Full Answer Section

• Outcome after Evaluation:
  • If, after evaluation, the person is deemed no longer an immediate danger and can consent, they may transition to voluntary admission.
  • If they are still deemed a danger but refuse voluntary admission, a process for inpatient commitment (involuntary admission) may be initiated.
  • They may be discharged if found not to meet criteria for further hospitalization and deemed safe.

2. Inpatient Commitment (Involuntary Admission)

This refers to a longer-term, court-ordered or medically authorized admission to a psychiatric hospital or mental health facility against a person’s will. It is generally for individuals who require sustained inpatient treatment due to a mental disorder and lack the capacity to make informed decisions about their care, or pose a significant risk to themselves or others.

• Criteria:
  • The person is suffering from a mental disorder.
  • Due to the mental disorder, the person is incapable of making informed decisions about their mental health status and/or poses a danger to themselves or others.
  • The person refuses voluntary admission or treatment, or is unable to consent.
  • The treatment required cannot be safely or effectively provided in a less restrictive environment.
• Process (simplified):
  • An application for involuntary admission is typically made by a relative, social worker, or police officer, accompanied by a medical report from a medical practitioner stating the need for admission.
  • This application is usually made to a magistrate’s court, which then issues an order for admission (a “reception order”) if satisfied with the evidence.
  • Alternatively, in emergency situations or specific circumstances, a medical officer (e.g., a psychiatrist) can authorize involuntary admission with specific forms (e.g., MED 615 by the doctor and MED 614 by the accompanying person/relative, under the 1989 Act).
  • The admission is subject to regular medical review and the patient has rights, including the right to appeal their admission.
  • The duration is not fixed at the outset but is determined by clinical necessity, with periodic reviews. The goal is always to return the patient to the community as soon as safe and appropriate.
• Key Aspect: It involves a legal process that overrides the individual’s autonomy because their mental state renders them unable to make sound judgments for their own safety or the safety of others.

3. Outpatient Commitment (Community Treatment Order / Assisted Outpatient Treatment)

This is a newer or less extensively developed concept in the formal legal framework of Kenyan mental health, especially compared to some Western jurisdictions. While the Mental Health Act of 2022 emphasizes community-based mental health care and rehabilitation, and aims to reduce the over-reliance on inpatient treatment, a specific, legally binding “outpatient commitment” order similar to what exists in some other states (e.g., Community Treatment Orders or Assisted Outpatient Treatment in the US or UK) is not as explicitly defined or widely implemented in the same way.

• Current Direction in Kenya: The 2022 Act and the Kenya Mental Health Policy (2015-2030) promote:
  • Community Mental Health Services: This includes comprehensive, integrated, and high-quality mental health care services at all levels of healthcare, from dispensaries to referral hospitals.
  • Rehabilitation and Reintegration: Focus on helping individuals with mental illness recover and reintegrate into the community, often with follow-up care, counseling, psychotherapy, and vocational support.
  • Family and Community-Based Care: Encouraging the development of systems for care and support within families and communities.
• Absence of Formal “Outpatient Commitment” with Enforcement Power: Unlike some other jurisdictions where a court can order a person with severe mental illness to comply with an outpatient treatment plan (including medication, therapy, appointments) and be subject to re-hospitalization if they fail to comply, such a direct, legally enforceable outpatient commitment order is not a prominent feature in Kenya’s current mental health legislation.
• Emphasis on Voluntary Engagement: The current emphasis is more on encouraging voluntary engagement with community mental health services, patient education, and family support to ensure adherence to treatment plans once a patient is discharged from inpatient care. There is no specific legal mechanism to compel an individual to receive outpatient treatment against their will in the community, unless their condition deteriorates to the point where they again meet the criteria for emergency or involuntary inpatient admission (i.e., becoming a danger to self or others).