By Andria Kades
WITH some fanfare earlier this month, and a visit from President Nicos Anastasiades, two wards at the Athalassa Psychiatric Hospital in Nicosia were renovated, but the same problems that have plagued the mental health sector for decades are still bubbling under the ‘shiny, new’ surface.
Although the renovation, with more to come, was a start, the problems extend beyond the walls of the facility and permeate everything from an obvious lack of support, the continued stigma attached to mental health within society and several examples that indicate the justice system is not adequately prepared to deal with patients facing such problems.
While these issues have been reported on countless times in the past, the reality came as a shock to Marcos Ioannou – not his real name in order to protect his privacy – when he had to deal first-hand with the Athalassa facility.
Ioannou’s son Stavros, now in his twenties was diagnosed with schizophrenia some years ago and though his family have tried everything they could to help him through everything from extra university studies to trips abroad, the the voices in his head – a symptom of his condition – are there and there is nothing much the family can do to help without the aid of pharamceuticals.
Although Stavros is on medication, one day, he became violent, as is sometimes the case with schizophrenic patients, and tried to hurt his parents. He had punched and stabbed doors with a knife and his father no longer felt it was safe so he called police to get his son admitted into Athalassa.
Two officers arrived at his home. “My son had gone for a walk, it calms him down. Every time I approached him he got agitated so I kept my distance and told police where he was,” said Ioannou.
After being handed around from one police station to another, hours after his father’s initial phone call, Stavros was eventually taken to Athalassa.
“This was a terrible, terrible, place. People came in smoking in both waiting rooms. There was food on the floor, graffiti everywhere, the waiting room was disgraceful,” Ioannou said.
He said there were a lot of patients lying in so-called couches or pacing up and a corridor. There were no games, nothing, “literally nothing at all for them to do there”, he said.
Stavros was put on medication and the family was advised he would have to stay for a few days.
“We went every day and each day we went, people were like zombies. They walked down that stretch of corridor, not quite drooling but almost at that stage,” Ioannou said. “There were cigarette ends on the floor, years of grime in the corridor.” He said the patients didn’t look neglected physically but “there was a feeling of neglect” about the place, he added.
In the past few years, nurses’ union Pasyno has made public several examples to illustrate the “third world conditions” its members operate under at the hospital and had cited being without hot water for a week.
“You remember the story, staff had to heat water in kettles to help the patients shower,” spokesman for the mental health branch of the union Georgios Pychides told the Sunday Mail.
A few months prior to that, the union had brought to the public’s attention that there had been no heating for 10 days.
“Things are much better now,” Pychides said. “There was an incident where for three days there was no heating but it was resolved.”
“In the past, we’ve had to take money out of our own funds and buy 70 blankets for the patients. There were shortages of consumables.”
In some instances, staff took some of their own clothes for patients as there was nothing there for them to use.
Pychides said the renovation works in two of the wards had been a vast improvement, and there were another two wards slated for works.
That does not take away from the fact that conditions in all other areas are still not up to scratch. “The conditions in the bathrooms are functional but disgusting,” Pychides added.
Under such unpleasant conditions, the work done by staff at the facility was beyond commendable, Ioannou said.
“They are absolutely fantastic, I have no criticism about them. The conditions and facilities there though are absolutely unfit for purpose.” He describes them akin to a 19th century madhouse.
It sounds simple, he added, but even adding a blackboard with some chalk so patients don’t have to smear the walls with their drawings – which often include profanities such as ‘f**k you all’ and ‘one day this place will blow up like Mari’ could go a long way in helping patients, he believes.
The mental health services said they could not comment without the health ministry’s approval, which had not, at the time of writing, responded to the Sunday Mail’s questions.
The latest report by the European Committee for the prevention of torture and inhuman or degrading treatment or punishment (CPT) in 2013, highlighted appalling conditions which have now, according to Pychides been resolved.
For instance, some patients at night would have their doors locked and be given buckets for their needs as they could not go to the bathroom.
The report also highlighted that checks by the Cyprus Mental Health Council – which falls under the supervision of the health ministry – did not carry out frequent enough inspections.
Deputy chairman of the council Andreas Agrotis said there has since been an increase in the amount of visits they carry out to state and non-government facilities that have to do with mental health care.
