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English Language Page Practically in all of the surveyed institutions the number of square meters of ward space per one patient is insufficient and does not comply with the established sanitary-hygienic norms. Among other factors this is accounted for by the fact that the majority of institutions occupy unsuitable facilities. In addition to that the currently existing rule — 8 m2 per patient — is impossible to observe in view of the outdated material base of the clinics, as well as the lack of new facilities that would be able to meet the requirements of modern psychiatry. In some institutions the living space of one patient is limited to three square meters. But this is the average figure. In practice the number of square meters of ward space per patient frequently depends on the number of patients currently in therapy in a particular department. For example, in the men’s department of the Krasnoyarsk regional psychiatric clinic #3 one patient had only 1.5—2.5 m2 of ward space, while in the women’s department of the same institution — 8 m.2 As a result, the average number of square meters per patient that is reflected in the clinic’s documentation is 4 m.2 It is clear that this figure does not adequately reflect the inadmissible situation in which patients of the men’s general psychiatry department of this institution have found themselves. Although the living space requirement of the existing sanitary-hygienic norms is not complied with by the majority of psychiatric institutions in some cases this violation acquires disastrous proportions. For example, the amount of square meters of ward space per patient at the Bryansk regional psychiatric clinic is 1.8 m,2 at the Kaliningrad regional psychiatric clinic — 1.6-1.8 m,2 at the psychiatric department of the Altai republican hospital — 1.5 m.2 No doubt such crowdedness in psychiatric institutions questions the effectiveness of the therapy they offer. The situation is additionally exacerbated by the fact that the size of wards in Russian institutions as a rule is also out of compliance with requirements of the modern psychiatry. Most of the institutions have large wards (for 10-15 patients and more) which had been set up to provide convenience for personnel and ignore the needs of patients. Sometimes ward sizes are unacceptably large. For example, the department of the Oryol regional psychiatric clinic that is designed to accommodate 76 patients consisted of two wards: one accommodates 34 patients, and the other — 42. In one of the wards of the women’s department of the Tula regional psychiatric clinic there were accommodated 66 patients. The crowdedness of departments results in the fact that beds in wards are pulled together and a free access to patients’ beds is obstructed. Sometimes due to crowdedness beds are placed in hallways but this may not be considered an acceptable solution to the crowdedness issue. For example, 20 beds were observed in the hallways of the Yaroslavl regional psychiatric clinic, 16 — in Smolensk, 10 — in Kostroma, and seven — in Chita regional psychiatric clinic. Note that in some institutions (Bryansk regional psychiatric clinic and Krasnoyarsk territorial psychiatric clinic #2) two-storey beds are still used. Some hospitals in their attempts to provide their patients with more decent living conditions have used their own resources to erect partitions in originally enormous wards and put together a number of relatively compact rooms in which one can try to create at least a certain semblance of homely coziness. But such cases continue to remain exceptions. Department capacity Among other factors the effectiveness and success of the therapy and rehabilitation process depends on the department capacity. A department designed to simultaneously accommodate 100 and more patients entails a significant increase of workload for the specialists and staff. A smaller department capacity allows organizing a better quality therapy process, paying more attention to each patient, reducing the amount of conflict situations and creating a more beneficial and home-like environment for the patients that facilitates their more rapid recovery. The current hospital staffing norms provide that the optimal capacity of the department equipped with a modern crew of specialists is 50 beds. According to Order #27 of the Ministry of Health Care of Russia of February 13, 1995 “On Staffing Norms of Psychiatric Care Establishments” for each 25 psychiatric beds a physician-psychiatrist must be allotted and for each 50 patients — a department head. In addition, a psychotherapist, a psychologist, and a social worker must be assigned to each 50 beds of a general psychiatry department. Nevertheless, most of the Russian psychiatric hospitals dispose of departments with capacity of 70-90 patients, and in some institutions there are departments whose capacity is more than 100 patients. Nine such hospitals were inspected in the course of the survey:
