Physical ill treatment in psychiatric hospitals
Güncelleme Tarihi:
Hurriyet Daily News
Oluşturulma Tarihi: Haziran 01, 2009 00:00
ISTANBUL - A European delegation reports ill-treatment and inter-patient violence in three mental health hospitals after their visit to Turkey in 2006. The report states that Bakırköy hospital in Istanbul is in a better situtation than hospitals in the Anatolian provinces of Elazığ and Samsun.
A delegation of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, or CPT, received a number of allegations of physical ill treatment, excessive use of force and verbal abuse in two mental hospitals in Turkey in their visit to psychiatric establishments and social welfare institutions at the end of 2006.
The CPT delegation visited the Elazığ, Samsun and Bakırköy mental health hospitals along with other social welfare establishments and legal safeguards between Nov. 22 and Dec. 4, 2006, and released their report and the response from the Turkish government last week. At the Samsun hospital, acts of violence among patients were perceived as having been committed at the instigation of orderlies, the report stated.
The situation was more favorable at the Bakırköy hospital in Istanbul, where only a few allegations of ill treatment like slapping and rude behavior by orderlies were heard in some of the acute male and forensic male wards, the report said.
The atmosphere in the establishment appeared to be generally more relaxed than that observed during the delegation’s 2005 visit. The ill-treatment allegations at the other two hospitals include mainly slapping and punching by orderlies in all male closed wards except the ’prison ward,’ according to the report.
Inter-patient violence
"The CPT is concerned about the frequency and seriousness of allegations of inter-patient violence made by patients at the Elazığ hospital. Some allegations of this kind were also heard at the Bakırköy and Samsun hospitals," the report stated. In the CPT's opinion, inter-patient violence at the hospitals stemmed from insufficient staff presence in the wards and a lack of alternative therapy approaches
"The committee must stress in this regard that the duty of care that is owed by staff in a psychiatric establishment to those in their charge includes the responsibility to protect them from other patients who might cause them harm. This requires not only adequate staff presence and supervision at all times, including at night and on weekends, but also for staff to be properly trained in handling challenging situations/behavior by patients," the report stated. The committee recommended that the procedure for selecting orderlies and their initial and ongoing training be reviewed, in light of the above remarks.
Further, the management of all three psychiatric hospitals visited should deliver to orderlies the clear message that all forms of ill treatment of patients, including verbal abuse, are unacceptable and will be the subject of severe sanctions.
Turkey’s response
However, Turkey in its response to the CPT said it received no allegations concerning ill treatment of patients at the Bakırköy hospital. "The majority of patients expressed their content regarding treatment by nurses.
The personnel in charge of patient care were provided adequate training with a view to protecting patient’s rights. The hospital administration has held a meeting with the personnel including orderlies and provided them detailed information on the CPT report. Every application made to the patient’s rights unit was examined meticulously and various punishments were handed down, including dismissal," the response letter stated.
All personnel at the Elazığ hospital, primarily the orderlies, were given a clear message both verbally and in writing as recommended in the report, the Turkish authorities said. "Furthermore, the personnel were provided a training program on patient’s rights in collaboration with Fırat University and a seminar on "Patient Ğ Personnel Relations and Behavior in Psychiatry" was organized in December 2006. All hospital units, particularly the closed wards, were put under 24-hour camera surveillance in an effort to prevent ill treatment. Two personnel found to exercise ill treatment on patients were dismissed from the hospital in 2007. It is also provided that this issue will also be taken into account in the selection process for new employees at the hospital," the response letter said.
About inter-patient violence, Turkish authorities said steps have been taken to improve the situation in hospitals and prevent the violence, including applying treatment other than pharmacotherapy in certain wards at the Bakırköy hospital, increasing the number of nurses and monitoring patients with cameras at the Elazığ hospital.
"The organized rude behavior of the patients in the closed male ward and the closed forensic ward at Samsun hospital toward other patients was seriously taken into consideration, the Turkish officials said.
"In this context, in order to observe the patients more closely, the frequency of interaction between the patients and the cleaning company staff was reduced as much as possible, and as a precaution medical personnel were assigned to these wards and a video camera record system was put into service. The number of assistant medical personnel was increased. An additional eight nurses were appointed to remedy the existing insufficiency," the response said.
