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English Language Page Among others, the monitoring was to answer the question of how psychiatric institutions and courts observe the current legislation regulating involuntary hospitalizations and what kinds of possibilities there exist to protect those rights of patients that are not associated with their residency at an institution. Court procedure for involuntary hospitalization Results of the survey indicate that legislation pertaining to individuals admitted to psychiatric institutions against their will is violated almost in all regions of Russia. For example, the monitoring of some psychiatric institutions (Irkutsk regional psychiatric clinic, Novokuznetsk city psychiatric clinic of the Kemerovo region, Kostroma regional psychiatric clinic, Penza regional psychiatric clinic, psychiatric departments of the Altai republican hospital, Prokhladnensk district psychiatric clinic of Kabardino-Balkaria, psychiatric department of the Komi-Permyatsky district hospital, Yaroslavl regional psychiatric clinic, and some others) resulted in identification of only a handful of cases when involuntary hospitalization was officially documented. This indicates that some of the patients whose hospitalization was documented as voluntary had in fact been institutionalized against their will (see Table 3). Individual’s consent to hospitalization and therapy is documented in writing: the patient signs either two special forms (the first one being the consent to hospitalization, the second — consent to therapy) that are attached to their clinical record and are consequently their integral part, or — a separate sheet of their clinical record. If the person does not want to put their signature and concede to hospitalization and therapy the case is subject to review in the court of law. However, according to one of physicians of the Kostroma regional psychiatric clinic, “patients are often coerced to provide their signature as they are threatened with possible court proceedings.” It appears that this practice is widely used to avoid the submission of documents to the court, especially considering that notification of patients of their rights is rather formal since oftentimes they do not understand what is going on (Chapter “Awareness” of this report). In the majority of Russian regions court proceedings on involuntary institutionalizations are held on the premises of the clinic that the patient has been admitted to. However, only 12 institutions (13%) (Regional psychiatric clinic of the Jewish autonomous district, Irkutsk regional neuro-psychiatric dispensary, Kurgan regional psychiatric clinic, Lipetsk regional neuro-psychiatric hospital, Perm city psychiatric clinic, Republican psychiatric clinic of Bashkortostan, Republican psychiatric clinic of Karelia, etc.) have assigned special rooms for this purpose. The rest of the surveyed clinics use doctors’ offices in the capacity of court-rooms. In some regions an illegal practice of holding court hearings in absentia is common, when neither the patient nor their representative or other required individuals are present. As a rule, in such cases the judge’s decision is announced in the court of law without holding a court hearing as such (Moscow regional psychiatric clinic #2, Orenburg regional psychiatric clinic #2, Perm regional psychiatric clinic, Republican neuro-psychiatric dispensary of Kabardino-Balkaria, Tver regional psychiatric clinic #2, and Ulyanovsk regional psychiatric clinic #1 named after Karamzin). In the Belgorod region (Bobrovo-Dvorskaya psychiatric clinic), Orenburg region (Orenburg regional psychiatric clinic #1), Primorsky territory (Vladivostok city psychiatric clinic), St. Petersburg (St. Petersburg psychiatric clinic #1 named after Kaschenko), Smolensk region (Smolensk city psychiatric clinic), Rostov region (Rostov regional psychiatric clinic, Peshkovo settlement), Buryat republic (Troitsk psychiatric clinic) and Khabarovsk territory (Khabarovsk territorial psychiatric clinic #2) court hearings for the most part are held in a due order with patient’s being present in the court of law. Note that psychiatric institutions independently take their patients to the court. If the condition of the patient prevents them from attending the hearing the latter is held in patient’s absence which is a direct violation of the patient’s right to legal defense. Only in the Orenburg regional psychiatric clinic #1 court hearings in such cases (and according to the chief physician, it is up to 30% of all court hearings) are held in the clinic. Courts often violate the five-day term within which they are required by law to review cases on involuntary hospitalization. This term starts when the court receives a petition from a psychiatric institution to issue a sanction to subject a person to involuntary hospitalization based on a conclusion made by the clinic’s psychiatric commission. Representatives of 10 psychiatric institutions reported violation of court review terms: Astrakhan regional psychiatric clinic, Krasnodar territorial psychiatric clinic, Krasnoyarsk territorial psychiatric clinic #1, Central Moscow regional psychiatric clinic #1, Kuznetsk city psychiatric clinic of the Penza region, Perm regional and city psychiatric clinics, Republican psychiatric clinic of Karelia, Khabarovsk city psychiatric clinic named after Professor Galant and Chita regional psychiatric clinic #2. In some regions courts delayed their decisions for as long as 30 days, and reminding them of the necessity to comply with the five-day requirement often caused irritation: “This is none of your business. Your business is to treat patients.” Head physician of the Chita regional psychiatric clinic #2 reported an example