LIMITED SOCIAL SPACE
Sopho’s life changed for the better a few months ago when she began taking a psycho-social rehabilitation course with 34 other patients at the Psycho-Social Rehabilitation Centre in Tbilisi.
“I come here every day and work on fabric,” she said. “Life is not as scary for me because I see I am not the only one who is ill. Here there are others with the same problems. I am very glad that there is such a place."
The Centre provides three meals daily and an individual six-month, pre-designed rehabilitation course for patients. After six months, if the patient still needs it, the process will start over again.
Georgia has three psychosocial rehabilitation centers; two are state-funded programs. The total budget for the state institutions is 70,000 lari (about $USD 40,000) a year. Georgia’s Social Service Agency (SSA) transfers 11 Lari (about $ 6.25 USD) each month to each patient via a voucher system.
"This 11 Lari is very small. If we didn’t have a foreign donor to cover our losses, our center would have a hard time operating. The quality would be much lower," said Manana Sharashidze, chairman of the board for the Georgian Association for Mental Health.
Marie Tsereteli, department head for the Social Service Agency’s guardianship, care and social programs, said that the Ministry of Health, Labor and Social Affairs would discuss increasing funding for day care centers.
A patient needs to have the status of a disabled person to get a voucher and participate in the Social Service Agency program. He/she must apply at an SSA tregional office. A social worker evaluates the case, and a board discusses if the patient should receive a voucher.
According to the government, priority is given to socially vulnerable patients who participated in the program during the past year. The number of vouchers is limited because licensed institutions can treat only a certain number of patients, and because government funding is limited.
Under the current system, the status of patients is based on their psychiatric diagnosis. Sharashidze believes they should be evaluated based on how they can function in society.
According to The National Center for Disease Control, there are 80,000 mentally ill people registered in Georgia.
Marina Kuratashvili, executive director of the Georgian Mental Health Coalition, said there have been no statistical studies on what are the needs for these people.
"It is accepted that the proportion between alternative rehabilitation and hospital services should be 50/50,” she said. “If we say that there are 390 beds in Tbilisi, and 300 of them are in heated rooms, that means at least 150 of those beds should be in rehabilitation programs.
“But if you consider that many of these people leave and then return quickly – maybe as soon as three weeks – and then stay in rehabilitation for several months, perhaps we need 600 or 700 rehabilitation beds.”
Sophie Morgoshia, a senior specialist at the Ministry of Health, Department of Health says each of the psychosocial rehabilitation centers serves about 30 patients, according to her latest data.
Kuratashvili says that for persons with mental disabilities, as well as for their family members, providing education about diagnosis is essential.
"Family members need to be able to understand the diagnosis,” Kuratashvili said. “They need to realize it is not a judgment. It is a disease. They need to know how to take care of a child, how to build a proper relationship with them."
The Coalition of Mental Health operates special Parents' Groups. She says parents share their experiences with each other, and that this is a great relief for them.
There is no a state program for family members of persons with mental health problems. Morgoshia says program changes are planned, but how they will change is still the subject of discussion.
“We developed the concept of mental health, which was approved by parliament last year,” Morgoshia said. “Now we are developing strategies and action plans for programs that will educate family members.”
The Psycho-Social Rehabilitation Center gets funds from both the government and foreign donors. heState Rehabilitation Center has received government funding since 2005. A 550 square-meter building was transferred by the government to the Center, but the Center has only managed to renovate only 150 square meters, Center leaders said they could use this space to serve more patients, open new workshop rooms, and improve quality of service.
Sopho is lucky. She found a place where she gets help dealing with her problems. She is diligently studying handicrafts, expressing her emotions and sentiments on different pieces of fabric.
Today, about 100 people with problems like Sopho are waiting in the hopes of getting suck psychosocial rehabilitation care.