History of Human Rights in Mental Health-FGIP

GIP started as a human rights organization with the goal to end the incarceration of dissidents in psychiatric hospitals. The information we received was often shocking, the treatment nothing less than torture and many of our “clients” stayed for many years under the most inhumane circumstances in psychiatric prisons. When the Berlin Wall came down at the end of the 1980s and all political prisoners were released, we discovered that the situation was much worse than we ever imagined. Hundreds of thousands of people remained locked up under inhumane conditions in psychiatric hospitals and ‘social care homes’, for the rest of their lives. Sometimes our project managers found dozens of people incarcerated in cellars without functioning sanitation, in some cases two persons sleeping in one bed; lice, dirty pajamas, no ventilation whatsoever… These are images we will never forget.

Initially we focused our work exclusively on Central & Eastern Europe and the former Soviet Union. We started with small projects, setting up psychiatric associations, associations of psychiatric nurses, family organizations and eventually also consumer organizations. We trained mental health professionals, established day care programs and gradually a new approach to mental health care provision was developed: an approach that focused on trying to keep people in the community as much as possible. Gradually the projects became bigger and together with our partners in the target countries we received support from local and national authorities that agreed to cover regular expenses (such as water, gas, electricity, salaries). As a result of ten or fifteen years of hard work the landscape of mental health in many of the countries was changed fundamentally.

Starting in 2005, GIP also focused on countries outside the region, in particular in Africa and South East Asia. In many of these countries the work is the same as what we did and continue to do in Central & Eastern Europe and the former Soviet Union. We help in integrating patients into society who were locked up in a psychiatric hospital for many years, and under very bad living conditions, or develop community mental health care services where no assistance has been available so far. In Africa we are particularly active in the field of HIV/AIDS, focusing on developing support programs for the millions of people who have been hit directly and indirectly by this epidemic and are often suffering from serious depressions and other mental health problems. We are also active in training nurses and establishing small-scale care programs, among others in the field of substance abuse.

Human Rights

During the first ten years of our existence we fought for the release of dissidents and religious believers who had been incarcerated in psychiatric hospitals for political reasons, in particular in the Soviet Union. We organized campaigns for their release, lobbied governments to increase pressure on the Soviet authorities to end this abuse of the psychiatric profession and supported the few psychiatrists who inside the countries opposed these violations of human rights.

But also in subsequent years human rights remained a core issue for our organization. Many of the people who were hospitalized in psychiatric institutions had their human rights violated on a daily basis, because of bad living conditions and maltreatment, but in particular because they were often locked up for the rest of their lives far away from urban areas. Even now it is estimated that approximately half a million people are residing in these institutions in Eastern Europe and the former Soviet Union, with virtually no chance of returning to the community.

When FGIP expanded into other regions, we encountered the same – and sometimes even worse – conditions, and naturally also in our new target countries defending human rights in mental health are a core element in our work. GIP is concerned about human rights everywhere and will promote them whenever local psychiatric systems are violating the spirit of the International Declarations, such as UN Convention on Human Rights and the UN Convention on the Rights of Persons with Disabilities.

Since the beginning of this century we also work in prisons and forensic psychiatric institutions. What we encounter there is often heartbreaking and brings us back to the work that we did in the 1980s. Still we often manage to bring about change. For instance the forensic psychiatric patients in Sri Lanka will for the first time in decades be able to go outside into the garden, and the prison service in Georgia has now a real mental health department where patients are treated instead of punished because of their mental health problems.

And, last but not least, we also pay much attention to the rights of patients and to support people with mental illness or a mental disability to stand up for their own rights. Although it is often a long and difficult road, when looking back we can conclude that a lot has been accomplished. But there is still a lot to be done.

Community Mental Health

People with a mental illness often live under bad living conditions: they are put away in a distant institution with little care or are locked up at home in a small room. GIP works with local partners to develop care and support for these persons in the community, because countless research programs have shown that this is what they want themselves. Caregivers are trained to provide this type of care and to educate family and patients to make sure that they adequately know how to deal with the illness. Developing this type of care is a long-term investment and requires a lot of negotiations with authorities to make it possible.

In Sri Lanka, FGIP is involved in a project for women in a large psychiatric hospital. During the past years a lot of work has been done to improve the living conditions. The sanitation has been modernized and daytime activities have been developed. The women have their own vegetable garden and some departments have even been equipped with their own kitchen. A number of women have found employment in a local factory and are living independently in a protected living environment.

In Sierra Leone mental health care is hardly developed. Only recently and with foreign aid the mental patients were moved from an old prison to new accommodations, as a result of which the living conditions have improved significantly. Because it is the only mental health care institution in the country, it can only assist part of all the mental patients. The rest remains without any form of care. FGIP is through its member organization GIP-Hilversum active in setting up mobile teams that can visit the patients in their own villages and by doing so can provide care throughout the country. This also increases the efficacy of the mental health care institution.

HIV/AIDS and Mental Health

Globally approximately 33 million people live with HIV/AIDS. Approximately three-quarters of them live on the African continent. As a result of the epidemic almost twelve million children have been orphaned. If these kids grow up without adequate support this will have huge consequences for the children themselves and, eventually, also for the socio-economic development of their country. 

The issue of the psychological effects of AIDS is one of the main target areas in the work of GIP. Problems in the mental domain can lead to increased risky behavior and thus to more chance of being infected with HIV. However, infection also can lead to mental health problems. Approximately 40% of the people that are HIV positive have a serious form of depression. Good psychosocial care and support for people with HIV/AIDS is for that reason of crucial importance, on one hand to improve the quality of life for people with HIV/AIDS and on the other hand to counter the spread of the infection.

FGIP initiated the opening of nine “Expert Centers on Mental Health and HIV/AIDS” in Eastern Europe, the Caucasus and Central Asia. These centers organize and coordinate training and research programs, and represent the interests of persons with HIV who have psychosocial problems. The goal is to reduce stigma and to improve care for people with HIV/AIDS and mental health problems. The program is now expanded to several countries on the African continent. There are also plans to expand further into South East Asia.