Apparently, the work of head physicians and other specialists in such conditions is significantly impeded; the probability of conflicts among patients, as well as among the staff within departments is much higher. Lighting, air Scarce state and municipal funding of psychiatric care creates a situation in which hospitals are not always in a position to ensure the due level of observation of elementary sanitary-hygienic norms, including those of the lighting and air in wards and departments. The lighting of wards during day-time depends on the number and size of windows, presence or absence of bars, and is satisfactory in the majority of wards. But electrical lighting of wards and departments is insufficient. Electrical bulbs on the ceilings are unable to provide a sufficient level of lighting of wards, some of them are not working, and there was no additional lighting equipment anywhere to be seen. Scarce funding of hospitals prevents administrations of institutions from replacing outdated and unusable lighting devices in a timely manner as well as from purchasing parts in sufficient quantities (light bulbs, plafonds, etc.) which results in the fact that in some institutions — Astrakhan regional psychiatric clinic, Voronezh city psychiatric clinic, Moscow regional psychiatric clinic #2, Nizhnii Novgorod city psychiatric clinic #1, Tver regional psychiatric clinic #1 named after Litvinov, Cheliabinsk regional psychiatric clinic #2, and Tula city psychiatric clinic — there is not enough light not only in wards, but also in hallways of departments. Many hospitals have established schedules for airing wards and departments. But due to the overall neglected condition of certain institutions the air in their wards and departments is permanently damp and musty (Voronezh regional psychiatric clinic, Kirov regional psychiatric clinic named after Bekhterev, neuro-psychiatric department of the district hospital of the Nenetsky Autonomous District, Republican neuro-psychiatric dispensary of Kalmykia, Republican psychiatric clinic of Tatarstan, Rostov city psychiatric clinic (Kovalyovka settlement), Tver regional psychiatric clinic #1 named after Litvinov, Yaroslavl regional psychiatric clinic, Yaroslavl regional psychiatric clinic “Afonino”). Due to insufficient funding not every hospital is in a position to equip smoking rooms with ventilation. Therefore in some institutions the air smacks of tobacco smoke, as is the case, for instance, in the Orenburg regional psychiatric clinic #2. In those institutions in which there are smoking rooms they as a rule are poorly equipped, require maintenance, and utilize a variety of home-made devises in the capacity of ashtrays (buckets, cans, pans with water, etc.). In the rest of the surveyed departments patients smoke in toilet anterooms (Republican neuro-psychiatric dispensary of Adygea), washrooms (Vologda regional psychiatric clinic, psychiatric department of the district hospital of the Komi-Permyatsky autonomous district), on balconies (Belgorod regional psychiatric clinic), in tambours (neuro-psychiatric department of the district hospital of the Nenetsky autonomous district) or in toilets. The latter case is come across most frequently and in many cases this situation impedes one’s utilization of the toilet since toilet bowls are not isolated from smokers in any fashion. In light of this fact some clinics have introduced schedules allowing their patients to smoke in toilets during specifically designated hours. For example, patients of the regional psychiatric clinic of the Jewish autonomous District smoke in the toilet five times a day, patients of the Kurgan regional psychiatric clinic — every two hours. Plumbing, sewage, heating The majority of clinics use cold and hot water without limitations. The supply of hot water is usually discontinued for one of the summer months for maintenance of hot water pipes, and in those times each clinic is left to its own devices as it strives to continue provisioning of its patients with hygienic procedures. During the periods when centralized supply of hot water is discontinued unaffected remain those hospitals that dispose of their own independent boilers and water heaters. Interruptions in hot water supply in many cases do not depend on administrations of institutions. Everyday living conditions of institutionalized patients are largely determined by the overall readiness of the local utility infrastructure for the heating season. For example, the Primorsky territorial psychiatric clinic #1 disposes of hot water when the local boiler is working, but its operation can be seriously impeded by interruptions in fuel supply. The hot water supply schedule established by Oryol regional authorities does not