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Ukraine: a psychiatrist’s point of view. Reports, thoughts, articles (1999–2004)
Y. Yur’yev

THE ESTIMATION ANALYSIS OF THE EXPECTING RESULTS AS FOR THE UKRAINIAN PSYCHIATRIC SERVICE FORMATION

L. N. Yur’yeva, S. G. Nosov, Y. B. Yur’yev

* Publication details:
Yur’yeva, L. N., Nosov, S. G., Yur’yev, Y. B. (2004). The estimation analysis of the expecting results as for the Ukrainian psychiatric service formation. In: Yur’yev, Y. Ukraine: a psychiatrist’s point of view. Reports, thoughts, articles (1999–2004), pp. 124–135. Dnipropetrovsk: Porogi.

Introduction

The psychiatric service reforming necessity in Ukraine is gaining a big significance during the last years. The improvement of the psychiatric service methods, its quality increase, the implantation of new diagnostic and medical technologies, the attitude change of the psychiatric service and the population in general to mentally ill people and thus perfect the quality of every day’s problems, that are to be solved by the reforming acts in psychiatry.

For the successful realization of reforms in psychiatry and efficiency forecasting of the planned and carrying on measures it is very important to study the population of Ukraine in the aspect of the expecting results as for the psychiatry service reforming. The features of the interaction of the Ukrainian population to the, first of all, mentality reforming that is initiated by social, political, cultural and traditional life of people.

The most important is the expectations’ studying of different population layers that face the activity of psychiatric changes in the individual and social life of the psychiatric services — mentally ill people. It is also important to know what people think on the matter of whether any changes in the private, life, leisure, social, political, legal aspects of the patients are occurring in the process of the planned and conducted psychiatry reforms. This will lead the reforming efforts to the necessary directions and will give the chance to predict their success.

In the majority of foreign countries studying of the abovementioned problems is constantly being carried out. The opinion of the professionals who work in the psycho health protection sphere and mentally ill people, their relatives and neighbours about the reforming of the psychiatry and their expectations haven’t been carried out in Ukraine before.

Our attention was focused on the natural history of psychiatric patients that were not a clinical but a social construct and supposes the description and the characteristics of the expecting changes in different life sides of mentally ill people in the process of the Ukrainian reforming.

The research was based on the understanding that the psychiatry service reforming would be characterised by a range of positive (or according to the other opinion, negative) changes in different life sides of mentally ill people, and this fact would reflect in their natural history.

We proceeded under the supposition that in the psychiatry reforming process of our country programs of out-of-hospital psychiatric help would be realized more often. The patients would spend less time in hospitals and more time in the society; the treatment prescribed by the psychiatrists would be more often discussed with the patients; the responsibility for the patients’ social rehabilitation would be laid not only on the psychiatry service specialists but also on the relatives, employers, public managers, on the people from the public organisations that take care of the mentally ill people’s rehabilitation.

The final aim of the research was the priority estimation of the psychiatry service reforming on the basis of the results analysis that was obtained in the natural history of the mentally ill people.

Material and research methods

The research was carried out in the terms of the “Attitudes and needs assessment in mental illness (ANAP)” international project.

The natural history of mentally ill people was studied on the basis of the data obtained in the result of the anonymous questioning. Forty four people who had ever faced the psychiatry service took part at the questioning; they were: the service consumers — schizophrenia ill people, the mentally ill people’s relatives, outside observers (neighbours of the mentally ill people), and the psychiatry service providers — specialists who render professional psychiatric help (psychiatrists, psychiatry hospitals’ nurses). A random respondent selection method was used.

For data obtaining a questionnaire consisting of 32 questions and 5 alternative answers was worked out (T. Tomov, 1999). The questions reflected different psychic and social functioning aspects of the mentally ill people: frequency, duration and acuteness changes of the illness in an acute condition under the psychiatry service reforming; qualitative and quantitative changes of the mentally ill people’s social contacts under the reforming process; family life and leisure planning changes of the ill people; changes in the suicide amounts and others. Five alternative answers reflected the gradation of questioned people statements from the completely negative to the unequivocally positive.

Under the informative similarity all the questions were divided into 12 groups, the systematization of which is presented in the table 1.

