From neglect to respect: Changing Georgia's mental health approach
15 Sep 2015 by Lisa Lenz, Democratic governance intern, UNDP in Georgia
Visiting a psychiatric clinic can leave a lasting impression.
I had the opportunity to visit a psychiatric hospital in Tbilisi to meet the doctors and experts taking part in designing a national reform of mental healthcare in Georgia.
This co-design work is largely supported by UNDP, the Government of Sweden, and civil society organizations.
The first thing I noticed was the hospital’s size. The huge concrete building looked left over from the Soviet era. Even after entering, it seemed more like an administrative center than a hospital housing more than 150 patients.
Dr. Eka Chkonia, however, looked young, energetic and eager to turn things around.
She told me that the ongoing reforms sought to address numerous problems inherited from the Soviet healthcare system, when those with psychiatric disorders were often hidden away from a society.
“Even in the 90s, we still had old-fashioned psychiatric hospitals focused on chronic patients only, with no room for acute stress cases. We are changing that now. We also work to integrate mental health services into general hospitals across the country,” she explained.
These changes are part of a five-year National Action Plan, developed by over 70 mental health professionals and experts with the support of UNDP.
It takes further steps toward the deinstitutionalization of large psychiatric hospitals and diversification of services available to patients.
Despite these changes, Georgia still has a long way to go. The process will require new ways of thinking and coordination.
Standing in front of an iron door leading to the ward for chronic female patients, I felt nervous – the only psychiatric hospitals I’d ever seen were in movies.
But when the door opened, I saw a huge corridor and the patients peering out of their rooms to see what was going on. They seemed pleased with having guests. Most of them had been living there for years and not many enjoyed regular contact with the outside world.
Isolation and social stigma are two major challenges to people with mental health disorders in Georgia, and can sometimes prevent them either from seeking professional help or reintegrating into society following treatment.
One solution to these issues is to expand community-based services for mental healthcare users, providing them with more opportunities to access services and prevent longer-term hospital stays.
This can include crisis intervention centers, dispensary clinics, social services, and a mobile team of doctors and psychologists who visit patients at home.
In 2014, 70 percent of mental health financing in Georgia was put toward hospital care. 28 percent was dedicated to out-of-hospital services, and only 4.5 percent of state funding went toward modern, community-based services like crisis intervention and mobile clinics.
The new Action Plan envisions that by 2020, a more balanced system will be in place, with 50 percent of funding dedicated to hospital care, and 50 percent devoted to community care. The reforms aren’t only focused on expansion of services, but at addressing broader social issues of respect, human dignity, tolerance and social inclusion.
After my visit, I felt hope for the success of reforms that have the potential to make this treatment more humane and effective, as we transform our response to mental health issues from neglect and ignorance to tolerance and respect.