Helsinki Citizens’ Assembly-Vanadzor

Within the framework of this report, the observation group in Psychiatric hospitals studied the components of ensuring personal hygiene of persons receiving treatment and care in 7 psychiatric hospitals of Armenia: organization of bathing, hand hygiene, provision of teeth, hair, and nail care, shortcomings of personal hygiene provision, and obstacles to its provision. 

The recorded problems related to the provision of conditions of personal hygiene for persons receiving treatment and care in hospitals are the following: 

• insufficient provision of personal space and conditions for storing personal belongings and/or absence at all 

The hospitals do not meet the minimum standards of having the necessary personal space. For this reason, persons receiving treatment and care are deprived, among other things, of the opportunity to keep their personal belongings, including hygiene and care items, separate. The observation group noted the discrepancy between the number of side closets and the number of beds, the dense arrangement of beds in the rooms, which makes entry and exit difficult, and closets for storing clothes are generally absent. 

• necessary for ensuring personal hygiene 

• improper sanitary and hygienic conditions of the areas
• insufficient amount of sanitary ware (shower, toilet, sink) and furniture (chair, non-slip mats) necessary for safe bathing
• Improper quality and dispensing procedure, insufficient quantity, or absence at all of supplies (shampoo, shaving foam, sanitary pads, etc.) 

As a rule, 1-3 toilets were installed in the wards, and the number of persons receiving treatment and care in the observation days was 7-65. The number of persons using one toilet was reaching up to 43 in the psychiatric hospitals. The problem becomes more serious when the toilet gets clogged. For example, on the visit day of the Gyumri mental health center, all three toilets provided for men were clogged, and the patients were using the toilets provided for the employees. 

The problem of cleanliness of the toilets, as well as ensuring the privacy of persons receiving treatment and care while using the toilet, was also recorded. In particular, the toilets are separated only on three sides (National Center of Mental Health Care and "Avan" Mental Health Center) or not at all (Sevan Mental Health Center). In other words, there is no separate space for taking care of personal needs. 

Moreover, the sinks are installed at the same places as toilets are. In other words, three persons can use the toilets, which do not have doors, and at the same time another three persons can use the sinks. This cannot be acceptable from the point of view of human dignity. 

One bathroom with one shower is generally available in wards of psychiatric hospitals. In hospitals where there are 2-3 showers in one bathroom, they are separated by partitions, except for the Sevan Mental Health Center. In the bathrooms, with the exception of the Lori Regional Neuropsychiatric Dispensary, a regular chair is used, which does not correspond to the description of a bathroom chair and, as a rule, is worn out. 

In the Syunik Regional Neuropsychiatric Dispensary, showering lasts 5-10 minutes. In Armash Health Center, named after Academician A. Hayriyan, three patients use one shower at the same time (with a total duration of 15 minutes). One of the beneficiaries notes. 

While one uses soap, the other uses water, and another one takes off their clothes. In this way, it is speedy, and the water suffices. 

Washing is not individualized; even underwear is not separated and individualized. At best, it is separated by wards. In other words, after washing one person's clothes (including underwear) in the ward, another person can receive them. 

In Armash Health Center, named after Academician A. Hayriyan, in case of water supply failure, persons receiving treatment and care wash their hands with water collected in a broken, unclean container, which was half-empty on the day of the visit, and the water was cloudy. Moreover, there was not even a small pot to take water. 

•  unavailability of water (especially hot)

For example, in Lori Regional Neuropsychiatric Dispensary, hot water is usually poured into bottles and given to the persons receiving treatment and care. In the Gyumri Mental Health Center, it is necessary to turn on the water pump for hot water in the bathroom. At the National Center of Mental Health Care and "Avan" Mental Health Center, constant hot water is available only in the winter months; in other months there is no hot water in the evening hours, and in this case it is as well probably for persons receiving treatment and care to take hot water in bottles for later use. 

• insufficient amount of human resources necessary for proper maintenance of hygiene rules

Monitoring results show that the number of staff in psychiatric hospitals is insufficient to properly maintain hygiene rules for 40-65 people in the ward, to support each as needed, and to work with them individually to develop self-care skills. Meanwhile, in the case of 5–10 people who need support, it is more realistic to ensure such support. 

You can get acquainted with a number of other recorded problems and recommendations HERE.

The psychiatric hospitals the observation group visited are the following:

"Avan" Mental Health Center” CJSC 

“National Center of Mental Health Care” CJSC

“Sevan Mental Health Center” CJSC

“Armash Health Center named after Academician A. Hayriyan” CJSC

“Gyumri Mental Health Center” CJSC

“Lori Regional Neuropsychiatric Dispensary” CJSC

“Syunik Regional Neuropsychiatric Dispensary” CJSC