Mental Health

 

Mental Health Care in Czech Republic is still behind other E.U countries

Sophia Hayat Taha

Prague, Czech Republic

Lack of funding, stigmatisation, staff shortages, the state of mental health care in the Czech Republic is struggling .photo 3

Lost within the massive grounds of a psychiatric hospital I take in the  intimidating, huge buildings in the lush green surroundings.  In the largest mental hospital in the country we meet Dr Pavel Mohr, head of the Clinical Division, who says that budget restrictions are just one of his worries. He hopes that in the next year reforms will materialise.

photo 2

He tells me about a revolutionary new monitoring system developed by medical researchers in Prague which is proven to prevent relapses in schizophrenic patients but which now struggles for funding. Dr. Filip Spaniel’s method uses text messages to check on the weekly experiences of patients.  The system evaluates a patients response to 10 simple questions and automatically flags to a doctor a patient who’s at risk of a relapse.  It is a scheme that has been exported around the world but now the Czech insurance companies are no longer willing to pay for it.

These long awaited reforms promise to bring more money to and change the provision of mental health treatment in the Czech Republic.  Currently there is little ‘care in the community’ with  few outpatient facilities existing and hardly any trained mental health nurses.  A lot of in-community care is instead picked up by NGOs but these are mainly concentrated in the larger cities such as Prague.

During communist era  mental health was barely spoken about.  Diagnoses of mental health problems were frequently given to people who disagreed with the running of the Soviet Union.  The Velvet Revolution in 1989 meant a lot of change for mental health issues. Dr Pavel Mohr says that “In the last twenty years a lot has improved”.  In particular the quality of care has got a lot better.  Modern treatments are available including the use of medications.   Tomas Petr, Manager of Psychiatric Intensive Care Unit, Central Military Hospital says that the state of mental health has definitely improved since the velvet revolution.  “It used to be a secret branch of medicine, now you can openly talk, but the stigma is still the same” He advocates that there is a need to change the opinion of the public. “There is a lot of prejudice; they want people away from the city, behind the walls”.

The motivation behind the  reform strategy is to improve the quality of life of those with mental illness and to increase the community network and number of community mental health nurses, in a move away from routine hospitalisation.  Most hospitals were built at the turn of the 20th Century and so are out dated with little privacy.  Rooms have 8 to 10 beds in.

Tomas Petr says the main hurdle to transformation of mental health care is people’s thinking.  “Firstly the professionals think working in asylums is the best way.  We have to take the professionals to the UK or Holland and see how it works”.  Tomas also discusses the controversial use of “caged beds”, saying that while there are no longer caged beds in the largest hospital, the use of caged beds still occurs in some smaller hospitals where the ratio of staff to patients can be 1 to 40.

Dr Pavel Mohr refutes this and says that caged beds are no longer used.  However Mental Health Europe reported suicide of a patient in a caged bed from September 2012 so it would seem that there are still some patients within these conditions.  Tomas says, “Caged beds are tolerated by the government” and that the reason for their use is staff shortages. He goes on to say, “if you have enough staff you don’t need caged beds”.

When asked about what the state of mental health care will be like in five years’ time Dr Mohr says that the changes, unfortunately, will be “mainly cosmetic”.  He doesn’t expect there to be the promised increase in money as mental health is not the primary focus within healthcare in the Czech Republic.  Only 4% of the healthcare budget goes on mental health care.  This is one of the smallest amounts within the EU countries.

graphgraph taken from presentation by Tomas Petr

While there have been improvements there is still a long way to go before the Czech Republic’s mental health system matches that of other European countries.  Stigmatisation left over from Soviet times still stands; as do the old buildings and the struggling institutions housed within them, dedicated to providing health care to society’s most vulnerable patients.  Funding is still woefully short of that in other EU countries and a lack of trained psychiatric nurses is a real problem in the sector.

