Martin Jarolimek - champion of community care for psychiatric patients
I'm now in a quiet residential area in the south of Prague, in fact just a few hundred metres away from the busy north-south thoroughfare that cuts through the city, symbolising the rat race - sometimes too hard to keep up with. Hidden in the greenery lies an inconspicuous white building. A few people are sitting outside it in the garden, chatting. As there is no reception desk, it took me a while to find the way to the director's office.
Psychiatrist Martin Jarolimek is the head of a day care centre for psychiatric patients and also the head of the Czech Association for Mental Health. He was one of the pioneers of non-hospital care for the mentally ill. He doesn't look like your ordinary doctor, with long hair and wearing jeans and T-shirt. Not a single white overcoat anywhere in sight.
The typical mental hospital in the Czech Republic is a large complex of buildings dating from the time of the Austro-Hungarian Empire. It is usually set in a park outside the city, surrounded by a fence. Doctor Jarolimek says he wanted to build an alternative to this type of care.
"The biggest difference is that we have no beds. It means that we offer to our clients only day care. The biggest advantage is that our clients, our patients, still have close connections to their families, to the community, compared to the big psychiatric hospitals where the patient is closed maybe for two or three months without any close connection to the other people, "normal" people and of course it is not very helpful for the patients to be so divided, so separated from normal life."
What does a typical day involve in the day care centre as opposed to in an ordinary psychiatric hospital?
"It differs. For example today I've seen two patients, a girl and a boy. Both of them are in an acute psychotic crisis. They can't be alone at home so in the morning their parents brought them by car to our day hospital, I met them, we talked about their mental health state, about the medication, they can be here till the evening or till late afternoon, in the garden, sometimes during the day they can talk with every member of our staff, just be here and relax."
Although Dr Jarolimek founded his day care centre seventeen years ago, his pioneering establishment still remains a rare bird.
"Unfortunately the number of facilities like this is still very low in the Czech Republic. After the year 1989 we expected that the number of these day hospitals or crisis centres, which are very useful, very helpful for psychiatric patients, will be much higher. But it didn't happen. So now I think that in the whole of the Czech Republic we have five or six day hospitals only."
As far as the availability and range of psychiatric care is concerned, there are large differences between individual regions of the Czech Republic.
"Concerning care for mentally ill people, Prague is the place for them. On the other hand, there are some areas in our country where there is nothing. For example, in the west or the south of the Czech Republic. For example one psychiatric patient has to travel a distance of 100 kilometres to find his psychiatrist for medication. So it's horrible."
Last year the Association for Mental Health, chaired by Dr Jarolimek, opened a community centre on a farm in the village of Stritez in South Bohemia. It is the very first such facility catering for people with schizophrenia.
"It is a farm but it is not psychotherapeutic because I want life on this farm to be very similar to normal life. Without psychotherapy. Now fourteen or fifteen long-term mentally ill patients live there. They were there in the garden, they have some animals, some chickens, some goats etc. They have daily work in one sheltered workshop which we have on this farm. So it is mainly about rehabilitation, social and vocational, for them to be prepared after one year or a year and a half to go back to normal life and to survive and to be maybe successful in normal life."
Doctor Martin Jarolimek has for many years been a staunch champion of integration of the mentally ill into society and a campaigner for community care, even in the days when an alternative to institutional care was hardly conceivable. His conviction stems from experience.
"You know, twenty-five years ago I worked at two big and horrible psychiatric hospitals. For me it was a good experience but a very horrible experience at the same time. After that I realised that I preferred a completely different type of care, which is called community care. So care which is closer to the people, care which isn't stigmatising the people compared to psychiatric hospitals. As I told you, seventeen years ago I established this day hospital, after that I started to run other organisations for vocational rehabilitation. One is called Green Doors and it runs three training cafes for psychiatric patients, mainly for schizophrenics. The other organisation is called Baobab and it is for leisure time or free time of the patients. So this is my way..."
A few years ago, Dr Jarolimek and his like-minded colleagues put forth a new model of psychiatric care in the Czech Republic. So far, they have offered the material to four successive health ministers for approval. They have not been successful. In a sad voice Dr Martin Jarolimek says he thinks the general quality of psychiatric care has not much improved since the fall of communism in 1989.
