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Human Rights Still Abused Regardless of Changes in Mental Health Institutions

October 15, 2008

Nona Suvarian, Tbilisi

Despite changes and implemented reforms in mental hospitals human rights of patients are still being abused in Georgia. Various facts of torture and inhuman treatment are still being observed at various mental health institutions throughout the country. 

On the World Mental Health Day the Georgian Public Defender’s office organized a presentation of reports submitted from the Civil Council of Human Rights Monitoring when it comes to the situation in mental health institutions. The reports described the situation that patients face in mental hospitals accompanying recommendations are provided.

Sozar Subari, Georgian Public Defender, stated that the Ombudsman has placed special emphasis on this subject and approaches noted problems diligently. His office has recently started monitoring mental institutions on a regular basis.  The council was established in January 2006. The results were obvious during the first presentation of the monitoring report.  Georgian Parliament started to work on new legislation and many problems were resolved. However, in spite of many improvements there is still much work to be done to bring these institutions to a responsible standard of patient care.

“In general, the situation in mental hospitals was improved.  However, the current level of funding is insufficient. Financial considerations still remain as the number one problem in this sphere. Medical treatment beyond an institutional setting or a hospital is a serious concern. Many people cannot be integrated into society because there is no corresponding service for them after they depart the hospital. Public attitude towards these people represents a well-established stigma towards those suffering from mental health problems. It has not been possible to overcome what continues to be an unresolved problem. However, I recall a Radio programs. When the first few programs were broadcasted, people started calling in and sharing their opinions with us; they claimed that people with mental problems are dangerous to society and as well to themselves.  Even after the third and fourth programs they still were calling and discussing the same kind of issues that had already been covered in our initial programs.”

Archil Talakvadze, advisor to the Public Defender, stated during the assessment of the situations in mental institutions that the administrations of these facilities are very constructive when it comes to implementing those recommendations. Much has been accomplished in getting the stakeholders to consider and share the attitudes that the council has set forth in its programs and policies. Thus, today they do not speak about details as what had to be actively discussed when the council was first established.

“The situation has changed when it comes to the provision of medicines and professional staff. Some hospitals have made marked improvements in their human resources and medical personnel. Today, most patients are not experiencing that much discontent or facing problems when it comes to the service being provided. Such a situation is much different than was the previous existing situation.”

However, Archil Talakvadze placed his attention to problems that have still not been resolved. For example, coordination and effective mechanisms should be implemented in order to improve the qualification of the personnel working in mental institutions.

“Today, most patients are still being kept under the status of being treated on permanent basis. About 40% of patients in all mental hospitals remain in hospitals forever.”

Particularly urgent are instances of torture, inhuman and degrading treatment of patients in the various facilities. “Although the number of such incidents has been reduced, as we learned during the monitoring in 2008, there are still violations reported.  In one instance the staff tried to explain to us that patients were tied up to their beds for several days in order to avoid incidents in the hospital. It must be pointed out that decisions on such methods were made through a violation of acting Georgian law and was totally outside of any international standard of treatment or disciplinary action. Moreover, such decisions were made by nurses and medical technical personnel and not by doctors.

The problem is also related to isolation chambers which are so-called cells for mental hospitals. Human rights are seriously breached when patients are placed in such close confinement “cages” without examining their health conditions and recording their situation. Physical labor of patients is still used in various institutions; they clean sanitarian places and look after other patients and assist staff in their work. There were even some instances at the end of 2007 when patients were engaged in making repairs to the facilities.

Nino Andriashvili is member of the Civil Council within the Public Defender. She visited Kutiri mental hospital during the summer of 2008. The council monitored patients, personnel and the living conditions at this institution.

“We observed that in comparison to previous years the number of violations had been decreased but still there were some problems to overcome. We observed violations while observing the living conditions of the patients. There were not enough tables and chairs in the dining-hall to accommodate all the patients. Thus, some of them have dinner without table or chair or they were sitting on the floor. Toilet and bathrooms were in horrible state. However, in spite of these shortcomings, the attitude of medical personnel towards patients had improved in comparison to previous years.”

Archil Talakvadze considers in his analysis that medical service remains serious problem that need immediate attention. “Non-psychiatric medical services are not being made available for everybody. Our monitoring proved that administrators of mental hospitals provide special medical assistance to certain patients based on some personal contacts. Thus, the principle of accessibility is violated and patients are not being treated on an equal basis. Very often, specialized hospitals refuse to accept new mental patients because they are already overcrowded. However, the monitoring council checked the situation two times and estimated that the refusal was based on ordinary discrimination. For example, Asatiani Mental Hospital petitioned to special clinic for help but the request was refused; the first aid service center also refused to assist the mental hospital. However, when the patient was taken home and the family then called for emergency services, the patient was returned to the hospital.”

The report discussed legislative initiatives. The law on Mental Assistance might be considered as being a positive initiative in the field of mental health that will eventually improve the status of human rights in this sphere.

However, members of the council still have some serious concerns. Archil Talakvadze spoke about some of these:

“When the court makes a legal decision on non-voluntary confinement for institutional treatment, a mental health patient should then be released from the hospital after a period of three months, or the court must review the case and pass new decision to extend the period of the confined treatment. Such difficulties appear when hospital intends to prolong medical treatment of certain patients. Doctors have to explain to the court why the patient needs additional treatment. Let’s imagine a doctor who tries to persuade the patient that soon s/he would be dismissed from the hospital because s/he is already healthy.

However, at the court proceedings he claims that the patient is still anxious and presents a danger to society. Such situations create tensions between such a patient and personnel working at mental institutions.”

Based on the results of monitoring, the council worked out recommendations for mental hospitals that fall under the responsibility of the Georgian Minister of Labor, Healthcare and Social Welfare as well as the Georgian Parliament.

A center for the protection of disabled people was established at the Public Defender’s Office that will also assist people with mental health related problems as well.

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