Dear Dinesh Bhugra,

In this letter, we would like to address our concern about upcoming dramatic
changes in psychiatry in Georgia. First of all, we want to provide a short
background overview of psychiatric services in Georgia. Since 1995, psychiatric
services in Georgia were directed and developed as state programs fully funded
by the Georgian government, which, with its gradual increase in funding, has
recently given rise to community-based services and modernization of inpatient
treatment.
The course of the ongoing reform in psychiatric services was consolidated in
2013 by a resolution of Georgian parliament on mental health protection model.
This resolution was the basis for the Mental Health Development Strategy and
Master Plan for 2015-2020 approved by Georgian government in 2014.
Since 2011, as part of the reform in psychiatry, 3 new psychiatric departments in
general hospitals (so called acute departments), as well as mental health
centers with 24-30 ward beds each and crisis intervention service centers have
been opened. Since 2015, the mobile MDT started to serve a small number of
patients. With the above-mentioned changes, Georgia recognized the
contemporary principles of psychiatry, namely, ensuring easily accessible
psychiatric services in humanistic environment, within easy reach of the
residential area of a patient.
At the same time, in Georgia, there still exist some old, big psychiatric hospitals
with lamentable infrastructure, inhuman living conditions and inadequate
services. In these clinics, patients are held for more than 6 month and, in some
cases, even years. Unfortunately, these institutions can not provide adequate
standards for treatment and care, let alone rehabilitation. These concerns were
supported in a study by European Commission in 2013 and a formal report of
Georgian Public Defender in 2015, detailing numerous facts of humiliation and
describing the living conditions there as being an affront to human dignity.
Now, we have more reason for serious concern.
A few days ago, Deputy Minister of Labour, Health and Social Affairs of Georgia
Zaza Sopromadze announced that the government is planning equalization of
inpatient services in old and new clinics both financially and medically which is
to be achieved by decreasing funding of new (acute) psychiatric departments
and centers while increasing funding of the old psychiatric hospitals for long-
term inpatient treatment. We can reasonably argue that this change will cause
closure of new psychiatric departments and centers; and encourage long-term
stay of patients in old psychiatric hospitals, which runs counter to Mental Health
Development Strategy and Master Plan for 2015-2020 approved by the Georgian
government in 2014 and contradicts the core developmental principles of
contemporary psychiatry.
We can only partially agree with the announcement of the Deputy Minister that
short-term inpatient services and re-hospitalizations of patients in the new
psychiatric departments cause the increase of expenses. However, we think that
this may be the result of insufficient out-patient services and underdeveloped
community-based services, as well as lack of social support. We suppose that
financial equalization of hospital services will not solve the problem, but, to the
contrary, will bring us back to the old Soviet psychiatric system and hamper the
future development for many years to come.

We hope for your support and kindness and ask for your recommendations and
opinion to find the best solution possible under the circumstances described
above.

Sincerely yours,