Table 1

Number of the group Name of the group
1. Biological and psychopathological aspects of the illness
2. Psychiatric service of the patients
3. Care Problems of the ill people
4. Interaction problems of the ill people
5. Sexual problems of the ill people
6. Family problems of the ill people
7. Education, employment and social protection
8. Leisure time of the patients
9. Political activeness of the ill people
10. Problems of somatic health and life duration
11. Problem of aggressive acts of patients and against patients
12. Problem of patients’ property

The estimation of natural histories of the mentally ill patients was carried out on the basis of paired comparison between 4 groups of respondents. The total quantity of everyone of 5 answering variants to the questions were incorporated into 12 semantic groups.

Besides, the respondents’ answers of each group to the question on what rights of mentally ill patients would get the most development and on the contrary, most frequently would be restrained in conditions of the reforms carrying out in psychiatry were systemized.

After research results and discussion

The results for every respondent group have been obtained in the research process. All the results are diagrammed and represented. The comparing analysis of the results among the groups notifies the following.

On the first group of questions (in particular the question “In what way would the duration of the period between the beginning of illness till the first contact with a psychiatrist under the psychiatry reforming conditions change?”) the schizophrenia patients considered that this period would be much shorter and the opinions that the duration wouldn’t change were rare. The psychiatrists and psychiatry service workers were less optimistic on that point. Relatives and neighbours often showed the opinion that the period between the beginning of the psychic disease and the first contact with a psychiatrist could be of the same duration in future under the reforming conditions, that the active definition of schizophrenia patients wouldn’t become better and the probability that mentally ill people would ask for help by themselves is very low.

There was a definite difficulty among the relatives and neighbours in answering the questions connected with the acuteness, frequency and duration changes of a psychic aggravation under the reforming conditions. This respondent group had the answers stating that the parameters’ expressiveness would decrease or would stay on the same level. Probably it is connected with the fact that one needs special psychiatry knowledge in order to answer the question. Respondents-psychiatrists showed optimism answering these questions, sharing the thought that acuteness, frequency and duration changes of a psychic aggravation under the reforming conditions would either considerably decrease or decrease but there were also negative answers on that question. The mentally ill people were less optimistic.

In general as for the first group of questions the answering allocation is represented in table 2.

Table 2

The answering allocation among the respondents on the first group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 8% 68% 24% 0 0
Relatives 0 90% 10% 0 0
Neighbours 5% 75% 20% 0 0
Psychiatrists 20% 62% 18% 0 0

As for the second group of questions there were the following answers. The question 5 (“In what way would the attitude to the active decision taking in the treatment process change under the psychiatry reforming conditions among mentally ill people?”) had the majority of optimistic answers among the ill people and their relatives. There was a definite optimism in the answers of the specialists. Neighbours were less optimistic.

The majority of psychiatrists and relatives hope that there‘s going to be a quantity increase among the schizophrenia ill people agreed for the treatment under the psychiatry reforming conditions. Although the answers “would stay on the same level” was often.

There is definite confidence in psychiatrists’ answers as for the quantity increase of mentally ill people’s voluntary appealing to the psychiatric service.

Answering the question “In what way would the percentage of loyal located patients change under the reforming process?” psychiatrists often noted: “would stay on the same level as it is at present” or “would increase insignificantly” having on their minds the fact that nowadays there are no illegally located patients in hospitals. Relatives of the ill people often had answers “would insignificantly increase” when the ill people’s answers were “would considerably increase” or “would insignificantly increase”.

In general as for the question of group 2 the answering allocation is represented in table 3.

Table 3

The answering allocation among the respondents on the second group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 9% 59% 32% 0 0
Relatives 0 89% 11% 0 0
Neighbours 12% 38% 50% 0 0
Psychiatrists 11% 51% 36% 2% 0

The question “Who would take care of the ill person after leaving hospital under the reforming conditions” the patients usually answered naming parents, their spouse or a nurse, very seldom naming a psychiatrist; at the same time specialists in psychiatry sphere named parents, spouses, themselves and their assistants. A psychiatrist, parents or a spouse appeared in parents’ and neighbours’ answers on that question.

In general as for the questions of group 3 there were the following answers. On the question about the supervision difficulty changes under the reforming conditions psychiatrists, relatives and neighbours gave answers in which they show hopes for the decrease of these difficulties although most of the ill people thought that the problem would stay on the same level.

In general as for the question of group 3 the answering allocation is represented in table 4.

