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English Language Page In some regions, funding for patients in hospitals remains meager. For example, in the Vologda region in 2001, a patient’s daily allotment for food was 7 roubles, and for medicine — 1.5 roubles; in the Kurgan region — 11 and 13 roubles respectively; and in the Penza region — 12 and 18 roubles respectively. Procurement of new generation drugs was not even an issue under such circumstances. The lack of funding for the medication has the most severe impact on outpatients. In Tula region, for example, free drugs have not been available for outpatients since 1994, in spite of the fact that an average pension is only approximately 600 roubles a month. Often, such patients face the dilemma of whether to buy expensive drugs with their own money or apply for in-patient treatment. The latter constitutes an infringement on their rights for provision of medical care under the least constraining circumstances. Some mental hospitals are crammed into unsuitable quarters, and most mental hospitals are still lacking funds for repair. The Domodedovo mental hospital in the Moscow region, for example, is located on the premises of a former military barracks, with up to 60 patients crowded into each ward. Most of the buildings of the mental hospital in the Penza region are totally unsuitable due to their dilapidated state. The out-of-town branch of the hospital is housing patients in barracks lacking basic sanitation requirements, with potable water being brought to the premises in water tanks. Some of the rooms of the Khabarovsk territory mental hospital are located in wooden barracks, which give no protection against draughts in winter. Water supplies are delivered twice a week. The lack of funding for major construction only adds to overcrowding in Russia’s mental hospitals. The standard requirement of floor space is 7.5 m2 per person. Mental hospitals in the Leningrad region provide each patient with only 2.5 sq. meters of floor space; the Chernyakhovsky specialized mental hospital (Kaliningrad region) with intensive treatment provides 2.8 m2; the mental hospital of the city of Yakutsk — 3.5 m2; the Penza regional mental hospital — 4.0 m2. Such overcrowded conditions promote an atmosphere of constant tension and often result in conflicts between patients and staff. Most mental hospitals do not offer their patients the use of a public phone. As a result, people are deprived of their right to communicate with their relatives and friends without limitations. In some cases, lack of warm clothing seriously impairs the likelihood for organized daily exercise out of doors. Whenever possible, patients are treated with new generation drugs, which have no harmful side effects. However, these drugs are not readily available everywhere, and doctors often have to use “heavy” neuroleptics, which produce a tormenting effect on some patients (especially when the necessary counter-drugs are not on hand). In a number of registered cases, unwarranted restraint or excessive doses of drugs were applied for the sake of “staff convenience.” Complaints of this kind often come from young people living in psycho-neurological homes, where they are sent from orphanages until they come of age, as well as from children’s wards of mental hospitals. In some children’s hospitals, discipline is enforced by establishing prison-like regime. Such is the case in the children’s ward of the mental hospital of the Antipikha village in the Chita region, where bathroom visits are limited. Going to the bathroom at an off-limit time is prohibited and those who dare to violate this rule are punished with a blow of a pipe. Many mental hospitals are still experiencing serious understaffing problems. Low pay, dire working conditions and the lack of insurance force doctors and medical personnel to leave government-funded psychiatric institutions for other branches of medicine or for businesses unrelated to the medical profession. Six districts of the Tula region, for example, do not have a single psychiatrist. Patients are left to the care of trained nurses. In the Kurgan region, the staffing levels of doctors’ positions in mental hospitals are at 52% of capacity, and medium and low-level medical personnel positions are filled to 65–70% of capacity. These statistics are characteristic for many other Russian regions as well. All of the difficulties mentioned above, combined with the lack of civic control over the operation of psychiatric institutions, result in the fact that infringement on human rights in psychiatry remains one of the most acute themes in modern Russia. Polls conducted among patients and their relatives show that patients in mental hospitals find themselves totally unprotected and dependent on the doctors and medical staff. According to the Chief Psychiatrist of the Ministry of Health of the Russian Federation, B. Kazakovtsev, 16 out of every 49 complaints (i. e., over 30%) about violations of patients’ rights at mental hospitals reviewed by the Special Commission of the Ministry of Health in 2001 were found to be well-grounded. This finding represents a very high percentage, especially