coincide with the schedule of hygienic procedures established at the Oryol regional psychiatric clinic. Upon the whole it is interruptions in hot water supply that chief physicians most often complain about . The Republican psychiatric clinic of the Komi Republic is not supplied with hot water during the summer time, and the Tver regional psychiatric clinic #2 is supplied with hot water year round but it is not available in all of its departments. However, institutions that are not regularly supplied with good quality cold water find themselves in the most disastrous situation. For example, the Republican neuro-psychiatric dispensary of Kalmykia has no independent water supply and obtains drinking water from water containers which the hospital personnel carry in buckets. The dispensary has no hot water supply either therefore water brought by water containers is heated once every ten days to enable the patients to take showers. Due to lack of funds the supply and quality of cold water is unsatisfactory in many institutions. The Republican psychiatric clinic of Karelia is not supplied with cold water. Clinical personnel have to independently extract water from artesian wells located in the clinic’s vicinity. (Water is heated twice a week but this schedule is sometimes violated due to lack of fuel.) The quality of the water supplied to the Tver regional psychiatric clinic #1 named after Litvinov is very bad because it is taken from an insufficiently deep aperture. Some time ago the construction of a new aperture had almost been completed but right now additional funds are required to complete the construction and set the aperture to work. The bad quality of water supplied to the Pskov regional clinic #1 is accounted for by the fact that local water and sewer pipes are worn out to a disastrous degree and there is not enough money to replace them. Not all of the surveyed hospitals are equipped with sewage; in some institutions sewer pipes are practically not functioning. Three of the surveyed hospitals — Krasnoyarsk territorial psychiatric clinic #3, Rostov city psychiatric clinic (Kovalyovka settlement), and Yaroslavl regional psychiatric clinic “Afonino” — have cesspits on their territories. Due to the fact that sewage pipes of certain institutions are worn out to a high degree they go frequently out of order or become clogged up (Krasnodar city psychiatric clinic, Pskov regional psychiatric clinic #1, Republican psychiatric clinic of Tatarstan named after Bekhterev, and others). Given that many institutions have never seen capital overhaul they have problems with not only plumbing and sewage but also with heating. The poor condition of heating pipes jeopardizes a stable provision of heat to psychiatric institutions. The survey took place in the summer time and it was impossible to check the condition of the heating system but representatives of some clinics did complain that the level of heating during winter frosts was unsatisfactory. Hygiene The problem of all Russian health care institutions that requires immediate solution is the insufficient provisioning of patients with sanitary-hygienic articles and equipment. Patients of practically all institutions are inconvenienced by a short supply of toilets, showers, and wash-basins. In practice patients are deprived of conditions of privacy required for satisfaction of natural physiological needs and are unable to shower regularly. Note that residing in departments that lack sanitary-hygienic equipment frequently turns into a serious psychological problem for mental patients, especially considering that many of them reside at the institution over extended periods of time. In order to change the situation however one needs considerable capital investments as well as a capital overhaul of the entire system of plumbing and sewage and none of the hospitals that receive meager funding from the state can afford that. As a result the situation with the sanitary-hygienic equipment remains disastrous. In some hospitals there are departments that have only one toilet bowl for 50 patients. In some clinics such situation was observed in mixed departments where men and women are in therapy together. For example, only one toilet bowl is available in the 50-bed mixed department of the Kotelnichesky psychiatric clinic of the Kirov region, in the 50- and 80-bed mixed departments of the Republican and Ukhta city psychiatric clinics of the Komi Republic. In the women’s department of the Republican neuro-psychiatric dispensary of Khakassia there is one toilet room with three toilet bowls for 220 patients, in the Kirov regional psychiatric clinic named after Bekhterev there is one toilet bowl for 125 patients, and in the Krasnoyarsk territorial psychiatric clinic #1 there is one toilet bowl for 78 patients. A more or less satisfactory situation was observed in only several