Table 4

The answering allocation among the respondents on the third group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 0 34% 66 0 0
Relatives 0 84% 16% 0 0
Neighbours 0 75% 25% 0 0
Psychiatrists 4% 76% 20% 0 0

As for the questions of the fourth group the answers were the following. The questions on the sexual life changes of the patients under the psychiatry reforming conditions the majority of respondents among the mentally ill people tried to avoid the answering or answered “the sexual satisfaction would stay on the same level as it is now”. Some of the mentally ill people and especially their relatives considered these questions less significant and unnecessary as it is connected not only with the psychiatry reforms but also with the features of the illness and the mentally ill person’s features of character.

Doctors-psychiatrists often showed the optimistic thoughts, considering that sexual life of the mentally ill people under the reforming conditions would be better.

In general as for the question of group 4 the answering allocation is represented in table 5.

Table 5

The answering allocation among the respondents on the forth group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 0 7% 93% 0 0
Relatives 8% 92% 0 0 0
Neighbours 0 50% 50% 0 0
Psychiatrists 0 66% 34% 0 0

As for the 5th group of questions the respondents presented the following answers. The majority of the questioned doctors-psychiatrists had no doubts that the quantity of social contacts and friendly connections would either stay on the same level as it is now or would increase. The majority of relatives considered that the quantity of social contacts would increase and the mentally ill people answered it would stay on the same level as it is in present. The relatives of the mentally ill people were the most optimistic.

In general as for the question of group 5 the answering allocation is represented in table 6.

Table 6

The answering allocation among the respondents on the fifth group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 0 80% 20% 0 0
Relatives 8% 92% 0 0 0
Neighbours 0 50% 50% 0 0
Psychiatrists 0 65% 35% 0 0

The questions connected with the marriage quantitative frequency among mentally ill people got similar answers of relatives, neighbours, psychiatrists and mentally ill people. The answers were either “would increase” or “would stay on the same level as it is in present”. The motivation on that point was that there are no any serious barriers for the realisation of these aspirations. Almost all the respondents were unanimous in the thought that the mentally ill people would find themselves in the better position then they are now as for their parental responsibilities.

In general as for the question of group 6 the answering allocation is represented in table 7.

Table 7

The answering allocation among the respondents on the sixth group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 0 22% 78% 0 0
Relatives 5% 61% 34% 0 0
Neighbours 0 25% 75% 0 0
Psychiatrists 4% 76% 20% 0 0

As for the 7th group of questions the answers were as following. The question “Would the mentally ill people change their educational level under the psychiatry reforming conditions?” got the answers: doctors-psychiatrists — more often — “would be better” or “would stay on the same level as it is in present”; relatives — “they would have higher level of education”, more rare — “would stay on the same level as it is now”; the mentally ill people considered their educational level would stay on the same level as it is in present.

As for the employment of the mentally ill people the answers of all the respondent groups, excluding the mentally ill people, were quite optimistic: “the educational level of the mentally ill people would increase”. According to the opinions of the majority of the mentally ill people their employment level “would on the same level as it is in present”. There was almost the same answering allocation among the groups as for the question “In what way would the psychiatry reforms reflect the earnings of the mentally ill people?”

There were few respondents who showed doubts as for the strong insuring system establishment after the psychiatry reforming process.

In general as for the question of group 7 the answering allocation is represented in table 8.

Table 8

The answering allocation among the respondents on the seventh group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 3% 36% 61% 0 0
Relatives 4% 66% 30% 0 0
Neighbours 0 50% 50% 0 0
Psychiatrists 2% 65% 31% 0 0

As for the questions of the group 8 the respondents informed the following. In all the groups there were no serious doubts that the psychiatry reforms would increase the quantity of patients actively spending their leisure time variously. As for the question about the changes of the political achievements of the patients under the reforming conditions the respondents’ answers were ambiguous: the mentally ill people, their relatives and neighbours were less optimistic, psychiatrists were more optimistic although the most frequent answer was “would be same as it is in present”.

In general as for the question of group 8 the answering allocation is represented in table 9.

Table 9

The answering allocation among the respondents on the eighth group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 8% 58% 32% 2% 0
Relatives 8% 60% 26% 6% 0
Neighbours 0 62% 38% 0 0
Psychiatrists 0 71% 29% 0 0

There were definite doubts as for the quality increase, medical care success in treatment of the schizophrenia patients under the reforming conditions. Psychiatrists showed convinced optimism on that point.