given that the reviewing officials at the Ministry of Health have always been mindful of the image of medical profession. The year 2001 saw the continuation of the trend to use institutionalization to resolve housing and other property disputes among family members. This was especially true regarding elderly people, whose desire to live in their own homes and independently dispose of their savings and property would often result in family conflicts and unwarranted applications for psychiatrist assistance. The careless attitude taken by professional psychiatrists in such cases, often leads to unreasonable and forced hospitalizations in mental clinics. Once in the reception ward of a hospital, the would-be patient is subjected to enormous pressure (in the form of direct threats and/or plain deception), aimed at turning a forced hospitalization into a seemingly voluntary one. This deprives the person of the opportunity to resolve the issue in court immediately after his/her hospitalization, and significantly impairs his or her chances of filing a complaint with the court in the future. There are also cases of forced hospitalization in mental clinics instigated by neighbors. Cat and dog lovers and champions of animal rights are under a constant threat of ending up in an involuntary meeting with psychiatrists. Such meetings can often have serious consequences. For example, a visit to a psycho-neurological dispensary resulted for G. F. in forced hospitalization in a Moscow mental clinic. She was referred by the psycho-neurological dispensary ¹5 to the mental hospital ¹1. Likewise, examination by a general hospital’s psychiatrist resulted in forced hospitalization of V. Cherenkevich (referred by a general hospital’s psychiatrist to the mental hospital ¹5). Both women were released a few days later, but no one has been taken to account for the moral damages inflicted upon them. Courts are bound to exercise some oversight over the procedures leading to forced hospitalization in mental hospitals, but this role is conducted superficially. Judges rarely go into the details of a case, normally granting the request of a hospital for forced hospitalization and treatment. Court hearings are often held in the absence of the patient, with a hospital official acting as the patient’s official representative. Such a representative, and an official from the prosecutor’s office, are required to validate the court proceedings. The appeals of patients contesting the need for being placed in a mental hospital to allow their relatives, friends, public organizations’ representatives, and sometimes even lawyers to be present at the hearing are usually denied. Thus, their attempts are often futile, as they have no opportunity to communicate with the outside world. Sometimes, doctors or medical personnel roughly suppress a patient’s attempt to seek protection of his or her rights. According to A. F, his letter addressed to the Independent Psychiatrists’ Association of Russia, which he planned to give to a visiting friend, was destroyed by a nurse of the Moscow mental hospital ¹15. While staying in mental hospital, patients are practically denied the right of appealing to the representative and administrative authorities, prosecutor’s office, courts, lawyers or public organizations, although this right is formally theirs, according to Federal Law “On Psychiatric Treatment and Citizens’ Rights in Receiving Such Treatment.” So far, there has been no governmental agency or service responsible for protecting the rights of mental hospital patients or for receiving their complaints. The Independent Psychiatrists’ Association of Russia came out with an initiative to trial-run a non-governmental service of this kind at one of the city’s hospitals, but this initiative was rejected as “premature” by the Moscow City Health Committee. What a response to get ten years after the enactment of the law on psychiatric treatment, which proclaimed the creation of such service! Psychiatric “repression” often targets those, who attempt to protect their rights by appealing to courts or higher-level medical administrative bodies. Such was the case when Ì. Ñ., Assistant Professor at the Orenburg State University, attempted to contest a medical decision in court. A public hearing of the matter did not suit the psychiatrists, who would have to justify their decision and actions to the court. Instead, an impressive group of psychiatrists (head of psychiatry department of the Orenburg State Medical Academy, Â. Budza, chief physician of the regional psychiatrist clinic, G. Pruss, Chief Psychiatrist of Orenburg, N. Belov and others) addressed the Chief Psychiatrist of the Department of Health, A. Yegorchenko, with a letter arguing for the need to conduct a forced psychiatric examination of M. C. In their letter, the authors maintained that “the activities of M. C. over the last several years, coupled with numerous appeals to the courts, are a vivid sign of the exacerbation of his chronic, progressing endogenous disease, which causes moral and material damage to those psychiatrists, who had been involved in treating his mental conditions in the