Revolution in Egypt's mental health care

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Patients who passed through Abbasiya's gates were not expected to emerge again

Lawmakers in Egypt have passed the country's first new mental health legislation in more than 60 years. The BBC's Yolande Knell in Cairo reports on the radical reforms to a system in which mentally ill patients are shut away in 19th Century asylums for decades.

When I tell my taxi driver where I want to go he looks surprised and then grins broadly. "Abbasiya? The crazy hospital?" he asks. "Are you crazy?"

The name of the asylum converted from a royal palace in 1883 under British occupation has become synonymous in Egypt with "mad" or "insane".

Nabila was brought to Abbasiya 22 years ago, after a traffic accident

It is common to joke that someone acting in an eccentric fashion could be locked up in Abbasiya and forgotten.

Unsurprisingly, most patients I meet there do not find the idea funny.

Nabila Said is in her 40s and has spent 22 years at Abbasiya. She remembers being brought to the hospital after a road accident.

Nowadays, she takes few psychiatric drugs but since her husband left her there is nowhere else for her to live.

"Although I have a sister and brother they cannot accept me and each of them has their own family," she says.

Community care

"My closest friend here is called Madiha. My only hope is that we leave the hospital together and find a small home to share."

A change is long overdue. Community-based treatment is what we're looking at now Nasser LozaMental Health Secretariat

Nabila might see her dream come true under new legislation finally agreed by the Egyptian parliament.

Mental Health Secretariat chief Nasser Loza has been pushing for the first update to the law in six decades.

"Law 141 dates back to 1944. Back then, the whole concept of caring for the mentally ill was very different, very asylum-based," he says.

"A change is long overdue. Community-based treatment is what we're looking at now. We're training community psychiatric nurses and setting up homes in the community."

Once they have finished their training the nurses will work in the community

The new law also sets time limits for patients' cases to be reviewed, allows them a greater say in their treatment and sets extra safeguards for those brought to the hospital involuntarily.

Feeling alive

Long-term residents of Abbasiya showing signs of recovery already get help to move on.

Magdi Abdel Halim, 50, was admitted five years ago.

"I was in my apartment and some people arrested me and brought me here," he remembers. "Maybe I had depression. Maybe someone told them something bad. I still don't understand."

"The first four years were really very tough, but in the last year things became better."

Magdi's condition has stabilised. Recently he started a job working with computers in hospital offices.

Social workers have also arranged for a lawyer to represent him in a legal dispute with his brother so he can reclaim his apartment.

Enjoying a football match is a first step back into society

"I will leave when I solve my problems," he smiles. "Maybe in weeks or months."

Rehabilitation at Abbasiya takes many forms. On the day of my visit, a football tournament is under way between teams of patients from Cairo's main mental hospitals.

The commentator is psychiatrist Tamer Zaghloul.

"Each patient has his rehabilitation programme. One is to be a player, to feel that he's alive and have emotions."

"He reacts: he's happy because he scored a goal or upset because the team lost. So we're reintegrating the patient into society."

Fighting stigmatisation

The old laws in Egypt assumed patients would be locked away in an asylum indefinitely. Now seven out of 10 are stabilised with medical treatment and Dr Zaghloul says many can go home.

"We discharged more than 450 patients; 250 or 300 were reintegrated into society and we don't hear anything more about them, and the rest are outpatients."

Patient rights groups have welcomed the new legislation, but misconceptions about mental illness and safety concerns mean the public may be harder to win over.

I relate my experience with the taxi driver to Dr Loza.

"The stigma associated with mental illness is still very strong and that needs to be changed," he says.

"We've worked on community awareness and it's gradually sinking in."

"Maybe today your taxi driver made faces, but I can tell you that a few years ago he would have refused to drive through our gates."