On a long, narrow road: The mental health law in Turkey

This article presents the historical transformation of the mental health system and policies in the case of Turkey and discusses the challenges to their effective implementation. The mental health system in Turkey has undergone a series of reforms in three periods, namely, the institutionalization of psychiatry and hospital-based mental health services in the mid-19th century, the introduction of first-generation community-based mental healthcare services in the 1960s, and the policy of deinstitutionalization after the 1980s. In this transformation process, certain initiatives have been implemented with the participation of interested actors across periods and small but important improvements. A draft has been prepared after a series of studies were conducted with regard to mental health policies and plans. However, no results have been obtained. The necessity of the mental health law has been clear. A notion that has been known is that the mental health law, which offers a holistic perspective, positively influences the functioning of the mental health system in terms of service users and providers. However, whether or not it actually pursues these intended improvements has been subject to doubt. Until now, no mental health law has been effectively implemented in Turkey, and measuring and evaluating in which aspects the law will be successful and where it will fail have been impossible. Turkey continues to be in need of a mental health law is practical and in line with international standards for the rights of patients and supervision against coercive measures.

The history of mental health policy in Turkey: tradition, transition and transformation

This article offers a brief history and the evolution of mental health policy in Turkey. It aims to analyse how mental health policies were transformed and why certain policies were introduced at specific times. The modern history of mental health policy is divided into three periods: the institutionalization of psychiatry and hospital-based mental health services; the introduction of community-based mental healthcare services; and lastly, the policy of deinstitutionalization after the 1980s. These periods have been categorized in a way that basically coincides with Turkey's modern political history.

The state of ethics education at medical schools in Turkey: taking stock and looking forward

BACKGROUND

Ethics teaching is globally considered an essential part of medical education fostering professionalism. It does not only provide knowledge for good clinical conduct, but also trains medical students as virtuous practitioners. Although Turkey has had a considerable experience in ethics education of healthcare professionals, the general state of ethics curricula at medical schools in Turkey is unknown.

METHODS

The purpose of this study was to collect comprehensive data about the ethics education programs at medical schools in Turkey. To this aim, we designed a cross-sectional descriptive questionnaire survey which focuses on the content, teaching years, teaching, assessment and evaluation methodologies, workforce and infrastructure. We delivered the questionnaire to all medical schools in Turkey. Seventy-nine medical schools participated in this study (response rate: 78%).

RESULTS

Although most institutions had an undergraduate ethics curriculum (91.1%), the findings suggest deficiency of teaching personnel (34.2% had no instructors). Furthermore, the distribution and composition of the workforce was imbalanced. The content varies largely among institutions. Medical schools with an ethics department were more likely to diversify teaching topics. However, ethics education was largely based on the four-principle approach. The content was usually conveyed to students theoretically. Around 90% of schools had classroom lectures. It is the only method used at one-third of them. Clinical ethics education was mostly lacking. Multiple-choice tests were widely used to assess and evaluate student attainments (86.1%).

CONCLUSIONS

Staff qualified to teach ethics and ethics education integrated into the six-year medical curriculum given by a multidisciplinary team are urgent necessities. Considering teaching, assessment and evaluation methodologies used, most medical schools seem to fall short of fostering students to develop ethical attitudes. Endeavors aiming for modern topics should be encouraged. As the organization ethics education change continuously, we think that a platform for monitoring ethics education at medical schools in Turkey should be established. Such a body would help ethics instructors to network and find solutions to current problems and build shared wisdom.

'Pinel of Istanbul': Dr Luigi Mongeri (1815-82) and the birth of modern psychiatry in the Ottoman Empire

Italian physician/alienist Dr Luigi Mongeri (1815-82), who graduated from the School of Medicine in Pavia and worked as chief physician at Süleymaniye and Toptaşı Lunatic Asylums, introduced important reforms that shaped modern psychiatry in the Ottoman Empire. Because of his projects and practices he was likened to Philippe Pinel (1745-1826), and was called the 'Pinel of Istanbul' or 'Pinel of the Turks'. This article aims to examine the birth of modern psychiatry in the Ottoman Empire, through the biography of Luigi Mongeri and his writings on insanity.