past.” Meanwhile, M. C. enjoys a good reputation at the Orenburg State University, and is socially adaptive. The letter does not carry any convincing evidence to justify the claim of his “chronic endogenous disease.” The intensity of the Orenburg psychiatrists’ concern about the fate of M. C., their claim that “without psychiatrist treatment his disease might progress further and result in an unpredictable delirious behavior with ensuing consequences” (which does not correlate with the orderly behavior of M. C. himself), as well as an unusual haste to implement the ruling of the Promyshleny district court of Orenburg requesting a forced psychiatrist examination of M. C. (Chief Psychiatrist of the region set up a special commission for the sole purpose of conducting one examination; an officer of justice was approached with a request to bring M. C. for the examination, etc.) might have seemed dubious to the court. Therefore, the presiding judge, Khloponina, withdrew her ruling. Nevertheless, M. C. cannot feel safe while the psychiatrists “are still concerned” about his health. A similar case of a campaign against whistle-blowers unfolded in Izhevsk. C. Mokhnatkin, being at odds with the Ministry of Health of the Udmurt Republic, dared to demand the resignation of the Minister of Health. Immediately after that, a letter (04–14/2076 of December 22, 2000), signed by the Deputy Minister of Health, Y. Blokhin, was sent to the chief psychiatrist of the Udmurt Republic mental clinic, À. Suntsov, claiming that C. Mokhnatkin “has been behaving incorrectly towards the senior officials of the health ministry.” Although no evidence was brought to justify the need for a forced psychiatrist examination, it ended with the following phrase, “The Ministry of Health is seeking your assistance in forcibly hospitalizing C. E. Mokhnatkin.” L. Yakovleva, a psychiatrist at the Udmurt Republic mental clinic, promptly appealed to the court asking for permission to subject C. Mokhnatikin to a forceful examination. Nevertheless, the court ruled that “the appeal was totally ungrounded.” There is a growing number of complaints related to the withdrawal of legal capacity. The cases in question rely on both ungrounded decisions on legal capacity, passed by the courts on the basis of unscrupulous expert testimonies, and to insufficient control over the activities of guardians. Expert institutions sometimes pass unfounded decisions to the effect that a person “cannot understand the meaning of his actions and, therefore, cannot be in charge of them.” Such rulings are often based primarily on the information received from relatives, rather than on the actual condition of the person under examination (especially when the examination is conducted on an elderly person). The person on whose conditions the experts have passed their decision is normally not invited to attend the court hearings, is recognized as legally incapable by the court and thus loses every opportunity to exercise his or her own rights. Boards of trustees usually appoint an immediate relative as guardian without inquiring about underlying motives or asking consent of the ward. As a rule, the victim ends up in a psycho-neurological home, when in fact he or she could have stayed in his or her own home with appropriate care. A typical example of this kind was the case of A. Kochurina, described in the Collection of Reports Human Rights in Russian Regions — 2000. The story continued to unfold in 2001 and finally resulted in full restoration of the elderly woman’s legal capacity. Antonina Kochurina was born in 1917. For the last couple of years, after her son’s marriage, a conflict started to unfold, leading to an openly hostile relationship with her daughter-in-law. A. Kochurina placed an advertisement for an apartment exchange in the papers. Soon afterwards, her son called a local psychiatrist, claiming that his 83-year-old mother presented a danger for those living with her (she had allegedly splashed boiling water at her daughter-in-law). The local psychiatrist spoke only with the daughter-in-law and the son, did not go into details and promptly sent A. Kochurina to the mental hospital ¹1 as someone “representing acute and present danger to oneself and others.” She spent about a month and a half at the mental hospital. It is noteworthy that her hospitalization was recorded as a “voluntary” (as it turned out, later her consent was obtained by making her sign a “receipt for her clothes”). Immediately after the hospitalization, her son filed an appeal with the Chertanovo intermunicipal court asking that A. Kochurina be ruled legally incapable. Following psychiatric examinations held at the mental hospital ¹1, on September 25, 2000, and later on October 10, 2000, she was ruled by the court as legally incapable. According to the testimony of A. Kochurina and one of her relatives, the medical treatment she received at the hospital had a negative impact on her: “her permanently salivating mouth was skewed, she could hardly move by herself, could talk only with great difficulty and sometimes even failed to recognize her relatives.” In this condition, she was presented for medical