From: Alice Taylor
In Depth: Albanian Mental Health Sector: Underfunded, Understaffed, and Not Understanding

A tragic event occurred on Sunday (21 August) in Tirana. Local media reported that a 20-year-old woman had taken her own life and was found hanging in her family’s apartment, but this is far from an isolated incident.

The last available data from the country show that in 2019, the suicide rate was 4.3 per 100,000 inhabitants, on the lower end of the global scale, but still 4.3 too many. While the suicide rate may be low, the incidence of mental health issues, including depression, trauma, anxiety, and various personality conditions, is believed to be much higher.

Unfortunately, there are no recent or comprehensive statistics that we can draw on. Statistics from the U.K. government from 2017 found that almost 5% of the population suffered from depression, while a 2020 survey found that 11% of those aged between 15-59 reported depressive symptoms in the previous two weeks. 

The U.K.’s statistics also found that at least 3.5% of the population reported suffering from anxiety, with 35% saying they felt anxious during the COVID-19 pandemic, according to World Vision.

An analysis published by Exit from 2021 found that 34,537 people in Albania live with disabilities, including neurological issues such as ADHD, Asperger’s and autism.

But up to date and accurate numbers of these conditions and others such as PTSD, borderline personality disorder, and even disorders such as sociopathy and psychopathy are hard to come by, suggesting that perhaps it is not a priority.

Not only that but there are simply not enough professionals to help treat those in need. In 2019, Albanian ranked last in Europe for the number of psychiatrists, with one doctor per 100,000 patients equating to just 25. The government, however, says the number is 1.83 per 100,000, but this is still the worst in the region.

Furthermore, therapy, counselling, and other treatments for various mental conditions and issues risk waiting lists and limitations through the public system or significant expenses through private clinics. An assessment for autism or ADHD costs around EUR 300, while a session with a psychiatrist costs around EUR 40.

This is without the cost of medication and appointments to renew prescriptions.

To make matters worse, there are also limitations to the kind of medications available for certain conditions, including depression and ADHD, with many newer or more innovative drugs simply being unavailable.

Furthermore, conditions such as depression treated with SSRIs are often treated with sedatives such as Xanax and Loram despite not being advised for such conditions.

Imports of Loram and Xanax have increased significantly over the last three years, suggesting a significant spike in demand, according to a Monitor report. In 2016 only, imports of both medicines grew by 18 per cent and 11 per cent compared to the previous year.

One American citizen living in Tirana told Exit, “Mental health services are non-existent here. Most medications are not available, and I am being treated by my primary care doctor and resorted to online counselling.”

An Albanian citizen said she went to the public hospital as a teenager due to mental health issues.

“It was a horrible experience. The psychologists were so insensitive, and no one sat down to understand. The psychiatrist I saw had a ten-minute conversation with me and determined I was chronically depressed.”

“They called my mum in and told her I was depressed, should go on medication, and if I didn’t get better in two weeks, they would keep me in the hospital. All of this while I was in the room,” she added.

The woman explained that during the start of her treatment, she had zero support from the doctors.

“As a therapist in the making now, I realise that it’s normal to feel worse before feeling better when starting medication, but no one told me this, so I stopped taking it.”

She was forced to seek private care, taking advantage of discounted rates but still costing 2000 ALL per session.

Another U.S. citizen reached out and said when she had tried to find recommendations for psychological help and counselling, all her Albanian friends had advised her that patient confidentiality “was not a thing”. Others explained how confidential information told during private sessions had been shared with mutual friends and other medical professionals without the patient’s consent.

Another patient, O.L, who has ADHD, approached a private psychiatrist to ask for further evaluation and help with medication. The doctor told them that adults cannot have ADHD and that as she was clearly just after drugs, she would not work with her.

“I was so insulted and was made to feel so ashamed like I was doing something wrong in looking for help,” they told Exit.

Another foreign resident echoed this sentiment, who said they received comprehensive and non-judgemental care at a private clinic, “as this clinic is different than most places in Albanian healthcare.”

“Depression runs in my family. They had me do a mental health screening survey and helped me with a herbal supplement for my sleeping problems, and we’ve been having to follow-up appointments. She was pretty affirming and didn’t shame or stigmatise the issue, which was a relief,” she explained.

Another U.S. citizen living in Albania spoke of the attitude of a psychiatrist who dismissed her long-standing struggle with M.E. as “women’s problems”.

“I had M.E. when I was in my 20s, and it never really goes away, and after COVID, I was a mess. I used low doses of Adderall in the U.S. over the short-term each time I relapsed, and it was the only thing that helped.”

While Adderall is unavailable in Albania, the psychiatrist she sought help from did little to assist.

“I got all my U.S. paperwork together, the prescriptions, the years and dates, drove to Tirana to be bullied and humiliated by the psychiatrist. He made many comments about the problems being because I am a woman,” she told Exit.

The patient continued that he didn’t like that she came prepared and accused her of trying to tell him how to do his job.

“He said clearly that he is the doctor and it is not my place to tell him what to do. We call it self advocating,”  she added.

But the most concerning account Exit received was from Albanian citizen G.H. She explained that in 2018, her father started suffering from paranoia and mild delusions. While at the hospital for heart problems, he ran away and became increasingly paranoid. He was evaluated by a psychiatrist who informed the family and the heart hospital that he needed 24-hour surveillance.

“The psychiatrist wrote in his evaluation that the patient is not in a clear state of mind and needs surveillance 24 hours a day as he might harm himself,” G.H. told Exit. Despite this, the hospital did not comply, and the family were forced to watch him 24 hours a day for the duration of his stay. On the third day, he threw himself from the third-floor window, despite his wife trying to stop him.

“I found his body on the floor with police, patients and doctors all around. They took him to reanimation; we didn’t know if he would live or die. My mum had tried to stop him, but she couldn’t,” she explained.

After coming out of intensive care, he required further treatment, but the heart hospital would not take him back. The psychiatry hospital was not an option because it would require him to share a room with unstable patients, which would put him at more risk. In the end, his family had to pay to keep him in a single room in the emergency department and remain with him, in shifts, 24 hours a day.

Suffering from broken legs, a damaged spine and being told he would never walk again, the hospital took no responsibility for what happened, and no support was provided to his family. G.H. considered suing but did not have the emotional strength to continue.

Speaking to the psychiatrist again after the incident, they stated, “I told the hospital this man needs care for 24 hours, but no one listened to me. No one did anything.”

Her father eventually recovered, but he still struggles to get the care he needs. His wife lost her job due to having to take care of him, and it was left to the children to provide additional money and support.

“It was an awful experience. There is no support for dealing with mental health issues. It is not taken seriously, “ she told Exit.