“They ended up in the asylum”\u2014in my childhood, this phrase was always spoken with deep regret, and it seemed we all agreed that almost nothing worse could happen to a person. It would not be an exaggeration to say that in the 1990s, being admitted to a psychiatric institution was often perceived as a harsher sentence than being sent to prison. This attitude did not emerge by accident. For years, psychiatry\u2014not only in Georgia but worldwide\u2014had been portrayed in literature and cinema as a space of fear, isolation, and violence. We were no exception, and it is perhaps unsurprising that even today, many families do everything they can to avoid placing a loved one in an inpatient psychiatric facility, even when that person poses a danger to themselves or others. When a system is associated with fear in society rather than help, people delay seeking support until the very last minute. Often, it is precisely this delay that worsens the condition and sometimes leads to tragic consequences.<\/p>\n
I remember my university years, when I had to enter a psychiatric ward for the first time; I was scared myself. I didn\u2019t know what I would find there, or how safe the environment would be for the patients or for me. Unfortunately, I cannot say that reality shattered all my stereotypes. Yes, the psychiatric clinic did not seem as terrifying as I had previously imagined, but if I needed to, I would probably still think for a very long time before deciding to admit a family member.<\/p>\n
A few years later, I had the opportunity to complete a residency practice at the psychiatric department of the Yale University Clinic, and there I encountered a completely different environment. In terms of amenities, the psychiatric department was in no way inferior to the other departments of the clinic, apart from the necessary safety measures. Patients had access to individual and group therapy, art therapy, supportive activities, and spaces for relaxation and socialization. There was no sense that a person represented a “danger” and therefore had to be kept in isolation. On the contrary, everything was tailored to make the patient feel safe and dignified.<\/p>\n
A person whose mental state has deteriorated to the point of needing inpatient treatment is already struggling to cope with stress, perceive reality adequately, and manage their emotions. They may experience intense fear, mistrust, paranoia, or aggression. At times like this, the most crucial element is a calm and stable environment where the patient can feel safe and gradually build trust with the treating staff. When the environment is the exact opposite, the condition often worsens further, leaving sedative medications as the primary recourse. Within a few days, the patient\u2014somewhat calmed by heavy psychoactive medications\u2014is discharged home. However, if nothing changes in their life or the treatment system, the crisis returns very quickly, and the family keeps running in this vicious circle.<\/p>\n
Information constantly circulates in society about psychiatric facilities where elementary hygiene and sanitation standards are not maintained, where patients live in harsh conditions, and where cases of abuse by staff are documented. Against this backdrop, private clinics do exist, but they are usually very expensive and often only accept voluntary patients. Yet during severe mental disorders, an individual is often unable to recognize the need for treatment, making hospitalization necessary through the intervention of the family, a doctor, or the court (in state clinics).<\/p>\n
However, systemic flaws do not only harm patients; it is also crucial to thoroughly assess the challenges faced by the staff working in psychiatric institutions. As a psychiatrist friend of mine explained, a harsh attitude toward patients is almost never rooted in malice on the part of the staff.<\/p>\n
According to them, several systemic factors drive the current situation. One of the main problems is staff shortages. In some departments, up to 80 patients are left in the care of only one or two nurses. A single person is forced to simultaneously manage aggression, feed patients, take care of hygiene, provide emotional support, and perform many other duties that should ideally be handled by several specially trained professionals.<\/p>\n
Compounding this is low pay, which forces staff to work across multiple institutions, including the penitentiary system\u2014something that unfortunately contributes to their burnout and emotional exhaustion. Furthermore, clinics largely lack de-escalation and aggressive patient management protocols, as well as the corresponding training, preventing the safe and humane management of crisis situations. There have been instances where employees themselves were injured, yet they received neither appropriate support nor compensation for the trauma they sustained.<\/p>\n
When speaking about people who require long-term psychiatric assistance, it is the state’s responsibility to provide safe, humane psychiatric services that meet modern standards. However, this responsibility does not extend to patients alone. The state must also look after the competence and safety of the specialists working in the psychiatric field. The system must ensure sufficient staffing levels, decent compensation, quality retraining, and modern working protocols. A psychiatric system cannot be humane and effective if the specialists working within it are overworked, unprotected, and unprepared. Ultimately, investing more resources into this field is essential for the well-being of both the patients and the people who perform one of the most difficult and responsibility-laden jobs every single day. A humane and safe environment in psychiatric institutions is not a luxury. It is an essential prerequisite for the well-being of patients, the specialists who work with them, and ultimately, the interests of society as a whole.<\/p>\n
Author:<\/b> Ana Maharashvili – PhD in Medicine, Clinical Psychotherapist<\/p>\n","protected":false},"excerpt":{"rendered":"
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