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Health Action Health Action - in the North Caucasus NEWSLETTER ON EMERGENCY PREPAREDNESS AND RE SPONSE, FEB/MARCH 2002 Psychiatric care in the Chechen Republic Overview for the year 2001 Medical personnel Recent years have seen a decline in the level Since the early 1990s a mass outflow of medical of psychiatric care in Chechnya: professionals started from Chechnya. Twenty- · The doctors:positions ratio has declined two psychiatrists left, leaving in Grozny in 1996, by two thirds; for example, only four doctors with sufficient · Low case detection rate, in particular qualifications (29 are required by the standard among children and adolescents (records staff table). based mostly on visits); The exodus of psychiatrists occurred from rural · Inadequate condition of psychiatric facili- areas as well. Qualified psychiatrists are cur- ties and equipment supply; rently available only at the central district hospi- · Insufficient supply of psychoactive medi- tals of Naursky, Shalinsky, Kurchaloevsky and cations; Nadteretchny districts and in Grozny. In other districts, psychiatric care is provided on a part- · Low efficiency of bed utilization. time basis by neurologists and in Shatoisky and Schelkovsky districts by nurses. Mental health facilities In 2001, there were 0.2 psychiatrists per 10 000 The mental health services in Chechnya are pro- population in Chechnya (versus 1.5 of the na- vided by the republican psycho-neurological dis- tional average in 2000). pensary, two psychiatric hospitals: the republi- It should be noted that most doctors providing can psychiatric hospital in Darbankhi (180 beds: psychiatric care have not taken relevant profes- 60 beds operational as of 1 January 2002) and sional or refresher courses for the last five to six the psychiatric hospital in Samashki (50 beds years. operational since mid-2001) and psychiatrists Facilities and equipment working at the central district hospitals. The psychiatric facilities and available equipment By 1991, there were 1 060 psychiatric beds in are very insufficient or inadequate. Chechnya, including 110 at the republican dis- After the 1994-96 combat actions, the republi- pensary, 50 at the day-care department, 330 at can dispensary in Grozny has been located in a Darbankhi hospital, 200 at Goryacheistochnen- semi-ruined building which was almost co m- sky hospital and 220 at Samashki hospital. Since pletely destroyed in the 1999 military campaign. 1991, the psychiatric bed capacity has been re- Due to the lack of a building fo r the republican ducing annually and by 1999 it was 260 beds as dispensary, Grozny does not currently have an a result of the so-called health sector restructur- inpatient department, even for emergency care. ing in Chechnya (180 beds in Da rbankhi hospital No appropriate building has been found to date, and 80 in Samashki hospital). The reform did with the republican dispensary being temporarily not foresee any in-patient facilities for children accommodated at Polyclinic no. 7. who were to be sent for psychiatric care out of the republic. The Darbankhi and Samashki hospitals are housed in old buildings without essential utilities 1 and medical equipment. The medical furniture Performance of psychiatric hospitals has been discarded without replenishment for In 2001, the psychiatric hospitals of Chechnya several years. The Samashki hospital has not reported 878 admissions, including 795 by Dar- had a water supply for some years and relies on bankhi hospital and 83 by Samashki hospital, delive ries from rural areas and tank storage. versus 556 and 75 in 2000, respectively. The Outpatient psychiatric services bed occupancy rate was 59.6% and 32.6%, ac- cordingly. The incidence of mental disorder (primary cases) in Chechnya has increased over the last two Both hospitals are not adequately supplied with years: from 280 in 2000 to 1 190 in 2001, or medications (neuroleptics), let alone their vari- 0.3 to 1.3:10 000. This is due to more primary ety. However, this situation has improved tangi- visits by patients who apply to be co nsidered as bly with the recent months’ supplies by the Min- disable (with the corresponding benefits). istry of Health of the Russian Federation and humanitarian organizations. The lack of required Despite the high shortage of professionals, the neuroleptics and their assortment denies quality outpatient care effort averages 3 667 visits per treatment and entails short remissions and the doctor a year, or 67.9% (the standard is 5 400 high disability rate. Patients, staying at hospi- visits). tals, for the most part are administered mainte- Estimated prevalence of psychiatric diseases in nance treatment, resulting in frequent exacerba- 2001 for Chechnya was 1.3:10 000. tion. Psycho-social rehabilitation in emergencies – a universal need By Zoya Khimchyan, researcher of the Institute of Psychology of the Academy of Sciences of the Russian Federation The long-lasting political and economic crisis in Chechnya and the many years of incessant hos- tilities resulted in a generation of “camp chil- dren”. Children, who are deprived of childhood, illiterate and some of them with an alarming de- velopmental lag and behavioural, affective and personality disorders. This problem was reco g- nised in a number of urgent needs of inte rnally WHO regularly arranges training workshops to im- displaced persons (IDPs), and presently in In- prove psychological rehabilitation work. gushetia there is a growing number of interna- tional governmental organizations and NGOs can not always be integrated successfully into involved in the psychosocial rehabilitation of af- the professional knowledge and skills. fected children from Chechnya. In the context of the current political and eco- Given the conditions, this work demands from nomic instability in Chechnya, professionals in the care -givers varied professional knowledge this field will remain increasingly in demand for and skills. Even the workers with psychological a long time. Therefore, WHO regularly arranges education need retraining for clinical psychology, training workshops to ensure sustainability and counselling and psycho-therapy, to say nothing better coherence of psychological rehabilitation about the volunteers working as non- work in the community. professional counsellors. The latter do gain size- I joined this process when I was invited to con- able practical experience; however, it is neither duct two WHO training workshops: the first on reviewed, nor arranged in order, and therefore psycho-diagnostics and therapy of post- traumatic stress disorders in general and the 2 second on more specific issue of psychosocial tres shape their new outlook and sense of their rehabilitation of disabled children. life in the protracted crisis, as well as acquire a The approximately 50 participants varied greatly new locally relevant speciality, i.e. the counsel- in the level of their qualifications and experience lor. in psycho-social rehabilitation. Educators, psy- The training and interactive exercises revealed chologists, physicians and students of psychol- the general professional and personal difficulties ogy schools were engaged in counselling chil- common for all of the participants: the partici- dren and their parents in the IDP camps and pants were rallied by, for example, their com- settlements via the work of centres for social mon woe (death of their kin, loss of home), and psychological rehabilitation and the preve n- bombings, unclear future. Few of them managed tion of mental disorders. to overcome their own traumas, which some- During the workshops the participants learnt times affects their work. about modern scientific perceptions of the na- The following recommendations were developed: ture of psychological trauma and its implications professional upgrading should be continued for the psyche, methods of psycho-diagnostics both academically and practically, because and post-traumatic stress disorder therapy, and the participants need to increase and sys- particularly about the peculiarities of social and tematize their professional knowledge in psychological rehabilitation of disabled children. clinical psychology and counselling; Emphasis was placed on the specifics of the a permanent supervision arrangement is work being carried out by counsellors and social required for professional upgrading and workers in the IDP camps. evaluation of the experience gained by rele- The educators themselves, while sustaining the vant practitioners to discuss specific clinical camp life hardships and burdened by their own cases and draft recommendations on social psycho-traumas, managed to counsel those who and psychological rehabilitation; needed it. Although aware of the shortage of ongoing work is appropria te with rehabilita- relevant experience and knowledge, these work- tion professionals for prevention of the ers try to compensate for it by their high co m- “emotional burn-out” syndrome and psycho- mitment and infallible effort while running the emotional stress removal, because they suf- risk of professional burn -out (wishful thinking, fer a secondary trauma resulting from their secondary traumas at work, frustration for lack occupation and a chronic stress caused by of qualifications etc.). This problem was dis- their residence in the refugee camps; cussed during the workshops and appropriate preventive and health promotion methods were a collection of relevant practical guidelines taught. on various aspects of social and psychologi- cal rehabilitation and booklets adjusted for The
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