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.

The English version of the report can be downloaded here

The Georgian version of the report can be downloaded here

Scope

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.

Conclusions

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.

Recommendations

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