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What Kind of Problems are People Suffering from a Mental llness Facing?

October 11, 2007

The Public Defender’s Office published the results of its investigation.

The right of access to information, the right to property and the right to free movement are still violated in the psychiatric hospitals of Georgia. Frequently, patients are being forced to work. Moreover, the living conditions in hospitals never comply with international standards.

Several days ago, the Human Rights Center learned that about the poor living conditions in psychiatrist hospitals and that they do not comply with international standards at all. Having visited M. Asatiani Psychiatrist Hospital, quite a neutral question was asked: “how often does the Georgian Ministry of Healthcare show an interest in the living conditions of people with a mental illness?”

Irakli Giorgobiani, Deputy Minister of Healthcare and Social Welfare, partly answered the question at the presentation held at the Public Defender’s Office yesterday. The Public Defender’s Office presented the report on “Human Rights and Psychiatry”. In the first half of 2007, five psychiatric hospitals - Tbilisi M. Asatiani Scientific Research Institute of Psychiatry, Kutiri Center of Mental Health, Surami Psychiatric Hospital, Bediani Psycho-Neurological Hospital and Batumi Republican Psycho-Neurological Hospital - were monitored with the support of “Open Society Georgia”:.

Irakli Giorgobiani stated that the Ministry of Healthcare undertakes many efforts to improve the conditions in all above-mentioned institutions. “In the near future, psychiatric establishments will be adjoined to other medical institutions; however we do not exclude the possibility that some separate mental hospitals will also be set up, where patients with particularly grave mental conditions will be placed. One of those institutions is Kutiri Mental Hospital, which we have reconstructed and there is no doubt the hospital will comply with international standards. That hospital was designed by Dutch Architects.”

Archil Talakavadze, a renowned specialist in administrative law and socio-economical issues, stated at the presentation that nearly 72.000 registered people in Georgia suffer from mental problems, but only 1.145 beds are allocated for in-patient psychiatric care.

The authors of the recommendations consider that it is necessary to increase the funds allocated to the treatment of such patients. It is necessary to regulate the discharge of committed patients undergoing voluntary treatment; alternative methods must be included in the process of treatment, which will facilitate the maintenance and development of skills of the committed patients.

The monitoring revealed positive as well as negative results. More precisely, in Tbilisi M. Asatiani Scientific Research Institute of Psychiatry, Kutiri Center of Mental Health ans Surami Psychiatric Hospital living conditions significantly improved in comparison to previous years. Patients are more satisfied with the service provided by medical personnel, than in previous years. Alternative therapy methods have been introduced in Tbilisi M. Asatiani Scientific Research Institute of Psychiatry, Tbilisi A. Zurabishvili psychiatric Hospital, Kutiri Center of Mental Health and Batumi Republican Psycho Neurological Hospital. Availability of non-psychiatric medical care has increased. Patients participate in cultural activities. The internal regulations and information about patients’ rights are displayed prominently in almost at all hospitals. Complaint boxes have been installed in departments.

As for the negative results of the monitoring, in every observed facility, patients worked for the establishments without any fair remuneration. Often, they perform activities assigned to lower medical personnel. The instance of patients having to work is most obvious and complicated in Bediani Psycho-neurological Hospital. Social problems of patients remain unsolved in all establishments. The issues related to their pensions are not clarified, which is actually a problem for all mentally ill people, not just for those in hospital care. The most acute problem is the problem of interaction with caretakers. Some of the patients do not require active in-patient treatment. For these patients the hospital serves as some kind of shelter, which facilitates the syndrome of “hospitalism” in patients and loss of skills required for independent life.

Salaries of medical personnel are still low, causing dissatisfaction and absence of motivation. Low salaries among medical personnel in psychiatric facilities make it almost impossible to attract highly-qualified staff. This, in turn, affects the quality of treatment and care.

The 2007 budget allocated for specialized in-patient psychiatric care has, increased by almost 20% in comparison to 2006. (In 2006 8,60 lari was budgeted for every patient. In 2007, the budget differentiated between acute, sub-acute and chronic conditions - 32 lari was allocated acute patients, 15 lari for sub-acute patients and 8, 60 lari for chronic patients). The increased financing is still insufficient though to provide patients with high-quality, present-day and effective psychiatric care.

At the presentation, a representative of the Public Defender drew particular attention to the violated rights of the patients. The investigation exposed that the communication of information to patients at psychiatric hospitals is inadequate and that whether information is offered to patients depends upon the good will of medical personnel. Information concerning their diagnosis, treatment, changes in treatment and prognosis is not provided to patients in an understandable way. This problem was common in all the investigated facilities.

The right to privacy for patients in psychiatric hospitals is limited. There are no telephones for patients, they cannot use a bathroom when desired and there is no individual lighting installed in the wards. Patients have no safe place to keep their personal items; theft often occurs among patients.

«Assistant» patients are often encouraged in psychiatric establishments. The patients, who help the personnel in the performance of certain tasks, enjoy various privileges – they get additional meals, tobacco, freedom of movement, etc. This problem is especially pervasive at Bediani Psycho-neurological Hospital and the Kutiri Center of Mental Health.

According to the results of the investigation, patients’ free movement is regularly limited, threatening and physical abuse often occur at some establishments, as well as continued isolation of patients.

It is remarkable that patients mentioned being punished by painful injections. According to the explanations provided by personnel, patients get injections in extreme situations, but according to the patients it forms a part of treatment. Patients perceive it as punishment because it occurs when a patient becomes aggressive or is distracted.

The investigation revealed that the patients’ right to free movement is violated at Tbilisi M. Asatiani Scientific Research Institute of Psychiatry, Kutiri Center of Mental Health and Batumi Central Psycho-neurological Hospital. Some patients (including those under voluntary treatment) do not have the right to go out into the yard. Patients are often not allowed to visit their relatives, family members, even when the person is receiving in-patient treatment for years. This problem remains partly due to the indifference on the part of the patients’ families. According to the personnel, the free movement of patients is restricted for the good of the patients – letting patients out is dangerous for themselves; in cold weather they may catch a cold, patients may get lost or get injured.

The treatment at psychiatric hospitals consists mainly of medicating patients. Surami Psychiatric Hospital and Bediani Psycho-Neurological Hospital do not recognize any kind of alternative treatments at all.

As a result of the investigation carried out in 2005-2006, the Public Defender recommended to the Central Election Commission and the administrators of psychiatric hospitals to allow psychiatric patients to participate in the elections. The investigation showed that the majority of patients did not have a possibility to participate in local elections on 4 October 2006, and the rest of them participated in it without ID cards, which is a violation of their rights. Shortcomings of election commissions with regard to psychiatric hospitals have been revealed.

The Georgian Public Defender and Council for Public Monitoring consider that investments which will only lead to superficial improvements to the current inadequate system will prevent the improvement of the entire psychiatric healthcare system. When the problem is only dealt with on a superficial level, the results of treatment, rehabilitation and reintegration will not be satisfactory.

Taking the results of the investigation into consideration, a set of recommendations was sent to the concerning facilities.

At the end of the presentation a short social advertisement was shown to the guests, which will soon air on Georgian public television.   

Nino Tarkhnishvili, Tbilisi

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