Mental health care in Georgia - forgotten by the revolution?

John Smock 12/10/04

A EurasiaNet Photo Essay

Forty minutes outside of Tbilisi, past decaying Soviet apartment blocks and an overflowing city dump, lies a harrowing reminder of the derelict state of health care in Georgia.

The Tbilisi Psychiatric Hospital, a labyrinth-like complex of empty window frames, crumbling plaster and broken furniture, is home to 300 patients. "If they are not completely insane when they arrive," commented Nana Zavradishvili, the director of a small Georgian non-governmental organization that advocates for the mentally ill, "they soon become so."

The hospital is one of Georgia's two main medical facilities for those with psychiatric problems, but that role means little for the standard of care available. To save money, hospital staff have switched off heat and lights throughout much of the hospital. In one ward, there is a piano, but it emits no sound. In another, there is a ping-pong table, but no balls or paddles. The only source of entertainment in the barren day rooms are old TVs, many of which can barely broadcast a picture.

The most common diagnosis here is schizophrenia, but Zavradishvili shrugs when asked whether the diagnoses are accurate or merely a catch-all label the staff gives to any case they don't understand. Mental illness in the family is still sometimes seen as a sort of curse in Georgia, with many afflicted individuals left undiagnosed and untreated.

In such conditions, the need for outside financing has become dire, yet, even here, sizeable shortcomings can occur. A three-year United Nations program to feed the hospital's patients will end in 2005, leaving the facility dependent on the $3 per day per patient that the Georgian Ministry of Health can provide.

Additional assistance comes from international development organizations, such as Cordaid, based in the Netherlands. A few patients receive group therapy from a Cordaid-trained social worker and others participate in therapeutic art classes. But limited resources make treatment so intermittent that these programs' effectiveness is questionable.

Zavradishvili plans to lobby the Ministry of Health that with proper diagnosis, nutrition and care, patients' conditions could dramatically improve, but her reception is uncertain.

The Tbilisi Psychiatric Hospital is more the rule than the exception in Georgia's mental health industry. The Tbilisi-based Asatiani Psychiatric and Scientific Research Inistitute cares for 250 adult patients, but other facilities, primarily in the north, are little more than dormitories for the severely mentally ill. Children receive some degree of care at special clinics and at orphanages.

Although President Mikheil Saakashvili has addressed the need to improve the country's health care system in general, too many ill-equipped hospitals and too many poorly trained and poorly paid doctors make for a daunting challenge. A little over a year after the Rose Revolution, Georgians in the mental health community have mostly adopted a wait-and-see approach to Saakashvili's promises of reform.

"The mentally ill are stigmatized in Georgia," Zavradishvili commented. "In our new democracy, where there is so little but so many asking, they are without any voice at all."

Editor's Note: John Smock is a freelance photographer and journalist.