Growing number of cafes in Czech Republic helping mentally ill lead normal lives
24.3.2006 - Ian Willoughby

Community-based care was a little known concept under communism, when the prevalent approach was to keep the mentally ill in institutions, and out of sight. But things are slowly changing, as steps are taken around the region towards destigmatisation and re-integration. In the Czech Republic, for instance, there is now a growing number of cafes which are helping provide the mentally ill with a route back to normal life.

The Kavarna na Pul Cesty, or Half Way Café, is a bright, homely place in the suburbs of Prague. Opened in 1997, it was the first centre of its kind in the Czech Republic.

"Through the café people with disabilities can meet the public in a, let's say, common atmosphere, and be in touch with common life. We want to make a space where people with disabilities can meet the public without any stigma."

Says occupational therapist Jana Pluharikova Pomajzlova.

"For our clients it is quite important that they go to a service which is not really...or you cannot really see that it is a service. For some people it is really important that nobody knows about their history, their experience. You cannot really see that it is some kind of psychiatry service...the stigma is maybe not so strong in that. And the other important thing is that it's much easier to reach the service."

The Half Way Café's clients are young people who are in the early stages of mental illness. Among them is Lubos, a softly spoken young man who clearly values the experience.

"What I get from it is that it is helping me to get some confidence back. In my last job things went terribly, and I got the sack really quickly. But here I feel I am becoming confident again...I take it as a kind of mental preparation for finding a job in the future."

After a maximum period of twelve months it's time for the café's staff to move on, and take the big step of trying to reintegrate with everyday society. Some clients must be sad to leave this cosy, supportive environment. Jana Pluharikova Pomajzlova again.

"Of course, and also for us it's quite difficult too, because we are in quite close contact with them, but it is part of the process. We try to prepare them from the beginning that it is for one year. And we are planning what the client will do after one year...Maybe 40 or 50 percent of people are successful in finding a job."

Do you stay in contact with your former clients?

"We support the clients for a minimum of three months after they finish rehabilitation, or the job in the café. And afterwards we try to stop the contact because we hope that the client already has enough support in his own environment."

Facing the facts of depression in Slovakia
24.3.2006 - Anca Dragu

The World Health Organisation says depression is number four in the list of the world's major diseases in terms of time suffered. And the problem is multiplying. By the year 2020, depression is expected to be the 2nd most common health complaint in all ages and both sexes.

In early January, I posted an article about depression on my Slovak weblog. I wrote that in Slovakia you often hear young people claiming that they are depressed every time they are in a bit of a bad mood. It has almost become a new way of being "cool". In reality they don't have any symptoms of depression. If only they knew what a serious illness depression can be, they wouldn't joke about it.

"We should clearly differentiate between the sad moods that all of us have more or less frequently, and real depression, which is a chemical imbalance at the level of neurotransmitters in the human brain. A depressed person loses interest in everything, feels unworthy, guilty, can't sleep, loses appetite and has suicidal thoughts. It simply incapacitates people. In Slovakia people over forty are the most exposed to depression and the problem is that they often do not want to admit it and do not seek medical help. Slovak society is patriarchal and conservative, therefore adults, especially men, are afraid of losing their social status if others find out about their depression," says psychologist Elena Tedlova.

There are no accurate data on how many people are affected by depression in Slovakia, simply because somebody is registered in statistics only if she or he goes to a doctor or psychologist. The numerous sufferers who do not seek medical help do not figure in the statistics. The World Health Organisation conducted a survey in 2003 and concluded that 18 percent of Slovaks have been depressed for more than six months. Some of those who reacted to my blog tried to prove that depression is not a real problem in Slovakia. Others simply informed me that Slovaks are depressive as a nation.

"Maybe there are some depressed people but we are not like the Americans who spend all day with a shrink."

"Politicians are so depressing and corrupt and ordinary people have become so apathetic. Everybody lives in her or his own box and doesn't care about the outside world. We live in a closed society full of envy."

"Come on, how can you say Slovaks are depressed? Look around, people have good jobs, have children, and go on holiday abroad. They don't look depressed at all."

Professor Imrich Ruisel from the Slovak Academy of Sciences has spent many years studying how satisfied Slovaks are with their life:

"Yes, many people lead better lives from the financial point of view but you know the old saying: 'Money doesn't buy you happiness'. People need affection too and they can fall into depression very quickly if they can't satisfy their needs. Currently in Slovakia a better paid job means longer, stressful hours in the office and less time for family and friends. Loneliness has become a hidden problem in this country and generally it is one of the leading causes of depression."