In general as for the question of group 9 the answering allocation is represented in table 10.

Table 10

The answering allocation among the respondents on the ninth group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 0 33% 67% 0 0
Relatives 0 38% 50% 0 0
Neighbours 0 24% 76% 0 0
Psychiatrists 0 64% 36% 0 0

As for the questions of the group 10 the respondents gave the following answers. There was almost complete unanimity in answers on the question about the changes in the somatic condition of the mentally ill people under the psychiatry reforming — “the somatic health would improve”. There were very few answers stating that “the somatic health would be the same as it is in present”, referring the ecological situation in the country.

There were no doubts among the psychiatrists, relatives that the meal and the feeding of mentally ill people would be better under the reforming conditions although the mentally ill people noted it “would stay the same”.

The question “In what way would the life duration of mentally ill people change under the psychiatry reforming conditions?” got the most often answer: “the life duration would stay the same”; more optimistic answers — “the life would be longer” were rare. There were also negative answers among some neighbours and doctors.

In general as for the question of group 10 the answering allocation is represented in table 11.

Table 11

The answering allocation among the respondents on the tenth group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 0 55% 45% 0 0
Relatives 5% 61% 34% 0 0
Neighbours 0 58% 32% 5% 5%
Psychiatrists 1% 68% 29% 1% 1%

The answers for the 11th group of questions were as follows. The majority of psychiatrists stated that the quantity of aggressive acts from the side of mentally ill people would decrease although some respondents answered negatively on that question. Under the psychiatry reforming conditions the quantity of the threatening acts against mentally ill people would reduce. Psychiatrists noted that mentally ill people would more rarely become offence and deceit victims, would rarely commit autoaggressive acts under the psychiatry reforming conditions. The ill people gave similar answers despite those connected with the quantity of threatening acts against the ill people; in that case the answers were “would stay on the same level as it is now”.

In general as for the question of group 11 the answering allocation is represented in table 12.

Table 12

The answering allocation among the respondents on the eleventh group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 0 38 44 18 0
Relatives 0 41 51 5 3
Neighbours 0 42 42 6 6
Psychiatrists 15 52 17 15 1

As for the questions of the group 12 the respondents noted the following. Psychiatrists and relatives of the mentally ill people stated for the supposition that under the psychiatry reforming conditions the ill people would have more residential property and would be able to keep it up as “their earnings would be higher, there would be an appropriate legislative basis and social care”. The patients were sceptical as for their residential property’s increase, giving the answers “it would stay on the same level as it is now”.

The answers on the question about the ability of mentally ill people to take care of themselves, to keep their looks up and to keep their personal hygiene were ambiguous. The ambiguity was caused by the fact that the increase of the above mentioned abilities is not connected with the economical possibilities only (availability of the hygienic means) but also with the chronic endogen disease current features, that influence the personality of the schizophrenia ill people. Most frequent answers among the psychiatrists were: “would stay on the today’s level” and “would increase”. Relatives were more optimistic, and the ill people were less optimistic, having the most popular answer — “would stay on the today’s level”. Some of the mentally ill people rejected to answer, being motivated by the thought that this question is insignificant.

In general as for the question of group 12 the answering allocation is represented in table 13.

Table 13

The answering allocation among the respondents on the twelfth group of questions

Respondents Considerable positive effect Positive effect Non effective Negative effect Considerable negative effect
Mentally ill people 0 59% 41% 0 0
Relatives 0 82% 18% 0 0
Neighbours 0 38% 62% 0 0
Psychiatrists 0 58% 40% 2% 0

Among the patients’ rights that could be consolidated in the result of the psychiatry reforms the most frequently named were: right for medical service, right for employment and leisure time activities.

Among the rights that are likely to be usually broken were named the following rights: right for the legal protection, for the social support and for the political activeness.

Conclusions

  1. The majority of respondents — Ukrainian citizens — stated the optimistic opinions as for the psychiatry reforms’ realization and do expect the quality improvement of the psychiatry service.
  2. The priority directions of the reforming realization (according to the results of this research) are: the quality improvement of the medical service, the development of new kinds of social help, the keeping process of the mentally ill people’s rights.
  3. There are definite difficulties as for the attitude of the population to the reforms: some respondents consider that the reforming process will extend the rights and possibilities of mentally ill people and that can lead to the aggression intensifying among the ill people towards the surrenders.

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