The Weird Guy in the Corner that People Respect: An Interview with Tristan Bishop

P1010020

Today I interviewed Tristan Bishop, office worker by day and DJ Dellamorte by night.  After success in the music industry in 2005 he runs Internet Radio Station, Barricade Radio.  He is using this to raise money for a campaign close to his heart.  On the 27th July DJ Dellamorte will be dj-ing and broadcasting live for 24 hours.   Thirteen guest Dj’s have agreed to take some half hour sets within the music marathon.  He’s holding an open house for his large group of friends so there’ll be a live audience present at all times.

 It’s going to be one hell of a party and all for a good cause

DJ Dellamorte is raising money and awareness for CALM (the campaign against living miserably), which exists to prevent male suicide in the UK.  Suicide kills more young men in England and Wales than road death, murder and HIV/AIDS combined (http://www.thecalmzone.net).  He is, unfortunately, all too aware of this.  In January he lost someone close to him; his best friend’s little brother. This tragedy really brought home the stigma mental health issues carry.  In his memory, his family fund-raised and now DJ Dellamorte, speaks about his own mental health demons and how music has helped him control them.

Why CALM?

As a mental health suffer I understand the stigma, it’s important to raise awareness and CALM do some good work.‘I have always been a bit of an over sharer by nature, however in the past I have clammed up.

He puts this down to the nature of the illness and the associated stigma

I was reticent to admit (publicly) to having problems, but that in itself was enough of a reason to do it.  Mental health and its perceptions interest me. When you mention in passing that you have suffered from illnesses like depression, you can see on people’s faces that they don’t know how to react.  Despite the progress made with some excellent ad campaigns, and Stephen Fry’s openness there is still a lot of work to be done. The most important thing is to not keep quiet about it.

Depression since childhood

His father left when he was three.  His memories of him are of an empty man who had no empathy and was not into emotions.  It wasn’t until Tristan was 26 though, and a friend told him that he needed help that he finally realized what the problem was.  He couldn’t cope with things.  He had massive breakdowns where he would scream until he couldn’t anymore.  He felt like he wasn’t in control of anything.  An increase in work load, 17-18 hours a day in the office then Dj-ing at night; led to a point where he snapped.  His music career dwindled and he was left feeling empty.  He stopped going out, stopped seeing friends and experienced suicidal thoughts and attempts.

Starting Again

Tristan started to improve a few months after being put on medication.  He decided to re-invent himself, broadening his musical repertoire and doing internet radio shows.  Frustration with unorganized clubs and radio stations led to the creation of Barricade. Here he plays music on his own terms in a supportive and creative environment.  The chat room is friendly and the music always leaves you in an excellent mood.

Now Tristan has been off medication for 2 years.  He has had ups and downs, mostly reactive to situations. The first three months of this year were very hard.

Sound-tracking people’s lives.

My dream is to be full time DJ.  I don’t care if I end up doing pub gigs, weddings and playing ‘STEPS.’ I was born to do this shit.  Hunting for music, playing, watching people’s faces, sound tracking people’s life.  The best thing about dj-ing is you get to be the weird guy in the corner and people respect you for it.

If you could change anything, go back in time; when would you go back to and why?

I’d go back and capitalize on the music opportunities I had.  The doors were open.  We had features on radio 1 and interviews, but I didn’t take the bull by the horns.  Maybe I was scared by it.  Doing music full time would have been fantastic.

Watch this space for a report on the event itself, if you would like to donate please go to the below link:

http://www.justgiving.com/barricade

 

Mental Healthcare: A Comparison of The Netherlands and Czech Republic

mentalhealth_onpage

 

Mental health problems affect 1 in 4 people around the world.  According to a report by Jolijn Santegoeds, for Stichting Mind Rights based in Eindhoven, “In 2011, 1.647 persons committed suicide in the Netherlands (population 16,7 million). That is 1 suicide per 10.113 inhabitants, almost 5 persons each day. In 4 years (2007-2011) the number of suicides has grown with 18%….In 2010 almost 25% of all deaths between age 15-30 are suicides (197 of 840), which is more than the number of deaths by traffic-accidents (146) and cancer (131).”

