Abuse of mentally ill is reported in Turkey

[Guest guest]

http://www.iht.com/articles/2005/09/27/news/turkey.php

Abuse of mentally ill is reported in Turkey

By Craig S. The New York Times

WEDNESDAY, SEPTEMBER 28, 2005

PARIS Turkey's psychiatric hospitals are riddled with horrific abuses,

including the use of raw electroshock as a form of punishment, according to

a human rights report scheduled for release in Istanbul on Wednesday, just

days before Turkey begins formal talks to join the European Union.

The report, by Mental Disability Rights International, an advocacy group

based in Washington, is likely to complicate the EU talks because many

European officials are already wary of letting Turkey join the Union and

will use any evidence that the country falls short of European standards to

argue against its membership.

But the authors of the report hope that the pressure will bring a quick end

to the worst abuses.

" We realized Turkey was a great opportunity for using that process to have

some influence, " said Rosenthal, Mental Disability Rights

International's founder, speaking by telephone from Istanbul. His

organization has fought for more than a decade to improve mental health

facilities around the world and has already used EU accession pressures to

bring change in Eastern Europe.

Turkey has made great strides in developing its society and economy to meet

European standards in recent years. After waiting for decades, formal talks

on its membership are scheduled to begin Oct. 3. But as with many developing

countries, some sectors of its society lag far behind the rest, including

its mental health system.

Of all the abuses witnessed by Rosenthal and his investigators, none was

more disturbing than the use of electroconvulsive therapy, also known as

ECT, without anesthesia to treat a wide range of illnesses in both adults

and children. The World Health Organization has called for a ban on

" unmodified " or " direct " ECT and states that children should never be

subjected to the treatment in any form.

The therapy, in which an electrical current is passed through the brain, was

developed in the 1930s and continues to be used in mainstream psychiatry to

treat a limited number of ills. But it is normally administered with

anesthesia and muscle relaxants. Without them, it can be painful, terrifying

and dangerous. Patients can suffer broken jaws or cracked vertebrae during

the artificially induced seizures.

The report quotes a 28-year-old electroshock patient at the Bakirkoy

Psychiatric Hospital as saying, " I felt like dying. "

The human rights group found that unmodified electroconvulsive therapy is

used on nearly a third of all patients undergoing a psychiatric crisis at

the state-run hospitals, including children as young as 9. The treatment is

also given for many illnesses that are not on the short list considered

appropriate by the international psychiatric community.

The report describes patients being dragged to electroshock therapy in

straitjackets and forcibly held down by staff during the procedure. Others,

it said, are told they are simply going to be X-rayed.

Turkey has been criticized for using unmodified electroconvulsive therapy

before: in 1997, the European Committee for the Prevention of Torture called

on the country to stop the practice. Turkey's Ministry of Health promised to

do so. It opened a new electroconvulsive therapy center at Bakirkoy and said

the treatment would be restricted to those illnesses for which it is

internationally accepted.

But Rosenthal and his investigators found that unmodified ECT continues to

be administered at Bakirkoy and other psychiatric hospitals for a wide range

of problems, including even postpartum depression, in part as a punishment.

" If we use anesthesia the ECT won't be as effective because they won't feel

punished, " the report quotes the ECT center's director as saying.

" That was one of most horrifying statements I've ever heard in 12 years of

doing this work, " Rosenthal said.

When Rosenthal and his staff visited the center one day in April, 24 people

received unmodified electroconvulsive treatment. Technicians at the center

told the group that only patients who had broken bones, presumably from

previous ECT sessions, were given anesthesia.

The Turkish Ministry of Health, which is responsible for the country's

psychiatric hospitals, said it had not yet read the report and declined to

comment on specific practices at its institutions.

Howitt, a British member of the European Parliament, said, " There's

no question that what's described in the report counts as torture under the

European convention and shouldn't exist in Turkey or anywhere in Europe. "

Howitt said he would bring up the report as part of the accession

negotiations.