examination, which concluded that A. Kochurina was “incapable of understanding the meaning of her actions and be in charge of them.” Neither A. Kochurina, nor a representative of the psycho-neurological dispensary was present at the court hearings. In spite of the hostile relationship with A. Kochurina, her son was assigned guardianship over his mother. Immediately after the court ruling, the son filed papers for her admission to a psycho-neurological home. Her grandchildren took A. Kochurina from the mental hospital, and it was only several months later that she learned about her legal incapacitation. For many months, she had to depend on her relatives and friends because her pension was sent and received by her guardian. Her relatives repeatedly appealed to the board of trustees of the psycho-neurological home ¹13 asking to change the guardian but their request was denied. Following a protest made by the local prosecutor’s office, the court reviewed A. Kochurina’ case. The court noted the fact that the conclusions derived from the psychiatric examination at the mental hospital ¹1 were not sufficiently justified (the conclusions were made against the background of the patient’s somatic and psychological conditions that were dramatically impaired as a result of her stay at the mental hospital). The court further noted the results of repeated examinations conducted by the Independent Psychiatrists’ Association, which testified to her good mental health. But most importantly of all, the court had an opportunity to form its own opinion of A. Kochurina’s condition, as she was present in the court room and could demonstrate to the court that she was in full control of her actions and words. As a result of the hearings, the court ruled to restore A. Kochurina’s legal capacity in full. It should be noted that the story of A. Kochurina is quite exceptional. Such cases tend to go on for years, causing serious moral and even physical damage to the people affected. It is especially difficult to defend one’s own rights when living in psycho-neurological homes. Administrations of these institutions are not concerned with the social and working rehabilitation of their inmates. Moreover, they often try to create all kinds of obstacles for the patients to come to terms with their lives. The struggle to allow Alexander Travin from the Klimovsk psycho-neurological home and Michael Semenychev from the Korobovsk psycho-neurological home, both mentioned in the Collection of Reports Human Rights in Russian Regions — 2000, to lead an independent life is still on-going. The only result of the appeals filed by non-governmental organizations to the Moscow regional prosecutor’s office against illegal seizure of the two young men’s identification papers was an investigation of the regional organization of the disabled and the “Lybutka” rehabilitation center, which are responsible for A. Travin’s and M. Semenychev’s rehabilitation. All of the psychiatrist institutions in the country still deny people access to their health records, although this right is guaranteed by the current health care legislation (Articles 31 and 61). A. P., resident of Sochi (Krasnodar region), for example, voluntary underwent a medical examination at the Moscow Psychiatry Research Institute. The findings of the examination were that he did not have any mental illness, and it was recommended that the local psychiatrist dispensary remove him from their registry. In 2001, A. P. was involved as a victim in a criminal investigation and had to provide evidence of his mental conditions. But all his attempts to obtain the necessary papers from the medical authorities, including his personal visit to the aforementioned institute, ended in failure. Doctors keep such information “a medical secret,” even from the patients themselves. Sometimes, doctors even refuse to provide this kind of information to professional psychiatrists’ organizations, following a personal request of the person involved. Such was the case with T. Rakevich, who turned to the public reception office of the Independent Psychiatrists’ Association with a complaint against her unfounded forced placement into the mental hospital ¹26 of the city of Yekateringurg. T. Rakevich’s case was taken up by the European Court of Human Rights. Nevertheless, medical officials guarding their collective interests replied to the official request of the Independent Psychiatrists’ Association (accompanied by T. Rakevich’s letter) that “based on the literal meaning of Article 46 of Federal Law “On Psychiatric Treatment..,” they are not entitled to give out exerts from T. Rakevich medical case history.” Also, there have been cases when physicians in general hospitals would exceed their rights and divulge privileged medical information. In July 2001, for example, A. C. was undergoing a paid course of treatment at the Neurologic Research Institute. An importune patient, he would grill the doctor as to the methods of his treatment and inquire about the procedures applied. As a result of his behavior, he was discharged prematurely from the clinic with the following note in his record: “diagnosis — schizophrenia? Examination by