Psychiatric hospitals in Uganda A human rights investigation w www.mdac.org mentaldisabilityadvocacy @MDACintl Psychiatric hospitals in Uganda A human rights investigation 2014 December 2014 ISBN 978-615-80107-7-1 Copyright statement: Mental Disability Advocacy Center (MDAC) and Mental Health Uganda (MHU), 2014. All rights reserved. Contents Foreword ...................................................................................................................................................................................................... 4 Executive summary ......................................................................................................................................................................................................... 6 1. Introduction, torture standards and hospitals visited.............................................................................................................................. 9 1(A). The need for human rights monitoring........................................................................................................................................................... 9 1(B). Uganda country profile .................................................................................................................................................................................... 10 1(C). Mental health .................................................................................................................................................................................................... 11 1(D). Prohibition of torture: International, regional and national legal framework ........................................................................................ 13 1(D)(i). United Nations standards ................................................................................................................................................................ 13 1(D)(ii). African standards .............................................................................................................................................................................. 14 1(D)(iii) . National standards ........................................................................................................................................................................... 15 1(E). Hospitals visited ................................................................................................................................................................................................ 16 1(E)(i). Butabika hospital ................................................................................................................................................................................ 19 1(E)(ii). Other hospitals ..................................................................................................................................................................................... 19 2. Monitoring findings: Ill-treatment and abuse in psychiatric hospitals ............................................................................................ 22 2(A). Coercion and compulsion ................................................................................................................................................................................ 22 2(A)(i). Seclusion .............................................................................................................................................................................................. 22 2(A)(ii). Restraint ............................................................................................................................................................................................... 24 2(A)(iii). Forced treatment and lack of consent ............................................................................................................................................ 25 2(A)(iv). Deaths .................................................................................................................................................................................................. 26 2(A)(v). Conclusions and Recommendations .............................................................................................................................................. 27 2(B). Detention on the basis of a disability ............................................................................................................................................................. 28 2(B)(i). Admission .............................................................................................................................................................................................. 28 2(B)(ii). Record-keeping ................................................................................................................................................................................... 30 2(B)(iii). Conclusions and recommendations ............................................................................................................................................... 31 2(C). Access to physical healthcare ........................................................................................................................................................................ 32 2(D). Conditions and patient safety ......................................................................................................................................................................... 34 2(E). Pharmacology and boredom ......................................................................................................................................................................... 35 2(F). Hygiene ............................................................................................................................................................................................................... 37 2(G). Gender-based discrimination ......................................................................................................................................................................... 38 2(H). Food ..................................................................................................................................................................................................................... 38 2(I). Access to medicine ........................................................................................................................................................................................... 40 2(J). Conclusions and Recommendations ............................................................................................................................................................. 41 3. Causes of ill-treatment and abuse .................................................................................................................................................................... 44 3(A). Community-based services ............................................................................................................................................................................. 44 3(B). Barriers to providing community-based mental health services ............................................................................................................... 46 3(C). Lack of legal compliance ................................................................................................................................................................................ 48 3(D). Lack of information and awareness about rights ........................................................................................................................................ 48 3(E). Staffing levels...................................................................................................................................................................................................... 50 3(F). Staff training ........................................................................................................................................................................................................ 51 3(G). Complaints procedures .................................................................................................................................................................................... 52 3(H). Independent monitoring and inspection ....................................................................................................................................................... 52 3(I). Conclusions and Recommendations ............................................................................................................................................................. 54 Appendices ........................................................................................................................................................................................................................... 56 Methodology ................................................................................................................................................................................................................ 56 Acknowledgments .......................................................................................................................................................................................................