New Law to Help Armenia's Mentally Ill

Armenia has passed its first piece of legislation on psychiatric treatment since independence, to provide legal safeguards for a vulnerable group which the state has insufficient resources to treat.

The new law gives a much more precise definition of mental illness than the previous Soviet-era legislation, and lays ground-rules to prevent people being wrongfully committed to an institution – although there is some controversy over how this will be decided.

The legislation, drafted by the health ministry, was adopted by the lower house of parliament swiftly and signed by President Robert Kocharian on June 21. It is due to take effect on July 1. The authors of the law say they were under pressure to fill the legislative gap to comply with demands by the World Health Organisation and the Council of Europe.

“A mentally ill person must be entitled to social protection by law, so that he or she can feel at home in their community,” Armenian health minister Norair Davidian told IWPR.

Armenia has about a dozen hospitals – all state-run – providing psychiatric treatment and care. The state provides around five US dollars a day for each psychiatric patient, which has to cover meals, clothing and medication. That means the state hospitals and day clinics cannot afford the most effective modern drugs because they are too expensive.

“As time goes by, new and more potent pharmaceuticals and technology are appearing on the market, but we are still using the old Soviet techniques for treatment,” said Professor Samvel Sukiasian, director of Armenia's Stress Mental Health Centre.

IWPR visited the hospital in Sevan, in the north of the country, which numbers a once-famous actress among its 320 inmates.

As you enter the women’s wing, you inhale a complex blend of chlorine and pharmaceuticals. The whitewashed walls are peeling, and the wards have as many as 40 bunks in a row.

The faces of the patients appear to mirror an inner anguish. Among them is Donara Mkrtchian – a former star of stage and film in Armenia, and widow of Soviet screen legend Frunze Mkrtchian.

Donara has been in this hospital for 20 years. With her vacant stare and trembling face and hands, she is barely recognisable as the fine-looking woman and brilliant actress she was before chronic schizophrenia set in. There are traces of cigarette burns on her hands and lips.

“There is no one in this body,” said psychiatrist Aram Alexanian, deputy director of the hospital. “The individual is gone. This is the final stage of her illness.”

“Let me go home," Donara asked the doctor, evidently not for the first time. "I’ve got my pension to pick up at Sundukian’s theatre, so that I can go and get some groceries.”

“Donara has no home or family to go to,” said Alexanian. “Her husband and two children have passed away. Her actor friends used to come and see her, but it’s been years since the last visit.”

Dr Alexanian sees social upheaval and hardship as the cause of many other psychiatric cases now seen in Armenian.

“The psyche of Armenians has been traumatised by a succession of misfortunes and turbulences, starting with the 1988 earthquake, the Karabakh war, followed by social and political upheaval, the collapse of the Soviet Union and the emergence of newly independent states – with all the social and economic adversities this entailed,” he said. A more recent contributory factor, he added, was unemployment and the separation of families as men go abroad to find work.

Professor Sukiasian believes there are large numbers of people with psychiatric disorders. The official statistics show 30,000 mental patients, and another 50,000 to 60,000 people seeing psychiatrists every year. But Sukiasian believes the real numbers are “significantly higher”.

Dr Alexanian disagrees, saying “There has been no rise in the number of mental patients, it’s just that you see more of them on the street. They used to be isolated, but not any more. Also bear in mind that whereas before it was 30,000 mentally ill people in a population of three million, now it’s the same 30,000 in a much smaller population that's been depleted by emigration.”

There does appear to be growing evidence of stress, depression and neurosis among the population. There are two institutions in Armenia that specialise in cases of stress, Professor Sukasian's Stress Centre and the Neurosis Clinic, but they cannot cope with the demand for their services.

“The worst thing is that until the illness really gets out of control, no one will go to see a doctor, especially a psychiatrist,” said Gagik Karapetian, director of the hospital in Sevan. “People will conceal their condition, whether it be neurosis or depression, and thus do irreparable harm to their health.”

Under the new law, a person can be forcibly committed for treatment only by court order, and only if a panel of psychiatrists has pronounced him or her both mentally ill and a danger to the community.

But the legislation fails to specify how such a panel of experts should be formed, and who should sit on it. The ministry of justice has stepped in to fill the gap, and plans to issue regulations streamlining the mechanism for enforcing a compulsory treatment order.

Psychologist Vadim Georgiadi thinks it is a bad idea to delegate powers to a non-specialist agency such as the justice ministry, and says parliament should take full control of the way the mental health law operates.

“The community itself should determine whether a person is a menace to it,” said Dr Alexanian. “It is also important to protect the patient from his family or guardians, who may be driven by mercenary interest such as control over the person's property."

The mental ill are vulnerable to losing out on the benefits due them, either through theft by relatives, or because of bureaucracy. At the social security ministry, IWPR learned that some mental patients are not drawing their disability benefit of around 5.5 dollars a month, because they have not applied for it. “Usually it’s the patient’s family or guardian who does it for them,” said Rosa Mkrtchian, head of the pensions department.

Even with this new law, Armenia’s mentally ill remain the most vulnerable members of a poor society.

Naira Melkumian is a freelance journalist in Yerevan.