Geneva Initiative on Psychiatry promotes reform of mental health institutions in Ukraine (12/08/96)

Geneva Initiative on Psychiatry promotes reform of mental health institutions in Ukraine

by Andrij Kudla Wynnyckyj
Toronto Press Bureau

TORONTO - Ontario's provincial capital is home to Dr. Ray Freebury, a board member of the Geneva Initiative on Psychiatry, an international foundation for the abolition and prevention of political abuses of psychiatry. "Although the dark days of Soviet excesses in the abuse of psychiatry are behind us," Dr. Freebury told The Weekly in a recent interview, "there is still much to be done to ensure there is no chance abuses will recur."

Dr. Freebury related that the GPI is the successor body to the International Association against the Abuse of the Political Use of Psychiatry (IAPUP) founded by Dr. Robert van Voren, a Canadian-born psychiatrist now living in Holland, who, prompted by reports of abuses in the Soviet Union in the 1970s, was instrumental in getting the World Psychiatric Association to formally oppose the political use of psychiatry. Dr. van Voren currently serves as GPI's general secretary.

IAPUP changed its name in late 1992 because, Dr. Freebury said, with the emergence of democracy in the former Soviet Union, political abuses of psychiatry declined significantly, and the organization decided to concentrate on assisting the reform of institutions and mental health practices.

Dr. Freebury said the GPI's activities are predicated on a recognition that people trained under totalitarian rule were going to find it difficult to adapt to Western ideas of patient rights and freedoms, and so a network of communication was established and the practice of holding annual meetings with participants from the West and former authoritarian states was set in motion.

For the last four years, Dr. Freebury has attended the annual Meetings of Reformers in Psychiatry, which brings together about 100 practitioners and scholars from North America, Western Europe and former Warsaw Pact countries. This year's conference was held in Madrid on August 28 to September 1 and coincided with the World Psychiatric Association's 10th congress. Previous sessions were held in Amsterdam (Holland), Prague (Czech Republic) and Bratislava (Slovakia)

In 1993, the first of the meetings focused on the formation of independent professional associations, the involvement of friends, families and relatives of patients to bolster community contact, and issues concerning psychiatric nursing staff.

The GPI's first "Reformers" sessions in August 1993 solidified contacts with Semen Gluzman, who in 1991-1992 organized the Ukrainian Psychiatric Association, capitalizing on the considerable influence he enjoyed with the administration of then-President Leonid Kravchuk.

Dr. Freebury mentioned that in late 1992, thanks to Dr. van Voren's contacts in Holland and Dr. Gluzman's efforts in Ukraine, the Dutch government provided a convoy of army trucks, which then transported an assortment of books, journals, medications and other materials to help establish the nucleus of an information distribution network.

At the 1994 meetings, Dr. Freebury said, discussions began about mental health legislation concerning patient rights and regulation of the profession, which aimed to bring the statutes of former Warsaw Pact countries into line with those of the West, and then culminated with the presentation of model legislation for adoption at the sessions in Bratislava in 1995.

Last year's sessions also initiated deliberations on the establishment of ethical codes for national psychiatric associations, Dr. Freebury recalled, and included a report by a Lithuanian clinician who chronicled his country's adoption of laws in the form proposed by the GPI.

This year's sessions included a joint presentation and workshop by Drs. Gluzman and van Voren on fund-raising among Western governmental and private foundations to buttress mental health care reforms.

A "Model Ethical Code for Psychiatrists" was proposed by Russia's Svetlana Polubinskaya and Prof. Richard Bonnie of the University of Virginia Law School. Dr. Irina Griga of Kyiv's Pavlov Psychiatric Hospital joined with Jo Lucas of the University of Kyiv-Mohyla Academy School of Social Work to conduct a workshop on "The Role of Social Workers in Mental Health Care."

Dr. Freebury reported that despite the significant strides made by the GPI in introducing legal and ethical concepts into Ukraine, problems are still being created by obdurate members of the old guard.

In July, Vyacheslav Lysovenko, Ukraine's chief psychiatrist, attempted to evict Dr. Gluzman and the independent Ukrainian Psychiatric Association from the offices they'd been granted in Kyiv. An intervention in August and September by the GPI's membership and Dr. Norman Sartorius, president of the World Psychiatric Association, with the Ukrainian government eventually forestalled such a move, but Dr. Freebury said this nevertheless reflects the climate in the top echelons.

Dr. Freebury added that the reputation of Ukraine's psychiatric profession in the West has been undermined by the ongoing tenure of Dr. Valentin Chuprikov as chief of psychiatric research in the country, because of the latter's fixations on dubious approaches, such as the use of colored lenses as therapy for schizophrenia.

Dr. Freebury said that, despite such difficulties, Dr. Gluzman has effectively made Ukraine the leader in psychiatric reform, on the strength of a solid core of professionals with integrity, such as Dr. Vladyslav Demchenko, Kyiv's chief psychotherapist, and Dr. Ludmilla Kotko of the Dnipropetrovsk Special Psychiatric Hospital. Both attended the Reformers' conference in Madrid, along with 16 other professionals, Parliament deputies, patients' advocates and community activists who formed the Ukrainian delegation (by far the largest).

Born in Britain, Dr. Freebury came to Canada to complete his studies in psychiatry and establish a practice. From the 1980s on, he was the American Psychiatric Association's representative for Ontario, its reporter to and then chair of its Committee on International Abuse of Psychiatry, vice-chair of the Section on Psychiatry of the Ontario Medical Association and director of the Toronto Institute of Psychoanalysis.

Dr. Freebury recently served as a member of a delegation assigned to investigate abuses of psychiatry in Cuba, but the delegation was refused entry into that country.

This fall, the GPI issued the first issue of its journal, Mental Health Reforms, in which Dr. van Voren's page-one editorial led with a description of Dr. Gluzman's efforts to establish the Ukrainian Psychiatric Association (UPA) and reform the profession and its practices in his country.

Dr. van Voren mentioned that he participated in the UPA's first press conference in March, at which Ukrainian psychiatrists "discussed their joint research project with the University of Pittsburgh, their psychiatric library, which is now the wealthiest on the territory of the former USSR, their nursing training program [and] their publication program" (there are more than 20 books to be published in 1996-1997).

Dr. van Voren noted that the UPA has a permanent secretariat that now includes a patient - a development he described as "revolutionary."

"For a mental patient to come out of the closet and work with psychiatrists on the territory of the hospital to which he was repeatedly admitted is a tremendous leap forward," the GPI general secretary wrote.

Dr. van Voren also noted that many of the psychiatrists he'd met in Ukraine in 1991 and saw once again this year "have become human beings and are surrounded by colleagues who are willing to further reforms."