" It is certainly part of the Copenhagen criteria on whether Turkey is

eligible to accede, " he said.

The report, which includes testimonies from former patients and videos taken

inside some institutions, reveals other abuse that is likely to complicate

the country's efforts to convince Europe that it has met standards equal to

those of the rest of the Union.

Much of the abuse took place in orphanages and rehabilitation centers for

children with developmental or intellectual disabilities where investigators

saw emaciated and neglected children, many of whom exhibited behavioral

problems that were probably the result of their mistreatment rather than any

pre-existing illness, Rosenthal said.

The group's investigators visited three institutions under the Directorate

for Social Services and Child Protection, which administers the orphanages

and rehabilitation centers.

The Saray Rehabilitation Center, near the airport outside Ankara, was one of

the most terrible.

" We saw children who were essentially abandoned, starving, tied down to

their beds, " Rosenthal said.

Photographs and videos taken at Saray, the largest of Turkey's state-run

rehabilitation centers, show skeletal children, some with plastic water

bottles taped over their hands to prevent them from biting their fingers.

Other children with only minor disabilities are mixed in with the rest.

Rosenthal said the Saray's director would not provide mortality figures for

the facility, but a footnote in the report notes that the large number of

admissions without a corresponding number of outplacements suggests that

many of the children die.

" We believe there's a very high death rate in these facilities, " Rosenthal

said.

Officials at the Directorate for Social Services and Child Protection could

not be reached.

The report found that there were no enforceable laws in Turkey to protect

mentally ill people from arbitrary detention or forced treatment and that

there are virtually no community services that might keep them out of

institutions.

As a result, according to the report, thousands of people are

institutionalized for life.

But Rosenthal said he was optimistic that Turkey could change, noting that

the country had a better government, more highly trained professionals and

more money than many other places he had worked.

" The most extreme abuses are problems they can remedy very quickly, "

Rosenthal said.

" There's no need for this to stand in the way of accession, " he added.

[Guest guest]

http://www.iht.com/articles/2005/09/27/news/turkey.php

Abuse of mentally ill is reported in Turkey

By Craig S. The New York Times

WEDNESDAY, SEPTEMBER 28, 2005

PARIS Turkey's psychiatric hospitals are riddled with horrific abuses,

including the use of raw electroshock as a form of punishment, according to

a human rights report scheduled for release in Istanbul on Wednesday, just

days before Turkey begins formal talks to join the European Union.

The report, by Mental Disability Rights International, an advocacy group

based in Washington, is likely to complicate the EU talks because many

European officials are already wary of letting Turkey join the Union and

will use any evidence that the country falls short of European standards to

argue against its membership.

But the authors of the report hope that the pressure will bring a quick end

to the worst abuses.

" We realized Turkey was a great opportunity for using that process to have

some influence, " said Rosenthal, Mental Disability Rights

International's founder, speaking by telephone from Istanbul. His

organization has fought for more than a decade to improve mental health

facilities around the world and has already used EU accession pressures to

bring change in Eastern Europe.

Turkey has made great strides in developing its society and economy to meet

European standards in recent years. After waiting for decades, formal talks

on its membership are scheduled to begin Oct. 3. But as with many developing

countries, some sectors of its society lag far behind the rest, including

its mental health system.

Of all the abuses witnessed by Rosenthal and his investigators, none was

more disturbing than the use of electroconvulsive therapy, also known as

ECT, without anesthesia to treat a wide range of illnesses in both adults

and children. The World Health Organization has called for a ban on

" unmodified " or " direct " ECT and states that children should never be

subjected to the treatment in any form.

The therapy, in which an electrical current is passed through the brain, was

developed in the 1930s and continues to be used in mainstream psychiatry to

treat a limited number of ills. But it is normally administered with

anesthesia and muscle relaxants. Without them, it can be painful, terrifying

and dangerous. Patients can suffer broken jaws or cracked vertebrae during

the artificially induced seizures.

