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Removing the Stigma

How can the Czech Republic have such low rates of depression and still so many suicides?

by Charlie Mitchell 23 January 2018

Jan Chylik remembers well what it was like when the depression he suffered as a teenager began to worsen, yet he was too embarrassed to seek help.  “I was avoiding meeting and even communicating with people, even those who were really close to me, family and friends.” He felt as though the people around him wouldn’t understand what he was going through, that they would believe the myths that only a traumatic event could bring on depression or that it isn’t a real sickness.

 

“Czechs need to know that this is an illness or disease like any other. It can be cured,” Chylik says. “Depressed people just need help from outside. They can't handle it by themselves.”

 

Statistics would suggest that one reason for such ignorance could be that, at least officially, Czechs rarely encounter anyone with depression, as compared with their European peers. The Czech Republic has the lowest reported rates of depression in the EU, with less than three percent of its population estimated to have “depressive symptoms,” according to the 2015 European Health Interview Survey. This is particularly surprising considering that a country such as the United Kingdom, for example, spends three times as much as the Czech Republic on mental health treatment, yet still has a percentage of people with depressive symptoms three times higher.

 

Back in 2013, figures published by Health Grove, which draws data from the Global Burden of Disease Study and other sources, indicated very low rates of mental illnesses in the Czech Republic, specifically in terms of anxiety and depressive disorders, in relation to the rest of the EU. And, there is little evidence to suggest things have changed. In terms of Major Depressive Disorders (MDD), which include more severe forms of depression, the figures are especially surprising. Survey-based research, conducted by the World Health Organization (WHO), has revealed that just one percent of the Czech population suffers from MDD. For comparison’s sake, in the United States, this figure is 16.9 percent.

 

Given such figures, one might assume fewer people in the Czech Republic end up taking their own lives. The opposite, however, is true. Though depression rates and MDD rates are so low, in comparison to countries such as the United Kingdom and the United States, the suicide rate in the Czech Republic is significantly higher. According to a 2016 OECD report (OECD), the suicide rate in the Czech Republic was 14.2 per 100,000. Whereas the UK and the US suicide rates were recorded as 10.1 and 12.93 per 100,000 population, by the Office for National Statistics (ONS)  and the American Foundation for Suicide Prevention (AFS) respectively, in the same year.  

 

What’s Going on Here?

 

A major part of the explanation may be that Czechs simply remain very reluctant to admit to suffering from mental illness, including depression, and the above data depends often on answers supplied through surveys about mental wellbeing.

 

“Stigma, in regards to mental illness, is a big problem,” says Lubos Chlad, a therapist and social worker at Bohnice, the country’s most well-known psychiatric hospital. He blames the communist heritage: “Before the 1989 revolution, there were no possibilities to speak about mental illness.” This statement is supported by a study published in The Lancet, which asserts how mental health issues were either misrepresented or neglected by the former communist regime, to deter a serious conversation the matter.

 

In The Lancet article, the author Katka Krosnar states: “Experts say that mental health issues were either neglected or misused by the former communist regime... During that time society looked very negatively on anyone who admitted to having mental-health problems.”

 

The Bohnice psychiatric hospital. Image via Psychiatricka nemocnice Bohnice/Facebook.

 

In addition to this, Rostislav Kotrc, who, at the time of publication, was Executive Director for the Czech Association for Mental Health, asserted that “under the communist regime anyone admitting to have a mental illness was automatically excluded from society.”

 

This exclusion and lack of opportunity to discuss mental illness could be the reason why depression rates are well below the EU average for two-thirds of the countries that were once part of the Soviet Union or Soviet-controlled Eastern bloc, which are now part of the EU.

 

Dr. Vanda Lukacova, a psychiatrist at Prague’s Military Hospital, says that the old regime also muddled the general public’s view of mental health by presenting people who didn’t agree with the communist agenda to be mentally ill. That strongly suggested that “it is not possible to disagree with communism and be normal,” she says. “So, from time to time it happened that political prisoners ended up in psychiatric hospitals.”

 

That is likely to have created confusion over what it meant to be mentally ill. And it would have also meant that those with a genuine need for psychiatric care would have been treated alongside “criminals,” who would have been detained in the same psychiatric hospitals.

 

Undoubtedly, that would have made the option of getting treatment that much more unappealing, and perhaps even frightening, says Lukacova. The result could be, she said, that “in some people is this fear of psychiatric illness, which is a different type of stigmatization,” she says.

 

The low numbers of people self-reporting depression and other mental health problems likely also stems from a shortage in professionals able to listen to them and diagnose such illnesses.  While the Czech Republic does have some respected mental health facilities in its big cities, it does trail some other EU countries greatly in terms of human mental health resources. When the WHO last published the number of mental health workers in the Czech Republic, in 2011, the country had considerably less people in roles such as psychiatrists, psychologists, and social workers per percentage of the population, than other countries within the EU. This is highlighted below.

 

Home Remedies

 

Those low numbers translate into an insufficient amount of community centers in more remote areas of the Czech Republic – and too few social workers making the trek to such places.

 

“In the countryside, it is a little bit harder to go to psychiatrists because there is a bigger fear of stigmatization than in the big city. So, they [people living in the countryside] try and treat it at home,” says Lukacova. “People in big cities are more likely to go to psychiatrists because of the possibilities and the anonymity.” And those suffering from depression also often lack the will or energy to journey to far-off cities in search of treatment.

 

Various events have taken place over the years to break down stereotypes of those with mental illnesses and remove the stigma associated with depression and other ailments. “Education is the only way – to talk about it on television and on radio and to create some campaigns that engage people,” says Lukacova.

 

The most prominent event with such a goal is Mezi Ploty (“Between the Fences”), a music festival that takes place at the Bohnice psychiatric hospital and annually attracts thousands of people and major Czech musicians. Profits go toward treating the hospital’s patients.

 

A calendar of events organized in 2017 at the Bohnice psychiatric hospital, including the Mezi Ploty festival. Image via Psychiatricka nemocnice Bohnice/Facebook.

 

In addition to pitching in with the organization of the festival, Chlad, the therapist, also helps to put together smaller events around Prague, which aim to assist those with different mental illnesses.

 

 “We try and create different destigmatization platforms through events and try to interact with the nearby communities of Prague,” Chlad says. “While Mezi Ploty is a good platform for mental health, it takes a year to organize and all your energy is focused on just one day every year. But, mental health patients need support all year around.” He also said that a key is to create different types of events – not just music festivals – but lectures, sport matches, and so on to engage diverse groups of people.

 

 “In the Czech Republic, it is more important to run events because they are the most popular way to engage with people,” he says. “And, if people are struggling, it is much easier to attend an event and talk to others than go to a hospital or psychiatrist.”

 

Unfortunately, the reach of these events doesn’t go much further than Prague, Chlad acknowledges. “It’s hard to get the grants, so funding is currently a major issue.”

 

Still, the situation is improving, and those like Jan Chylik should feel at least a little more comfortable discussing their depression with others and reaching out for help. Recent data indicate that twice as many people now seek treatment at Czech psychiatric wards for neurotic disorders than did in 1988 (though it remains unclear if that is a result of a reduction in the stigma of seeking assistance or a rise in mental illness, or both).

 

“It is getting better,” says Chlad. “We are beginning to speak about it a bit more and, for each generation, the conversation is getting better.”

Charlie Mitchell is a freelance journalist who writes on social and political topics.

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