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English Language Page But in comparison with the Soviet period the terms of treatment have reduced significantly. For example, the average duration of stay at the Chukotka regional neuro-psychiatric dispensary is 25 days. The same figure applies to the psychiatric department of the Altai regional hospital whereat however the term of stay is largely affected by the fact that the department is permanently overcrowded: in order to admit new patients they have to discharge patients whose worst condition is over. In addition to these two, 11 other psychiatric institutions (a total of 14% ) boast therapy terms that do not exceed 45 days (see Table 5), although only four of them dispose of expert beds whose turnover is usually longer than that of regular ones. The Khabarovsk regional hospital also treats mental patients with tuberculosis who stay at the institution for as long as several months. Thus, patients of these clinics only stay for as long as it is required to undergo intensive treatment in stationary conditions. Therapy can be continued without isolation from the regular life.
In the majority of clinics patients who have been admitted due to exacerbation of their mental conditions stay there for as long as two-three months — a term quite sufficient to select an adequate therapy method. Nobody has the right to hold the patient at the institution against their will. Should the patient prove unable to solve this issue with their attending doctor they have the right to address this issue with the head physician or department head (Paragraph 1, Part 2, Article 37). The other bloc consists of clinics (a total of eight or nine percent) in which patients stay for more than 100 days.
All these clinics except the Yaroslavl regional hospital “Afonino” and the Republican neuro-psychiatric dispensary of Kalmykia, dispose of multi-bed psychiatric-tuberculosis departments, and the Vladimir regional psychiatric clinic #4 and the Troitsk hospital in Buryatia in addition treat patients admitted against their will by court order. These patients are especially disadvantaged since their discharge depends not so much on opinions of psychiatrists as on decisions of courts which sometimes have their own ideas about the necessary terms of treatment. Head of the Perm city hospital said during the interview that at some point a local court had justified its refusal to satisfy the clinic’s petition to replace residential treatment of one of the patients with outpatient therapy in view of the improvement of their mental condition in the following fashion: “He will stay in your hospital for as long as he otherwise would have to stay in prison.” In some cases the duration of patient’s stay at an institution is directly accounted for by external reasons that do not depend on the clinic. In Russian health care in general and in psychiatry in particular there is a tradition to not discharge a patient if they do not have a permanent domicile or are conflicting with their family members. If a patient is unable to live independently due to their mental condition and their relatives refuse to collect them the clinic petitions to court and requests that the patient be granted a disability status and then transfers the patient to a foster home (NPI). In the meantime such patient could reside at home under the oversight of a conscientious custodian. For example, the lengthy duration of stay at the Republican neuro-psychiatric dispensary of Kalmykia (approximately one year) is accounted for by the fact that 40% of its patients are admitted to it on the basis of “social indications.” In fact they do not need therapy but they have no place to live and the republic experiences a catastrophic deficit of neuro-psychiatric foster homes. The situation when patients have to stay at an institution is characteristic of practically all of the surveyed clinics. As a rule it is citizens of foreign countries who have completed their therapy and stay at the clinic for several months waiting to be sent back home, homeless people, as well as army draftees. In the Bryansk region that borders on Ukraine and Belarus the problem of discharge of foreign citizens from the regional psychiatric clinic #3 is a very important one. State authorities responsible for deportation of foreign patients often delay the processing of official deportation documents. Upon the whole, due to cumbersome bureaucratic procedures and non-effective operation of state structures patients are unjustifiably held in psychiatric institutions. For example, at the request of a garrison clinic the Stavropol territorial psychiatric clinic #1 conducts psychiatric examination of soldiers in order to determine their fitness for military service. Examination is completed within a rather short period of time and then soldiers wait for several months for their examination results. As it has been stated above, today psychiatric clinics admit a great number of homeless people who oftentimes have no identification documents. Social divisions of institutions find out their names and surnames, restore their documents, search for their relatives, and place them in social institutions. All of this takes a lot of time to complete and all this time the homeless person stays at the psychiatric institution. In some cases the clinic provides the patient with registration so that they could receive their pension benefits that are only paid at the place of registration. The patient can spend this money to buy necessary articles and supplementary food stuffs. NPA knows some cases when clinics used pensions