Cooperation by all means
The CPT delegation appreciated Turkey for its cooperation during their visit. However they also stressed that the principle of cooperation is not limited to steps taken to facilitate the work of visiting delegations, but also requires that decisive action be taken to improve the situation in light of the CPT's recommendations. "In this connection, the committee was very concerned to learn that most of the recommendations made after its first visit to the Samsun hospital in 1997, in particular regarding patients' living conditions, have still not been implemented," the report said.
The CPT delegation visited the Elazığ, Samsun and Bakırköy mental health hospitals along with other social welfare establishments and legal safeguards between Nov. 22 and Dec. 4, 2006, and released their report and the response from the Turkish government last week. At the Samsun hospital, acts of violence among patients were perceived as having been committed at the instigation of orderlies, the report stated.
The situation was more favorable at the Bakırköy hospital in Istanbul, where only a few allegations of ill treatment like slapping and rude behavior by orderlies were heard in some of the acute male and forensic male wards, the report said.
The atmosphere in the establishment appeared to be generally more relaxed than that observed during the delegation’s 2005 visit. The ill-treatment allegations at the other two hospitals include mainly slapping and punching by orderlies in all male closed wards except the ’prison ward,’ according to the report.
Inter-patient violence
"The CPT is concerned about the frequency and seriousness of allegations of inter-patient violence made by patients at the Elazığ hospital. Some allegations of this kind were also heard at the Bakırköy and Samsun hospitals," the report stated. In the CPT's opinion, inter-patient violence at the hospitals stemmed from insufficient staff presence in the wards and a lack of alternative therapy approaches
"The committee must stress in this regard that the duty of care that is owed by staff in a psychiatric establishment to those in their charge includes the responsibility to protect them from other patients who might cause them harm. This requires not only adequate staff presence and supervision at all times, including at night and on weekends, but also for staff to be properly trained in handling challenging situations/behavior by patients," the report stated. The committee recommended that the procedure for selecting orderlies and their initial and ongoing training be reviewed, in light of the above remarks.
Further, the management of all three psychiatric hospitals visited should deliver to orderlies the clear message that all forms of ill treatment of patients, including verbal abuse, are unacceptable and will be the subject of severe sanctions.
Turkey’s response
However, Turkey in its response to the CPT said it received no allegations concerning ill treatment of patients at the Bakırköy hospital. "The majority of patients expressed their content regarding treatment by nurses.
The personnel in charge of patient care were provided adequate training with a view to protecting patient’s rights. The hospital administration has held a meeting with the personnel including orderlies and provided them detailed information on the CPT report. Every application made to the patient’s rights unit was examined meticulously and various punishments were handed down, including dismissal," the response letter stated.
All personnel at the Elazığ hospital, primarily the orderlies, were given a clear message both verbally and in writing as recommended in the report, the Turkish authorities said. "Furthermore, the personnel were provided a training program on patient’s rights in collaboration with Fırat University and a seminar on "Patient Ğ Personnel Relations and Behavior in Psychiatry" was organized in December 2006. All hospital units, particularly the closed wards, were put under 24-hour camera surveillance in an effort to prevent ill treatment. Two personnel found to exercise ill treatment on patients were dismissed from the hospital in 2007. It is also provided that this issue will also be taken into account in the selection process for new employees at the hospital," the response letter said.
About inter-patient violence, Turkish authorities said steps have been taken to improve the situation in hospitals and prevent the violence, including applying treatment other than pharmacotherapy in certain wards at the Bakırköy hospital, increasing the number of nurses and monitoring patients with cameras at the Elazığ hospital.
"The organized rude behavior of the patients in the closed male ward and the closed forensic ward at Samsun hospital toward other patients was seriously taken into consideration, the Turkish officials said.
"In this context, in order to observe the patients more closely, the frequency of interaction between the patients and the cleaning company staff was reduced as much as possible, and as a precaution medical personnel were assigned to these wards and a video camera record system was put into service. The number of assistant medical personnel was increased. An additional eight nurses were appointed to remedy the existing insufficiency," the response said.
Cooperation by all means
The CPT delegation appreciated Turkey for its cooperation during their visit. However they also stressed that the principle of cooperation is not limited to steps taken to facilitate the work of visiting delegations, but also requires that decisive action be taken to improve the situation in light of the CPT's recommendations. "In this connection, the committee was very concerned to learn that most of the recommendations made after its first visit to the Samsun hospital in 1997, in particular regarding patients' living conditions, have still not been implemented," the report said.