Additionally Slovaks have started to feel the pressure of consumerism as psychologist Elena Tedlova explains:

"Take a look at the covers of magazines for women and men or watch the TV channels offering reality shows and you realize that they try to promote a certain type of successful person. Some people realize that it is simply marketing but there are some, especially youngsters, who feel under pressure to be like those featured by the media and set unrealistic goals for themselves. Some end feeling unworthy and depressed."

And talking about marketing and consumerism, they also influence the treatment of depression. Pharmaceutical companies have built up a powerful lobby in favour of prescribing drugs. They are relatively cheap and therefore favoured by health insurers. Psychologist Petra Wagnerova says that sometimes drugs prescriptions are used to cover the lack of therapists in Slovakia:

"The treatment should consist of a combination of antidepressants and therapy but psychology graduates do not tend to become therapists, because they have to undergo extra training, which costs around 10,500 euro. Many people still choose to study Psychology because it sounds cool and they think it will also help them to solve their own soul-searching issues. Not everybody can work as a psychologist. You need to have some native communication skills and empathy. As a consequence we end up with a lot of older therapists who are also old fashioned and do not always know how to cope with the latest hot issues in society, such as the internet."

"You see in Slovakia we have our own way to cope with the hardships of life. We drink a shot of home made brandy called Borovicka. It is the best psychologist in the world. But please don't start to ask me about alcoholism now," says professor Ruisel smiling.

In the end, there might be some truth in the lyrics of the song "Crazy" by Canadian singer Alanis Morisette: "We are never gonna survive unless we are a little crazy".

Hungarians battle depression with community psychiatry
24.3.2006 - Agi Varga

In the mid 1980's Hungary regularly made the headlines for one unhappy reason - it had the world's highest suicide rate - an average of 46 suicides a year for every hundred thousand people. And many thought rates of depression and suicide would increase after the fall of communism. But to the surprise of many, the number of suicides has fallen.

Conditions for people with mental illness have improved significantly thanks to policies introduced since the fall of communism and growing efforts by human rights organisations. But unemployment is high and people with mental illness continue to be among the first to lose their jobs. There is another way to get help, complementing standard, internationally approved treatments.

This is community psychiatry, when with the patient's agreement relatives or friends are also involved in the treatment. It may still be relatively new and underdeveloped, but according to Dr Judit Harangozo, who is a pioneer in the field, it does seem to be working in Hungary:

"Community psychiatry is provided basically for schizophrenic patients and people with mental disorders, like manic depression or severe personality disorders. This kind of treatment has very good results. Patients can get better and improve their work performance. More than 50 per cent of our clients who receive this type of service are working or learning something. This is much higher than with traditional forms of treatment."

Istvan Bitter heads the Department of Psychiatry and Psychotherapy at the prestigious Budapest-based Semmelweiss Medical University:

"We have a large part of the population suffering from mood disorders, mainly depression, and from anxiety disorders. People are worried about something so they avoid certain things. We call this 'phobia'. In the elderly especially we have an eventual decline of mental capacities, like dementia."

Dr. Bitter points out that one per cent of the population suffers from schizophrenia, and up to 40 per cent of the population suffers from a mental disorder which needs treatment at some point during their lives.

In a massive brain drain some of Hungary's best doctors are leaving for better salaries in countries like Britain and Sweden. This is compounded by a decline in the number of health facilities available. Dr. Bitter is pessimistic.

"The treatment system is becoming more and more insufficient, but it's not only psychiatry. It's a general issue in health care in this country. The number of psychiatric beds decreased by 50 per cent, which is fine because we no longer want to treat most patients in hospitals, but unfortunately the money saved was not used for improving outpatient services. But we still have a very good state supported outpatient network throughout the country, which means that each patient discharged from hospital has free access to outpatient care."

So, the battle is only half won, until Hungarians join forces and pave the way for people with mental illness to integrate into mainstream society.

Growing rate of child and teenage suicides in Poland
24.3.2006 - Slawek Szefs

For the past several years police statistics in Poland have been registering close to 5,000 suicides annually. What is most alarming is a steady 15% annual rise in suicides among the youngest generation.

17-year-old Krzysztof was found by his kid brother Arek who returned from school early. Just a couple of minutes more and it would have been too late. Krzysztof is now home from hospital, but since then has been silent and his thoughts remote. Arek overheard the next door neighbour whispering it might have been attempted suicide.