of patients who had been admitted on the basis of social indications to buy furniture and soft accessories for departments, clothes and footwear, detergents and other necessary articles. This is all processed as a voluntary donation but its voluntary nature is rather questionable since patients do not always realize what is going on. Some of the homeless patients do not need to be transferred to neuro-psychiatric foster homes; they are quite able to live independently if they were given a residence and minimal assistance. For such cases hostels are needed. Federal Law “On Psychiatric Care” (Article 16) provides that the state should create hostels for individuals with mental conditions who have lost social connections. In 1995, the RF Ministry of Health Care included the creation of such hostels in its program of immediate measures targeted at the improvement of the system of psychiatric care. However this program was funded only by 0.2% and construction of such hostels remained only on paper. The only exception is St. Petersburg where thanks to the efforts of the city’s chief psychiatrist, L. Rubina, the City Duma funded a regional program of the development of the psychiatric service and the first hostel for mentally-challenged persons was created in 2000. Today there are eight such hostels in St. Petersburg and six — in the Leningrad region and the problem of homeless mentally-challenged persons is solved to a significant extent. A hostel for 100 beds has been established in Bashkortostan under the Republican psychiatric clinic, there is a hostel in Pervouralsk (Sverdlovsk region) however those are clearly not enough since there are a lot of mentally-challenged people both in Bashkortostan and the Sverdlovsk region who have nowhere to live. In the rest of the surveyed regions, including Moscow and the Moscow region, such hostels have not been established yet and their establishment is not envisioned anywhere in the nearest future. In 2005, the Jewish autonomous district intends to open hostels for mentally-challenged persons who have lost social connections, but in the other areas this is a perspective of a far more remote future. In 16 psychiatric clinics the share of individuals who have been admitted on the basis of social indications exceeds 5% of all patients (see Table 7).
This creates additional problems for the operation of institutions and worsens other patients’ conditions of stay and treatment. The situation of the Perm city psychiatric clinic is especially difficult because it is always significantly overcrowded (at the time of the survey it housed 1 100 patients having the bed capacity of 660). The reason accounting for this situation is the acute deficit of places in social establishments for mentally-challenged persons, i.e., neuro-psychiatric foster homes. For example, it was expected that a neuro-psychiatric foster home for 300 beds would be opened yet in the late 80s. However socio-economic difficulties resulted in the fact that it has never been opened. There are serious problems with placement of patients in foster homes for mentally-challenged persons in the Adyg republic, Republic of Kalmykia, Komi republic, Marii El republic, and Udmurt republic, in the Krasnodar territory, Perm, Pskov, Sverdlovsk, Rostov, and Chita regions. Patients wait to be transferred to foster homes for several years occupying already overloaded and poorly provisioned beds of psychiatric institutions. For example, there are several patients at the Chukotka regional neuro-psychiatric dispensary, whose capacity is only 60 beds, who cannot be transferred to the foster home because it is being renovated since 2000. Seven male patients are registered at the psychiatric clinic of the Jewish autonomous district because there is no foster home for men in this area and the one that there is in the neighboring region, the Khabarovsk territory, refuses to accept them. Not counting on state assistance some clinics were compelled to independently organize alternative foster homes or hostels within their own structures. Departments for patients who have lost social connections have been established at the Astrakhan regional psychiatric clinic, Voronezh regional psychiatric clinic, Smolensk regional psychiatric clinic, and Khabarovsk territorial psychiatric clinic. The main purpose is to separate them from those who have been admitted to the clinic to undergo therapy. In the course of the monitoring information was obtained indicating that only very few clinics have solved the problem of transferring their patients to foster homes and other similar institutions. For example, the Smolensk municipal psychiatric clinic have no patients registered there: patients are directly transferred to foster homes or discharged to the care of their relatives. The Vladivostok city psychiatric clinic is also able to operatively transfer patients who do not require therapy — a special department of social rehabilitation and a foster home serve that purpose. Transfers to foster homes are also promptly effected at the Krasnoyarsk territorial psychiatric clinic #1. During interviews some physicians also admitted that sometimes they deliberately delay the discharge of patients in order to complete the course of therapy since they know that certain kinds of treatment cannot be continued on the outpatient basis. The fact is that institutions are much better provisioned with pharmaceuticals than outpatient services and patients receiving therapy on the outpatient basis cannot always independently acquire costly medications they need. |
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