It is a poignant and important issue yet the differences between countries when you compare their mental healthcare systems are huge. The Netherlands’ expenditure on mental health care is one of the higher ones in the EU; the Czech Republic is the second lowest.  To understand the problems, successes and improvements needed in mental healthcare within the EU we compare the two countries.

Lack of funding, stigmatisation, short staffed, the state of mental health treatment in the Czech Republic is suffering.  During communist times in the Czech Republic mental health was barely spoken about and diagnoses of mental health problems were frequently given to people who disagreed with the running of the Soviet Union.  The velvet revolution in 1989 meant a lot of change for mental health issues.  Particularly the quality of care has got a lot better.  Modern treatments are available including the use of medications.   Tomas Petr, Manager of Psychiatric Intensive Care Unit, CentralMilitaryHospital says that the state of mental health has definitely improved since the velvet revolution.  “It used to be a secret branch of medicine, now you can openly talk, but the stigma is still the same”

Despite offering training to the CzechRepublic in many areas of mental healthcare the Netherlands struggles too.  Once more a lack of funding and budget restrictions is blamed. Roos Korste, Psychologist, blogger and trainer from in2mentalhealth based in the Netherlands says “Because of our economic crisis and because costs were spinning out of control, we face huge budgets shortages.”

There are two main methods of treating mental health problems in Europe, psychiatric hospitals and social care institutions. Most countries in Europe use psychiatric hospitals to treat acute cases and short hospitalisations but in the Czech Republic due to the lack of resources many patients have long stays within these institutions.

Dr Pavel Mohr, head of the Clinical Division, works in the largest mental hospital in the Czech Republic; he says that budget restrictions are just one of his worries. He hopes that in the next year reforms will materialise.  These reforms promise to bring more money to and change the structure of mental health care in the CzechRepublic.  Currently there is little care in the community with hardly any outpatient facilities and barely any trained nurses.  A lot of work with care in the community is picked up instead by NGOs but these are mainly concentrated in the larger cities such as Prague.

He tells me about a revolutionary new method of monitoring and preventing relapses in schizophrenic patients which now struggles for funding. Dr. Filip Spaniel’s method uses text messages to check on the weekly experiences of patients.  The system can automatically flag to a doctor a patient who’s at risk of a relapse from their responses to 10 simple questions.  It is a scheme that has been exported around the world but now the Czech insurance companies are no longer willing to pay for it.

In the Netherlands too, a lot has improved, Roos Korste got into the profession because she is “a strong believer in the potential of people to grow and overcome difficulties.” She goes on to say, “ I’m a strong supporter of the empowerment of people and a transparent, honest and dignified mental health care. I’m a(n) optimist and idealist and want to contribute in finding ways for people with (severe) mental conditions to live a(n) independent and fulfilling life.”  She says that in the last 20 years, “the stigma for seeking mental health care for e.g. family or relationship problems, depression, anxiety, occupational problems, etc seems to be decreased. For a lot of people nowadays, looking for a psychotherapist in order to enhance coping with life problems is not surrounded with shame or stigma. It’s regarded as taking good care of yourself or your child, and an opportunity for personal growth.”

What are the problems in both countries?

In the Netherlands agencies are downsizing, and according to Roos Korste “too much attention is going to the business aspects, and too little to the content of the treatments offered. Decisions made by our national politicians are based on money and not on ‘what is the best care for our people’.