institutions which disposed of one toilet bowl per 10 and less patients, but none of the surveyed clinics had toilets installed in wards. One cannot help concluding that such conditions humiliate human dignity and may not be considered acceptable. Nevertheless local authorities that provide funding for psychiatric institutions do not undertake any measures to change this situation, although in some cases administrations of hospitals do manage to obtain means to improve living conditions of their patients. For example, patients who pay for their therapy are in a definitely better position. Such patients reside in wards that have in-built bathrooms (Samara regional psychiatric clinic). The situation with wash-basins is somewhat better as some hospitals (Irkutsk regional psychiatric clinic, Irkutsk regional neuro-psychiatric dispensary, Nizhnii Novgorod regional psychiatric clinic #1, Republican neuro-psychiatric dispensary of Adygea, Khabarovsk city psychiatric clinic named after Professor Galant) even have wash-basins installed in wards. However the majority of institutions dispose of insufficient quantities of wash-basins — one per 15—20 and more patients. The most disastrous situation with wash-basins was observed in the Kirov regional psychiatric clinic named after Bekhterev in which one wash-basin is available for 125 patients. Approximately the same situation was observed in the Republican neuro-psychiatric dispensary of Khakassia in which one wash-basin is used by 110 patients. The Yaroslavl regional psychiatric clinic “Afonino” for chronic patients who stay institutionalized over extended periods of time there is only one wash-basin for 100 persons. Many hospitals find it very difficult to comply with the existing sanitary-hygienic norm that requires all patients to bathe and change their underwear and bed linens once every ten days. Outdated equipment, facilities that are found unsuitable by sanitation authorities, lack of bathhouses, etc., force administrations of institutions to look for alternatives. For example, patients of the Kurgan regional neuro-psychiatric dispensary use the municipal bathhouse to which they are taken once every ten days. Hospitals in which bathing takes place in departments almost ubiquitously lack showers and bathtubs, therefore bathing opportunities of patients are extremely limited. For example a mixed 50-bed department of the Kotelnicheskaya psychiatric clinic of the Kirov region disposes of only one bathtub, and the Kirov regional psychiatric clinic named after Bekhterev makes its only bathtub available to 125 patients; the Krasnoyarsk territorial psychiatric clinic #1 disposes of two showers that are available to 97 patients, in the Kurgan regional psychiatric clinic there is one shower available to 65 persons, and the Moscow regional psychiatric clinic #2 has two showers that are available to 120 persons. At the same time bathing facilities and the condition of bathtubs themselves aggrieves one with their impracticality and lack of sanitation even though junior personnel does take pains to create at least minimally acceptable conditions. The majority of the surveyed institutions obviously require immediate repair of their sanitation facilities. The lack of funding prevents hospitals from providing their patients with necessary articles and means of hygiene. Most institutions provide their patients only with soap, and most often it is the industrial heavy-duty soap unsuitable for bathing. Single patients and patients of few means are in the most difficult situation as they cannot count on external assistance, while acquisition of diapers for senior single patients is viewed by the majority of physicians and staff as an extravagance that only the most affluent hospitals can afford. Furniture Furniture in hospitals remains in short supply. The assortment of furniture is extremely limited; primarily departments are provisioned only with beds and bedside tables. The furniture available in the majority of institutions is worn out and in fact is no longer usable. Oftentimes beds are the only furniture found in wards. The situation is exacerbated by the fact that due to lack of funding the inventory is not renewed on a timely basis. As a result beds in the majority of clinics are old, with wire gauzes, and in many cases the latter are sagging to the floor (Astrakhan regional psychiatric clinic, Tver regional psychiatric clinic #1, Yaroslavl regional psychiatric clinic, etc.). Beds in the psychiatric department of the district hospital of the Komi-Permyatsky autonomous district are old and have sharp corners that are dangerous for the patients. The situation with storing personal belongings is absolutely unacceptable. In the majority of psychiatric institutions there is not enough bedside tables for all the patients and one bedside table has to be shared by four patients (Vologda