How Georgia is Reforming Mental Healthcare
14 Aug 2015
Visiting a psychiatric clinic is a special experience that can leave a lasting impression. I had such an opportunity in July 2015 when I came to a psychiatric hospital in Tbilisi to meet the doctors and experts taking part in designing a national reform of mental healthcare in Georgia, 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, and even after entering 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 from a society and left in the care of huge institutions.
“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. For example, this hospital has a specific ward for acute patients. We also work to integrate mental health services into general hospitals across the country,” she explained.
Despite these changes, Georgia still has a long way to go in mental healthcare reform. The five-year National Action Plan, developed by over 70 mental health professionals and experts including Dr. Chkonia with help from the UNDP takes further steps toward the deinstitutionalization of large psychiatric hospitals and diversification of services available to patients.
“It is going to be a long process which will require new ways of thinking and excellent coordination throughout the healthcare and social service systems,” Dr. Chkonia says.
Moving from her office to a ward for chronic female patients, I didn’t know what to expect. Standing in front of an iron door leading to the ward, I remember feeling nervous – the only psychiatric hospitals I’d ever seen were in movies. When a 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. As I learned later, 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.
“The #1 goal of the National Action Plan is to create a balanced system of mental health service, transitioning from a hospital-only system to a balanced system of psychiatric treatment which includes community services,” says Nino Agdgomelashvili, project manager at the Global Initiative on Psychiatry – Tbilisi (GIP-T), a local foundation that provided technical guidance to the Action Plan elaboration process.
In 2014, 70 percent of mental health financing in Georgia was put toward hospital care. 28 percent was dedicated to out-of-hospital services, although the majority of these services were still focused on specialized, institutional care. 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.
Agdgomelashvili adds that the reforms aren’t only focused on expansion of services, but address broader social issues:
“It’s about respect for human dignity, tolerance and social inclusion.”
On my way out of the hospital, I felt a combination of relief for leaving the solid walls, compassion for those staying behind, and hope for the success of reforms that will make the whole system of mental healthcare in Georgia more human and effective. One feeling prevailed, though: a feeling of my personal responsibility to fuel this change by combatting stigma and transforming our response to mental health issues from neglect and ignorance to tolerance and respect.