“We decided that more inspections will be unannounced,” so as to have a better picture of what is going in, he told the Sunday Mail.
The commission’s role is to present their findings to the health ministry so it can act upon any problems it may have pinpointed.
As it is mainly Pasyno’s voice that has been heard over the years, Agrotis denied the commission had been dragging its feet but rather “we prefer results as opposed to publicity.”
Why several problems have taken years to resolve however may be because “much as the health ministry wants to help us, they have so many things (on their plate),” that the commission may not be prioritised.
Nonetheless, “we push them a lot and things get done,” Agrotis said.
Although the CPT noted that staff “demonstrated a caring attitude towards patients” there had been complaints by patients of ill treatment which “allegedly consisted of slaps as well as verbal threats and various types of disrespectful behaviour by staff towards patients.”
What appears to be lacking is a safe procedure by which relatives could properly outline such concerns without fear of antagonising the very people who are responsible for taking care of their loved one. Agrotis outlined that facilities however have boxes where only members of the commission can open, by which patients can put their concerns in writing.
Beyond the walls of Athalassa?
Those close to psychiatric patients feel there are concerns that extend beyond the walls of the facility and are rooted right at the core of society, branching out across several sectors, including police.
Ioannou was perplexed when officers arrived at his home on previous occasions when his son was behaving violently only to leave without doing anything.
But this almost pales in comparison to the experience Georgia Pavlou had when her brother was diagnosed over 20 years ago with psychosis.
“There have been numerous times when I have had to call police myself. It’s not because he’s violent, he hasn’t been violent to me once. It’s because he didn’t take his medication. My mother is a senior citizen and cannot handle this kind of procedure,” she said.
One summer, not too long ago, Pavlou was at the village home with her brother for almost a week before police arrived.
“I kept calling them and calling them and they would say ‘we’re busy now, tomorrow’. And I was in a house alone with my brother who wouldn’t take his meds for a week until they came.”
Eventually when they did arrive, her brother got wind of what had happened and locked himself in a bedroom.
“I wouldn’t wish on anyone to witness what I saw. We broke the door down. My brother was cowering away in a corner, they handcuffed him, had him walk down the street and the officer, because it’s a small community, would greet locals at the coffeeshop he knew shouting ‘hey! I’ve come here to take your fellow villager to Athalassa’ while I was trailing behind them.”
“I cannot possibly describe to you how that felt.”
Police told the Sunday Mail that there are instances where, after a court order is secured, officers take patients to Athalassa. If a family requests police arrive in civilian clothing, it may be arranged, a spokesman told the Sunday Mail.
Asked whether officers undergo certain training for these cases, he said “sensitivity is something we each have inside of us, especially for cases like these.”
Pavlou’s brother was 25 when he was diagnosed and although there have been over two decades where she has been involved in the ins-and outs of the mental health sector, a steady stream of support from the state is virtually non-existent, she said.
The best form of support she has found, has been the association of friends and relatives of mental health patients which was set up three years ago.
Founder Maria Stephanou, told the Sunday Mail very little is out there to help families come together and stay strong when cases like these hit home.
Though the association aims to offer a pillar of support for both the rights of mental health patients and their loved ones, “people still feel shame about mental health.
“Many parents or siblings, when finding out their child has a mental illness start to feel guilty, like it was their fault, like there was something they could have done about it to stop it or prevent it.”
Stephanou said even within the association, few relatives actually turn up to events because they don’t want to be associated with the stigma – which shouldn’t be there.
While Cyprus has come forward over the years as far as how it sees and perceives mental health, there is still a long, long way to go, she adds.
Ioannou, who has neither seen nor heard of any support from the state said the signs of neglect from the sector were evident from the first psychiatrist he took to see his son.
“Barely listened to us, had a wad of currency notes in his pocket.” Payment was by cash, no receipt, prescribed something and off they went. The second psychiatrist, did not show any more concern than the first one, he said.
“I’ve reached a full stop, I don’t know what else there is I can do for him now…but I do have a lot of faith in the psychiatrist Stavros is seeing now,” he added.
“In Cyprus, if someone has a broken leg, everyone understands. When it’s mental health, they’re just kicked to the side.”
To contact the association of friends and relatives of mental health patients call Maria Stephanou at 99 611 638 or Lenia Nicolaou at 99 366 562.