Problem: What problem is this project trying to address?
Mental, neurological and behavioral disorders are cause immense suffering and staggering economic and social costs. People with mental disorders are often subjected to social isolation, poor quality of life and higher death rates. Turkey is no exception. Although there is no detailed statistical information about people with mental disabilities in Turkey, several sources including the World Health Organization (WHO) refer to statistics of at least 1.5 million people with psychiatric problems and 1 million people with developmental disabilities, such as mental retardation. By factoring in the families of these people, the population affected by mental disabilities triples.
People with mental disabilities are among the most vulnerable groups in Turkey. General discrimination and stigmatization in the community, as well as insufficient policies and services, leave them socially excluded and without access to key services. In Turkey, only 20% of individuals with mental disabilities are able to access some form of treatment. Many live deprived of their basic human rights, such as housing, employment and social security and are thus dependent on others to determine their futures. The conditions are significantly worse for those from disadvantaged communities, such as women and children of families from low socio-economic status.
Turkey’s approach to mental healthcare has been primarily dependent on regional “depot hospitals” that serve 12 to 18 provinces at one time. There are only eight of such hospitals in the entire country. As a result, some of the largest ones host over 15.000 patients a year, averaging 500 outpatients a day. RUSIHAK’s monitoring report covering these hospitals and their rehabilitation centers stresses human rights abuses in a multitude of areas such as the right to proper treatment, rehabilitation conditions and methods, the right to informed consent, the right to mobility and humane conditions of detention such as hygiene, care, and access to personal belongings.
RUSIHAK’s monitoring report also reports insufficient diagnosis and treatment services, such as when a psychiatrist sees an average of 40-50 patients every day. The time spared for a patient is limited to 5-10 minutes, leaving room for no other service beyond prescribing drugs and arranging dosage and frequency. In the absence of community-based services that provide support to people with mental disabilities and their families in their social environments, people stay in institutions for prolonged periods of time and must return to the institutions very often, as there are no follow-up services available.
As such, current state resources fall short due to their paternalistic nature, scarcity and one-size-fits-all approach, while current civil society interventions do not go much beyond self-sustaining patient family groups. There is a great need for interventions in the mental health field that approach the issue though a professional, progressive, and rights-based approach to ensure social inclusion of the mentally disabled population.
Solution: What is the proposed solution? Please be specific!
RUSIHAK was established in 2006 when Şehnaz Layıkel, a trained clinical psychologist, gathered a group of mentally disabled people and their families together. She realized from this group that the social isolation and lack of access to quality health services they experience represents only the tip of the iceberg: their experience is the result of a set of complex relationships in which people with mental disabilities are not perceived as full citizens with full rights.
This realization inspired Şehnaz to create a new approach for the mental health field in Turkey, which was previously dominated by self-help patient groups and psychiatrists associations. Şehnaz’s new approach intervenes with the problem at three critical points: first establishing communities of resistance in mental health institutions, connecting them to a civil monitoring system that creates the skeleton for the first mental health rights movement in Turkey and finally acting as an intermediary platform that channels its know-how towards reforming outdated laws and dysfunctional institutions.
Within six years, RUSIHAK has become the first private initiative in Turkey to 1) enter public mental health institutions and open up space for democratic decision-making 2) systematically monitor and report on their conditions and operations from a human rights perspective, and 3) provide scientific data on the mental health field to inform policymaking at the national level. Most importantly, RUSIHAK places the responsibility to change the mental health system in the hands of people who are “experts by experience:” individuals and their families who have been users and survivors of psychiatric treatments. Because these affected individuals comprise the majority of the staff and management of RUSIHAK, Şehnaz’s organization becomes living proof of the abilities and unrealized potential of the mentally ill.
RUSIHAK’s ultimate goal is to overturn the system of top-down medical intervention that continues to dominate the mental health field in Turkey. Her vision is a diverse, comprehensive system that respects the dignity of the patients and prioritizes their full integration and empowerment, rather than isolation from public life.