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Latent, hidden processes are usually thought to be the most dangerous. If someone has deep psychological problems, even those close to the sufferer often do not know about it. The consequences of psychological depression can be dreadful. This is why it is so important to focus attention on mental health problems, as many people do not want to seek psychiatric help in their hour of need for fear of being labelled a "psycho". This is one of the reasons why 10 October has been marked as World Mental Health Day since 1992 at the initiative of the World Federation for Mental Health. The aim is to raise awareness of the problem of discrimination against people with mental health issues. 

Depression, suicide, divorce

This issue is topical for Azerbaijan. There are very many people in Azerbaijan suffering from psychological problems who refuse to consult specialists for fear that society will misinterpret this, Dayanat Rzayev, chief psychologist at the Regional Psychology Centre, told R+. "Moreover, very often people with psychological problems receive help and treatment only at the final stage, when it's difficult to help a patient. It should not be forgotten either that there is a major lack of qualified personnel in Azerbaijan. It is important to understand that psychologists and psychiatrists are doctors of the spirit. The first part of the word 'psychology' translates from the Greek as 'spirit' or 'psyche'. This means that if someone has psychological problems, then the root of the problems must be found, which can be done only by specialists, and there aren't many of them in Azerbaijan."

 Our country has a shortage of practising psychologists. "I am very worried by our preference for consulting fortune-tellers, witches and faith healers over any difficulties or mental anxieties. In so doing, we drive ourselves into a blind alley which does not even have a way out. Statistics show that some 200,000 psychologists are practising in North America today, while in Nigeria there are 100 and in China 500. One in five students in America is educated in psychology and, by the way, most of them, almost 90 per cent, are women. I think that instead of 200,000 qualified psychologists in Azerbaijan, far more fortune-tellers and shamans are 'treating the spirit'," Dayanat Rzayev says. There are 22.2 qualified personnel working in Azerbaijan's state psychiatric institutions and in private practice for every 100,000 people. Ninety-two per cent of psychiatrists work only in state psychiatric institutions, while practising psychologists should include marriage consultants, whom we don't have, sex experts and sex pathologists, of whom there is a severe shortage, the psychologist said. 

More than 80,000 people a year in Azerbaijan seek help for their mental health - these are the figures of the local representative office of the World Health Organization (WHO). However, the Baku office is convinced that this is just the tip of the iceberg of people who really need to consult a specialist. The WHO calculates that there are more than 450 million people suffering from mental illness in the world today. 

One dangerous trend is the annual increase in the number of suicides in Azerbaijan. This shows that more and more people are experiencing deep, personal anxiety and depression and can no longer cope. There are various reasons for suicide but one symptom - mental instability - which requires timely expert intervention. There is no targeted work in Azerbaijan to prevent suicide. True, in comparison with Western countries the level of suicide in Azerbaijan is not that high. This does not mean, however, that these issues can be ignored - laws need to be passed on psychiatric safety, mental health and psychotherapy. The relevant ministries and departments should take the initiative on this. In Azerbaijan it is only possible to consult a private psychologist over personal or family problems - the country does not yet have state psychological services.

Dayanat Rzayev says that "hot lines" or "confidential phone services" - services that are very popular in the West - could provide considerable social and psychological assistance. "We had this kind of psychological assistance service set up by UNICEF. Children with limited physical abilities worked there. They were not professionals but their tough life experience as disabled people helped them in their work. They gave telephone consultations and did very well. But since it could not pay its way, the service closed down. I can, therefore, say with confidence that the level of preventative psychological work in Azerbaijan is zero. The number of suicides is increasing. We should think about this. It's not that difficult to set up a confidential phone service at the state level. And if the service manages to avert just one suicide, that will be a great victory," the psychologist said.

A large percentage of divorces in Azerbaijan are related to stress and depression, Dayanat Rzayev thinks. Couples' sexual problems are often the cause of the collapse of families. Problems will make themselves felt eventually. "Typically, men experience problems in sexual relations but rarely consult psychotherapists, which leads to family conflict and marriage breakdown," the specialist said.

Action plan 

Until recently mental health did not receive enough attention in Azerbaijan, but the Health Ministry's chief psychiatrist, Garay Garaybayli, is convinced that this situation is about to improve. He said that work has been under way since 2006 on a national policy on mental health. The programme has already received expert review by international organizations and it includes a 10-year plan of concrete action aimed at improving psychiatric services and mental health. Asked whether the amount of mental illness had increased in Azerbaijan recently, Garay Garaybayli said that there was an upward trend in illnesses related to stress, natural and social disasters, information overload and changes in life and lifestyle. Anxiety phobias are the result: depression and other borderline conditions and post-traumatic stress syndrome are a reaction to stress. These illnesses are also on the increase in Azerbaijan, as a country integrated into the world community. Mental illnesses are not uniform diseases, they can include chronic psychoses too, but the latter are not increasing rapidly.

Garay Garaybayli also said that people in Azerbaijan are very wary of consulting a psychologist or psychiatrist: "When you realize that many family conflicts and divorces could be avoided by an ordinary consultation with a specialist, you decide that action must be taken to overcome the problem of social 'stigmatization'," (from the word 'stigma' meaning 'mark, i.e. 'to mark - Author). The network of institutions providing psychiatric and psychological help is to be expanded. They will operate either as psychological health centres or psychological consultation centres. "It is hard for someone to make themselves go into a psychiatric hospital as a medical institution to consult a psychiatrist. These clinics are popularly known as 'nut houses'. If a psychiatrist receives visitors in psychological centres, where the atmosphere is quite different, this will look like an ordinary trip to the polyclinic," the country's chief psychiatrist is convinced.

The latest figures in the report on psychological health in Azerbaijan, compiled by the WHO's Baku office and endorsed by the Health Ministry, show that the state spends $0.34 per head of population on mental health a year. Some psychiatric disorders, such as mild or moderate depression or anxiety, are not considered serious emotional problems: the concept of "mental illness" is associated only with severe psychiatric disorder. While there is a lack of mental health institutions, the conditions and equipment in those that do exist do not meet modern medical standards. The overwhelming majority of these institutions are in old, dilapidated buildings which do not have the necessary water supply and heating. 

 The Health Ministry spends 3 per cent of its overall health care expenditure on mental health, according to WHO calculations. Eighty-five per cent of the funds allocated to this sphere go to psychiatric hospitals. 

The report says that, fearing the label of "psychiatric patient", people prefer not to be registered as patients. They thereby lose their entitlement to free psychotropic medication and have to pay for their medicines themselves. 

The report also says that Azerbaijan does not have a proper mental health structure. The country has 11 out-patient psychiatric institutions, of which only one is intended for children and teenagers. Some 25 per cent of patients who are treated in the out-patient psychiatric institutions are women, while around 16 per cent are children and teenagers. For cultural reasons, women in Azerbaijan do not seek psychiatric help as often as men; they more often find support from family and relatives. Women have a greater fear of being labelled psychiatrically ill than men and their complaints are often not taken seriously. Those who visit out-patient psychiatric institutions because of mental health problems and behavioural disorders are diagnosed with neuroses, stress, somatic illnesses (25 per cent) and schizophrenia and with illnesses that have symptoms of schizophrenia and delusion (19 per cent).