The latest figures speak of 61 suicides among children under 14 annually and 266 among teenagers between 15 and 19. Professor Brunon Holyst, who heads the Polish Suicidological Society, attributes the rise to social changes that have taken place in Poland since the rapid political and economic transformations started in 1989:

"The reasons, the motives, are connected with an acceleration process. We can observe the bad situation in families. Also the sometimes less than friendly situation in schools: some young people committed suicide because of difficulties in school."

Bozena Szafranska, a psychologist at one of Warsaw's specialist centers for children with school problems, stresses the importance of signals sent to grown ups:

"Suicidal children have some personal features such as low self-esteem, low tolerance for frustration, feelings of hopelessness, worthlessness, guilt, anger. Children are not able to express those feelings any other way."

These signals are often ignored by adults who tend to share a naive stereotype that childhood is a trouble free period. Unfortunately, a similar mistake is committed by many professionals in Poland who underestimate the problem of young suicides. Professor Holyst points to a 5:1 ratio of adult men and women who consider suicide as opposed by a 2:1 rate among boys and girls. This arises, ironically, from increasing equality between the sexes in terms of social pressure and expectations.

"We can say that the standard of living is equal within the young society and population. And conflicts, which are the origin and play the dominant role in the roots of suicidal behavior are the same, for instance, love, difficulties at school, a bad situation within the family, or an unfriendly attitude toward teenagers."

Psychologist Bozena Szafranska is worried by the disregard for life created by contemporary civilisation and culture and adults' reluctance to find time to discuss difficult issues with their kids. The latter might not seem strange in a predominantly Catholic, conservative country such as Poland.

"Parents or guardians rather hide it, than talk about this. They hide it because they feel shame, guilt, or embarrassment. They are afraid of social reactions, in their families, their neighbourhood, or their place."

Opinions that Poland ranks average in international reports on suicide is no consolation. The total number of unsuccessful suicide attempts cannot be verified, but unofficial estimates place their number at 10 times that of the figures for actual deaths. Children and teenagers with a parental suicide record are 9 times more likely to consider attempts on their life than those who do not have that family history. Professor Holyst:

"We can observe the accumulation of suicidal behavior within selected families."

It should be remembered that a child's suicide is always a cry for help addressed to us, grown ups. Unfortunately Poland has a real scarcity of hot lines and help centers for those discouraged by reality. And in contrast to the virtual world created by the computer age, in real life there still remains only ONE life to live - a life that must be cherished.

Castles used as mental hospitals in Slovenia, a dying practice
24.3.2006 - Michael Manske

Slovenia may be a small country, but it is full of castles. After the Second World War, these castles were nationalized by Tito's socialist government and in some cases converted into prisons, homeless shelters or mental institutions.

One such case is the castle of Hrastovec, about 15 kilometres outside of Slovenia's second largest city, Maribor. The beautiful building was turned into a mental institution after the war, and remains one to this day. The director of Hrastovec, Josip Lukac spoke to us about this peculiar practice:

"In Western Europe, castles have been transformed into museums or are still owned by aristocrats. It is typical for the Balkans that castles were emptied after WW II and the authorities put people with special needs - the homeless, alcoholics, mentally ill - in castles. The castles had no suitably trained personnel and there was no health care. It was a typically Balkan phenomenon, Western Europe was different."

The institution around Hrastovec currently houses 630 people with varying degrees of psychological problems. The castle itself is home to roughly 150 patients. Lukac admits that the conditions in the old castle are less than ideal. In some places, 40 inmates share only 4 toilets. But Hrastovec's days are numbered. The castle will stop housing patients within two or three years. Lukac explains:

"We decided to move [from the castle] for professional and cultural reasons. Firstly, castles are designed for aristocrats, not for the mentally ill. Secondly, castles give a feeling of being captured and pushed away by society. Thirdly, in the Hrastovec castle there are large rooms shared by 10 to 12 inmates, so there is no personal area for the individual, one is always surrounded by 30 or 40 people and that causes tensions."

The current trend in Slovenia, when it comes to mental health issues is towards decentralization. Thus, the facilities at Hrastovec will be scaled down to house between 200 and 250 people. The rest will be transferred to smaller, local institutions. Another important factor is the continuing growth of Slovenia's tourism sector. Visits were up by 3% this year, and the opening of budget airline routes between Ljubljana and elsewhere has brought in a steady stream of tourists.

The fate of Hrastovec is still undecided, but it could conceivably be transformed into a museum or other tourist attraction. Either way, in Slovenia, the practice of using castles as mental institutions will soon be a thing of the past.