The 1997 Mental Health Law (amendments of 2003 and 2007) and the rights of mental patients in Cyprus
This Law was passed by the Parliament of Cyprus in 1997 replacing the one existing for half a century on the “Mentally insane”. It is based on the recommendations of the Council of Europe as well as the Principles declared by the General Assembly of the U.N. fifteen years ago.
The main features of the present Law are the following:
Inpatient psychiatric treatment is offered in two categories of Psychiatric Centers that belong either to the public or the private sector. They ought to fulfill certain minimum standards in order to obtain a license for this purpose from the Minister of Health. They are:
- Open Centers for voluntary admission and treatment
- Secure Centers for involuntary (compulsory) admission and treatment with court order
The protection of the rights of the patients during admission procedures and treatment are guaranteed by many articles. e.g. a) they have the right to be heard and be accompanied by their own psychiatrist and lawyer at the process before the court. It should be noted that the court order calls for a temporary period of 28 days for evaluation and treatment which is followed by periodic reevaluations every two months for a maximum of one year. b) abuse and neglect during hospitalization is against the Law. c) an informed consent is necessary for ECT or psychosurgery. d) the patient regains all his civil, political and other rights after his discharge from the involuntary hospitalization. There is discussion whether even during his compulsive treatment he could still retain some of those rights. e) He(she) has the right to communicate with people outside the Center unless if this is considered detrimental to his (her) mental state or contrary to some regulations of the Center. f) He(she) or his(her) representative can have access to his(her) records unless if this is not helping his(her) condition or can affect negatively other people.
The Law covers also the possibility of refusal by the patient to be examined with the issue of an examination order by the court. It also covers the case of a seriously disturbed patient creating problems in public by allowing the police to apprehend and transfer him to a secure establishment for 24 hours observation and treatment while the procedures for a court order are initiated. Unfortunately there are no crisis mobile teams for intervention.
One of the significant innovations of the present Law is the appointment by the Government of a Mental Health Commission. It consists of the president and 7 members who represent various professional and other lay organizations. This Commission which I have the honor to preside for the last six years has a consultative but not executive role towards the Minister of Health. Among its responsibilities are:
- Monitoring the implementation of the Law and introducing any necessary changes.
- Inspecting the Psychiatric Centers in order to ascertain that they maintain minimum standards regarding construction, facilities, personnel and satisfaction of the rights of the patients.
- It is being informed for all involuntary admissions and gives permission for the continuation or not of hospitalization in certain cases.
- It examines complaints from patients, relatives or other interested people and acts accordingly.
A few articles cover the treatment of psychiatric offenders and the units where this should take place. This was the subject of heated debate in the last few years and a preliminary decision for the establishment of an independent unit in the Central Prison in Nicosia has been taken. Our Commission took the initiative of inviting an expert in Forensic Psychiatry from Germany, Professor Andreas Marneros, who examined recently the existing situation and sent his report and suggestions regarding the necessary legal framework and the best solution for the care of these doubly stigmatized patients.
In the present Law brief mention exists of the role of the Mental Health Commission in inspecting various establishments that should exist in order to implement Community Psychiatry and deinstitutionalization . Cyprus introduced very early the idea of psychiatric wings(units) in General Hospitals but has been very slow in opening other facilities such as community mental health centers, hostels, day care centers etc. The legal framework for the operation of these facilities is under preparation for some time now but the lack of political decisions, financial support and the stigma that still surrounds mental illness are drugging the whole process.
A more liberal amendment of the Law that allows admission and treatment of a patient without his consent for up to72 hours to an open center provided there is a written recommendation by two physicians (at least one being a psychiatrist) was passed this year by the Parliament. Our committee has to be notified immediately.
We printed two leaflets with summaries (brief and more extensive) of the Law with the rights and responsibilities that derive from it . They have been distributed to all appropriate agencies and interested parties as well as to each and every admitted patient and his family. The brief leaflet is both in Greek and English.
Furthermore a national survey of the number of patients with dementia or chronic psychosis being cared in nursing homes has been conducted by us, studying various parameters including level of satisfaction of their families and themselves.
Mail boxes where patients and their families can make complaints and suggestions have been placed in each ward of the Psychiatric Hospital and are being opened by our secretary weekly.
Finally, our Committee organizes successful conferences with speakers from Cyprus and the European Union almost yearly. At the same time members of our Committee visit various EU countries exchanging experiences on mental health programs and legislations.
We hope that this website will be useful to all interested people and will help in creating the right atmosphere and knowledge surrounding the care of mental patients.