Author: Dallandyshe Xhaferri
While the number of patients needing mental health Services is increasing, the number of staff and the structure are the same. Problems of access and quality of psychiatric Services, including lack of training and shortages in staff, are some of the challenges facing the health system today.
For more than 3 hours, patients at polyclinic number 3 of Tirana have been waiting in line to see the psychiatrist. Although it is the beginning of the year, (January 5) patients feel the need to consult with a psychiatrist.
"I came here at 12 noon and I can't leave without seeing the doctor," says an elderly man, next to whom, waiting, is Luljana, a girl in her mid-thirties who has been living with depression and anxiety attacks for more than 8 years.
"It all started at the age of 22. I spent nights thinking about everything that was happening to me at that moment and suddenly I couldn't breathe. At first I managed the situation myself with breathing exercises , but then it became impossible," says Luljana, who says that the biggest problem for her was getting to know a psychologist. In the National Business Center, in 2017 there were 38 offices throughout the country offering psychologist Services, while for 2023 there are 247 offices.
"In the first consultation, the psychologist asked me: what do you want from me? I just wanted help and I couldn't express myself. It's a difficult situation and the problem also lies in not accepting the fact that I'm going through depression," she says.
Tirana, the population doubles, but not health structures
Arjana Rreli, a psychiatrist at the Community Mental Health Center near polyclinic number 3, tells "Sinjalizo" that in addition to the increase in the number of people in Tirana, the events that have been recorded in recent years, such as the earthquake of November 26, 2019 and isolation at home during the pandemic of the Coronavirus, have increased the flow of patients turning to psychiatrists for help, while the number of state structures where doctors provide Services has remained the same.
"Since Tirana, the capital, is a metropolis, it is a city that expands every day and increases in residents, our structures have remained three, both in Tirana, which had 400 thousand residents, and in Tirana, which today has over 1 million. Therefore, the increase in the number of residents presupposes that the probability of having mental health problems in this population is also higher. The flow to us has increased from year to year," says Rreli, adding that patients who have received the service at this Community Mental Health Center are also residents of Gërdec (the 2008 incident) whose mental health has been accompanied by long-term consequences of post-traumatic stress.
Currently, 3 psychiatrists for adults and 1 for children provide Services in this center.
"While there are 3 Community Mental Health Centers in this city, there is no doubt that the staff is fully staffed as far as Services are concerned, but in terms of the flow of patients that the Services have to deal with, they are a problem, they are overwhelmed," says Rreli, emphasizing that in order to be efficient and to understand more about the patient's condition, the psychiatrist must have a limited number of cases that he treats in a day.
According to official data from the quotas covered by the Ministry of Health and Social Protection, at least 8 doctors pursue specialization in adult psychiatry and 4 in child and adolescent psychiatry. In 2019, 25 psychiatrists worked in all state hospitals.
“The doctor should have a limited number of visits to be as effective as possible, to make the best decisions, to draw the best conclusions for the case, but also for the other staff: the psychologist, the social worker, the therapist, the nurse,” – says Rreli, adding, – “when I was in Italy, the psicatri studio did not treat more than 5 to 6 cases a day. Here I treat an average of 20-25 patients a day.
The increase in cases of patients with mental health disorders has also been reflected in psychiatric hospitals, in which the number of treatment days for patients has decreased.
"The number of days of hospitalization has decreased significantly, and you need to recover the patient's condition as quickly and as completely as possible, not until the end, so that the bed can be freed up for the next patient ," says physician Arjana Rreli.
Meanwhile, sources from the "Xhevit Gjata" psychiatry service in Tirana inform that the number of beds in the building remains limited from 98 to 100, not allowing the admission and treatment of any patient who goes to hospitals.
"There are patients who need to be hospitalized in order to receive treatment, but there is a limited number of patients who are admitted . Social Services are not functioning properly. There are many patients who should not be hospitalized, but their families have abandoned them. If social Services took care of them, then more places would be made available for people who really need it," the source tells "Sinjalizo".
"They are patients who are greatly influenced by the external environment, by environmental factors, but in the building the infrastructure leaves much to be desired. The toilets do not have even the most minimal conditions and the smells are not pleasant at all," says the source, adding, " the ratio between doctors and patients is 2 doctors for 20 patients,"
Valbona Treska, director at the Order of Psychologists, tells "Sinjalizo" that not receiving the full service remains problematic for people with mental health problems.
"We definitely do not yet have a strong chain of Services provided to the individual. We provide support Services to the individual, but they are segmented, the full service is not provided..."
Problems in accessing and quality of mental health Services
Access to Services and their quality for people with disorders remains one of the biggest problems that accompanies these patients.
"The problem in general has to do with access and quality of Services," Neli Demi, a consultant psychiatrist for the World Health Organization in Albania, tells "Sinjalizo".
"Regarding the type of Services offered in psychiatric hospitals, they are mainly biologically oriented Services . We treat them with medications without paying much attention to therapeutic Services or psychological intervention," says Demi.
"According to the action plan approved in 2013, community Services were planned to be established in 12 regions of the country, but this has not been realized," says Demi, adding that community Services have been established in cities where patients could receive Services in hospitals.
"Again, these community Services have been established in places where other Services have been established, such as: Vlora, Elbasan, Shkodra, Tirana. With some small exceptions such as Korça, Kavaja and a very basic center in Gramsh," says Demi, emphasizing the problem of obtaining specialized mental health Services, including equipping regional hospitals with psychiatric beds.
"It has been a continuous battle to have psychiatric beds in all regional hospitals, which for various reasons, whether due to a lack of human resources, whether due to a lack of financial resources or bureaucratic resistance or political decision-making, have not been made still possible and this is a necessity" - he concludes.
In the Local Mental Health Plan 2023-2026 published on the official website of the Ministry of Health and Social Protection, it is stated that the creation of Community Mental Health Centers resulted in the reduction of the number of psychiatric hospital beds.
"In this context, the process of reducing the number of psychiatric beds, implemented in parallel with the increase in community Services, has led to 600 beds in mental health Services by 2023 from 900 beds in 2000," the publication quotes.
According to a report published by the Albanian Committee of Helsinki (KShH), in addition to vacancies in the psycho-social staff, there is also a lack of training for a part of the existing staff.
"Vacancies in psychosocial staff, the lack of necessary training or qualifications for some of them, the lack of diversity in rehabilitation and therapeutic activities, the failure of this staff to maintain documentation regularly, as well as the failure to complete the special section for the psychological assessment of patients in their clinical records, the lack of special facilities for outdoor rehabilitation, for meetings between patients and psychosocial staff, etc., we assess as some of the shortcomings that psychiatric hospitals/wards have in terms of providing an adequate rehabilitation service for the treatment of patients with mental health illnesses," the report states.
However, the wave of patients and structural problems are the real challenges for mental health Services.
In the face of these challenges, there is awareness among health care professionals, policy makers and the public of the urgency we are in. Increasing funding, expanding community Services and training mental health professionals are bells ringing loudly.
The stories of individuals like Luljana, who bravely face depression and anxiety, underline the importance of a better quality mental health system closer to citizens. Tirana is one of the cities that needs the most to offer its residents the best possible service.
Dedication alone is not enough, but it is time to make mental health a priority, to have an environment where all those who need it feel safe.
This article was created based on input provided by individuals who have chosen to speak up. Share your story, empower others and be an agent for change. Visit the website: www.acqj.al/sinjalizo-dhe-ti/
