The consequences of Ministerial Decree No. 220 of 2025, which raised the prices of services at psychiatric hospitals and addiction treatment centers by up to 900%, have sparked warnings of a collapse in free mental healthcare, worsening suffering for low-income patients, and calls for the decision to be reversed.
Ministerial Decree No. 220 of 2025, issued by the Minister of Health and Population and Deputy Prime Minister for Human Development, Dr. Khaled Abdel Ghaffar, raised the cost of medical services in psychiatric hospitals and addiction treatment centers by up to 900%, according to MP Maha Abdel Nasser. The decision has triggered widespread discontent and serious concerns. Doctors, sector experts, and human rights advocates warned of its harmful consequences, stressing that it poses a heightened threat to psychiatric patients requiring compulsory admission—such as those with psychosis, suicidal tendencies, or violent behavior—due to their inability to afford treatment. This could lead to the deterioration of their conditions and risks to society, families, the economy, and tourism.
Previously, the internal regulations allocated 60% of hospital beds in psychiatric facilities for free treatment. However, the new decision increased the costs of inpatient care, economic ward accommodation, psychotherapy and speech therapy sessions, IQ tests, medical analyses, and psychiatric medications. The new regulations, issued on July 14, raised inpatient stay fees to range between 150 and 550 Egyptian pounds ($3.09–$11.34) per day, depending on the ward class—excluding medical and therapeutic service costs. The fee for medical consultation was increased to 200 Egyptian pounds ($4.12), while the consultation ticket for psychiatric or addiction patients, or those with autism spectrum disorder, rose to 20 Egyptian pounds ($0.41). The price of a psychological support session for addiction patients rose to 100 Egyptian pounds ($2.06), and monthly follow-up sessions to 400 Egyptian pounds ($8.25). Attending a Narcotics Anonymous session now costs 10 Egyptian pounds ($0.21), while the entry ticket is 5 Egyptian pounds ($0.10). Family counseling sessions were raised to 20 Egyptian pounds ($0.41), and services for children now cost 50 Egyptian pounds ($1.03) for speech screening and dyslexia testing, 40 Egyptian pounds ($0.82) for speech sessions, 45 Egyptian pounds ($0.93) for behavior modification sessions, 60 Egyptian pounds ($1.24) for day-care sessions, and 30 Egyptian pounds ($0.62) for psychotherapy sessions for children and adolescents. The fee for phone or online consultations via the National Mental Health Platform rose to 50 Egyptian pounds ($1.03).
Psychiatric and addiction patients have felt the impact of these price hikes at mental health hospitals over the past few days. Patients who spoke to Zawia3 reported that the price of a consultation ticket at addiction treatment hospitals increased ninefold. The cost of inpatient care for addiction patients for one month rose from 1,800 Egyptian pounds ($37.11) to 4,200 Egyptian pounds ($86.59), with some cases reaching between 6,000 Egyptian pounds ($123.72) and 11,000 Egyptian pounds ($226.77) per month. The daily ticket for dispensing a methadone dose—part of the opioid substitution treatment program at harm reduction units—rose from 1 Egyptian pound ($0.02) to 10 Egyptian pounds ($0.21) per day. Each additional psychiatric medication now requires a new ticket costing 20 Egyptian pounds ($0.41). Moreover, services that were previously free, such as medical tests and medication dispensing, are now subject to fees.
However, according to a medical source who requested anonymity, addiction patients receiving methadone were later exempted from paying the daily ticket fee following widespread objections and an administrative decision by the General Secretariat for Mental Health.
Article One of Ministerial Decree No. 220 of 2025—which Zawia3 obtained a copy of—stipulates the enforcement of the unified financial and administrative regulation attached to the decree, concerning the Service Improvement Fund for psychiatric hospitals and addiction treatment centers affiliated with the General Secretariat for Mental Health and Addiction Treatment under the Ministry of Health and Population. According to Article Two, the price lists accompanying this decree apply to all psychiatric hospitals and addiction treatment centers under the same administrative authority. Article Three cancels any prior decisions that contradict the provisions of this decree, its regulations, or the attached price lists. Article Four mandates all relevant bodies to implement the decree, effective from the date of issuance.
