Hungarians battle depression with community psychiatry

In the mid 1980's Hungary regularly made the headlines for one unhappy reason - it had the world's highest suicide rate - an average of 46 suicides a year for every hundred thousand people. And many thought rates of depression and suicide would increase after the fall of communism. But to the surprise of many, the number of suicides has fallen.

Conditions for people with mental illness have improved significantly thanks to policies introduced since the fall of communism and growing efforts by human rights organisations. But unemployment is high and people with mental illness continue to be among the first to lose their jobs. There is another way to get help, complementing standard, internationally approved treatments.

This is community psychiatry, when with the patient's agreement relatives or friends are also involved in the treatment. It may still be relatively new and underdeveloped, but according to Dr Judit Harangozo, who is a pioneer in the field, it does seem to be working in Hungary:

"Community psychiatry is provided basically for schizophrenic patients and people with mental disorders, like manic depression or severe personality disorders. This kind of treatment has very good results. Patients can get better and improve their work performance. More than 50 per cent of our clients who receive this type of service are working or learning something. This is much higher than with traditional forms of treatment."

Istvan Bitter heads the Department of Psychiatry and Psychotherapy at the prestigious Budapest-based Semmelweiss Medical University:

"We have a large part of the population suffering from mood disorders, mainly depression, and from anxiety disorders. People are worried about something so they avoid certain things. We call this 'phobia'. In the elderly especially we have an eventual decline of mental capacities, like dementia."

Dr. Bitter points out that one per cent of the population suffers from schizophrenia, and up to 40 per cent of the population suffers from a mental disorder which needs treatment at some point during their lives.

In a massive brain drain some of Hungary's best doctors are leaving for better salaries in countries like Britain and Sweden. This is compounded by a decline in the number of health facilities available. Dr. Bitter is pessimistic.

"The treatment system is becoming more and more insufficient, but it's not only psychiatry. It's a general issue in health care in this country. The number of psychiatric beds decreased by 50 per cent, which is fine because we no longer want to treat most patients in hospitals, but unfortunately the money saved was not used for improving outpatient services. But we still have a very good state supported outpatient network throughout the country, which means that each patient discharged from hospital has free access to outpatient care."

So, the battle is only half won, until Hungarians join forces and pave the way for people with mental illness to integrate into mainstream society.