Psychiatric patients in the vacuum of legal protection / Who has the right to issue a mandatory hospitalization order?

More than two decades have passed since the beginning of efforts to develop a law to protect the rights of people with psychiatric disorders in the country; A bill that was supposed to respond to one of the most important gaps in the health system in the field of protecting the rights of psychiatric patients, but despite going through numerous expert and legislative stages, it has not yet been completed...

According to Ambassador Arjan's report, quoted by Ambassador Arjan; The importance of this bill is due to the fact that the lack of comprehensive legislation in this field has caused some processes related to hospitalization and maintenance of patients to be ambiguous and the responsibility of the relevant institutions is not clearly defined.

Now, after more than 20 years, the question is still raised, why is an issue of such importance and sensitivity not placed on the agenda of the government and parliament again, and what should be done to resolve the existing concerns and achieve a balanced framework between the needs of treatment and the protection of patients' rights?

Dr. Vahid Shariat, the head of the Scientific Association of Psychiatrists of Iran, while explaining the reasons for the importance of this bill, mentions the existing legal loopholes, the challenges of forced hospitalization and the necessity of determining responsibilities and monitoring mechanisms, and emphasizes that the final law should protect patients and prevent treatment processes from becoming more complicated.

Statistics of 25% of psychiatric disorders in the country

Dr. Vahid Shariat, in a conversation with Ambassador Arjan on the occasion of Mental Health Week, said about the state of psychiatric disorders in Iran: The results of the latest national mental health survey show that about 25% of people in the society have experienced some kind of psychiatric disorder. Therefore, it can be said that one out of four people is facing some kind of psychiatric disorder. Depression is the most common psychiatric disorder and anxiety disorders are the next most common psychiatric disorders.

Stating that the last mental health survey was conducted before 1401, he explained: This survey is the second wave of examining and monitoring the state of mental health in the country, and the first wave was also conducted years ago. The time interval between these two waves is about 10 years.

The need to update the mental health survey

This psychiatrist stated about the importance of updating the information related to the mental health of Iranians: conducting large-scale surveys at the country level is a difficult and very expensive task, and in addition to financial resources, it requires complex coordination. For this reason, the implementation of such surveys needs strong support from the government. Mental health surveys have always been carried out with the support of the Ministry of Health, but in the context of budget restrictions, it becomes more difficult to repeat such surveys. According to the information I have, periodic repetition of these surveys is still in the plan of the Ministry of Health.

A bill to support people with psychiatric disorders

He explained about the existing legal loopholes for the protection of people with psychiatric disorders: The bill for the protection of people with psychiatric disorders went through a very long process to be presented in the government and parliament. The background of the bill for the protection of the rights of people with psychiatric disorders shows that the drafting of this bill took more than 10 years.

The head of the Scientific Association of Psychiatrists of Iran said about the content of this bill: Part of the content of the support bill was dedicated to the issue of compulsory hospitalization and coordination between different institutions, such as the judiciary and the Ministry of Health, each of which has different responsibilities. Also, several issues regarding the support of people with mental disorders, including "guardianship" and "custody", were raised in this bill.

The bill covered the minimum necessary for patients' rights

Stating that this bill partially covered the minimum necessary to protect the rights of psychiatric patients, Sharia clarified: After the introduction of the bill to support people with psychiatric disorders, oppositions and concerns were raised, and finally, the bill was withdrawn from the parliament in the 13th government. Drafting of this bill started in 2003 and at the end of Hassan Rouhani's government, it reached the final stages and was presented to the parliament.

Too many legal loopholes to protect mental health patients

Stating that there are many legal gaps in the field of supporting people with psychiatric disorders, he explained: Currently, there is no specific law to support these patients. This legal vacuum is such that even the institution or group that is legally responsible for protecting these people has not been identified.

Challenges in the field of hospitalization of patients

The head of the Scientific Association of Psychiatrists of Iran said about hospitalization of people with psychiatric disorders: The law has not specified under what conditions people with psychiatric disorders can be forcibly hospitalized and under what conditions we are not allowed to do this. Although there are routines for admitting these people, these routines are not specific enough and may be implemented arbitrarily.