regional psychiatric clinic, Irkutsk regional psychiatric clinic, Tula regional psychiatric clinic, etc.), five (Bryansk regional psychiatric clinic #3, Republican psychiatric and tuberculosis clinic of Marii El, Republican psychiatric clinic of Bashkortostan, etc.), six (Lipetsk regional psychiatric clinic, Moscow regional psychiatric clinic #2, etc.), seven (Krasnoyarsk territorial psychiatric clinic #2, psychiatric department of the district hospital of the Komi-Permyatsky autonomous district, etc.), nine (Vladimir regional psychiatric clinic #4, Oryol regional psychiatric clinic, etc.), ten (Bobrovo-Dvorskaya psychiatric clinic of the Belgorod region, Prokhladnensk district psychiatric clinic of Kabardino-Balkaria) and more patients. Patients are forced to store their personal belongings in unsuitable for that purpose places, for example, under the pillow or on the windowpane (psychiatric department of the Altai republican hospital), or under the mattress (Tver regional psychiatric clinic #1). In those clinics where the number of bedside tables corresponds with the bed capacity of departments they are practically unusable. For example, bedside tables of the Krasnoyarsk territorial psychiatric clinic #1 have no handles, those of the Republican psychiatric hospital of Udmurtia have no shelves, and their doors will not close, etc. Availability of the required amount of beds and bedside tables in some departments does not always meet the existing needs of the clinics. Soft furniture that is required from the viewpoint of psychiatric institutions is not to be found in the majority of departments. Bedding, clothing, footwear Given that the funding of hospitals is scarce not only do psychiatric departments experience a deficit of furniture, but they also are in short supply of the soft inventory. Many a hospital has difficulties acquiring bedding, mattresses, and clothing for patients. Some hospitals dispose of only two-three sets of bedding per bed instead of the required four-five. The bedding used in institutions is as a rule of a bad quality. For example, the bedding in the Yaroslavl regional psychiatric clinic is “very worn-out,” in the psychiatric department of the district hospital of the Komi-Permyatsky autonomous aistrict — “not fresh,” mattresses of the Republican neuro-psychiatric dispensary of Udmurtia are “decrepit,” etc. Some hospitals ask their patients to bring their own bedding from home, in others patients do it of their own accord as they are not satisfied with the quality of bedding provisioned by the hospital. Somehow or other, but oftentimes the right of patients to use their own bedding during the therapy turns into their obligation. They are induced to bring their own bedding to the hospital. For example, only those patients of the Nizhnii Novgorod psychiatric clinic #1 receive hospital bedding who are unable to bring any from home. Medical insurance provided by the state implies provision of free health care and full funding of patients’ residence at health care institutions. But in some cases patients have to pay for their institutionalization. For example, the Republican psychiatric-tuberculosis hospital of Marii El purchases mattresses, blankets, and bedding at the expense of patients’ pensions because the hospital has no means of its own to do that. Due to the fact that financial possibilities of hospitals are limited the situation with provisioning of patients with clothing and footwear is often unsatisfactory. Hospital clothing is usually unsightly and sometimes unusable. Oftentimes hospital clothing is “decrepit, looks untidily” (Voronezh regional psychiatric clinic), “worn-out,” “old” (psychiatric department of the District hospital of the Komi-Permyatsky autonomous district, Krasnoyarsk territorial psychiatric clinic #2, Kurgan regional psychiatric clinic, etc.), while footwear is extremely worn-out and oftentimes “does not fit” (Republican psychiatric clinic of Bashkortostan, Republican psychiatric clinic of Tatarstan, etc.). Patients of many departments use their own clothing and footwear that they bring from home. Interior The interior of wards and departments that facilitates the promotion of a psychologically comfortable environment is an important factor of the therapy and rehabilitation process. Russian psychiatric clinics had been ignoring this factor for a long time focusing their primary efforts exclusively on pharmacotherapy. It used to be characteristic of psychiatric hospitals to have absolutely bare walls and no decorations or articles of homely coziness. Over the past several years this attitude has been revised but funds have never been made available for an elementary decoration, let alone professional design. Therefore the atmosphere in many hospitals remains to be official and one does not feel like staying there. The problem is that some physicians still