when the court reviewed a case on involuntary hospitalization approximately one month later than required. The court refused to authorize involuntary hospitalization of a citizen in view of the fact that at the time when the review of the case was completed the patient was in a mental condition that was not accounted for by any of the provisions of Article 29 of Federal Law “On Psychiatric Care and Guarantees of Rights of Citizens in Therapy.” As a result the clinic was forced to discharge the patient in the middle of their therapy. When courts fail to meet the five-day review deadline some psychiatric institutions put together and submit new petitions requesting authorization of an involuntary hospitalization, and quite justifiably so. Upon the whole the amount of courts’ refusals to authorize involuntary hospitalization is relatively small, approximately 1-2 % of the overall number of reviewed cases. This is oftentimes accounted for by the fact that courts do not want to go into details of each particular case and make their decisions entirely on the basis of conclusions of psychiatric commissions of clinics who represent one of the parties interested in the outcome of the matter. Many judges refuse to review cases on involuntary hospitalization in a comprehensive manner referring to their lack of knowledge of psychiatry — “We do not understand anything about it anyway, we rely on physicians.” In the meantime the psychiatrist must establish if a person has a mental condition and whether or not they require therapy at the moment. Whether it is legitimate or not to subject this person to involuntary hospitalization must be decided by the court which must establish in the course of a court hearing if the person has qualities accounted for by Article 29 of Federal Law “On Psychiatric Care” (“Grounds for involuntary hospitalization at a psychiatric institution”). To eliminate the vicious court practice described above the law requires that a representative of the institutionalized citizen attend the court hearing. The goal of the participation of citizen’s representative in the court hearing is to better defend and competently protect the interests of the individual institutionalized against their will and prevent them from further staying in the hospital if there are no grounds for involuntary institutionalization. The survey showed that cases on involuntary institutionalization are practically always reviewed without the participation of a representative of the institutionalized individual, the only exception being cases of underage and disabled persons. In 19 institutions (20%) there is a practice when patients themselves do not attend court hearings — depending on their condition (see Appendix 3). Although in a number of other regions (Oryol region, Penza region, Republic of Mordovia and some others) if patient’s condition prevents them from attending the court hearing it is held right by their bedside. In some rare cases patients are represented by lawyers or relatives. For example, the staff lawyer of the Vladivostok city psychiatric clinic represents patients at court hearings on involuntary hospitalization. Although in a situation when the lawyer is accountable to the chief physician as their superior and depends on the institution financially the effectiveness of their work becomes questionable. To comply with the requirements of the law, to observe the rights of individuals subject to hospitalization, and eliminate the inequality of the interested parties the lawyer must be employed gratis and not by the psychiatric institution but by the court of law. This is practiced by some courts in Moscow, as well as Belgorod, Bryansk, Voronezh, Kemerovo, Lipetsk, Nizhnii Novgorod, Novgorod, Orenburg, Oryol, Penza, Rostov, Tula, and Tyumen regions, Khabarovsk territory, Jewish autonomous district, Adyg republic, Republic of Tatarstan (Kazan), and Republic of Udmurtia. At the court hearing the psychiatric institution is usually represented by the deputy chief physician, head of the department in which the patient is resident, or the patient’s attending doctor. The prosecutor is practically always present as well. As far as the judges who review such cases are concerned, in 15 % of the Russian Federation regions it is judges who specialize in this particular category of cases. Sometimes it is accounted for by the fact that courts are understaffed with judges: some district (city) courts, for example, employ only one to three judges. Sometimes it is a deliberate tactic chosen by the court with respect to cases the review of which may require special preparation. The latter case best meets the requirements that are necessary to observe and defend the rights of individuals suffering mental conditions. The amount of cassation appeals on court decisions that have to do with involuntary hospitalization is approximately 0.01 % of the overall number of decisions made on such cases. This is accounted for by the fact that patients are not aware of the full scope of their rights. In many institutions patients are not informed of court decisions made on their cases, nor are they provided with court decrees. The patient undergoing therapy at an institution is not in a position to obtain qualified legal assistance and as a rule is unable to prepare a cassation appeal independently. Access to legal counselors Of the 93 surveyed institutions 12 (13%) do not have lawyers on their staff at all: either there is no such a staff unit in view of the small capacity of the clinic or the existing staff unit is not occupied. Given that clinics as a rule do not have any other resources of legal assistance, nor do they have any relations with legal consultancies or human rights organizations, one may state