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English Language Page For a treatment to be effective it is desired that it be conducted in the conditions of ecologically clean area. Therefore the clinic must be distanced as much as possible from zones affected by industrial enterprises and its territory must be covered with greenery to the maximum degree possible. Patients of the majority of the surveyed clinics (64%) are in a favorable ecological situation. Regardless of whether the clinic is located within city limits or in the suburbs the territories of clinics have greenery. As a rule it is man-made — trees, fruit orchards, flowerbeds, sometimes — forest territories. Nevertheless there are few clinics whose location and territories are unsatisfactory. For example, on the territory of the Astrakhan psychiatric clinic one feels a strong smell of sewage, while on the territory of the Altai republican clinic one feels a lack of clean air as the clinic is situated at an intersection of two dirt roads and is not fenced at all. Territories of the Chita regional psychiatric clinic #1, the District clinic of the Nenetsky autonomous district, and the Dankovskaya psychiatric clinic of the Lipetsk region lack greenery. It is necessary to note that the ecological situation on the territory of the clinic is accounted for by the general ecological situation in the region. Location of the majority of the clinics in recreational zones reduces the negative influence from the existing pollution of the environment but radical improvement especially in those few clinics whose ecological situation is unsatisfactory oftentimes depends not on the administration of the clinic but on the state. Remoteness Psychiatric care must be easily accessible for the population. Complete isolation negatively affects the process of therapy and especially that of rehabilitation. Patients need contacts with the external world and their regularity among other factors depends on the organization of transportation. Patients and their relatives should not face any difficulties, including transportation problems. Regularity, accessibility of transportation becomes more important when it comes to large regional or territorial institutions that admit patients from the entire region (Krasnoyarsk territorial psychiatric clinic, Perm regional psychiatric clinic). For example, the psychiatric department of the republican hospital of the Altai Republic is located in Gorno-Altaisk downtown but it takes not less than 10 hours to reach it from certain districts of the republic. The survey shows that the majority of clinics are located away from urban centers, which is sooner an advantage than disadvantage from the viewpoint of psychiatry, since patients of these clinics find themselves in more beneficial ecological conditions. Nevertheless the remoteness of hospitals from cities requires a regular and reliable operation of transportation. Otherwise the rights of patients to preserve contacts and social links become jeopardized. And although isolation of mental patients is one of the aspects of psychiatric care it is inadmissible to limit one’s contacts unless it is recommended by doctors. In the meantime patients of certain clinics are significantly isolated from the external world. It is the patients of 17 psychiatric institutions (Kaliningrad city psychiatric clinic, Sverdlovsk regional psychiatric clinic #1, St. Petersburg psychiatric clinic #1 named after Kaschenko, and others) that practically have no communication with residential areas and are complexes of buildings that include facilities for the treatment of patients and living quarters for staff. In this case the distance separating patients from their relatives ranges from seven to 60 km and is oftentimes rather difficult to overcome for the relatives, especially in view of frequent transportation issues. Many clinics that are situated at a distance from residential areas operate their own buses but these are designated predominantly for staff. At the same time vehicles are in short supply and many require replacement. Difficulties with transportation have been observed in 14 psychiatric institutions (15%). Naturally in such circumstances relatives cannot count on assistance from clinics in the organization of visitation of patients. Interruptions in the operation of transportation and the short supply of vehicles create difficulties not only for patients’ relatives, but also for clinical staff and specialists. For example, the Stavropol territorial psychiatric clinic #2 is situated on the outskirts of a settlement that is 40 km away from the city. The only means of transportation there is a bus that is used by both clinical personnel and patients’ relatives, which operates twice a day. Clearly such schedule cannot meet the needs either of clinic’s employees or patients’ relatives. |
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