Lack of supervision and complete execution of processes

This psychiatrist continued: The existing processes are also not implemented well due to the lack of sufficient supervision. When the actions are done in a tasteful way, it is difficult to follow them and the work process becomes opaque. It is possible that a person will be kept in a camp without his consent and will not even be allowed to leave. On the other hand, there should be a mechanism for hospitals to admit people in urgent situations. Necessary conditions mean that the person is not competent to make decisions about himself at that moment.

He continued: When the competent person to make a decision is not clear, one person may consider a person qualified and another person may have a different opinion. It is also unclear who legally has the right to recognize this issue; Therefore, the question whether a psychiatrist, judge or police has such a right remains unanswered.

The lack of a clear legal framework can lead to the violation of people's rights

The head of the Scientific Association of Psychiatrists of Iran stated that the lack of a clear legal framework can lead to the violation of people's rights and explained: A person may be admitted to a hospital and it may take a few weeks to prove that he was admitted for no reason. Unfortunately, examples of such cases are not few. There are people in the society who are hospitalized in psychiatric hospitals and practically their voice does not reach anywhere to prove that their hospitalization was without reason. These people must have a lawyer to follow up on their situation, file a complaint and get a ruling from the court; A procedure that is very difficult and in many cases does not work.

Creating a specific mechanism for hospitalization of patients by implementing the bill

Shariat in response to the question, "What noticeable change will the implementation of the bill to support psychiatric patients bring about in the current situation?" He said: A specific mechanism is being formed for hospitalization of psychiatric patients. First, it will be determined who can order the hospitalization of people and who must accept responsibility for this action. There is also a possibility that a committee will be formed to make the decision so that the decision is made by a committee instead of an individual.

The authority of the committee should be limited

This psychiatrist explained the necessity of the limited powers of the decision-making committee: a time limit should be considered for the committee's decisions so that the committee has the authority to deprive the person of his freedom and keep him in the hospital for a short period of time. After the expiration of the committee's authority, a legal representative must also be present to confirm the process.

The head of the Scientific Association of Psychiatrists of Iran stated that creating a legal mechanism can reduce the possibility of abuse or harming people, and stated: When the responsibilities are clear, the responsible people should be held accountable and this process should be monitored. For example, a legal representative can visit the hospital every week, check on people who have been admitted against their will and evaluate their case. Forensic medicine can also interview the patient to determine whether the necessary conditions for such an action were present or not.

Shariah in response to the question that "it is possible that a person does not want to be hospitalized from a personal point of view, but needs to be hospitalized from a scientific and medical point of view, and this issue creates a challenge in the implementation of the law?" He explained: There is this challenge, but the important issue is how long we have the right to carry out the hospitalization process against people's wishes. For example, consider a person who smokes. We all know that smoking is harmful to the body, but do we have the right to force someone to quit smoking? We have no such right; Because a person has the authority to make a decision and can check the advantages and disadvantages and then make a decision.

The head of the Scientific Association of Psychiatrists of Iran continued: Many people with psychiatric diseases may have injuries and problems, but they are not necessarily dangerous for anyone and do not cause serious harm to others or themselves. Therefore, these people cannot be hospitalized and treated against their will. But if the disease is more severe and the person has conditions for hospitalization, then hospitalization is necessary.

A challenge called treatment adherence

In response to the question "Does the implementation of the law to support people with psychiatric disorders reduce the desire for treatment?" He said: The issue of not wanting to be treated is not a new issue and we are facing it these days and it will be there in the future.

The need to support people with psychiatric disorders

Stating that there is a difference of opinion about the bill for the support of people with psychiatric disorders, this psychiatrist said: the necessity of organizing the hospitalization process of people with psychiatric disorders and supporting these people is not hidden from anyone, and the government and the parliament are expected to amend and approve it.

The crooked and contagious process of hospitalization of patients

Stating that we currently do not have a specific law for admitting these patients, he clarified: Currently, things are being done in a crooked and contagious process, although the text of the bill for the support of people with psychiatric disorders was not a bad text, but concerns about the inclusion of non-scientific issues in the text of the bill caused it to be withdrawn.

The law should not complicate the situation

Stating that the existence of a law to protect people with psychiatric disorders is necessary, Shariat said: having a law is definitely better than not having it; But a law should be passed that does not make the situation more complicated.