According to Jolijn Santegoeds, “A person in a mental health crisis in the Netherlands can be exposed to forced treatments. (18.000 persons a year)”  He argues that this counts as a form of torture.  He goes on to say “Several laws in the Netherlands allow for substitute decision making by a court order regarding forced treatments. Under Dutch laws (BOPZ, PIJ, OTS) both for children as for adults, the practice of forced treatments is legally connected to forced admission to a (specialized) mental health institution.” Later he reports that “A few hundred persons each year in the Netherlands are subjected to long term solitary confinement inside mental health care institutions, and long term fixation (physical restraints) in facilities for persons with intellectual disabilities and elderly care.” 

While this is not on the same level as caged beds, a problem that is still in the Czech Republic, it is still an inexcusable treatment of people with mental healthcare problems.   

In the Czech Republic Tomas Petr says the main hurdle to transformation is people’s thinking.  “Firstly the professionals think working in asylums is the best way.  We have to take the professionals to the UK or Holland and see how it works”.  The second thing is to change the opinion of the public.  He says “there is a lot of prejudice; they want people away from the city, behind the walls”. Tomas also says that while there are no longer caged beds in the largest hospital, the use of caged beds still occurs in some smaller hospitals where the ratio of staff to patients can be 1 to 40.  Dr Pavel Mohr refutes this and says that caged beds are no longer used.  However there was a reported suicide of a patient in a caged bed from September 2012 so it would seem that there are still some patients within these conditions.  Tomas says, “Caged beds are tolerated by the government” and that the reason for their use is staff shortages. He goes on to say, “if you have enough staff you don’t need caged beds”.

How does the Netherlands help the Czech Republic?

Tomas says, “The Dutch system is one of the best” and he speaks of a lot of cooperation with friends and colleagues from Holland.   Studies have taken place between the two countries this includes work by The Netherlands Institute for Health Services Research (NIVEL) which has collaborating projects with the Czech Republic amongst other partners.  These projects support healthcare reforms.  They hope to improve primary healthcare and general practice services.

What does the future hold?

In the Netherlands there are still problems  and in order for improvements to be made in the next 5 to 10 years Roos Korste  advocates that “More attention for human rights and empowerment of service users and their carers. More use of psychological and community approaches in mental health care, because the psychotropic medication approach have been showing its limitations”

When asked about what the state of mental health care will be like in five years’ time Dr Mohr says that the changes, unfortunately, will be “mainly cosmetic”.  He doesn’t expect there to be the promised increase in money as mental health is not the primary focus within healthcare in the Czech Republic.  Only 4% of the healthcare budget goes on mental health care.  This is one of the smallest amounts within the EU countries.

What can we learn?

While the Netherlands has a lot of advancements over the Czech Republic there is still a lot of room for improvement.  People are advocating a rethink about forced care and asking for a greater amount to be spent on mental health care within both countries.   While there is a lot to be proud of in the Netherlands, this mustn’t distract from the improvements needed.

 

My “Crazy” Ex – dating someone with mental health problems.

Image

Mental health issues affect 1 in 4 people.  According to the health survey for England the average man has 9 partners in a lifetime and the average woman has 4.[1] Realistically then you have probably dated someone with a mental health problem.[2]

The term ‘My Crazy Ex’ is used frequently when people retell their dating history.  This got me thinking, what is it like to date someone with a mental health problem?  As a sufferer of cyclothymic disorder I self-indulgently wondered if my decision to be wary of dating (for the sake of the other person) was necessary.    There is still a lot of stigma, I still feel uneasy announcing it to potential dates, but I am also desperate for someone to understand me.  If I go quiet or cry for no reason, there is a reason.  It’s cyclothymic disorder and despite it I am also a rational human being (most of the time!).

Below are a few stories from people who have dated ‘crazy’ people.  I asked them the same questions to keep some continuity.  For the sake of relationships and friendships I am avoiding using names where people have asked me to.  This article will be updated when I receive a few more stories that are due to come back to me.

Dating a Manic Depressive[3]:

What was it that first attracted you to the person and when did you notice signs of a mental health problem?

