At some point in their life, one in four people come face to face with a mental disorder or illness. At the moment, such disorders plague about half a billion people - which means that mental health disorders are one of the dominant causes of illness in the world. This, in turn, means that a mental illness or a mental disability will, in all likelihood, affect one or more people around us - including ourselves. But even though it is possible to treat practically all mental illnesses successfully, almost two thirds of those afflicted never try to get treatment. According to World Health Organization experts, stigma, discrimination and self-denial all present obstacles to obtaining proper help. However, it would seem that the fear of going to a psychiatrist or of being treated in a psychiatric hospital is justified - once you've been admitted to one, it quickly becomes apparent that fundamental rights do not apply there. Not only are you not being consulted on treatment options or possible side effects, but the treatment itself takes several times longer than with somatic diseases - and in those long weeks or months of being treated, you will not even be given a place to talk in private with family members who come to visit. You're not even able to lock the door to the bathroom.

Psychiatric hospitals are more feared than prison

Following the inspection of the psychiatric clinic at the Republican Šiauliai Hospital, the Seimas (Parliament) ombudsmen discovered that human rights were being systematically and constantly abused at the medical institution.

Seimas Ombudsmen Augustinas Normantas found that the facilities do not ensure a safe environment for the patients or staff. The patients at the psychiatric clinic are not informed about their treatment or its effectiveness. They are also not given information about the medication used or about the possibility to refuse medical intervention, and patients that have been hospitalized involuntarily are unable to challenge court decisions because they are not invited to court hearings. In addition, the procedures for the registration and discontinuation of any special measures for patients are still not able to function properly.

The situation is stuck

Unfortunately, the head of the psychiatric clinic at the Republican Šiauliai Hospital viewed the conclusions regarding the violation of patients' rights with derision. The hospital's management formed an investigative commission to study the conclusions of the Seimas ombudsmen, but as can be seen from the openly hurt comments in the local press show, what it plans to do is to deny rather than study the findings because, naturally, there are no violations, there can be no violations and the law doesn't allow abuse. What does that remind you of? It reminds me of the Soviet era.

Almost a decade ago, the very same institution was visited by an independent group of psychiatrists, lawyers and psychologists. Experts from four NGOs - the Human Rights Monitoring Institute, the Global Initiative on Psychiatry (now the Mental Health Perspectives), "Viltis" (a Lithuanian welfare society for persons with mental disability) and the Vilnius Centre for Psychosocial Rehabilitation - visited psychiatric hospitals in all parts of Lithuania in order to collect reliable first-hand information on existing human rights problems and to encourage these institutions to follow international human rights standards, to improve conditions for the inmates and to prevent human rights abuses. This national effort was part of a larger international investigation that sought to assess the observance of human dignity, together with fundamental rights and freedoms, in closed mental health care institutions.

Numerous human rights violations were also discovered at that time - violations of the right to information, right to respect for private life, right to property, freedom of movement and even the prohibition of torture and inhuman treatment. We saw no practice of informing the patient of what ails them, the medication prescribed, its effect, potential risk and unwanted side effects. The staff viewed giving patients information about their illness as a potential threat to their condition.

The investigation revealed that psychiatric health hospitals limit their patients' right to respect for private life to the highest degree, with the right being practically nonexistent in acute treatment wards. By not adhering to the requirements pertaining to how many patients can be placed in a room and, at the same time, by not permitting the patients solitude when they so desire, these instructions do not meet the requirements set out for the protection of their patients' personal data and do not provide their charges with the opportunity to conduct hygienic procedures or use the phone in private.

Inhuman treatment at the hospital - an everyday occurrence?

It became clear that, at the staff's discretion, the patients are not permitted to have mobile phones and are taken to use the public pay phone in groups - and even then, only if the patients themselves have a pay card. Can you imagine how fun it is to speak to your loved ones when, in essence, half the ward is in on the conversation? However, what probably shocked me the most was the fact that people are simply being humiliated. For example, you are not allowed to take a shower in the acute treatment unit - you can only take a bath twice a week. A woman who recently gave birth and was suffering from postnatal depression and postpartum psychosis was not allowed to use the shower in the general ward - despite the fact physiological indications prevented her from taking a bath. In another hospital, one ward had the bath, the shower, the toilets and the smoking facilities all installed in a single room without any partitions - I mean, after all, do the patients really value their privacy that much? Why bother?

It is then that I understood that being diagnosed with a mental illness or even a short-term disorder brands the person as one of the damned, which automatically means that any and all of their rights are forfeited. I recall - as clear as if it happened yesterday - how, when discussing the results of the investigation on television, the head of one of the main psychiatric hospitals argued in a raised voice that it was absurd to speak to people with mental illnesses or disorders. In his mind, the "loonies" did not understand anything and couldn't be trusted. A former patient of this hospital that called the studio then said - with great pain - that although he had been cured a long time ago, he would never forget the humiliation he was forced to endure there. And all that time I couldn't stop thinking of the horribly brownish-green walls of the ward for severe patients, where a depressed woman told me - in a voice scarcely more than a whisper - that she no longer believed that she'll ever be able to leave the place.