The report quotes a 28-year-old electroshock patient at the Bakirkoy

Psychiatric Hospital as saying, " I felt like dying. "

The human rights group found that unmodified electroconvulsive therapy is

used on nearly a third of all patients undergoing a psychiatric crisis at

the state-run hospitals, including children as young as 9. The treatment is

also given for many illnesses that are not on the short list considered

appropriate by the international psychiatric community.

The report describes patients being dragged to electroshock therapy in

straitjackets and forcibly held down by staff during the procedure. Others,

it said, are told they are simply going to be X-rayed.

Turkey has been criticized for using unmodified electroconvulsive therapy

before: in 1997, the European Committee for the Prevention of Torture called

on the country to stop the practice. Turkey's Ministry of Health promised to

do so. It opened a new electroconvulsive therapy center at Bakirkoy and said

the treatment would be restricted to those illnesses for which it is

internationally accepted.

But Rosenthal and his investigators found that unmodified ECT continues to

be administered at Bakirkoy and other psychiatric hospitals for a wide range

of problems, including even postpartum depression, in part as a punishment.

" If we use anesthesia the ECT won't be as effective because they won't feel

punished, " the report quotes the ECT center's director as saying.

" That was one of most horrifying statements I've ever heard in 12 years of

doing this work, " Rosenthal said.

When Rosenthal and his staff visited the center one day in April, 24 people

received unmodified electroconvulsive treatment. Technicians at the center

told the group that only patients who had broken bones, presumably from

previous ECT sessions, were given anesthesia.

The Turkish Ministry of Health, which is responsible for the country's

psychiatric hospitals, said it had not yet read the report and declined to

comment on specific practices at its institutions.

Howitt, a British member of the European Parliament, said, " There's

no question that what's described in the report counts as torture under the

European convention and shouldn't exist in Turkey or anywhere in Europe. "

Howitt said he would bring up the report as part of the accession

negotiations.

" It is certainly part of the Copenhagen criteria on whether Turkey is

eligible to accede, " he said.

The report, which includes testimonies from former patients and videos taken

inside some institutions, reveals other abuse that is likely to complicate

the country's efforts to convince Europe that it has met standards equal to

those of the rest of the Union.

Much of the abuse took place in orphanages and rehabilitation centers for

children with developmental or intellectual disabilities where investigators

saw emaciated and neglected children, many of whom exhibited behavioral

problems that were probably the result of their mistreatment rather than any

pre-existing illness, Rosenthal said.

The group's investigators visited three institutions under the Directorate

for Social Services and Child Protection, which administers the orphanages

and rehabilitation centers.

The Saray Rehabilitation Center, near the airport outside Ankara, was one of

the most terrible.

" We saw children who were essentially abandoned, starving, tied down to

their beds, " Rosenthal said.

Photographs and videos taken at Saray, the largest of Turkey's state-run

rehabilitation centers, show skeletal children, some with plastic water

bottles taped over their hands to prevent them from biting their fingers.

Other children with only minor disabilities are mixed in with the rest.

Rosenthal said the Saray's director would not provide mortality figures for

the facility, but a footnote in the report notes that the large number of

admissions without a corresponding number of outplacements suggests that

many of the children die.

" We believe there's a very high death rate in these facilities, " Rosenthal

said.

Officials at the Directorate for Social Services and Child Protection could

not be reached.

The report found that there were no enforceable laws in Turkey to protect

mentally ill people from arbitrary detention or forced treatment and that

there are virtually no community services that might keep them out of

institutions.

As a result, according to the report, thousands of people are

institutionalized for life.

But Rosenthal said he was optimistic that Turkey could change, noting that

the country had a better government, more highly trained professionals and

more money than many other places he had worked.

" The most extreme abuses are problems they can remedy very quickly, "

Rosenthal said.

" There's no need for this to stand in the way of accession, " he added.