Mathari Hospital in Nairobi.
Mathari National Teaching and Referral Hospital is overflowing with recovered mental health patients who have remained stuck in the institution, some for more than 40 years, the Health Committee heard.
Lack of clear legal framework, complex discharge process and bureaucratic inefficiencies within the administrative and judicial system have left hundreds of recovered patients stuck in Kenya’s largest mental health facility.
The hospital’s chief executive officer Julius Ogato made the startling disclosures when he appeared before the National Assembly Departmental Committee on Health led by Endebbes MP Robert Pukose, on Wednesday.
Dr Ogato decried the agonising lengthy discharge process, which has since left many Kenyans stuck in the mental health hospital with their future in limbo years after their full recovery.
The patients were initially committed to the hospital by court orders after they were found to be criminally unfit to stand trial.
Entrance of Mathari National Teaching and Referral Hospital in Nairobi.
According to Dr Ogato, for such patients to be discharged from the facility, a court clearance must be issued which takes extremely long due to delays in processing the necessary judicial approvals.
“In fact, we have a patient committed there (at Mathari) for 40 years. Some of them are mentally well but we can’t discharge them. We have a legal void. Those with mental capacity are committed to our hospital for life,” Dr Ogato said.
He went: “We have several patients who are fit and stable for release but we cannot release them without legal clearance because they were admitted through court orders. Unfortunately, the process takes too long due to various bureaucratic inefficiencies within the judicial and administrative system.”
Currently, offenders who are either minors or mentally unfit to stand trial are handed indefinite prison terms.
Legally speaking, they are jailed at the President’s pleasure, which means their fate is determined by the Power of Mercy Advisory Committee (POMAC).
The committee draws its authority from Article 133 of the Constitution and the Power of Mercy Act.
Its job is to determine petitions for release by individuals who are jailed at the President’s pleasure.
Successful petitioners are pardoned through a gazette notice.
Some High Court judges have in past decisions faulted jailing of individuals at the President’s pleasure, arguing that it interferes with judicial independence, and that indefinite prison terms also violate rights of convicts.
Appearing before the MPs during the scrutiny of the2025/2026 Budget Policy Statement (BPS), Dr Ogato said prisoners overstay at the national facility has been aided by a legal lacuna where the Judiciary has been admitting mentally ill suspects or convicts through court orders and without mechanisms of discharging them.”
'No law'
The Mathari Hospital boss attributed the lack of a legal framework to fast-track the discharge process, to the reason dozens of patients are still languishing in the mental health for decades long after completing their treatment.
“We are required by law to wait until the court gives a directive or ruling. The court system is slow and sometimes no follow-up is made after admission,” he stated.
The officer’s sentiments came against the backdrop of widespread concern among hospital officials, lawmakers and mental health advocates over the prolonged confinement of patients beyond their treatment duration.
They argue that the extended stay, apart from stretching the already limited resources at the mental health facility, also contravenes the recovered patients’ rights and freedoms.
'Sound until proven unsound'
Persons can be admitted to Mathari through a court order Section 11 of the Penal Code states that every person is presumed to be of sound mind until the contrary is proven.
According to legal experts, this means that when a person is accused of committing a crime unless there is evidence proving otherwise, the court will assume they are mentally capable of understanding their actions.
The burden of proving the accused individual was insane during the time of committing the said crime lies with the defense.
The Mental Health (Amendment) Act 2022 was signed into law on June 21, 2022, and it states that, Subject to CAP. 75 of the Criminal Procedure, “no person shall be received or detained for treatment in a mental hospital unless he is received and detained under this Act.”
Section 26 (3) of the Mental Health Act, CAP. 24 states that, “if, upon inquiry, it is determined that a person suffers from a mental disorder to the extent that they are incapable of managing their affairs—yet remain capable of managing themselves and pose no danger to themselves, others, or public decency—the court may issue appropriate orders for the management of their estate.
This includes making provisions for the accused person’s maintenance as well as support for any dependents
In such cases, however, the court is not required to issue an order regarding the individual’s custody.
Flaw in the law
While the law mandates that persons declared medically unfit to stand trial be confined in a mental health facility until they regain stability, the discharge of such patients is not automatic and it requires a formal court approval.
However, there have been instances of delayed or misplaced court records compounded by the existing lack of clear follow-up mechanisms, much to the detriment of mental health patients.
Further, fear of potential relapse and stigma has made some families reluctant to take back their loved ones making their release even more complicated and unnecessary institutionalisation.
In efforts to address the plight of patients still detained in mental health hospital beyond their treatment period, the legislators led by the Health Committee chairperson have called for urgent legal reforms.
Dr Pukose has urged the Judiciary and the Health Ministry to work together in fast-tracking the process of reviewing the cases of recovered mental health patients warning that their prolonged confinement is contrary to the law.
“It is unacceptable for a person who has fully recovered to continue being locked up because of inefficiencies in the administrative system. It is a human rights violation,” stated the Endebess MP.
He appealed to the government to “Establish a proper system to ensure fair treatment and reintegration into society of recovered mental health patients.”
The legislators are contemplating the introduction of a special tribunal to fast-track judiciary court mechanisms as well as regularly reviewing cases of patients being held at mental health institutions due to delayed court orders.
“There should be an expedited way to facilitate patients' discharge once they have been declared stable by medical professionals. We should not wait for years to process a simple release order,” he remarked.
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Other than the overwhelming number of increasing admissions, the continued detention of recovered patients has further exacerbated the situation at the Mathari Hospital which is now grappling with a congestion problem, leading to resource constraints and substandard care for new admissions.
“We have limited space and personnel. Every bed occupied by a recovered patient who should have been discharged is a bed denied to another mentally ill patient who urgently needs treatment,” stated Dr Ogato.
Besides hospital congestion, he explained that the prolonged detention of patients also affects their psychological well-being.
Experts argue that keeping a mentally stable individual in a psychiatric institution longer than necessary can trigger depression, frustration, and a sense of hopelessness.
Recommendations
Mental health stakeholders are now urging the government to develop policies that will prevent unnecessarily prolonged confinement of recovered patients.
One of the proposed solutions is to create a dedicated legal desk at Mathari Hospital to liaise with the Judiciary and expedite release procedures.
Additionally, mental health advocates are calling for better reintegration programs to assist patients in transitioning back into society.
Legislators have vowed to push for legislative amendments that will streamline the release process for such patients.
“This matter needs urgent attention. We must amend the Mental Health Act and other relevant laws to ensure these people are not unfairly incarcerated in hospitals,” stated Dr Pukose.
Mental health practitioners including Dr Ogato have implored the Judiciary to conduct regular case reviews for patients held at Mathari under court orders to determine those eligible for release.
“The Judiciary should have a system where they periodically review the cases of patients committed through court orders. This will help us avoid unnecessarily prolonged detention and ensure those who have recovered can regain their freedom,” stated the MNTRH boss.