that patients of these clinics are unable to obtain qualified legal assistance or count protection of their interests in court. The low level of lawyers’ compensation prevents clinics from employing competent specialists. For example, the lawyer’s salary at the Voronezh city psychiatric clinic is 1163 rubles a month. The lawyer of the Kaliningrad city psychiatric clinic is paid 500 rubles a month and holds two jobs simultaneously. Nevertheless, some clinics have found a way out and pay their lawyers on the basis of contracts raising additional funds and inviting highly qualified specialists (Volgograd regional psychiatric clinic, Voronezh regional psychiatric clinic, Kazan city neuro-psychiatric hospital, and some others). Some large institutions have established legal departments (for example, there are four lawyers working at the Volgograd regional psychiatric clinic). This enables the clinic to effectively defend its own and its patients’ interests in the court of law. Clinical lawyers consult patients and their relatives, assist in the development of various documents that have to be submitted to various instances, and in some cases defend the interests of clinic’s patients in court. Whether or not a patient requires a legal consultation is usually decided by the attending doctor or head of the department. 12 clinics (Volgograd regional psychiatric clinic #2, Kaliningrad regional psychiatric clinic, Kirov regional psychiatric clinic named after Bekhterev, Krasnoyarsk territorial psychiatric clinic #1, Kurgan regional psychiatric clinic, Magadan regional neuro-psychiatric dispensary, Kazan city neuro-psychiatric hospital, Samara regional psychiatric clinic, St. Petersburg psychiatric clinic #1 named after Kaschenko, Sverdlovsk regional psychiatric clinic #1, Chita regional psychiatric clinic #2, Yaroslavl regional psychiatric clinic “Afonino”) reported that a number of their patients had won their court cases and managed to return their once-lost property, have their jobs back, and reinstate their once-violated inheritance rights. In absence of a sufficient number of lawyers, psychiatrists employ themselves to defend the rights of their patients. Special attention is paid to those patients who are unable to defend their rights independently, i.e., underage and the disabled. Article 31 of Federal Law “On Psychiatric Care” requires that psychiatrists not only see to it that patients are hospitalized on sufficient legal grounds, but they also ensure that patients are regularly visited by their relatives, that they receive parcels, and that they are discharged from the institution in a timely manner. Heads of many an institution report unscrupulous legal representatives of patients to custody councils and prosecution authorities, assist in the replacement of custodians, participate in court hearings on revocation of custodies, etc. Physicians of the Arkhangelsk regional psychiatric clinic #1 and Tyumen regional psychiatric clinic petition to prosecution authorities when orphanages refuse to take back their pupils. Physicians of the Khabarovsk regional psychiatric clinic refuse to certify patient’s signature on documents authorizing patient’s relatives to receive their pension benefits on their behalf if these relatives do not visit the patient and do not bring parcels for them. Physicians of the Magadan regional neuro-psychiatric dispensary and Khabarovsk territorial psychiatric clinic have petitioned to courts to reinstate the official ability of their patients to work which proves that they treat their patients with care and respect. Representatives of some clinics (Kaliningrad city psychiatric clinic, Moscow psychiatric clinic #4) reported that they had witnessed a growing number of cases lately when certain people attempted to institutionalize their family members without sufficient grounds. Physicians defend the rights of such persons and refuse to institutionalize them. This is supported by the data on involuntary institutionalization that were obtained in the course of the monitoring: in 21 clinics (22%) cases were registered when involuntarily hospitalized patients were discharged within 48 hours of their admission following an examination by psychiatric commission. For example, the psychiatric commission of the Krasnoyarsk territorial psychiatric clinic #1 did not deem it possible to retain and subject to therapy six out of 118 patients who had been admitted against their will. The psychiatric commission of the Novgorod regional psychiatric clinic discharged 25 out of 266 involuntarily hospitalized patients following their examination, and the Republican psychiatric clinic of Buryatia discharged two out of 46 such patients. On the other hand cases are known when people without serious mental disturbances who had quarreled with their family members were brought to psychiatric institutions. Their protests against involuntary hospitalization were regarded as pathological agitation and they were subjected to therapy without prior examination by a psychiatric commission which must first confirm the necessity of therapy and then forward appropriate documents to the court. This happens most frequently to people of senior age. Upon the whole however one must admit that legal protection of patients is poorly organized. Patients are unable to receive qualified legal consultations and defend their rights in court, while institutions do not have means to pay lawyers; therefore cases when clinics defend the rights of their patients in the court of law are rare. In the meantime people with mental conditions are one of the most vulnerable categories of the population and they certainly require special protection from the state. |
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