There was a physical attraction and in the beginning there was no sign of any issues there were of course good sides to the person.  Things got bad very early but he didn’t  know if it was a one off  crisis and he assumed things would get better.
Despite the signs of a mental health problems being apparent quite early on into the relationship he said that, “you think you can be the super-hero and save this person.” [4]  The problem was, I had “no prior knowledge of mental health problems, no one in my family had” so the whole experience was something shocking and new.  He remarks,   “when you see the scars you say wow. (scars from self harm)  What is the point of the scars? They have no effect, people who do that maybe they need help, not in a negative way.”

Did you openly discuss them as a couple?

“ I remember once we argued she was in the bathroom but she said she was cutting herself.  You feel guilty…it’s hard to believe it’s not to do with you.”
“when I mentioned the possibility of schizophrenia she wasn’t willing to consider this, but was ok accepting bi-polar – it’s complicated”

He puts this down to the different levels of social stigma for different mental illnesses

What did you feel your role was within their mental health issues?

He was her boyfriend, however , “everyone has compassion for the person who is mentally ill but no one gives a shit about the boyfriend or family…..it was the first time I was seriously confronted with the issue of mental health…..What annoys me is that the family is not pitied, to her everyone was ‘evil’….“She would always say ‘ I don’t deserve you’” .

How long did your relationship last?

They dated for 7 months before she broke up with him for no reason.  He would have stayed in the relationship longer.  “When you have feelings you expect things to get better but they got worse”.  He is still saddened by the affair as he talks to me about it.

Do you regret anything from the relationship

“I’d still date her, you need to know people, it was bad, nearly traumatising experience for me but why would you avoid life experience. “  He goes on to say, “ I have baggage as well, including very low self esteem so this experience didn’t help, but my self esteem is my problem, when you’re with someone you need to show your brave face”

Would you warn someone off dating a person with the same mental health issues?

No, “Everybody’s story is different” but he does point out that, “the superhero feeling has gone, the lessons are learnt, I’m compassionate and helpful but I still don’t know what to think about it all” Now I wouldn’t date someone again with mental health problems.  “once beaten twice shy”

Dating a narcissistic sociopath/ Narcissistic personality disorder[5]

What was it that first attracted you to the person

“he seemed normal, thoughtful, gorgeous and romantic”

When did you notice signs of mental health problems

Within a few weeks. It didn’t seem like problems because I always explained the behaviour away – “he’s tired, stressed, whatever”.

Did you openly discuss them as a couple?               

“No, at the time I really didn’t realize anything was wrong because I rationalized his behaviour. “

How long did your relationship last?

1.5 years or so. Yes, how long it lasted before i realized everyone else was right and he was a sociopath”

Do you regret anything from the relationship

What did you feel your role was within their mental health issues

My role was the target/placator. I was the one who sparked the issues but I was also the rational one who could bring him back down from a blind crazed rage to a depressive apologetic state.

Would you warn someone off dating a person with the same mental health issues?

YES – he had no conscience that anything he did was wrong and would manipulate those around him to think they were the ones at fault. If he wasn’t the centre of attention that was a problem and would do anything to get it to be the case (e.g cause me to lose a job etc to spend more time with him). Narcissists only think of themselves but being a sociopath in the mix meant that he didn’t think there was anything wrong with that or that the consequences to anyone else were his problem.  He was a classic case.

If you would like to answer the same questions so this article can be extended please do get in contact


[2] .   (I’ll be honest I cant be bothered to do the maths)

[3] http://en.wikipedia.org/wiki/Manic_depression

[4] I have found that this super-hero ideal is common amongst people who don’t suffer from a mental health problem.  In my own dating experience people have assumed that it is they who can make me magically better.  Sweet but frustrating.  If doctors are still trying to get it right after 12 years, you, the new date of mine are unlikely to ‘cure’ me.

[5] http://en.wikipedia.org/wiki/Narcissistic_personality_disorder

Advertisements

One thought on “Mental Health

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s