Türkiye'de Ruh Sağlığı Politikası Reformu: Kullanıcı Gruplarının Yaklaşımı Üzerine Nitel Bir Çalışma

Abstract

Türkiye'nin ruh sağlığı politikası, 2006'dan beri bir dönüşüm sürecinden geçmektedir. Bu değişimin temel amacı, toplum temelli ruh sağlığı hizmetlerinin kurulmasına öncelik vermek ve ülke çapında erişilebilir bir ruh sağlığı hizmet ağını kurmaktır. Bu çalışmanın temel amacı Türkiye'de ruh sağlığı politikası değişikliğinin siyasetini analiz etmekle birlikte bu süreçte kullanıcı gruplarının rolünü ve ruh sağlığı kullanıcı gruplarının bu dönüşüm hakkındaki görüşlerinin nitel analizini ortaya koymaktır. Bu bağlamda, 2018 yılının Nisan ve Haziran ayları arasında Ankara, İstanbul ve İzmir'de ruh sağlığı kullanıcı gruplarının temsilcileriyle yürütülen 13 adet derinlemesine yarı yapılandırılmış görüşmeler gerçekleştirilmiştir. Bu makale, bu politika değişikliğinin hastane-toplum dengeli bakım modeli halini aldığını ve toplum temelli ruh sağlığı hizmetlerinin ruh sağlığı hizmetlerinin kullanımını ve erişimini arttırdığını ortaya koymuştur. Öte yandan, toplum temelli ruh sağlığı hizmetlerinin, kullanıcıların iyileşme süreçlerine sadece tıbbi açıdan yaklaşımları nedeniyle katılımcılar tarafından sorgulandığını ve bu politika değişikliğinin, Türkiye’deki ruh sağlığı sistemine iyileşmeyi kolaylaştıracak, sadece tıbbi destek yoluyla değil aynı zamanda ruh sağlığı sorunları yaşayan bireyleri güçlendirecek sosyal destek yoluyla bütüncül bir bakış açısı getirmede yetersiz kaldığını göstermiştir.

Keywords

• toplum temelli ruh sağlığı hizmetleri
• ruh sağlığı politikası
• kullanıcı grupları
• sosyal hizmetler
• sosyal destek

Mental Healthcare Policy Reform in Turkey: A Qualitative Study on the Perspectives of User Groups

Abstract

The mental health policy of Turkey has been undergoing a transformation process since 2006. This change aims to prioritize the establishment of community-based mental health care services and to organize an accessible mental healthcare service network across the country. The main objective is to analyse the politics of mental health policy change in Turkey and to understand the role of user groups in this process by a qualitative analysis of the views of mental health user groups on these transformations. In this context, semi‐structured interviews were conducted with representatives (n = 13) of patient organisations based in Istanbul, Ankara and İzmir. This article reveals that this policy change took the form of the balanced care model, and the introduction of community-based mental health care centers provided to increase the utilization of mental health care services. However, the services in community-based settings were questioned by the respondents due to their purely medical approach to users' recovery processes and this policy change falls short of introducing a holistic perspective to the Turkish mental health care system that would facilitate recovery not only through medical support but also through social support that would empower individuals living with mental health issues.

Keywords

• community-based mental healthcare services
• mental health policy
• user- groups
• social services
• social support

References

1. Anthony, W.A. (1993). Recovery from mental illness: the guiding vision of the mental health service system in the 1990’s. Psychosocial Rehabilitation Journal, 16(4), 11–23.
2. Avşaroğlu, N. (2018). A cash-for-care scheme targeting children with disabilities in Turkey: Parent / caregiver perspective (Unpublished Master’s Thesis). Boğaziçi University, Istanbul, Turkey.
3. Bilge, A., Mermer, G., Çam, O., Çetinkaya, A., Erdoğan, Elif., Üçkuyu, N. (2016). Türkiye’deki toplum ruh sağlığı merkezlerinin 2013-2015 yıllarının profili. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 2(2), 1-5.
4. Bilir MK, Artvinli F. The history of mental health policy in Turkey: tradition, transition and transformation. History of Psychiatry. 2021;32(1):3-19. doi:10.1177/0957154X20966178
5. Caria, A. (2009). Psychiatric patients' rights and users’ groups. International Journal of Mental Health, 38(4), 70-76.
6. Chow, W. S. & Priebe, S. (2013). Understanding psychiatric institutionalization: A conceptual review. BMC Psychiatry,13:169. doi: 10.1186/1471-244X-13-169
7. Coşkun B (1987) Türkiye’de ruh Sağlığı hizmetleriyle ilgili varolan kaynaklar, bu konudaki güçlükler ve çözüm yollar [Resources, difficulties and solutions regarding mental health services in Turkey]. Toplum ve Hekim 44: 5–11.
8. Dole C (2015) The house that Saddam built: protest and psychiatry in post-disaster Turkey. Journal of the Ottoman and Turkish Studies Association 2(2): 281–305.

