To mark Egypt's first conference on mental patients' rights, Amira El-Noshokaty spent the day at the Abbasiya Mental Hospital "All the rumours are true," one middle-aged patient who has been in the Abbasiya Mental Hospital (AMH) for over 15 years testified. "This," he pointed to the garden, "was a dump overrun by snakes and scorpions." For the first 12 years of his stay, he remembered, "the beds were little more than dirty mattresses infested with bedbugs. The food was inedible. Nurses acted like wardens, beating patients up or applying electric compulsive therapy without anaesthetic and without the need for it as a form of punishment." He seemed unusually calm as he added, with a smile, that conditions have improved in the last 15 years. There have been other rumours, too: rape, torture, even death; initially part of a palace built by Khedive Abbas Helmi in the late 19th century, the AMH, which overlooks Salah Salem Road, was said to be a haven for criminals pretending to be insane to avoid a prison sentence; in popular discourse, indeed, the AMH has been synonymous with the proverbial "place from which there is no return". Architecturally, at least, the AMH has a glorious history. According to Nihal Tamraz's Nineteenth Century Cairene Houses and Palaces, part of the saraya safra (yellow palace -- a common synonym for the AMH) was transformed into a "lunatic asylum" in the reign of Khedive Tawfiq, Abbas Helmi's better known successor, after which it became a British hospital (1930-1940) before turning irrevocably into what it is today. One presumes conditions deteriorated at a steady rate. The most recent climax occurred in the 1990s when an escapee was implicated in a terrorist attack on tourists. Mody Zaki, head of the Committee for Patients' Rights at the AMH, says that, "being a matter of national security, the incident had serious consequences. The hospital director was put behind bars and the doctors ordered to tighten security -- naturally at the expense of the patients and their families' right to visits. "Today," he goes on, "our doors are open to the media and whoever wants to check the hospital." The corruption, he added, extends to families who pay the nurses to keep their relations in confinement; but cases of malpractice are immediately reported to the prosecution and the culprit suspended. Such measures are required in the light of statements in the World Health Organisation (WHO) Resource Book on Mental Health. The book estimates that across the globe 340 million people suffer from depression, 45 million from schizophrenia and 29 million from dementia, experiencing with physical, sexual and psychological abuse on a daily basis. Existing legislation does not guarantee the protection of patients' rights, WHO argues; and only 75 per cent of the countries in question have legislation in the first place. In Egypt the relevant law dates back to 1944, and among its many shortcomings is that it pays no attention to how a patient is admitted into care in the first place and presupposes, as was indeed the medical opinion of the time, that all mental diseases are incurable; a new bill is currently under review in parliament. Nasr Loza, secretary-general of the Mental Health Programme in Egypt (MHPE), says reform of the mental health apparatus has been ongoing for many years with the object of monitoring the performance of institutions and ensuring that detention lasts only for as long as it is necessary; and the last five years have seen progress in leaps and bounds. "We received funds from the government of Finland to develop the MHPE, including training, setting management standards for mental hospitals, a national campaign to promote awareness and a new law." Due to the fact that electric therapy was conducted without anaesthetic, he added, the law does not require the latter. Rather than spending the rest of their lives in the AMH, newly released patients long since abandoned by their families will be provided with a hostel and the full gamut of civil rights. Nasr explained that mental patients make up 15 per cent of any given population at any given time and that they are no more prone to violent behaviour than others, with 90 per cent of street crimes committed by mentally "healthy" individuals. Only where an illness poses imminent danger to himself or others will a patient be admitted into care against his own will; on admission, undertaken on the basis of reports by a member of the family, a social worker, police officer or doctor, a resident physician must give a second opinion, whereupon a patient is confined for no more than 28 days, extended only with permission from the Council of Mental Health. "No longer will people be confined for 20 years or anything like that." Back at the AMH, across from the garden, stand the premises of the Intermediate Service Programme (ISP), founded in 2003 and run on Finnish funds. This recovery-oriented initiative comprises a day-care centre and work-treatment courses in the framework of a rehabilitation unit. It also aims to enhance patient-family ties. According to Samah Ali, an ISP social worker, the unit is modelled on a typical community to help patients adopt a daily routine that would work outside. Rehabilitation takes four to 10 months, she says, depending on condition: "no less than 100 patients are reintegrated into society every year." Speaking on condition of anonymity on the premises, the "first patient to gain membership of the Patients' Rights Committee" praised the unit's cleanliness and the inclusion of a daily self-expression meeting among other means of promoting independence. "It's less overcrowded, too, and has a hotline service." He expressed the hope that the mandatory badge identifying AMH patients will be banned, adding that, "the media is 90 per cent responsible for degrading mental patients, exaggerating and stereotyping their troubles. Patients are referred to as the refuse of human nature. Let's hope the new law secures privacy and better treatment." One particularly admirable side of the ISP is the opportunity for patients to learn arts and crafts as a means to both self-expression and income- generation, since their work is on sale at a permanent exhibition on the hospital grounds. Speaking on condition of anonymity while she resumed her needlework, one woman said, "I have been in and out of this hospital for over 10 years and I can tell it's never been better than the way it has been for the last few years. Now we go on day trips, we are even granted a monthly financial award if we finish our tasks. Being here gives me a reason to live, and I have come to prove myself through my needlework." As Nader Abdel-Aziz, head of public relations at AMH, explains, the civic sector has played a significant role, too, with the Amal Association for Mental Health formed in 2005 to provide mental patients and their families with support, as well as working to help raise awareness to counter the stigma associated with mental disease. The male ward is living proof of how inaccurate the media stereotype of mental illness is. The space is painted turquoise; it has giant open windows overlooking a long shady garden. This is where I spoke to the middle-aged man, who was taking his afternoon walk. "The times," he went on, "they are a-changing. Since Ismail Sallam, the former minister of health and population, took charge, conditions have drastically improved." But, due to low wages and the newly instituted part-time system, the hospital continues to suffer from a shortage of medical staff -- down from six or seven to three or four per ward. The AMH administration struggles with too small a budget. Nurses at the AMH receive a monthly salary of LE400 as opposed to the LE1,000 their counterparts get at private hospitals. In the 25 mental hospitals of Egypt, the capacity of which is 10,000 beds, the AMH's share is 1,900, divided between free of charge and economic departments. The AMH is a good option for the unfortunate given the fact that there are only 1,000 psychiatrists in Egypt, and the treatment is usually extended over a long period of time, making the whole procedure much costly. But many believe the issue of mental disease is more than a legal question. For taxi driver Ahmed Fouad, whose neighbour was admitted to the AMH following the death of both his mother and brother in the same year, only to end up homeless and destitute following his release, leading to a deterioration of his condition, it is rather a question of social attitude. "There is nothing shameful about being sick," he says, "and this is just a kind of sickness that could happen to anyone." The government must prevent malpractice, he adds: "the government must work to pick effective and kind staff. Patients must never be abused, which only worsens their condition." For his part, the patient to whom I spoke in the garden says the key to change starts at home . "If the family accepts and respects its patient, society will," he concluded.