The Ministry of Health set the prices for daily accommodation services in psychiatric hospitals and addiction treatment centers based on various classifications depending on room type and available amenities. The highest category listed is the “suite,” priced at 550 Egyptian pounds ($11.34) per night. It includes two internal rooms and a private bathroom—one room furnished with a bed for the patient and complete furniture, while the other is designated for receiving visitors. The “first class premium” room costs 380 Egyptian pounds ($7.83), and is a single room with a private bathroom, air conditioning, and an LCD screen. The “first class” room costs 300 Egyptian pounds ($6.19), with two beds and a shared bathroom. Prices then decrease to 180 Egyptian pounds ($3.71) for the “second class,” and 150 Egyptian pounds ($3.09) for the “third class,” which accommodates four to six patients per room.
The listed prices include accommodation only and exclude any additional fees, except for phone calls or special requests. A companion is permitted when necessary, provided they do not use the patient’s bed. An extra bed can be added without exceeding room capacity. For children, one companion is allowed to share the same bed free of charge for patients under 12 years old. Children above this age are charged the full bed rate in addition to a fee for the companion’s bed. An additional fee of 70 Egyptian pounds ($1.44) per day is charged if an air mattress is used. Medical tests range in cost from 20 to 500 Egyptian pounds ($0.41–$10.31), with significantly higher fees for drug screenings and molecular biology tests, reaching up to 3,500 Egyptian pounds ($72.16) in some cases.
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High Prices, Poor Services
While healthcare service fees at psychiatric hospitals have sharply increased, the Ministry of Health and Population has made little effort to improve the quality of care. One psychiatric patient told Zawia3 that the conditions inside the wards of Al-Abbassia Psychiatric Hospital have deteriorated. Patients there reportedly suffer from the absence of fans and air conditioning, poor hygiene, and infestations of insects and cockroaches. The patient also reported cases of physical and verbal abuse against patients.
A medical source at Al-Khanka Psychiatric Hospital revealed that the hospital’s addiction treatment building, which has a capacity of 150 beds, has been using only 40 beds for the past seven years due to unresolved problems in the sewage system. These issues, the source claimed, persist because of what he described as “deliberate administrative negligence” that ultimately benefits private centers. He pointed out that the unused beds are equivalent to the capacity of four private addiction treatment centers, while establishing just one private center with 25 beds would require around 2 million Egyptian pounds ($41,237). The hospital’s daily statistics reportedly show about 100 people in need of treatment, but they are told there is no availability—despite the actual existing capacity. The source added that admission decisions are often based on personal connections and favoritism.
Regarding the recent ministerial decree raising mental health service fees, the source acknowledged that it carries a few limited positives. Among them is reducing opportunities for illegal profiteering by some nursing staff, who used to charge patients’ families unofficial fees. Another is curbing the phenomenon of families exploiting psychiatric hospitals to admit relatives who are not actually ill—either to avoid caring for them or as a form of familial retaliation. With the ministry now officially collecting payments, such practices may decline.
However, the source emphasized that the decree lacks social justice, as it requires patients or their families to pay amounts ranging from 4,000 to 20,000 Egyptian pounds ($82.47–$412.37) just to access care. He asked, “Is it reasonable to demand this amount from the family of a patient who may be a danger to himself or others? Mental illness does not wait for financial readiness.” He stressed that administrative corruption exists in psychiatric hospitals and that free mental healthcare in Egypt is in gradual decline. The latest decree, he argued, reflects an unofficial privatization policy of mental health services and deprives thousands of patients of their constitutional right to free treatment.
Until September 2020, patients who could not afford care were exempted from the 100 Egyptian pound ($2.06) admission fee for treatment in mental health facilities, according to Ministerial Decree No. 351 of 2012. However, the former Minister of Health and Population, Dr. Hala Zayed, later issued a new ministerial decision amending Article (2) of Decree No. 351 of 2012, which set the fees outlined in the Mental Patient Care Law. The amendment stipulated that the 100 Egyptian pound ($2.06) admission fee be applied to all cases entering psychiatric facilities covered under Law No. 71 of 2009 on the Care of Mental Patients. The previous version of the article had applied this fee only to non-governmental psychiatric hospitals and only if the patient’s stay exceeded one week.
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Depriving Vulnerable Groups of Free Treatment
Dr. Alaa Ghannam, head of the “Right to Health” unit at the Egyptian Initiative for Personal Rights, strongly criticized Ministerial Decree No. 220 issued by the Minister of Health, which increased the prices of mental health and addiction treatment services in public hospitals. He asserted that the decision is ill-considered and constitutes a clear violation of the rights of the most vulnerable groups in society.
He told Zawia3: “If psychiatric patients are left outside hospitals, it will be a disaster in the streets. The new decision effectively deprives them of the possibility of treatment due to the imposed fees for accommodation and services, which exceed their financial capacity. The decision is a blatant violation of their constitutional right to free treatment.”
