Georgia, formerly part of the Soviet Union, garnered independence in 1991. From 1991 to 1993, following its break from the communist regime, civil war and unrest had wracked the country; its post-Soviet Union status still had not allowed the state to fully escape the shadow of its political past. PLOS Medicine reports that traditionally inhumane and outdated medical practices, ranging from biological treatment to high rates of institutionalization, heavily characterize mental health services in Georgia.

In 2009, Global Initiative on Psychiatry (GIP) reported that social exclusion, mental ill health and poverty were all correlative; the mental well-being of residents in poorer, more remote regions of the country proves a focal point for discussion. It was not until the Ministry of Labour, Health and Social Affairs (MoLHSA) introduced the 2011-2015 National Health Care Strategy that there was a key turning point in Georgian mental health services. The status of mental health underwent a momentous transformation, both in the realm of primary health care and in the community. This is a chronological breakdown of the reformation roadmap thus far.

1995-2009 Programs and Laws

The establishment of the 1995 mental health assistance program meant that officially registered mentally ill patients, according to the national psychiatric register, received free services, according to PLOS Medicine. These people received treatment at various hospitals as well as outpatient clinics. PLOS Medicine records show that six psychiatric clinics provided hospital care to these patients and have housed and cared for more than 1,000 people.

In 2007, a newly introduced law on psychiatric services resulted in the illegalization of the involuntary hospitalisation of mentally ill patients in Georgia, PLOS Medicine reports. A court decision was mandatory if one viewed institutionalization as the only remaining viable option. The EU has repeatedly berated Georgia on torture for the poor conditions of the country’s mental institutions; the violation of human rights was a huge motivation behind the upheaval of its mental health services.

In 2009, Georgia replicated the 2007 law on psychiatric care alongside several adaptations, carried out by psychiatric experts. This included the proposal of treatment management techniques such as physical restraint as well as treatment options relevant to forensic psychiatric treatment and prison mental health, PLOS Medicine reports.

2011-2015 National Mental Health Care Strategy

In 2010, Georgia announced the 2011-2015 National Mental Health Care Strategy with a specially curated team of psychiatrists prepared to implement these reforms. At the time of the strategy’s introduction, MoLHSA officially recorded approximately 80,000 mentally ill civilians but also admitted that they viewed this as an underestimation, PLOS Medicine reports. The program emphasized the importance of mental well-being; the strategy’s overarching objective was to improve the general population’s mental health by 2015.

By 2013, 18 outpatient psychiatric clinics were already in use but there was a negative correlation between the increased presence of available services and poorer, more remote regions; citizens of poorer regions could not access mental health services of the same quality, according to PLOS Medicine. The principal reform within this entire process was deinstitutionalization which occurred in early summer 2011 via the closing of the largest psychiatric institution at the time, the Asatiani Psychiatric Hospital.

2015-2020 Mental Health Care Strategy Plan

The country announced the plan in 2014 and prioritised the improved accessibility of mental health care services to the Georgian population. Georgia declared its obligations to care for all disabled civilians and safely keep their rights and freedoms. The strategy emphasized the destigmatization of mental health treatment and mental illness. The World Health Organization (WHO) report stated that, at this time, neuropsychiatric disorders were behind 22.8% of the country’s fatalities.

In 2016, there was an increase in funding for more mobile teams; 11 mobile teams received funding for their work across the country by 2018. The implementation of a separate scheme in this same year attempted to ensure the rights of mentally ill Georgian prisoners, specifically. 

2022-2030 National Mental Health Strategy

This national plan aims to emphasize child and adolescent mental health. The strategy further champions deinstitutionalization and the importance of community-based care for mentally ill patients. In 2022, 8.4% of the mentally ill population received treatment in a mental hospital with the remaining populace receiving care at a community-based service.

Moving Forward

Treatment for mentally ill patients has transformed in various manners since the Georgian state obtained its independence. Firstly, however, it appears that treatment is geographically discriminatory with only civilians who reside in the country’s capital being prioritized; citizens who reside in poorer, more remote regions find treatment is less accessible to them.

Secondly, it seems that treatment for mentally disabled prisoners is immensely stagnated, especially in comparison to services which are accessible to non-incarcerated civilians. The Public Defender’s Office (PDO) of 2022 noted the sub-standard conditions available for mentally ill inmates and reported a severe lack of services specifically for those with disabilities. The former Soviet Union state has made major progress since the early 1990s and will hopefully continue to make further steps to ensure all Georgian civilians, irrespective of their geographical location and incarcerated status, can access adequate mental health services.

– Naomi Finapiri

Naomi Finapiri is based in London, UK and focuses on Global Health for The Borgen Project.

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