Report Examines Hungary's Mental Health System

By Eric Rosenthal

Mental Disability Rights International (MDRI), an advocacy organization dedicated to the international recognition and enforcement of the rights of people with mental disabilities, recently released a report based on a fact-finding mission to investigate the human rights situation within Hungary’s mental health system. Human Rights & Mental Health: Hungary examines that country’s compliance with international human rights laws, as set forth in international treaties such as the International Covenant on Civil and Political Rights and the 1991 United Nations Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (the MI Principles).

Human Rights and Mental Health: Hungary is a product of a three-year collaboration between MDRI and Hungarian disability advocacy groups representing consumers, family members, and progressive mental health providers. The report is based on interviews with psychiatric institution directors, staff, and patients, and with government officials, judges, and others involved in civil commitment and guardianship proceedings. Local collaborators also included human rights organizations, such as the Hungarian Civil Liberties Union and the Awakenings Foundation.

Hungary’s mental health system is still largely based on custodial, institution-based care. The official mental health system is comprised of large psychiatric hospitals and the psychiatric wards of general hospitals. Unfortunately, these programs do not link with community-based services, since the Hungarian government has preferred to support in-patient “neurosis wards” in lieu of community care. Thus, many patients who might best be served in the community find themselves unnecessarily forced to receive treatment in in-patient psychiatric settings. Approximately 7,000 people who have been labeled “beyond treatment” reside, segregated for life, in remote “social care homes.” Since these homes are technically outside the purview of the mental health system, their residents have little or no opportunity to obtain rehabilitation or other support that might give them hope of someday returning to their communities.

MDRI fact-finding teams documented serious human rights violations in the Hungarian institutions. The most grievous abuses occurred in the social care homes. For instance, MDRI visited one home at around 5:00pm in the afternoon to find a dark room populated by 19 patients in cages. The cages — seven by four foot metal frames placed over each bed — virtually jailed patients, allowing them no room to either sit up or move around. Left to defecate in bed pans that usually spilled over onto the sheets, the patients were subject to bed sores and other life-threatening infections. The home’s acting director said that the cages were necessary because there were not enough staff to spend full-time with the patients. According to the ward staff, the patients are held in the cages for months at a time.

Human Rights and Mental Health: Hungary cites the MI Principles and other international human rights treaties in urging the government of Hungary to initiate an open, public national planning process to bring the country’s mental health system into conformity with international human rights law. A broad range of service providers and local advocacy groups — many of which were trained by MDRI with support from the Open Society Institute — have welcomed and used the report in their efforts to stave off government cut-backs in mental health services and to obtain public support for community-based mental health programs.

Public support for the recommendations proposed by the MDRI report has lead to positive change. The Hungarian Ministry of Health and Social Welfare has proposed that many of the MI Principle provisions — including the right to treatment in the least restrictive environment — be incorporated into the new Health Act currently under consideration by the Parliament. And, the Hungarian Psychiatric Association has drafted new professional guidelines that adopt international standards on the use of physical restraints, such as cages. Advocates are now working to have these standards added to the new Act.

Critical to the process of change is compliance with the United Nations Standard Rules on Equalization of Opportunities for Persons with Disabilities, which stipulate that the disabled have a right to be included in the national planning process. As part of our continued commitment to mental health reform in Hungary, MDRI is working closely with Hungarian partners to create a new Disability Council. The Council will offer disability activists the opportunity to engage their government in dialogue about the challenges of reform and human rights enforcement that lie ahead.

Eric Rosenthal is Executive Director of MDRI. For further information about Human Rights and Mental Health: Hungary, readers may contact Mr. Rosenthal at Mental Disability Rights International, c/o Judge David L. Bazelon Center for Mental Health Law, 1101 15th Street, NW, Suite 1212, Washington, DC 20005-5002; 202/467-5730 (telephone); 202/223-0409 (fax); or (email).