The recent death of Susan Kamengere at a hospital inspired a lot of debate on social media. While a postmortem has confirmed that she was strangled on her hospital bed, the excuse given for her admission raises a critical matter in health care. What do psychiatrists and other mental health professionals refer to as involuntary admission? When and how should it be applied?
A person suffering from a severe mental health condition is admitted without their consent because they don’t understand they are sick and that they may pose a danger to themselves or others. They are unable to make informed decisions due to the severity of their mental illness.
A person can be involuntarily admitted if they are unable to take care of themselves and they have no adequate social support, and are unlikely to consent to involuntary treatment because they have no insight. This is usually done after an evaluation from mental health practitioners.
A relative, a guardian, police officer, community health volunteer, or medical officer must apply for the involuntary admission and the request must be accompanied by a medical report. In emergency cases, police or a chief may take a person directly to a mental health facility for assessment.
After involuntary admission and sedation, keen observation of the patient is critical. Close monitoring by qualified nursing and other medical staff to ensure the patient’s safety, manage potential side effects of medication, and prevent harm to the patients or others is mandatory.
After a doctor has ascertained the need for involuntary admission, the patient is only detained for up to 48 hours.
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The 2022 amendment to the Mental Health Act emphasises rights-based care in which each patient must be treated with dignity and respect. The Mental Health Review Board must analyse and approve longer stays.
The board, a statutory agency, was established to protect the rights of individuals with mental health conditions. Patients (or their guardians) have the right to challenge involuntary admission for the board to conduct hearings, ensuring procedures align with fundamental justice principles. Only then can the period for admission be extended. The Act also established the Kenya Board of Mental Health, which provides overall oversight and policy direction for mental health services. The board also has a duty to intervene whenever a complaint is lodged. It can stop an involuntary admission if in their assessment the patient doesn’t need it.
Involuntary admissions occur because there are many myths and a lot of stigma associated with mental health. Informed consent is usually the norm, and involuntary treatment is therefore a last resort necessitated by the best interest of the patient and not any other motive.
Dr Mutisya is 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