Ghannam emphasized that this group has no alternative to public sector care or paid clinics. He explained that psychiatric patients constitute no less than 1% of the population based on global standards and are among those most in need of free care. He added that the decree is part of a continuous pattern of flawed policies in managing the healthcare sector.
He continued: “This decision cannot be separated from the broader policy of health privatization. What we’re witnessing is a continuation of the same approach we saw in cases like Al-Haram Hospital. But here, the situation is more dangerous—because psychiatric patients can pose a threat to themselves and to society if left untreated.”
The head of the “Right to Health” unit stressed that placing the financial burden of treatment on psychiatric patients in public institutions marks a serious regression in the state’s commitment to marginalized and vulnerable populations. He called for the immediate reversal of the decision and a comprehensive review of health policies to ensure they align with the Constitution and human rights principles.
Dr. Ayman Attia, a legal medical advisor specialized in professional ethics, also warned of the catastrophic consequences of Ministerial Decree No. 220, which increased mental health service fees—some by nearly 900%. He stressed that the decision is a direct threat to the constitutional right to free treatment, as guaranteed under Article 18 of the Egyptian Constitution, and that it paves the way for the explicit privatization of the mental health sector.
He told Zawia3: “Previous claims that the price hikes would apply only to the economic (paid) treatment and not to the free services are inaccurate. The number of free beds in psychiatric hospitals had already been reduced earlier, and this new decision makes things worse by increasing the cost of even the so-called free services.”
Attia pointed out that the gradual decline in free care began when the designated quota was reduced from 60% to just 25%. He warned: “What will actually happen on the ground could be much worse. That percentage may continue to shrink until it disappears entirely.” He explained that the cost of inpatient care has risen sharply, which burdens poor families and may force them to remove their loved ones from hospitals—leading to an increase in psychiatric patients on the streets and resulting in serious security and societal threats.
Attia affirmed that the decision clearly contradicts the right to free healthcare. He asked: “If someone has a mental illness and no money, where will they go? These conditions cannot be treated in a day or two. They require long-term treatment and substantial costs that most citizens cannot afford.” He argued that this is part of a broader policy to reduce access to free treatment as a prelude to privatization.
He added: “Any part that is shifted toward a private model at the expense of public services is privatization. If you have 1,000 beds and allocate 600 of them to economic or private care, that’s not balance—it’s a blatant bias toward those who can pay.”
The expert described the decision as “completely unstudied”, noting that although the costs may appear low compared to private hospitals, they are extremely burdensome for poor and low-income groups. He emphasized that psychiatric patients and individuals with addiction often cannot work or afford any fees. Shutting the doors of free care in their faces will inevitably lead to a return to drug use—worsening crime and social violence. He called for clear alternatives to be provided before making life-altering decisions that affect the fate of thousands of patients.
There are currently 21 psychiatric hospitals and mental health centers affiliated with Egypt’s Ministry of Health and Population. The most notable include: Al-Abbassia Psychiatric Hospital, Al-Khanka Psychiatric Hospital, Helwan Psychiatric Hospital, Heliopolis Psychiatric Hospital, Demerdash Psychiatry Center, Al-Maamoura Psychiatric Hospital, Tanta Psychiatric Hospital, Port Said Psychiatric and Addiction Treatment Hospital, and Damira Hospital. All of these facilities offer free mental health services, along with other government hospitals in various governorates that provide either free or low-cost care.
According to a national mental health survey conducted by the Ministry of Health and Population in 2018, 25% of Egyptians suffer from mental disorders. Mood disorders, especially depression, ranked highest at around 44%, followed by substance-related disorders at 30%, and generalized anxiety and phobia disorders at 25%.
There are no official statistics on the number of individuals with severe mental illnesses in Egypt. However, in 2017, Dr. Sameh Haggag—then Deputy Director of Al-Abbassia Psychiatric Hospital—stated in a media interview that there were 900,000 people in Egypt suffering from schizophrenia.
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Questions Raised About the Rights of Psychiatric Patients
Mahmoud Fouad, head of the Egyptian Center for the Right to Health, expressed strong rejection of Ministerial Decree No. 220 of 2025, which stipulated raising the prices of accommodation and medical tests at psychiatric hospitals. He considered it a blatant violation of the rights of psychiatric patients in Egypt—especially those who are financially incapable or legally incompetent—and an extension of ongoing policies in recent years aimed at reducing the space for free treatment in public healthcare institutions, threatening both health and social justice in the country.
