Arbitrary detention of every person – In the absence of any enforceable law or procedures for independent judicial review of commitment, every person in Turkey’s psychiatric facilities are detained arbitrarily and in violation of international law;
The inhumane and pervasive use of electroconvulsive or “shock” treatment (ECT) without the use of muscle relaxants, anesthesia, and oxygenation(referred to as “unmodified” ECT) in state-run institutions – ECT is a psychiatric treatment whereby electricity is administered to the brain and is thought to alleviate certain conditions that do not respond to more conventional treatment. However, in its unmodified form, it is extremely painful, frightening and dangerous and violates the European Convention for the Prevention of Torture. The World Health Organization (WHO) has called for an outright ban on unmodified ECT.
I only had ECT one time. It was the first and the last time. They hold you down, they hold your arms, they hold your head and they put cotton in your mouth. I
heard them say 70 to 110 volts. I felt the electricity and the pain, I felt like dying. – 28-year-old former Bakirköy psychiatric patient
The use of ECT as punishment - The director of the ECT center at Bakirköy Psychiatric Hospital, one of the largest institutions in the world, told MDRI investigators that they do not use anesthesia because “patients with major depression feel that they need to be punished.” Patients cannot refuse this treatment and they are frequently lied to and told they are getting an x-ray. Terrorized people are commonly dragged into the ECT room in straitjackets and are forcibly held down by staff during the procedure. ECT without the use of anesthesia and muscle relaxants violates all internationally accepted medical standards. Other psychiatrists observed that, because there are no standards on the use of ECT in Turkey, ECT is abused and used as punishment.
We use ECT for people with major depression. Patients with major depression feel that they need to be punished. If we use anesthesia the ECT won’t be as effective because they won’t feel punished. – Chief of ECT Center,Bakirköy
The use of ECT on adolescents and children – The WHO has stated that there are no clinical indications for the use of ECT (even with anesthesia) on children and the practice should be banned in all cases. Psychiatrists report that ECT is regularly administered to adolescents and on rare occaisions on children. In Turkey, children as young as nine years old are administered ECT withoutanesthesia.
Over-use of ECT – ECT is massively overused in Turkish psychiatric facilities in cases for which there is no clinically proven justification. ECT is used for the convenience of institutional authorities when more appropriate services in the community are unavailable. The over-use of ECT exposes thousands of people to unnecessary, frightening and dangerous experiences and violates the Turkish government’s own public commitments to the European Committee for the Prevention of Torture.
Rehabilitation Centers and Orphanages
I love my daughter, but I hope she dies before I do. I do not know what will happen to her after I die and can’t take care of her any longer. I do not want her ever to have to live in the institution.
– Director of a private school for children with mental disabilities
Starvation and dehydration – MDRI observed bedridden children, unable to feed themselves due to their disability, left inadequately fed and without assistance by staff. Investigators observed children emaciated from starvation. Staff reported children dying from starvation anddehydration.
Many of the children could not feed themselves. Some were struggling to hold onto or reach the bottles and much of the contents spilled out onto beds or wasn’t eaten. A little girl, who looked to be about 2 years old, was crying and squirming in her crib. A full bottle of formula was lying in the corner of her crib, just out of reach. I watched for over an hour, and no one came to feed her. She would have had nothing if I hadn’t eventually helped her.
Over the course of a number of feedings, I watched as staff came quickly into the room, dropped off bottles, and then picked up the bottles as they left the room. If a child could not pick up the bottle to eat or drink, shestarved.
MDRI investigator
Lack of rehabilitation and medical care – There is a broad lack of rehabilitation and physical therapy for children and adults with disabilities detained in orphanages and rehabilitation centers. Left to languish for years in a state of total inactivity, placement in these facilities is likely to contribute to a person’s disability. Children’s arms, legs, and spines become contorted and atrophy from the lack of activity or physical therapy. The effect of living without loving care-takers or any form of stimulation causes some children to become self-abusive. Rehabilitation centers offer no assistance for self-abusive children other than to tie them down. According to staff at one facility, children with the most severe physical and mental disabilities are denied medical care when they become ill and are left to die.
Nurses come to the units and stand in the doorway. They ask workers if there are any sick children, they just yell in. The workers always say no even if the children are very ill. When children get sick, they are no longer bathed and are not allowed to be taken out of bed. They are tied into their beds at times. If children are not taken care of, they do die. One is dying now.
Saray staff
The use of physical restraints and seclusion on both children and adults – MDRI observed children tied to cribs and beds, some of them permanently restrained. Four point restraint, that is, legs and arms tied to the four corners of the crib or bed, is also used. Children who scratch or hurt themselves – a reaction to the mind-numbing boredom they are forced to endure – were found with plastic bottles permanently duct taped over their hands. MDRI investigators also found a young child locked in a tiny room alone. At another institution we observed a small seclusion room with no toilet, reeking of urine.
Personnel get cut in half on the weekends. On some of the units, children are restrained. If you let them go, they go after the quiet children. They are just bored and frustrated. So they are restrained all the time. [The children] are between 7 and 15 years old. – Saraystaff
Lack of communitycare
People with mental disabilities and families are abandoned – Community-based care and supports are almost entirely unavailable for people with mental disabilities. Throughout the world, it has been demonstrated that community programs can help people with mental disabilities (either psychiatric or intellectual) live fully as part of society, to enjoy relations with family members and friends, and to take advantage of educational opportunities, work and cultural life. Without such support, people with mental disabilities in Turkey are often segregated from society in institutions or their own homes. People with mental disabilities may have no choice but to depend on families for a life-time. Without adequate support, family members often become overwhelmed and impoverished.
