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Psychiatric patients lack social safety net upon discharge

Well hidden amidst the endless rows of Petržalka's mammoth blocks of flats sits a white concrete complex of one storey buildings. Known to the locals as the 'kindergarten', the site is actually a sanatorium which serves the needs of Bratislava's recovering psychiatric patients.
The daily routine unfolds as usual: just past noon, some 35 patients sit at their daily community meeting, undisturbed by the outside world. Then the halls of the sanatorium suddenly fill with patients as the doors of the community hall open for lunch. Some walk in pairs up and down the halls, some stand motionless on the balcony, smoking their cigarettes. They all speak quietly and guardedly among themselves and seem unaffected by the presence of a visitor.


Dotyk, a group which helps psychiatric patients readjust to the outside world, held an open house carnival in February to promote awareness.
photo: Courtesy Pinelová Hospital, Pezinok

Well hidden amidst the endless rows of Petržalka's mammoth blocks of flats sits a white concrete complex of one storey buildings. Known to the locals as the 'kindergarten', the site is actually a sanatorium which serves the needs of Bratislava's recovering psychiatric patients.

The daily routine unfolds as usual: just past noon, some 35 patients sit at their daily community meeting, undisturbed by the outside world. Then the halls of the sanatorium suddenly fill with patients as the doors of the community hall open for lunch. Some walk in pairs up and down the halls, some stand motionless on the balcony, smoking their cigarettes. They all speak quietly and guardedly among themselves and seem unaffected by the presence of a visitor.

But as the status quo continues inside the centre, social workers and psychological experts are at their wits end trying to figure out how to create more suitable conditions for the patients. It's an uphill battle, they explain, because the state constantly fails to allocate sufficient funds to the centres, and furthermore because Slovak society views psychiatric patients as 'freaks' and treats them as outcasts.

"Psychiatry has always been on the fringes of public and even official state interest," said Marek Zelman, a psychiatrist who works at a psychiatric hospital in the southern Slovak town of Hronovce. "If you have a regular medical problem it's normal to assume that you have to be treated by a specialist. But if your soul hurts you become an outsider in this society."

A 1999 study on psychiatric care in Slovakia by leading Slovak psychiatrists Peter Breier and Pavel Černák illustrated the country's inadequate services. "Only 18 out of 48 Slovak regional hospitals have beds for psychiatric patients," they wrote in their book, titled Reform of Psychiatric Care. "The distance between a psychiatric institution and a patient's home is often more than 100 kilometres, which causes even greater isolation of the patient from his family and home environment."

But although the problems have been identified, steps aimed at improving the situation have been slow to follow. "Some reform has been achieved, mainly in explaining to the public that most psychiatric illnesses can be treated as simply as gall stones, for example," said psychiatrist Anna Gombošová, from Pinelova Psychiatric Hospital in Pezinok. "But almost none of the necessary changes in the infrastructure have been achieved, largely because of the lack of money in the Slovak health care sector in general."

Family atmosphere

At the Petržalka centre, officials said that despite such barriers, they were trying to create a healthy environment for patients in hopes of curing the afflicted.

"We are trying to create a family atmosphere here," said head nurse Eva Sedlárová in a calm and relaxed voice. "We don't just give them pills and send them back out into the world. If they have problems we spend hours and hours talking to the clients [as the patients are referred to], individually or in group therapy."

This style, Zelman added, signified a different approach to the psychological treatment patients receive now as opposed to before the 1989 Velvet Revolution. "During communism, colossal psychiatric centres existed which were ineffective and hardly offered any help to patients who needed to re-establish their lives after psychiatric treatment."

Valéria Popeláková, a psychologist who works at one of Slovakia's 48 centres for counselling and psychological services (CPPS) also underscored the need for more centres, and added that society as a whole needed to be more understanding of the patients' plight.

"Our society has been through more than 50 years of ignorance [under communism] about psychiatric patients," Popeláková said. "We have many prejudices against the psychologically disturbed - anyone who's been treated by a psychiatrist is automatically labeled as a 'weirdo', and looked down upon. Sometimes even close relatives turn away rather than offer support."

As a result, she continued, many patients who had been 'cured' often returned to the centres with more disturbing ailments and were then saddled with more severe diagnoses than before.

Breaking the cycle

For Zelman, the way to break the cycle was to help patients to adjust to society gradually after their release - a necessity the Slovak medical sytsem ignored. "After three months in a centre psychiatric patients by law have to be released from hospital care," Zelman explained. "This sudden return to a world which doesn't understand their problems and treats them as dangerous lunatics only serves to complicate and destroy our efforts to help these people."

Zelman said that 'protected homes', or 24-hour live-in halfway houses, could help ease the shock many patients experience when re-entering mainstream society by allowing them to gradually acclimate to the often harsh realities of the outside world. Last year, in fact, Zelman founded a civic association called Efko in order to help recovering patients readjust to the outside world. The project has been slow to progress, however, due to a perpetual lack of money.

A similar association, called Dotyk (Touch), was started last year by psychiatrist Gombošová as part of the Pinelova Hospital in Pezinok. "We started Dotyk because there are no such facilities whatsoever outside the Bratislava region," she said.

Dotyk has 68 members; mainly Pinelova hospital doctors, patients and their relatives. The group meets every two weeks and discusses patients' problems such as re-integration to life outside the hospital. "We give advice to patients and their families," Gombošová said. "But we also organise social events like exhibitions of paintings created by our patients. We held a public carnival in February so that people from outside the hospital could come and see that our patients are just like any other patients receiving 'normal' hospital care."

But, she added, Slovakia's poor psychiatric services remained a pressing problem. CPPS's head Jolana Kusá shared this view: "The situation is catastrophic, especially in the east of Slovakia - there are almost no such places [psychiatric care centres] in the Košice region, for example. It's a terrible situation."

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