Two Branches of the Same Tree: A Brief History of Turkish Neuropsychiatric Society (1914-2016)

Introduction

The aim of this article is to provide a brief history of Turkish Neuropsychiatric Society by examining its institutional background, the milestones within its history, and the major activities undertaken by the organization during the years.

Methods

Firstly, the books, journals, and articles that are related to the history of psychiatry and neurology in Turkey have been reviewed and the information that can explain the history of the society has been brought together. The founding records, regulations, journals, and congress booklets of Tababet-i Akliye ve Asabiye Cemiyeti (Society of Psychiatry and Neurology) have been examined and the newspapers of the period have been reviewed to collect news concerning congresses and meetings. Besides, oral history interviews have been conducted with regard to the recent history of the society.

Results

Although the roots of neuropsychiatry in Turkey date back to the mid-nineteenth century, the first society, which was called Tababet-i Akliye ve Asabiye Cemiyeti (Society of Psychiatry and Neurology), was founded in 1914. The organization now maintains its activities under the name Türk Nöropsikiyatri Derneği (Turkish Neuropsychiatric Society). Turkish Neuropsychiatric Society has organized monthly meetings, conferences, and national congresses and has published numerous scientific journals in the field of neuropsychiatry over the past century.

Conclusion

As one of the earliest societies of medical specialty in Turkey, Turkish Neuropsychiatric Society has played a crucial role in the development and institutionalization of psychiatry and neurology. The administration and activities of the society occurred in the following institutions respectively: Toptaşı Asylum (1914-1925), Bakırköy (1925-1955), and Çapa (Psychiatry Clinic of Medical Faculty of İstanbul University). The society was mainly composed of psychiatrists and neurologists; however, neurosurgeons, psychologists, and neuropsychologists also attended the congresses and meetings held by the group.

Insanity, belonging and citizenship: mentally ill people who went to and/or returned from Europe in the Late Ottoman Era

The Ottoman Empire, which encompassed a vast territory, had several facilities for the protection and treatment of the mentally ill. By the late nineteenth century, some wealthy families had begun to send their patients to mental hospitals in Europe for better treatment. During the same period, the process of repatriation of mental patients who were Ottoman subjects also began. These processes, which resulted in complex bureaucratic measures, later found a place in regulations and laws. The Ottoman Empire had an additional incentive to protect mentally-ill patients during the Second Constitutional Era, when discussions about 'citizenship' reappeared. This article examines the practices of sending mentally-ill people to Europe and the repatriation of mentally-ill Ottoman subjects from European countries.

THE ETHICS OF OCCUPATIONAL HEALTH AND SAFETY IN TURKEY: RESPONSIBILITY AND CONSENT TO RISK

Work-related diseases, injuries, risks and deaths are the issues that have been recently gaining importance especially in developing countries. The ethical dimensions of occupational health and safety have remained as relatively understudied areas. Concepts such as responsibility, consent, autonomy, paternalism, choice, and certain values or justifications that are used in medical ethics and bioethics are also applicable to occupational health and safety. This article examines the ethical issues of responsibility and consent to occupational risk. It will first define the concepts of consent and risk, and then different views on responsibility and consent to risk will be discussed. The article will also examine the responsibility of the society and government regarding these concepts.

More than a disease: the history of general paralysis of the insane in Turkey

This article explores the history of general paralysis of the insane (GPI) and its treatment in Turkey. GPI was considered as "a disease of civilization" at the end of the nineteenth century. From the early years of the twentieth century, Turkish psychiatrists discussed and interpreted the causes of GPI and followed the European diagnostic and treatment methods of the disease. Austrian psychiatrist Julius Wagner-Jauregg (1857-1940) introduced and developed "malaria fever therapy" for general paralysis in 1917. Malaria fever therapy spread to other countries and, during the 1920s, the treatment was also used in Turkey. This article not only aims to illuminate an unnoticed aspect of the history of psychiatry in Turkey but also uses GPI as a model to illustrate how psychiatry in Turkey was influenced by the developments in Europe.