MSF report describes desperate condition of psychiatric care

Psychiatric care in Tajikistan is in a desperate condition, and the need for long-term reform is imperative, says a new report by the international health NGO, Medecins Sans Frontieres (MSF). “This report is the first of its kind, and this research was part of a wider campaign to raise awareness on this issue in Tajikistan,” Paul McPhun, an MSF spokesman, told IRIN from the Tajik capital, Dushanbe, on Tuesday. Tajikistan currently has 16 psychiatric institutions for people with mental disorders, which can hold a total of just 1,000 patients, while the Ministry of Health believes that Tajikistan has 40,000 people who are in need of psychiatric care. Some of these who are not living in institutions receive care from outpatient clinics, whilst the majority are receiving no care at all. “There is a need to develop a strategy for mental health reform and to meet the immediate short-term needs of the patients,” Joanna Cox, also with MSF in Dushanbe, told IRIN. According to the report, it became apparent to MSF in 1997 that the Tajik government was not in a position to provide adequate health care, following the collapse of the system in 1992. Patients were dying due to inadequate treatment, whilst those who did survive lived in conditions failing to respect the most basic levels of human dignity, the report said, adding that MSF started a programme, which continued until July 2003, providing emergency food, medical supplies and conducting emergency repairs on institutional buildings. Currently, the 1,000 patients in institutions have minimal access to psychotropic drugs, which are needed to control their symptoms and the supply of such drugs is still dependant on emergency humanitarian supplies. A doctor from one of the institutions said in the report that the impact of the lack of drugs was leading to acute patients becoming chronic, meaning that more than 90 percent of the patients were now suffering from acute disorders. Even if drugs were available, the report highlighted, families were often unable to afford them and the lack of treatment was leading to catastrophic results. One nurse cited in the report described patients tearing mattresses and clothes and attempting to burn everything and inflicting injuries upon themselves. It is estimated that out of 150 patients who are discharged, 100 return to the institutions after two to three months with the average duration of stay being 150 days. This is again linked to the unavailability of drugs to control symptoms of patients and lack of support and education for the community on how to help people suffering from mental conditions. “If families are illiterate, it is difficult to explain the principles of psychiatric illness and if they believe their family member to be cured, they stop buying their medication,” a doctor explained in the report. The document highlighted the fact that there was no occupational therapy available and all of the 16 institutions lack staff due to low salaries. The supply of food is also of concern. MSF believes that the Ministry of Health’s lack of capacity to provide food could lead to an emergency situation, and have yet to commit to increasing their food provision. However, they say they have been encouraged by the commitment shown by the government. “The Ministry of Health have received the report and are responding constructively to date,” Cox said, adding that MSF hoped that by placing mental health on the agenda and raising awareness, that some support would be offered to the ministry to develop reform strategies. “There is a lack of cooperation between the Social Welfare and Protection Ministry and the Ministry of Health which places a heavy burden on the Ministry of Health and affects the way acute patients can receive treatment,” Cox stressed.