A Eurasianet partner post from The Guardian
It started as a family row over property. Julietta Amarikian and her brother were arguing about a flat they had jointly inherited from their parents. She wanted to sell and share the proceeds; he wanted her to move out so he could live there with his wife.
The conflict escalated and Amarikian says her brother, unable to get his way, threatened to have her committed to a psychiatric institution if she would not cooperate.
She did not take him seriously at first but when police and medics in white gowns arrived at her door a few days later, she realised he had not been joking.
The 54-year-old says she was taken by force to a Yerevan mental health clinic where she was held for a month against her will. “They locked me up and left me,” she says. “No one even examined me. I was terrified. I thought it was the end of me.
“I have never had problems with my mental health,” she adds. “I only had problems with my brother.”
Human rights workers say that Amarikian’s experience is not unique in Armenia, where it is all too easy to have someone declared mentally incompetent in a hangover from Soviet times when institutionalisation was sometimes used to silence troublemakers.
Under Armenian law, one phone call to the police or a psychiatric institution claiming that someone is a risk to themselves or others is enough to have them hospitalised. If the person refuses to be admitted, the hospital can apply to a court for a mandatory treatment order – without the patient being represented.
An examination by a “psychiatric commission” is required within 72 hours of the order, but staff from the same hospital usually make up the panel. There is no requirement to periodically review the decision and the law does not set limits on the duration of treatment.
Not only is the law open to abuse, human rights workers claim there are perverse incentives for institutions to admit people unnecessarily.
Hospitals are paid 6,000 drams (about €11) a day for each inpatient – a significant amount in a country where the official state pension is 16,000 drams a month.
According to the data provided by the Armenian judicial department, 1,367 people were ruled mentally incompetent between 2008 and 2014. Of these, 247 were committed to psychiatric institutions against their will.
The Armenian state deputy ombudsman, Tatevik Khachatrian, believes the legislation requires complete revision.
“We have registered cases when people with no mental illness were locked away in institutions where they were tied up and abused,” Khachatrian said. “The legislation inherited from the Soviet years is so outdated that our help in most cases is minimal, when the person is already in a hospital.”
Artur Sakunts, head of the Armenian branch of the human rights NGO Helsinki Citizen’s Assembly, said his organisation had documented cases of forced committals being used to solve conflicts over property, inheritance or relationships.
“The situation is disturbing,” said Sakunts. “A person might be completely healthy but just one phone call from relatives, neighbours or someone else who has a grudge against them could lead to them being picked up by police and locked up in a psychiatric institution indefinitely.”
Faced with a lengthy incarceration, Amarikian was lucky. A human right activist visiting the clinic became aware of her case and helped her launch a court appeal to secure her release.
Amarikian was allowed out of the institution while her case was reviewed, but her battle to prove her competency is ongoing.
“With our help Julietta Amarikian was able to overturn the court’s decision and was released,” said Marietta Temurian, of the Helsinki Citizen’s Assembly.
Amarikian’s brother has refused to comment on the allegations against him.
Narine Avetisian was not as fortunate. The 46-year-old spent six years in a psychiatric institution as a teenager after falling out with her family. Avetisian says it started when she was raped by a relative at 14, and tried to press charges against him.
“My mother was telling me to keep quiet,” she said. “No one believed me. When I was 15 I was sent to a psychiatric clinic upon [a family member’s] request. I spent all my young years trying to escape from mental hospitals, being humiliated and feeling abandoned by everyone,” Avetisian said.
The teenager managed to escape from the institution, and eventually left Armenia to live in Denmark. She returned 30 years later to confront her rapist, and her story was made the subject of a popular television show.
The Armenian singer Sona Avagyan was another to fall foul of the arbitrary incarceration – not once but twice.
Her first hospitalisation ended after an intervention by the office of the ombudsman, but the psychiatric facility was granted a court order to have her re-admitted. Avagyan says the order was granted in her absence, and that her parents were refused permission to visit her in hospital.
After 37 days as an inpatient she was released from hospital, and has taken her case to to the European Court for Human Rights.
Human rights defenders say that publicity around these cases has drawn attention to the problem, but that the government has failed to act.
“We presented the government with suggestions, such as creating an independent body at psychiatric hospitals and amending the law to offer adequate protection, but we haven’t had a response from them,” said Sakunts.
Hospitals deny abusing the law, saying forced admissions are sometimes necessary. “A healthy person cannot appear in a mental hospital; that is impossible,” said Arega Hakobyan, the head of a clinic in Yerevan. “It is up to doctors, and not to human rights activists, to decide whether a person is sick or healthy.”
But the government seems prepared to admit that this is a concern. “If a problem is being discussed, it means the problem does exist,” said the health ministry’s chief psychiatrist Samvel Torosyan. “The more we develop the legislation to make it more accessible and clear, the more the patients will benefit; increased transparency will result in greater trust.”
For Amarikian, reforms cannot come soon enough. “All I wanted was to live in a corner of my own but [after being institutionalised] I have no idea what will happen to me next. Every moment I fear that all that horror is not over.