I am writing this open letter because after 30 years of active engagement in Ukraine’s road to democracy I have reached the point when I really doubt my future engagement and I wonder why I should waste so much of my energy.
The main reason is the fact that I see that a group of patriotic “reformers” is endangering the lives of people with mental health problems by pushing through the next phase of a health reform program that is ill-advised, is widely criticized by international experts and has within weeks led to a collapse of the psychiatric system.
I am even more disenchanted when I see that these very same people are actively supported by international representatives in Ukraine, who seem to be unaware of what is happening and might only wake up when the damage is done and when we face a repetition of the disasters that fell upon psychiatry in the United States under Ronald Reagan when thousands of mental patients were put out on the streets, or in South Africa a few years ago when an ill-devised reform plan left 134 patients dead in Gauteng Province alone. The only reason why I have not taken this step is that I cannot abandon my friends and, maybe even more important, cannot abandon the people to whom I have dedicated all of my professional life: persons with mental health problems.
This predicament is to me the more painful because for more than 30 years I have been an active participant in building a Ukrainian society based on the rule of law. I visited the country an endless amount of times, have many, many friends there and, in many ways, I call it home. I have been at the cradle of many nongovernmental organizations in the sphere of mental health, implemented literally hundreds of projects in this field including the establishment of a publishing house that operated for 10 years and managed to publish 139 manuals and textbooks for mental health professionals in the region. Of course, I didn’t do this alone, but was supported by dozens of foreign specialists who spent many weeks working in projects on a voluntary basis. We did our work on a shoestring, with minimal salaries, but with a lot of love and feelings of solidarity with Ukrainian mental health professionals, the users of mental health care services, and their relatives and careers.
Having been one of the leaders of the international campaign against the political abuse of psychiatry in the U.S.S.R., I started out believing that all Soviet – and therefore Ukrainian – psychiatrists were abusers of psychiatry and were completely corrupted. During my thirty years of active engagement, I have come to believe that the overwhelming majority are hard-working professionals, who really care about their patients and who carry out their difficult job with incredibly small salaries with which it is virtually impossible to feed a family. I have come to respect them deeply – and I believe that respect is a vital component in partnership and collaboration.
Almost six and a half years ago, I lived through one of the most inspirational periods of my life when I became an active supporter of the EuroMaidan Revolution in Kyiv, which toppled Viktor Yanukovych’s presidency on Feb. 22, 2014. My first visit was in early December when the mood was still upbeat, no persons had been killed and the idea that this might end in bloodshed and a protracted Russian-Ukrainian war and occupation of part of the country was unfathomable.
When I came to Maidan I believed, like many others, that now we would be able to move things forward and bring about the fundamental change that was so much needed: to transfer a still very institutional mental health care system into a community-based and consumer-oriented system and to start the dismantling of the system of social care homes. In other words: to finally end the remnants in psychiatry of the Soviet past.
After Maidan, we expanded our work in many fields, and for all the following years I came to your country usually two or three times a month in order to help Ukrainians to reform their country and to implement the hopes and believes that I thought Maidan stood for. Only the COVID-19 pandemic ended my traveling, but not my engagement: every day, from early in the morning until late in the evening, I still have Ukraine on my agenda.
Unfortunately, things did not work out the way I hoped or believed. Of course, changing a huge country like Ukraine at a time when it is at war and facing a constant threat from its much larger neighbor is maybe sometimes similar to a Sisyphus task. But to me, the greatest disappointment is not the inertia of the system and the continuation of Soviet practices. My disenchantment was caused by the opposition we met from the most unexpected side: from those who claimed to uphold the principles and values of Maidan – often having been an active participant in that national uprising – but who at the same time barged in without any respect for what we accomplished before and who started what has now led to a collapse of the psychiatric services in Ukraine. They seem to have a sort of monopoly on the “truth,” and if you dare to disagree with them you are not a “patriot” and your opinion loses value.
I really don’t understand this incredible blank spot in the heads of those who still support the former acting minister of health, Ulana Suprun, and her active supporters. Sometimes it looks like a religion, where everything they say and do is seen in a very rosy light of “reform activism.” And criticism has become almost blasphemy. I love activism, as my life trajectory has shown, but I also believe that it is essential that you know what you are doing, that you involve those who are supposed to implement your plans and that you show respect to those who came before you.
What they did is a fundamental mistake of activism: they are so revolutionary that they kill the old before they build the new. Instead of first building community based mental health care services, their program has led to the collapse of the old system of institutional care, and the result is that people with mental health problems – the people we care about and work for, our constituency – are left without proper care. To me this is unforgivable. And the worst is: most of those who support this group do not even want to hear this criticism, because it is “sacrilegious”, and thus they will probably not even print my letter.
I don’t understand why mental health professionals in Ukraine have to work with salaries that not even a cleaning woman would touch, while the “reformers” are able to fetch Western-size salaries. Something is fundamentally wrong here, and I see how Western support again “corrupts” by paying wages that are not in any relation to normal salaries in the country. One corruption is replaced by a new one and, in the end, it is the people who suffer again, and especially – as usual – those who are disadvantaged because of mental illness or psychosocial disability.
To tell you the truth, I am disgusted. I watch the webinars and presentations about who are responsible for the current mess, and I feel physically sick. I see young people, activists like myself, who have become zealots and part of a new profession, where it is no longer possible to say “hey, let’s take a step back, maybe we are heading in the wrong direction” or to acknowledge that things did not work out.
Well, you are heading to a disaster, that is self-evident. And it will be people like me, and those who are surviving in the crumbling mental health care services, who will have to gather the pieces and repair what you have left behind.
I am appalled, and I ask those who support these “reformers” to really think – maybe saying you are a reformer is not a guarantee you actually are, and maybe there is a moment when you reconsider your support before it is too late?
Robert van Voren is chief executive of the international foundation Human Rights in Mental Health and executive director of the Andrei Sakharov Research Center for Democratic Development in Kaunas, Lithuania. He is a professor of Soviet and post-Soviet studies at the Vytautas Magnus University in Lithuania, and Ilia State University in Tbilisi, Georgia. Van Voren is a board member of several organizations in the field of human rights and mental health. Van Voren has written extensively on Soviet issues and, in particular, issues related to mental health and human rights, and published a dozen books.
