Summary.
The draft bill specifies the minimum staff for each Mobile Crisis Unit (Unidades Móviles de Crisis): a psychiatrist or general practitioner with certified training in community mental health, a licensed clinical psychologist, a social worker, and an emergency medical technician or nurse specializing in mental health. Relatives within the fourth degree of blood relationship or second degree by marriage could request the service. Neighbors or local authorities, including justices of the peace, could do so when a person’s serious mental health deterioration is evident and threatens that person’s safety or dignity. Users could also request assistance through the national emergency line.
The units would use verbal de-escalation and mediation while respecting human dignity. The proposal prohibits military or police-style uniforms, mobile cells and items that portray a patient’s medical condition as criminal. Public security personnel could intervene only around the perimeter, at the express request of the physician in charge, when extreme violence is imminent and the safety of the team and patient must be protected. If a person with visible signs of a severe mental disorder refuses care because of anosognosia, the unit would begin periodic home visits to build trust and follow up with the family and social network. Those visits would seek voluntary acceptance of care or consent from the person’s legal support network under the proposed framework.
Public and private hospitals, health centers and polyclinics would have to ensure suitable facilities, qualified staff and timely supplies of essential psychiatric medicines. A shortage of mental health medicines or refusal to provide timely care to a patient in crisis would be a serious public health violation. The bill classifies improper recording of an advance directive and obstruction of a Mental Health Facilitator’s access to consultations as minor violations. Serious violations include refusing care or hospitalization to a patient referred by a Mobile Crisis Unit, disregarding an Assisted Outpatient Treatment order and an unjustified shortage of essential medicines in the public network. Very serious violations include involuntary admission outside the statutory exceptions, electroconvulsive treatment or isolation without the required consent or judicial safeguards, and discrimination or physical abuse based on a patient’s mental health condition.
The Technical Health Council (Consejo Técnico de Salud) of the Ministry of Health (Ministerio de Salud) would impose fines on private clinics and hospitals ranging from five thousand balboas (B/. 5,000.00) to twenty-five thousand balboas (B/. 25,000.00) for serious violations. Very serious violations would carry fines from twenty-five thousand and one balboas (B/. 25,001.00) to fifty thousand balboas (B/ . 50,000.00) and/or temporary suspension of an operating license. Following an administrative proceeding, public employees and health professionals could receive a written warning, unpaid suspension from 15 days to six months, or dismissal and disqualification from public service, without precluding civil or criminal liability.
Funding for the units would include an allocation of at least 2% of annual selective tax revenue from alcoholic beverages, cigarettes and tobacco; annual budget appropriations for the Ministry of Health and the Social Security Fund (Caja de Seguro Social); and international donations, bequests or contributions. The Executive Branch (Órgano Ejecutivo), through the Ministry of Health, would issue implementing regulations within 90 calendar days; a later provision sets a 180-day period. Rollout would begin in Panamá, Panamá Oeste and Colón, continue in Coclé, Herrera, Los Santos, Veraguas and Chiriquí, and reach Bocas del Toro, Darién and the Comarcas Indígenas. The Ministry of Health and state universities would provide mandatory training for unit staff, justices of the peace and public security personnel supporting them. The state would allocate implementation funds, and the bill would take effect the day after its promulgation in the Official Gazette. Its provisions could affect public and private health care providers, patients and families, health professionals, state universities, and businesses connected with alcoholic beverages and tobacco.
What it proposes.
- Staffing and activation of Mobile Crisis Units.
- Non-invasive response and follow-up when a person refuses care because of anosognosia.
- Health care duties, administrative violations and penalties.
- Funding, training and phased territorial implementation.
Who it would affect.
- People seeking or requiring mental health care and their relatives.
- Mobile Crisis Unit personnel.
- Public and private hospitals, clinics, health centers and polyclinics.
- Public employees and health professionals subject to the proposed duties.
Key points.
- Each Mobile Crisis Unit would include, at a minimum, medical, clinical psychology, social work, and emergency care or specialized nursing personnel.Art. 7
- Relatives within the specified degrees of relationship could request activation of the service.Art. 8
- Neighbors or local authorities could request activation when evident, serious deterioration threatens a person’s safety or dignity.Art. 8
- Users could activate the units themselves through the national emergency line.Art. 8
- The response would follow principles of verbal de-escalation, mediation and respect for human dignity.Art. 9
- Military or police-style uniforms, mobile cells and other items that criminalize a patient’s medical condition would be prohibited.Art. 9
- Public security personnel could provide only perimeter support, at the physician’s request, when extreme violence is imminent.Art. 9
- When care is refused because of anosognosia, the unit would make periodic home visits and provide family and social follow-up to seek voluntary acceptance or consent from the legal support network.Art. 10