Mental health law profiles

The states of Iran and the United Arab Emirates (UAE), both rich in natural resources, face each other across the Persian Gulf and come closest geographically at the highly strategic straits of Hormuz. Iran enjoys an exceptionally rich historical heritage, as one of the earliest centres of civilisation and political authority in the world and including having been the seat of power of two empires that were the largest in their times. The Abbasid Caliphate in particular reigned strong at the centre during the golden age of Arab science (Al-Khalili, 2012). Today, Iran is an Islamic Republic. UAE is a young federation of seven absolute hereditary monarchies.

As the authors of the two mental health law profiles in this issue report, in both Iran and the UAE recognition of the human rights of people with mental illness remain inadequately defined and protected in law. Gender differences in mental health in the Middle East (Ghuloum, 2013) highlight the need for the law to protect women with suspected or confirmed mental health problems from unfair and harmful approaches to evaluation and management due to patriarchal prejudices. This is something that the dependence on families for decision-making and care may make difficult at times. In Iran, where in addition to civil and criminal courts there are revolutionary and special clerical courts, it must be ensured that patients’ rights are protected across the whole range of courts. The fact that the vast majority of the resident population in the UAE are immigrant workers (Zahid, 2014) underscores the need for specific attention to be paid to their needs in mental health legislation as well as service provision. International anxiety is particularly high at present about the health of immigrants in the member states of the Gulf Cooperation Council.

It is encouraging that in both Iran and the UAE efforts are being made to create mental health law in the light of international norms. Such laws, however, need to safeguard patients’ access to a range of legitimate professional perspectives on mental illness, not limited to that of doctors. The family and police are no substitute for social work, psychology, occupational therapy and nursing inputs during the application of the law. This is particularly the case when considering or reviewing compulsory detention and the application of intrusive treatments such as electroconvulsive therapy. To create adequate safeguards, the voices of mental health services users themselves must be heard as well. The two papers published here do not provide full assurance in relation to such requirements, although the ongoing process of drafting and enacting legislation should provide opportunities to ensure that legitimate expectations are met. Any deficit in meeting such legitimate expectations would be a cause of concern to the international psychiatric community.