Fouad pointed out that the Egyptian Mental Health Law stipulates that 60% of treatment provided in psychiatric hospitals must be free of charge. He considered the imposition of entry fees to these hospitals—what he described as “ticket issuance”—a dangerous precedent occurring for the first time in the history of these institutions. He emphasized that psychiatric patients are subject to a special law that acknowledges their legal vulnerability and lack of capacity, which necessitates special protection—not the imposition of financial burdens.
Fouad, who previously served on the board of Al-Khanka Psychiatric Hospital, told Zawia3: “The hospital used to provide services to thousands of patients from the most vulnerable groups, relying on limited resources and community donations to cover basic needs such as food and clothing. Imposing new financial burdens on patients—especially in the absence of families or support systems—only worsens their living and humanitarian conditions.”
He criticized the increasing reliance on service improvement funds to finance hospitals at the expense of patients, arguing that the primary goal of the decree is to generate financial resources to cover staff salaries and bonuses—not to improve service quality. He highlighted the ongoing crisis of shortages in psychiatric and neurological medications, with only 20% of the needed medicines available in hospitals, while patients are forced to purchase the rest out-of-pocket.
Fouad also warned that the decree will give the private sector further dominance in the field of mental health and addiction treatment, as private prices will rise to match the new government rates, thereby increasing the burden on patients and their families. He noted that some private hospitals provide an unsuitable environment for psychiatric treatment, as they house large numbers of patients under inhumane conditions.
The head of the Egyptian Center for the Right to Medicine concluded his statement to us by saying: “This decree marks a new regression in the state’s constitutional commitments to public health. We call for its reversal and the formulation of more just and fair policies for marginalized groups, foremost among them psychiatric patients.”
According to official data, the number of staff working in psychiatric hospitals affiliated with the General Secretariat includes 1,073 doctors, 2,931 nurses, 354 psychological and social specialists, and 2,007 administrative staff.
The General Secretariat’s psychiatric and addiction treatment hospitals provide care services to those in need through outpatient clinics and a basic inpatient bed capacity of 6,660 beds, with an operational capacity of 5,616 beds.
Egyptian newspapers had previously quoted a senior source at the Ministry of Health and Population, in late 2024, stating that the ministry plans to establish, open, and develop a number of psychiatric and addiction treatment hospitals during the period between 2024 and 2026, with a total estimated cost of around 14 billion Egyptian pounds ($288.66 million).
The development plans are expected to include the opening and operation of Esna Addiction Treatment Hospital in Luxor Governorate with a capacity of 60 beds, the opening of Suez Addiction Treatment Hospital with 60 beds, the opening of Abbas Helmy Addiction Treatment Hospital in Alexandria with 90 beds, the opening of Alwan Addiction Treatment Hospital in Assiut with 90 beds, and the opening of a new addiction treatment hospital in Sohag Governorate with a capacity of 100 beds.
Parliamentary Moves
In the first parliamentary action following the decree’s issuance, MP Freddy El-Bayadi, member of the House of Representatives for the Egyptian Social Democratic Party, submitted an urgent parliamentary question to the Minister of Health and Population regarding the new financial regulation for psychiatric hospitals, which began implementation this week. He considered it a serious threat to the most vulnerable groups in society and a clear continuation of the state’s retreat from its constitutional obligations to support the underprivileged.
El-Bayadi explained that the new regulation raised the cost of inpatient care in psychiatric hospitals from 150 Egyptian pounds ($3.09) to 550 Egyptian pounds ($11.34) per day, without including any medical services in that cost—raising legal and humanitarian questions about the compatibility of this decision with the provisions of the Egyptian Constitution, particularly Article 18, which guarantees the right to free treatment for those unable to pay.
In his parliamentary question, which Zawia3 reviewed, El-Bayadi stated that the old regulation stipulated allocating 60% of hospital beds for free treatment, later reduced to 25%. However, the current situation suggests the complete elimination of this quota in psychiatric hospitals—without any official announcement or transparency. He considered this a gradual erosion of the right to free treatment, questioning the logic behind forcing families of psychiatric patients to bear the cost of compulsory hospitalization, which is imposed for the safety of both the patient and society—especially since most of these patients have no source of income and their families are often among the poorest and most vulnerable.
The MP viewed the decision as another episode in a long series of making citizens pay the price for failed public policies—even in their moments of greatest weakness and need for healthcare. He stressed that mental health is not a luxury but a humanitarian, societal, and constitutional responsibility. He called on the Minister of Health and Population to clarify the basis on which the ministry issued this financial regulation and to publicly state the ministry’s position on free treatment in psychiatric hospitals. He also demanded the immediate cancellation of the regulation’s application to compulsory admissions, as these are the most in-need groups and have no alternative options.