psychiatrist recommended.” An official letter from the Independent Psychiatrists’ Association to the head of the Neurologic Research Institute was enough in this case to have the unacceptable entry stricken from his medical records. But for some time afterwards, A. C. could not bring himself to turn to other doctors, and he suffered severe moral harm. There is also a growing number of cases related to the violation of property rights of people suffering from mental illnesses. Moreover, such violations tend to be rougher in nature. Mentally ill people who are not in charge of their actions are made to sign papers to dispose of their property (deeds of gift, barter deeds, sale, rent with permanent alimony, etc.), only to be thrown out into the street afterwards. Instead of standing guard over the interests of their patients, some psychiatrists become accomplices of those who make the deception of mentally ill people their business. In April 2001, for example, the Independent Psychiatrists’ Association conducted a legal psychiatric inquiry into the case of B. I., a mentally ill person who had sold his apartment to his relative. The expert commission was unanimous in deciding that at the moment of signing the deal B. I. was not capable of judging his actions adequately. This ran contrary to the claim of Stangarov, chief physician of the Moscow psycho-neurological dispensary ¹2, where B. I. had been treated for a long time. The claim maintained that B. I. was in perfect health and fully capable of disposing of his property. Half a year later, nevertheless, B. I. was recognized legally incapable. The year 2001 saw continued discriminations of people with different mental illnesses in the field of labor and education. Practically all higher and medium level education institutions require applicants to provide a mental health certificate, although in most cases the professions they teach are not included on the list of professions with limitations regarding mental health conditions, as approved by the Ministry of Health of the Russian Federation. Also, anyone who has had any contact with a psychiatric treatment is the first one to go during staff reductions. Municipal services and law enforcement bodies rudely violate the rights of mentally ill people as well. Their complaints are not accepted or followed-up on, and no measures are taken to protect them against their neighbors, relatives or third parties. The following must be stated in conclusion. The situation with funding of psychiatrist institutions in 2001 has somewhat improved over the previous period. Some of the regions, for example the Leningrad region, have secured funding to launch municipal programs that have promptly and significantly improved the level of psychiatrist services available to people. Many hospitals conduct research on developing new psychiatric methods. Services of professional psychologists, lawyers and social workers have become more readily available. As a result of the initiative of a number of non-governmental organizations and, especially, relatives of mentally ill patients, a number of rehabilitation programs and social assistance centers for the mentally ill people have been launched with the support provided by foreign charity foundations. However, on the whole, the number of human rights violations of the mentally ill is not declining. Of special concern is that the year 2001 was marked by new attempts to curtail the activities of non-governmental professional and non-professional organizations set on defending human rights in the area of psychiatry. A Federal Law “On State Legal Expert Activities in the Russian Federation,” which was enacted in May of 2001, seemingly allows expert examinations outside the framework of governmental institutions. But at the same time, the Ministry of Health endorsed an executive order on licensing medical activities. The appendix of the order lists medical work, services subject to licensing and, for the first time, includes legal psychiatric examination. It is widely believed that it would be extremely difficult or practically impossible to obtain such a license for a civic organization, which does not have in its charter lawful and psychiatrist examination listed as its prime activity and which provides such services free of charge. Thus, the Independent Psychiatrists’ Association of Russia now has limited capabilities to present parallel expert opinions in court. Given the rapid deterioration of the quality of legal and psychiatric examinations in the recent years, increased abuses of human rights with psychiatry being used as a tool may be seen. Meanwhile, in November 2001, the Independent Psychiatrists’ Association of Russia received a notice from the RF Ministry of Justice, which stated that the Independent Psychiatrists’ Association is conducting its expert activities contrary to the Russian legislation. Since no grounds were given to support this claim, the Independent Psychiatrists’ Association appealed the notice of the Ministry of Justice to the Tagansky intermunicipal court, which will hear the case in the near future. Back |
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