After almost nine months of COVID-19 restrictions, mental health professionals agree on at least one thing: the effects of lockdown will have a long-lasting effect on the mental health of the population worldwide. Some specialists are already warning for a “fourth wave,” the long-term mental health consequences of the COVID restrictions. Research shows that not only are the numbers up with regard to mental health issues, e.g. cases of depression, suicidal thoughts, anxiety, panic attacks, etc. It also shows that persons with mental illness run also a higher risk of becoming infected because they are less likely to follow rules strictly. And then it is now also clear that persons who have mental illness are also at a higher risk to die from COVID-19 for physical reasons. All in all a bad picture, and one that gives enough reason for deep concern.
In short, life during the COVID pandemic has been difficult at best. However, in Ukraine, there are more than 30,000 persons for whom lockdown was already a daily reality, and not just temporary until the pandemic is under control. Persons living in psychoneurological boarding homes, of which there are 145 in Ukraine, have always been restricted in their movement, contacts, and ability to live a worthy life. These places, often euphemistically referred to as “social care homes,” are a remnant of the old Soviet psychiatry, and a very stubborn remnant indeed. Over the past five years, I have visited quite a few of them together with teams of international experts and on basis of these assessments, we published several reports that all came to the same conclusion: the system of social care homes should be reformed fundamentally and changed into one that is focused on keeping people as much as possible in the community, rather than removing them from the community, often for the rest of their lives.
In many of the institutions, human rights are violated, and even the staff and management acknowledge this fact. They are storage places for people that have been ostracized from society, and on basis of our research, we concluded that about one-third of the clients should never have been hospitalized. They entered the place because they didn’t fit into society, because their family wanted to get rid of them, or because as an orphan they entered a children’s institution and then automatically were transferred to an adult institution when they turned 18.
Some of the places that we visited had directors who really tried their best to make life for their residents less hopeless. Some, however, abused their position, allowed massive human rights violations to happen, and basically used the residents as slaves for free labor, sometimes “renting” them to outsiders and pocketing the earned money themselves. We met a director who was a complete alcoholic, another who had built a prison within his prison for those who violated the rules. There we met a man who had been “temporarily” hospitalized by his brother, but who never came back to pick him up. In another institution, we met a woman in her early 30s who showed no sign of mental illness and had been outside for the last time when she was a small kid, more than twenty years ago. And, above all, what we found was an ocean of misery, people spending their days in emptiness.
So when we complain about the restrictions and how our lives have been messed up, maybe we then also better understand how messed up the lives are of those who spend most or all of their lives in closed institutions, without any hope of ever coming out. And because the overwhelming majority of residents are put under guardianship with either a relative or the institution management being the guardian, they legally have no voice and thus very little chance of changing their fate. Most succumb to the inevitability of their situation and after a couple of theirs become completely institutionalized.
This is a system that needs to be changed, fundamentally. There is no way this system can continue to exist in a civilized country. Change is possible when society raises its voice and demands this change from the government. For that reason, a group of four mental health organizations will initiate a campaign to focus the attention on the fate of persons living in social care homes in Ukraine who are suffering from a double level of isolation because of the COVID-19 pandemic. The four organizations are the Ukrainian Psychiatric Association, the Research Center for Social Policy in Ukraine, the Vilnius-based NGO Mental Health Perspectives, and the Federation Global Initiative on Psychiatry. The campaign is part of an international project “Mind the Gap” that promotes social solidarity and combats social isolation and tries to change the vocabulary from social distancing to physical distancing. Within the framework of this campaign six clips will be produced, of which three have been launched today. They will become available on social media, and can also be watched by clicking on the link below this article.
Robert van Voren is chief executive of the Federation Global Initiative on Psychiatry.
Video 1: https://youtu.be/rz39NlCkhtk
Video 2: https://youtu.be/78eDB5a17ps
Video 3: https://youtu.be/cBEv48gBRYQ