9. Fakhoury, W. & Priebe, S. (2007). Deinstitutionalization and reinstitutionalization: Major changes in the provision of mental healthcare. Psychiatry, 6(8), 313-316. doi: 10.1016/j.mppsy.2007.05.008
10. Guest, G., Bunce, A., Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Family Health International Field Methods, 18 (1), 59–82.
11. Gökalp RP and Aküzüm NZ (2007) Community mental health services in Turkey: past and future. International Journal of Mental Health 36(3): 7–14.
12. Lauber, C., Anthony, M., Ajdacic-Gross, V., Rossler, W. (2004). What about psychiatrists' attitude to mentally ill people? European Psychiatry. 19(7), 423–427.
13. MFLSS 2020. _Istatistik Bulteni Ocak 2020 (Statistics Bulletin January 2020). Ankara: MFLSS
14. Ministry of Health of Turkey (2006). The National Mental Health Policy (NMHP) for Turkey. Retrieved December 20, 2018, from https://www.mindbank.info/item/69 Ministry of Health of Turkey. (2011). The National Mental Health Action Plan (2011-2023). Retrieved December 20, 2018, from https://www.psikolog.org.tr/doc/ulusal-ruh-sagligi-eylem-plani.pdf
15. Ministry of Health of Turkey (MoH) (2019b) 2020 Yılı Bütçe Sunumu – TBMM Plan ve Bütçe Komisyonu [2020 Budget Presentation – TBMM Plan and Budget Commission]. Ankara: Sağlık Bakanlığı.
16. Ministry of Health of Turkey (MoH) (2021) Health Statistics Yearbook 2019. Ministry of Health: Ankara. https://dosyasb.saglik.gov.tr/Eklenti/40564,saglik-istatistikleri-yilligi-2019pdf.pdf?0
17. Munir K, Ergene T, Tunaligil V, Erol N. A window of opportunity for the transformation of national mental health policy in Turkey following two major earthquakes. Harv Rev Psychiatry. 2004;12(4):238-251. doi:10.1080/10673220490509615
18. Muijen, Matt, and Andrew McCulloch. 2019. “Reform of Mental Health Services in Eastern
19. Europe and Former Soviet Republics: Progress and Challenges since 2005.” BJPsych Int 16 (1): 6–9. doi:10.1192/bji.2017.34.
20. OECD. (2014). Making mental health count: The social and economic costs of neglecting mental health care. Paris: OECD Publishing. doi: http://dx.doi.org/10.1787/9789264208445-en
21. Piat, M. (1992). Deinstitutionalization of the mentally ill: theory, policy and practice. Canadian Social Work Review, 9(2), 201-213.
22. Rochefort, D. A. (1997) From poorhouses to homelessness: Policy analysis and mental health care London: Auburn House.
23. Rose, D., MacDonald, D., Wilson, A., Crawford, M., Barnes, M., Omeni, E. (2016). Service user led organisations in mental health today. Journal of Mental Health, 25(3), 254-259.
24. Sartorius N, Schulze H. (2005). Reducing the stigma of mental illness: A report from a global association. Cambridge: Cambridge University Press.
25. Sercu, C. & Bracke, P. (2016). Stigma as a structural power in mental health care reform: An ethnographic study among mental health care professionals in Belgium. Archives of Psychiatric Nursing, 30(6), 710–716.
26. Speed, E. (2006). Patients, consumers and survivors: A case study of mental health service user discourses. Social Science and Medicine, 62(1), 28-38.
27. State Personnel Presidency. (2018). Retrieved December 20, 2018 from http://www.dpb.gov.tr/tr-tr/istatistikler/engelli-personel-ve-omss-istatistikleri
28. Piat, M. (1992). Deinstitutionalization of the mentally ill: theory, policy and practice. Canadian Social Work Review, 9(2), 201-213.
29. The Republic of Turkey (2005). Engelliler Hakkında Kanun (Law on Disabled People). Ankara: The Grand National Assembly of Turkey.
30. Thornicroft, G. & Bebbington, P. (1989). Deinstitutionalisation-from hospital closure to service development. British Journal of Psychiatry, 155: 739-753.
31. Thornicroft, G. & Tansella, M. (2002). Balancing community-based and hospital-based mental health care. World Psychiatry, 1:2.
32. Thornicroft, G. & Tansella, M. (2004). Components of a modern mental health service: a pragmatic balance of community and hospital care. British Journal of Psychiatry, 185: 283-290.
33. Thornicroft, G. (2006). Shunned: Discrimination against people with mental illness. Oxford University Press.
34. Thornicroft, G. & Tansella, M. (2013). The balanced care model for global mental health. Psychological Medicine, 43(4), 849–863.
35. WHO 2019. European Health Information Gateway j Health for All Explorer. Accessed 31 July 2021 https://gateway.euro.who.int/en/hfa-explorer/
36. Yazici, A., Temiz, M., Erkoç, Ş., Yıldız, Ö. (2007). Psychiatric rehabilitation services in Turkey. International Journal of Mental Health, 36(3), 15-20.
37. Yılmaz, V. (2012). İnsan hakları ve karşılaştırmalı sosyal politika yaklaşımı ışığında Türkiye'de ruh sağlığı politikaları: Tespitler ve öneriler. İstanbul: RUSİHAK Yayınları.
38. Yılmaz, V. & Bilir, MK. (2020) A rights-based critique of the Turkish mental healthcare reform: deinstitutionalisation without independent living?, Disability & Society, DOI: 10.1080/09687599.2020.1867072
39. Yılmaz, V. (2017). The politics of healthcare reform in Turkey. Cham: Palgrave Macmillan.
40. Zengin, Fatma. And RUSIHAK 2017. “Turkey.” In Mapping and Understanding Exclusion: Institutional, Coercive and Community-Based Services and Practices across Europe, edited by Agnes Turnpenny, G abor Petri, Ailbhe Finn, Julie Beadle-Brown and Maria Nyman, 169–174. Brussels: Mental Health Europe and Tizard Centre at the University of Kent.