Psychiatric Illness is a Stigma within the Family

The Human Rights Center decided to interview Davit Zurabishvili, chairman of the Council of Directors of the M. Asatiani Scientific Research Clinic of Psychiatry. The Human Rights Center decided to do so after the organization received several complaints regarding the bad situation at the clinic. It was claimed that patients were not treated properly at the hospital.  

-Mr. Zurabishvili, can you tell us under what conditions the patients live at the hospital?

-Of course the situation at hospital is not ideal, but we try to do our best to create a perfect environment for our patients. If we had a bigger budget, we would be able to do more for them. With the money we do have, we do as much as we can to create a comfortable situation for people. Unfortunately, we do not have enough money to change the plumbing system in the hospital; we cannot afford to re-floor the building, but we do take care of what we have and try to keep the hospital clean. In addition, we feed our patients with high-calorie food and provide them with all necessary medication. In previous years, the state allotted the hospital 6 lari per patient. Now the budget has increased to 32 lari per patient. Although, 32 lari is not enough to care for a patient the budget is increasing. With that 32 lari we are able to give our patients all the medication they need. We categorically prohibit relatives of patients to bring medication to the hospital.

-What kind of methods do you use to calm down aggressive patients?

-Society may refer to it as being bound and chained, but we should find a more appropriate term. When a patient gets too aggressive, and s/he might hurt himself or others, we restrain him/her. We use a soft cloth to tie him/her up, but in a way which does not hinder blood circulation. In addition we inject him/her with a sedative. As soon as s/he is calm, we release him/her from the restraints. We never use chains or leather traps.

-How long do patients remain in you clinic?

-A Patient remains in the clinic as long as is necessary for the patient to recover. The length of treatment for psychiatric patients depends on whether the patient has an acute, sub-acute or chronic condition. There are independent departments for all three conditions; we have one department for acute patients, four departments for sub-acute patients and two departments for chronic patients. It takes fifteen days to transform an acute condition into a sub-acute condition. The maximum length of treatment for a sub-acute condition is 45 days. In general, chronic conditions take much longer to treat, but patients are released when their health can be managed. Psychiatric hospitals which offer psychiatric patients medical assistance are situated in almost every city in Georgia. Patients visit those hospitals and they are supplied with free medication. All kind of medical assistance is covered by the state budget. A psychiatric patient has the right to register at the hospital of his/her choice. A psychiatric illness can surface at any moment. In the case of an acute psychiatric condition the patient is examined. The results of the examination determine the medical treatment required by the patient. No patient will ever be refused medical attention.

-What happens to a patient who has nowhere to go?

-A patient cannot stay in hospital for 10 to 12 years. Psychiatric facilities which would enable patients to stay as long as they wish, even up to 10 or 15 years, should be established. In most cases the patients are homeless, but cannot be left to live on the streets. At the moment we send homeless, psychiatric patients to Surami and Bediani Psychiatric Hospitals or to Tbilisi Psychiatric Hospital, which is located in Gldani District. We know of some situations where family members of psychiatric patients took advantage of the situation by selling their houses or taking their pensions. We have a legal aid center at our hospital that protects the rights of the patients in order to avoid similar situations. Our duty is to look after the patients.

-How do patients arrive at your hospital?

-Neither our clinic nor other Georgia based psychiatric hospitals aim admit patients to the clinic. Ambulances, family members or policemen on patrol take psychiatric patients to us. Having arrived at the hospital, the medical condition of the patient is examined and afterwards the patient is asked if s/he wants to receive treatment at the clinic. In most cases the patient refuses treatment; in such a case a doctor examines the patient and decides if forcible treatment is necessary. If so, we start a court procedure within 48 hours of arrival of the patient and inform the patient. A judge then decides within 24 hours on the need to forcibly commit of the patient. The legal counsel of the patient observes this process at all time. If the patient does not have an attorney, pro-deo legal counsel will be appointed for him/her. The judge also assigns the hospital a time-limit within which we have to treat the patient. However, when a psychiatric patient recovers before the final date of commitment set by the judge, we will discharge him/her from the hospital. The opposite may be the case as well, we might request the judge to extend the time set for treatment when the assigned time turns out to be insufficient. In most cases the patient refuses treatment, but there are some cases where the psychiatric patient is aware of his illness and is able to give an indication of his/her psychiatric condition. Consequently, s/he accepts our treatment eagerly.

-What methods of treatment are used in your hospital?

-We apply to two methods of treatment-with and without medicaments. The second one aims to send back the patient to the society and rehabilitate him/her. Thus, being in hospital should not mean white gowns and medicines only. These people need various entertainments for amusement like chess, piano, books, newspaper, TV set. We actively use art-therapy where patients paint, model, embroider-they do whatever they do. In addition to that psychologists work with them. They teach our patients what to do to avoid aggravation of their psychiatric conditions. We also apply to family therapy in framework of what we teach family members how to live alongside psychiatric patients.

-What do patients know about their rights?

-Patients have complete information about their rights. There are special posters in all departments which state the rights of patients and if their rights are violated psychiatric patients can request help from the Public Defender’s Office. Unfortunately, these people tear-off the posters. I must also underline that we do not prevent our patients from getting acquainted with their rights. Furthermore, the rights of patients are more protected than those of doctors nowadays.

-Some time ago, relatives of one of your patient appealed to our organization and complained about your service. They claimed that the psychiatric patient was bound during the whole night and nobody paid attention to him…

-You see, relatives of our patients complain when we intend to discharge the psychiatric patients from hospital. Mostly, people do not even want the family member to stay in their house. It is a stigma in Georgia and abroad and unfortunately societal attitudes towards mental illness have not shifted. In order to eradicate the problem, we should establish psychiatric facilities in Georgia, where chronic patients will be placed. It is impossible to have patients stay at our hospital for years.

Nino Tarkhnishvili, Tbilisi