After comparing data from that study with data from the present study, it becomes evident that many of these practices still remain. It is still accepted to decide on the involuntary treatment (or the continuation of involuntary treatment) of the patient without them being present at the court hearing. Where's the harm? It violates the patient's rights - both the right to a fair trial and the right to proper treatment (by enforcing a judgment that is based solely on the lopsided information given by a mental health expert, without considering the patient's opinion on the matter).

The practice of so-called "professional solidarity" - when doctors, aware that the diagnosis is wrong, do not attempt to change it, are reluctant to speak of such cases and prescribe treatment in line with the misdiagnosis - may be utterly baffling, but it has become commonplace.

Given the context, it is regrettable, though not necessarily unexpected, that hospital staff - the very people who should help, support and try to understand patients - would actively punish their charges in a myriad of ways: with strait jackets, by tying them to their beds, using depressants that made them feel really unwell, giving injections, prohibiting them from drinking coffee or smoking, changing the regime from a less restrictive to a more restrictive one - which automatically means that an even greater limitation is placed on their rights and liberties (e.g., being forced to wear a hospital gown).

Speaking of the prohibition of torture and inhuman treatment, the situation we discovered was dire indeed - many Lithuanian psychiatric hospitals did not have a standardized procedure for applying physical segregation, physical and chemical restraints, nor did they have a mechanism for the discontinuation of these measures. At the same time, hospitals that did have these procedures in place would abuse them.

In fact, it is only permissible to physically restrain (tie to a bed) an agitated, aggressive patient for up to two hours - it is also necessary to maintain contact with them during this time and release them immediately if their condition improves. However, it became clear that in practice, people would be left restrained for the whole night, with no one to interact with them - they would simply be given large doses of strong depressants to improve their condition. During that time, they would not be cared for at all (including procedures, medication, even being taken to the bathroom).

As such, I thought that these matters could not continue as they were and that the situation would be resolved as soon as we started discussing them. Unfortunately, these cases happen now as they did then - just recently, one mother of a severely autistic youth confided in a psychiatrist colleague of mine about the horrifying panic attacks her son is forced to endure almost every day while tied to his bed for hours at a time.

While we adopt new technologies, we also trample on human rights

While Lithuania, following the restoration of its independence, continues to adopt modern medical technology and medication, with facilities being better cared for, contemporary human rights standards are still left somewhere on the wayside. The modern Mental Health Strategy was prepared almost a decade ago and founded on human rights principles - its cornerstones are the protection of patient dignity, the need to inform patients and the right to choose. The future of psychiatry lies in providing services - not in isolating human beings and the overuse of pharmacotherapy. Has this strategy been implemented?

Six months ago, I participated in the discussion of this strategy at the Parliament. All of its points were covered - except for the very first ones, related to ensuring human rights in the provision of mental health care. I was hardly surprised. My questions were met with comments about a naive girl being unable to comprehend the situation - belittling, patronizing comments that are still prevalent in Lithuania today.

I am not sure whether we will see the day when Lithuanian psychiatrists will stop looking towards the Great Fatherland - the Russian Federation, a country that for some reason they feel so much nostalgia for. That country in particular lives by the principle that the doctor is everything, while the man (the patient) is nothing. Western mental health care specialists understand just how outdated the principle of paternalism - when good intentions dictate that patients shouldn't be "burdened" with information and no one asks for their opinion - really is, and how it demoralizes patients.

There are various ways to protect human rights in the world: constant monitoring of persons with mental disabilities and their physicians, which ensures both patients and psychiatrists are able to get help if needed. Mental health specialists themselves would discover that their work is made easier by sharing responsibility and involving the patients and their families in a joint effort, in decision making. Both monitoring and observations only help to understand whether we're going in the right direction, and which direction we need to take if we want to improve - that is, of course, if we actually wish to do so.

Thus, this naive girl hopes that our politicians and public officials start seeing the field of mental health care as a field of human rights, as a field that demands the implementation of European and Western - that is, meant for the protection of a human being - standards. The business environment isn't the only one that needs to be modern, innovative and flexible - so too does mental health care, capable of affecting each and every one of us, and hundreds of thousands of patients who are no less deserving of flexibility and the modern touch. It is paradoxical that, so far, senior officials have only miraculously opened their eyes to the truth in the face of a loved one's illness - then, horrified by the order in place, they scamper to look for exceptions without understanding why a member of their family has been thrown back to the middle of the XXth century. Perhaps these "converts" could find the courage to share their revelation with their colleagues? Not just for them, mind you - for all of us.

Written by: Dovilė Šakalienė, director of the Human Rights Monitoring Institute