Psychiatry as a tool of coercion in post-Soviet countries 2012-2017
On May 19, 2017, at the Office of the Ombudsman for Human Rights of the Verkhovna Rada in Kyiv, Ukraine, a new report on the resumption of political abuse of psychiatry in the former USSR was presented. The report, published by the international foundation ‘Human Rights in Mental Health-FGIP”, presents all the available data on the resumption of psychiatry as a tool of repression in former Soviet republics in the period 2012-2017. It lists more than thirty new cases, of which almost half in occupied Crimea. The other cases are in Russia, Kazakhstan and Uzbekistan. The report is authored by Viktor Davydov, a former political prisoner and victim of political abuse of psychiatry; Madeline Roache, a British researcher and free-lance journalist, and Robert van Voren, Chief Executive of Human Rights in Mental Health-FGIP.
The authors of the report believe that the world has reached a crossroads and that unless sufficient pressure is exerted on national authorities in the countries concerned, one can expect that in some of the former Soviet republics we will slide back towards a governmental policy of using psychiatry for non-medical purposes.
The authors conclude that it is pivotal that serious efforts are made in the field of human rights education and the monitoring of human rights in closed institutions.
The English version of the report can be downloaded here
The Russian version of the report can be downloaded here
Mental health care in Central and Eastern Europe still neglected
An international research team, led by Dr Petr Winkler and Dr Dzmitry Krupchanka from the National Institute of Mental Health in the Czech Republic, has considered the state of mental health care in Central and Eastern Europe and concluded that it is outdated and ineffective. The study, which focuses on the last 25 years of development of mental health care systems in the region, and which several staff and board members of the Federation Global Initiative on Psychiatry contributed to, is to be published this week in the renowned scientific journal “The Lancet Psychiatry”.
Just over 25 years have passed since the fall of Communism in Central and Eastern Europe and the beginning of the profound socio-, economic-, political- changes that have taken place since then. However, the anticipated revolution in mental health care has failed to materialize. Despite many promising policy documents, in practice services are still reliant on large psychiatric hospitals, in which conditions are often inadequate. In some facilities, the buildings are run down with little or no space for privacy. The underdevelopment of community care and lack of alternatives to hospital treatment in some countries lead to unnecessary psychiatric admissions and long-term hospitalizations, with people being hospitalized for over 20 years in some cases. Systems of mental health care are underfinanced, and the effective allocation of the few resources available is hampered by a dearth of epidemiological and economic evidence. Stigma and discrimination are widespread and human rights violations continue to occur.
“The burden associated with mental health and substance use disorders in the region is one of the highest in the world, suicide rates are high in the majority of countries, and alcohol consumption is excessive. Despite all these facts, the attention devoted to mental health and mental health care in the region is very limited,” comments Dr Krupchanka, one of the authors of the study.
“What we see in Central and Eastern Europe is a continuing taboo around mental illness, which leads to both, low quality public debate about mental health, and to structural discrimination against people with mental health problems. This is not just ethically problematic, but also unfortunate for us as humans, because mental health is not just the absence of mental illness, it includes also an ability to cope with a stress, experience happiness, joy and fulfillment, and to develop satisfactory relationships with other people. Mental health is fundamental to our overall quality of life,” adds Dr Winkler, the head of the Social Psychiatry Research Program, National Institute of Mental health, Czech Republic.
Report on privatization of psychiatric services in Georgia published
More than twenty-five years after the collapse of the Soviet Union, much of the highly institutionalized and biologically oriented psychiatric service of the USSR is still in place, and resistance against the introduction of modern, community-based and user-oriented services remains very strong. Over the past decade Georgia has implemented a national mental health reform program that focused on the introduction of a humane and community based mental health system that meets basic standards of human rights. However, the full implementation of the program has not been realized. Of the newly developed services some were never fully operationalized and in other cases the process was halted or even reversed. Recently, privatization has been introduced in general health care as a format that would allow an influx of non-governmental capital, providing a new format that is targeted at upgrading services in mental health to an acceptable level.
Hitherto the state program to privatize health care facilities in the country did not include its mental health hospitals. The sudden and rather unexpected privatization process that started with the privatization of the hospitals in Qutiri and Batumi was not part of any of the national mental health plans that were adopted in recent years. For that reason, FGIP felt the urgent need to assess the situation, understand the basis and format of the privatization process and see where modifications ought to be implemented in order to ensure the continuation of care and protect the rights of persons with mental illness seeking professional help from national mental health care services.
In our assessment, we wanted to scrutinize in detail the opportunities and risks of privatization, understand the key drivers and considerations of the private investor’s business case, assess the issue of sustainability and what mechanisms would ensure good governance of the privatized institutions. We were also very keen to establish the plans of managers and the owner to improve the quality of care and to ensure that the rights of the patients are respected.
The outcome is not wholly positive. It is unclear what the goals are for privatization and how this will contribute to the implementation of the National Concept on Mental Health and National Strategy. The privatization process seems rushed and was carried out without any consultation with stakeholders. There was no open call and no predefined qualifications or experience required of potential investors, and no uniformity in the format of the two privatizations. There is no certainty in terms of the long-term planning of services and their financial sustainability. The investor’s business case remains unclear.
Privatization must come with clear expected standards on the quality of care, patient safety and aspects of human rights. A State monitoring body of qualified officials must make regular inspections, both announced and unannounced and there must be regular external monitoring, e.g. through a Societal council and/or a patient’s council. None of this currently exists and must be introduced as quickly as possible. Particular attention must be paid to forensic mental health and compulsory treatment units. A monopoly on care should be avoided at all cost. In the case of forensic psychiatric care this implies that at least one other facility should be opened.
Treatment and rehabilitation are not only matters of medication. Patients should be stimulated to participate in activities and need to prepared for a return into society. Much more attention should be directed towards the professional knowledge and skills of clinical personnel.
Absolute transparency is necessary, both with regard to the framework within which privatized mental health institutions function and with regard to ownership, business plans and profits. All future privatizations should follow a process whereby potential bidders must demonstrate that they meet specific criteria to qualify for the tendering outline their business models and long term plans to develop services. Contracts must ensure that they operate a service that meets a full range of financial and clinical standards. Privatization contracts must also stipulate the obligations from the Government. All hospitals, both State owned and private, should have these performance figures monitored and treated in non-discriminatory manner.
It is important to suspend the process of privatization until all the important preconditions and an adequate legal framework are in place. This should include a detailed list of requirements and specify sanctions that will follow in the case of non-compliance. Adequate governmental and non-governmental control mechanisms are essential, including the development of societal and patient councils and a mechanism for patients to submit complaints when they feel their rights have been violated.
The English version of the report can be downloaded here
The Georgian version of the report can be downloaded here