For the first time, Ecuador has a Mental Health Law. UNITE member Hon. María José Plaza, from Ecuador, was one of the key figures behind the recently approved law, and shared the key features and challenges of its implementation with UNITE, emphasizing the importance of adopting a multisectoral approach.
Starting from November last year, UNITE members from Latin America, namely Hon. Saraí Núñez Cerón, from Mexico, and Hon. Gisela Scaglia, from Argentina, shared their experiences regarding national mental health laws in their respective countries, with Hon. María José Plaza, from Ecuador. These insights were then applied to the development of Ecuador’s National Mental Health Law, which was still in the project phase at the time. Also, later in March this year, UNITE organized the first edition of the “Post Pandemic Talks”, bringing together parliamentarians from 10 Latin American countries to discuss Mental Health legislation in the region. Hon. María José Plaza recognized the value of drawing lessons from these experiences, as they significantly contributed to empower this new law:
Hon. María José Plaza also described to UNITE the key features of the new law and how it will benefit people with Mental Health conditions in Ecuador.
The key elements of the approved Mental Health Law are based on promoting the overall well-being of individuals in Ecuador. It focuses on the physical, psychological, cognitive, emotional, and relational aspects of Mental Health. The law aims to prevent mortality, morbidity, discrimination, disability, and institutionalization of individuals with mental disorders through timely and preventive care, treatment, and rehabilitation.
Hon. Plaza further explained that the law aims to encourage healthy living practices throughout the different stages of life, for individuals, families, and the community. Additionally, it seeks to ensure access to healthcare services and medications for those in need, through insurance policies and coverage in both the public and private sectors. The implementation of this law will enable the National Health Authority to actively promote Mental Health, Prevention, Comprehensive Care, and Recovery.
When asked about groups or communities that will benefit from the new law, Hon. María José Plaza highlights the focus on individuals with mental disorders who are abandoned or that lack protection. Hon. Plaza states, “In such cases, after controlling the crisis that led to their hospitalization, the interdisciplinary team, in coordination with the National Authority for Economic and Social Inclusion, will seek to locate the patient’s family. If no family members are found, these individuals will be transferred to protected homes or, exceptionally, to State Care Centers while continuing to receive necessary outpatient treatment at the nearest healthcare facility.”
The law also addresses the issue of reducing stigma around Mental Health. Hon. María José Plaza emphasizes, “The law prohibits any treatment that violates the physical and psychological integrity of individuals, including treatments to change sexual orientation and any violations of Human Rights. Such infringements will be sanctioned as stipulated in the law.”
Moreover, the new law places a significant emphasis on recovery as a process of social, labor, educational, family, community, participatory, and cultural inclusion for individuals with Mental Health issues. It focuses on providing support for the possibility of choice and self-determination for each person.
However, Hon. María José Plaza acknowledges that there will be challenges in implementing the new law. Hon. Plaza identifies the need for clear procedures and regulations, which will be determined by the National Health Authority through protocols for different healthcare providers, both public and private. The creation and operation of public and private establishments providing mental health care will be regulated by the National Health Authority. The prioritization of community-based mental health establishments and services in the primary and secondary levels of care is also highlighted.
Another significant challenge lies in the procedures surrounding the hospitalization of individuals requiring immediate intervention. Hon. María José Plaza explained “Hospitalization involves the admission of an individual with a mental health issues to a healthcare facility that offers hospitalization services. This admission must be timely and based on technical criteria provided by the interdisciplinary Mental Health team. Voluntary hospitalization requires the written informed consent of the person seeking treatment, presented to the competent authority before treatment initiation. In the case of voluntary hospitalization for minors, it must be indicated by a family member, caregiver, or legal guardian.”
Involuntary hospitalization, on the other hand, is considered an exceptional form of care that applies only when a patient poses an imminent risk to their own life or physical integrity, or that of others, after exhausting outpatient treatment options. In these cases, involuntary hospitalization must be recommended by the treating interdisciplinary mental health team and supported by a corresponding judicial decision from the competent authority.
Addressing these challenges will require a multisectoral coordination that respects the rights of individuals throughout the implementation process.
I am grateful to UNITE and each of the parliamentarians who were concerned about the Ecuadorian legislation. Thanks to their contributions and recommendations, we can have the Mental Health Law today in Ecuador. Also, to the “Post Pandemic Talks” space, which was very useful for the development of this law. Only together can we build better health policies worldwide.