authorised by a psychiatrist and for purpose of emergency treatment, by a senior mental health practitioner.

The person kept in seclusion according to the law, is entitled to the basic needs like beddings, clothing, food, and drink and toilet facilities.

Anyone who violates this provision is liable to a fine of shs3.6 million or imprisonment not exceeding 18 months or both.
Tying the legs and arms of mental patients to restrict their movement is also prohibited. It allows restriction of movement through medical means.

Physical restriction of movement of mental patients can only be used when a psychiatrist authorises and for emergency treatment by a senior health worker.

This restraint is also meant for the protection, safety, or well-being of the patient or of any other person with whom the patient may come in contact or to prevent the patient from persistently destroying property.

The law provides that the of restraint shall be given in writing and indicate the period for which it is given.
It is another offence to use mechanical bodily restraint or bodily restraint and one is liable on conviction to a fine not exceeding Shs600,000 or imprisonment not exceeding 15 months or both.

The Mental Health Act also prescribes that the person, human dignity and privacy of a patient shall be respected and not be subjected to any form of torture or cruel, inhuman or degrading treatment or punishment.

It adds that ‘subject to such limitations as are prescribed by law, a person with mental illness has the right to protection from physical, economic, social, sexual and other forms of exploitation and abuse’.

In the treatment of suspects which has been another area that has been disregarded over time, the law states that police officers shall not effect arrest of persons suffering from mental illness but rather take the person for an assessment of his or her mental health.
Mental health conditions according to the law include, but are not limited to depression, bipolar, anxiety disorders, schizophrenia and addictive behaviour due to alcohol/substance abuse among others.

Mr Bukuwa is a senior information officer,
Parliament of Uganda