Ukrainian psychiatry needs to be reformed

Whenever I ventured into unfamiliar districts and saw grim buildings surrounded by high walls topped with barbed wire, I always assumed they were penitentiaries. Now I know that they are either prisons or psychiatric hospitals. In Ukraine both these institutions are practically indistinguishable from each other in Ukraine in form and essence. This is the conclusion of a team of psychiatrists and psychotherapists from Poland and Germany, who recently completed a study of the living conditions of residents of psychiatric hospitals in Ukraine. The conditions in these facilities are enough to drive anyone insane.

To feel human, a person needs a private space: an apartment, a room, an office, a cupboard, or even just a corner with a locker. The videotapes that were screened by the Polish and German experts show rows of bunk beds jammed closely together. There are no lockers for patients, and each room contains several dozen beds. The daily schedule is as follows: the patients get up, have breakfast, and then lie down on their beds; this is repeated at lunchtime and supper. Days, months, and years pass in this dreary monotony.

The very appearance of psychiatric hospitals is frightening: the floors, ceilings, walls, and stairs are dented, chipped, or flaking, and the washrooms are ghastly, some of which do not even have toilets. There are bars on the windows, and the yards are enclosed by tall chain-link fences topped with barbed wire.

As reported by The Day , over 1.2 million people in Ukraine suffer from various psychiatric disorders, including split personalities, neuroses, depression, and phobias. Yet only one in five Ukrainians seeks professional help, as a rule only in serious cases, such as schizophrenia. Considering the state of our psychiatric hospitals, this is understandable.

“When we visited Ukrainian hospitals, we were surprised most of all by the readiness of local physicians to open all doors and show us everything (they are fed up with their meager salaries, working conditions, and the health ministry’s “concern” for them — O. M. ). Unfortunately, the conditions in which we found the patients in overcrowded wards are incompatible with the concept of human dignity,” said Dr. Niels Poersken, chief physician of the Bielefeld and Luneberg psychiatric hospitals in Germany.

“Your society, parliament, and executive authorities should pay more attention to psychiatry. The experience of Germany, where at one time the Nazi regime decided to get rid of all people with psychological problems and the intellectually handicapped, and other countries shows that this contingent is the closing link of the chain making up society. Unless these problems are solved, all of society will suffer.”

The group of medical experts visited hospitals in the city of Kyiv, Kyiv oblast, Odesa, and the Autonomous Republic of the Crimea. Whereas in Kyiv, where conditions can be described as tolerable, in the Crimean hospitals the doctors saw things that they had never encountered. The patients, who live in abject misery, are administered the cheapest, and obsolete, drugs, and are sometimes discharged “because of the lack of necessary medications.”

Commenting on the required changes, Dr. Poersken said that Ukrainian psychiatry is in better shape than German psychiatry was in the 1970s, when reforms in this field were launched. He said that the German parliament voted for the psychiatric reform bill, after which the government began providing all the necessary conditions for the reform, including hundreds of millions of euros.

Today Germany does not have huge psychiatric hospitals packed with patients. Instead, psychiatric problems are mostly treated in small hospitals, and specialists in various medical fields do their best to avoid hospitalizing patients. Their treatment is in the hands of psychiatrists, who write out prescriptions, and a multidisciplinary group of professionals, including psychotherapists, psychologists, social workers, ergonomic therapists, and physiotherapists.

Kyiv psychiatrists who visited Polish hospitals were amazed to learn that the emphasis is on non- drug methods for treating psychiatric disorders through psychotherapy, special rehabilitation groups, art therapy, etc. Patients who are being treated with these methods are also living at home (environment therapy).

“When we started our reform in Poland in 1992, the biggest problem was providing enough room for each patient. Six square meters is standard. Our program is designed for 20 years and today it is being carried out. Of course, there are many problems, including funding,” said Dr. Krzysztof Nazimek, the director of the neuropsychiatric hospital in Opole. During his trip to Ukraine he was most impressed by the dedication of Ukrainian medical personnel. “Before starting a reform of psychiatry,” he emphasized, “you have to provide these people with adequate living conditions that are no worse than those for somatic cases.”

This is the gist of the reform on which the Ukrainian Psychiatric Association has been insisting for more than 10 years: decentralization (switching from big to small district hospitals) and the involvement of specialists from other fields (to avoid hospitalization and enable treatment at patients’ places of residence).

All this requires heavy funding. Europe’s experience shows that the most important factor is the government’s desire to carry out this reform, after which investments can start coming in and specialists can begin working on the lower levels. Although both Poland and Germany are prepared to help Ukraine, our country is just planning to embark on this road. Lower-ranking bureaucrats at the Ministry of Health are talking about “first steps” and drawing up a program.

What program? According to Olha Koliakova, who heads a special medical assistance unit of a department that organizes medical aid at the Ministry of Health, there are no budgetary funds for this. Of course, the ministry is aware of the dreadful conditions in the country’s psychiatric hospitals. But according to Dr. Semen Gluzman, head of the Ukrainian Psychiatric Association, Ukraine’s health ministry did its best to prevent journalists from learning about the European mission’s findings.

Nevertheless, he remains optimistic and hopes that the “political will” to implement the reform of Ukrainian psychiatry will be found. According to Dr. Niels Poersken, it took a whole generation to implement the reform of psychiatry in Germany. The reform of Polish psychiatry is still ongoing. When such a reform will start in Ukraine is anyone’s guess. Europe is prepared to help us, but as its experts correctly point out: “First and foremost, this is your problem.”