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English Language Page The principle of “respectful and humane treatment excluding the humiliation of one’s dignity” is reflected in the list of rights of patients in the Law on psychiatric care as well as in the “Foundations of RF legislation on the health care of citizens.” In this sense the Russian legislation complies with the provisions of the International Covenant on Civil and Political Rights which forbids subjecting any human being to torture or cruel, inhumane, and degrading treatment and punishment. The right to dignified treatment is found in the principle of non-restraint, information, in the requirement to provide decent living conditions, and in fact in all other rights because it has to do with the style of treatment of patients. In the meantime, mentally challenged individuals are often characterized by a hypersensitive and exaggerated, and sometimes even totally inadequate perception of the attitude of other people towards them (as far as their respectfulness, attentiveness, and willingness to help are concerned). They can perceive therapy as coercion, as a torture which they have to put up with. A paternalistic, directive style may exacerbate the negative perception of therapy. This heightened false perception of the attitude of other people — one of the most characteristic qualities of psychiatric institutions, something that constitutes their specificity. What is important is the psychological atmosphere of the institution which is set first and foremost by the junior personnel, as well as the head of the department and the head physician. Rudeness, familiarity, excessively rigid regime, lack of individual approach, tactfulness, elementary politeness, attentiveness, and patience, neglect of requests and complaints, rudeness demonstrated by personnel and physicians with respect to each other in front of the patients, etc. — are factors that may largely complicate therapeutic processes. According to data obtained from physicians and personnel members a more beneficial psychological atmosphere exists in those medical establishments in which there is a permanent staff of employees who have worked in psychiatry for many years. In some small psychiatric institutions that are located far away from large residential areas special relationships evolve between patients and personnel members: they know each other for many years and their relationships are marked with special care and warmth. Here is for example what personnel members of the Bobrovo-Dvorskaya psychiatric clinic of the Belgorod region have to say about it: “Everything here is like at home. We all — patients and personnel — are as one family.” “Orderly women treat patients very gently, call them by their first name, and know every circumstance of their lives.” “When someone is disquieted in their soul they come to me, put their head on my shoulder. I will speak with the patient; I will stroke her gently over her head, or simply hug her. She calms down.” “There is more humanity in rural clinics.” Regular work with junior personnel Given that it is the junior-level personnel that are largely responsible for the psychological atmosphere in the department regular work with it is an absolutely required aspect of the organization of a therapy process. Not only must physicians and nurses conduct regular classes for orderlies but they also must constantly ensure that they treat patients without rudeness or disrespect. According to some of the surveyed head physicians patients often complain about the manner in which they are treated by orderlies. Unfortunately, these complaints are rarely paid enough attention to as they are usually regarded as unjustified. Many clinics conduct regular classes for junior personnel on a monthly and even weekly basis to train them on how to apply restraint measures, on peculiarities of working with mentally challenged patients, etc. However, in the conditions of an extremely high turnover of personnel even a monthly work is not enough. “He has just started to work. He has not learned anything yet, he has not understood anything yet, but he is already leaving.” Elderly women with a significant experience in psychiatry working as orderlies put their psychiatric institutions in a more beneficial position. |
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