El-Bayadi also urged the government to stop shifting the burden of public healthcare system failures onto citizens and to fulfill its constitutional obligations to all citizens—especially the underprivileged suffering from mental illnesses or disorders that require compulsory hospitalization for their protection.
In the same context, MP Maha Abdel Nasser also expressed her strong opposition to the Ministry of Health and Population’s Decision No. 220 of 2025, which mandates a price increase of up to 900% for medical services in psychiatric hospitals and addiction treatment centers. She described the decision as “irresponsible” and said it would worsen the suffering of patients and their families amid difficult economic conditions.
In a press statement obtained by Zawia3, the MP said: “The government continues to impose additional burdens on citizens, without considering the special circumstances of the most vulnerable groups, such as psychiatric patients and individuals with addiction, who need support and care—not more financial pressure. These groups already suffer from complex social and health conditions, and adding new costs of this magnitude harms their mental and physical health, and negatively affects their families and society as a whole.”
According to the new decision, the MP explained that the daily accommodation rates in psychiatric hospitals now range from 150 to 550 Egyptian pounds ($3.09–$11.34), meaning that the monthly stay could cost up to 16,500 Egyptian pounds ($340.41). Meanwhile, the cost of a medical examination in some cases reached 200 Egyptian pounds ($4.12), not including medications, therapy sessions, or psychological rehabilitation. She noted that these amounts clearly exceed the capacity of most Egyptian families, especially amid continued inflation and rising prices.
The MP warned that these price increases will lead patients to refrain from seeking treatment, pointing out that many poor families will be unable to bear such costs—potentially causing patients to stop treatment entirely. She stressed that the consequences of this decision could be “catastrophic”—whether in the form of worsened addiction cases due to lack of medical follow-up, increased suicide rates stemming from feelings of hopelessness and despair, or rising crime rates resulting from the mental deterioration of neglected patients. She questioned the rationale behind making such a decision without a thorough study of its social and psychological consequences, while also criticizing the government’s disregard for warnings from specialists and civil society representatives.
Abdel Nasser emphasized that government psychiatric hospitals are not equipped to provide services commensurate with these prices, as they suffer from deteriorating infrastructure, weak services, and a lack of maintenance and staff incentives. She considered the claim that price increases will improve service levels to be “baseless and not grounded in actual reality.”
She added: “The decision not only harms the patients—it affects the entire society. Leaving psychiatric patients without care exposes them to homelessness and risky behaviors, turning them into a burden on their families and communities. Instead of empowering patients to access the necessary psychological care, the government is contributing to their exclusion and neglect—turning them into ticking time bombs within society.”
The MP described the decision as a social and health disaster, affirming that the government, instead of being part of the solution, is adding further tragedy to the lives of these patients. She demanded the immediate cancellation of the decision, asserting that it is “not only unjust but poses a major threat to public health and Egypt’s social fabric.”
In statements to Zawia3, Dr. Ashraf Hatem, Chair of the Parliament’s Health Committee, explained that the committee has not yet discussed Ministerial Decree No. 220 regarding the increase in mental health service fees because parliamentary committees are currently suspended due to the recess. He clarified that what has been submitted by MPs in relation to the decision was not in the form of briefing requests, but rather parliamentary questions—since the parliamentary session has ended and briefing requests cannot be submitted during this period. Instead, parliamentary questions are directed to the Speaker and the General Secretariat, and the government responds to them in writing.
When asked for his comment on the ministerial decision, Hatem said: “I haven’t reviewed the decree, nor do I know its rationale or justification, so I cannot comment on something I haven’t seen. Certainly, there are motives behind the decision, but I have not reviewed it yet. We will have a position once Parliament resumes.”
In conclusion, the new ministerial decision—affecting one of the most vulnerable groups in society—has forced psychiatric patients and their families to face new financial burdens, threatening to exclude them from the free treatment system and deepening their psychological, physical, and social suffering.
Despite the implicit promises within Decree No. 220 of 2025 to improve services, field testimonies, warnings from doctors, rejections by human rights advocates, and parliamentary movements all paint a troubling picture of a rapidly accelerating privatization path in the mental health sector. This trajectory effectively strips the right to free treatment of its meaning and shifts the burden of economic policies onto Egypt’s most disadvantaged populations—without offering any real alternatives.
While the Ministry of Health remains silent in the face of widespread criticism, thousands of psychiatric patients face an uncertain future, left to bear the consequences of official decisions that disregard their basic humanity.