sincerely think that curtains on the windows or reproductions of paintings on the walls are absolutely unnecessary and even extraneous in the conditions of permanent lack of funding. The survey showed that in many hospitals (Voronezh regional psychiatric clinic, Kotelnicheskaya psychiatric hospital of the Kirov region, Kirov regional psychiatric hospital named after Bekhterev, Ulyanovsk regional psychiatric clinic named after Karamzin, Yaroslavl regional psychiatric clinic, etc.) wards and in some cases departments did not have any decorations in them. At the same time patients have to spend many months in such conditions, and sometimes even years. Upon the whole decorations were limited to curtains on the windows and reproductions of paintings on the walls in wards and curtains, reproductions and potted flowers — in departments. In some institutions there was wallpaper, drawings, and mirrors on the walls, but it was the atmosphere of only six departments that human rights activists assessed as relatively cozy (Vladimir regional psychiatric clinic #1, Regional psychiatric clinic of the Jewish autonomous aistrict, Moscow psychiatric clinic #4, Penza regional psychiatric clinic, and some others). Thus, the atmosphere in the majority of institutions does not meet the requirements of modern psychiatry and the survey showed that no improvements are envisioned in that respect any time in the nearest future. Specialization of departments and wards Availability of departments of different profiles within the structure of an institution, differentiation of patients on the basis of age, sex, and acuteness of their conditions allows providing each patient with the most suitable for them conditions of residence and a personalized degree of limitation of their freedom. For example, departments for involuntarily institutionalized patients who have breeched the law and been rendered non compos mentis employ additional security guards and administer a more stringent observation regime, whereas sanitarium-type departments designed for patients with marginal conditions administer an open-door policy and provide their patients with home vacations. Specialization of wards (observation wards — for agitated and potentially dangerous patients, general — for equable patients, and small — for patients prone to solitude) is necessary in order to provide a patient with the most suitable for them environment and a most adequate restraint measure. Availability of day-care facilities where patients only spend their day-time gives them an opportunity to choose the most appropriate for them regime, prevents them from developing a sense of hospitalism that is so characteristic of mental patients who stay at psychiatric institutions for extended periods of time, allows them to preserve social skills and mobility, and spend a significant amount of time at home. According to survey results only a handful (10 of the surveyed) institutions did not have specialized departments: all departments were those of general psychiatry (Kaliningrad regional psychiatric clinic, Dankovskaya psychiatric clinic of the Lipetsk region, Republican neuro-psychiatric dispensary of Kalmykia, etc.), involuntary therapy ordered by court (Kostroma specialized psychiatric clinic with intensive observation), and those for chronic patients (Yaroslavl regional psychiatric clinic “Afonino”). Specialization was not found in psychiatric departments of multi-profile hospitals — psychiatric department of the District hospital of the Komi-Permyatsky autonomous aistrict, neuro-psychiatric department of the District hospital of the Nenetsky autonomous district, and psychiatric department of the Altai republican hospital. In the rest of the surveyed institutions specialization of departments was found to be at a due level: 54 institutions disposed of children and adolescent departments, 31 — geriatric departments, 25 — sanitarium and psychotherapeutic departments, as well as departments for neurotic patients. Some institutions have put together nursing departments for elderly patients (Shadrinsk neuro-psychiatric hospital of the Kurgan region, Penza regional psychiatric clinic, etc.) whose primary goal is to provision patients not as much with therapy but with care and decent living conditions; special departments for individuals who have lost social connections (Astrakhan regional psychiatric clinic, Republican psychiatric clinic of Tatarstan, Khabarovsk territorial psychiatric clinic #2, and others); departments for patients with severe chronic conditions (Magadan regional neuro-psychiatric dispensary, Republican psychiatric clinic of Karelia, Yaroslavl regional psychiatric clinic, and others). Large hospitals also disposed of narcological departments (Belgorod regional psychiatric clinic, Kostroma regional psychiatric clinic, and others) and departments for patients with psychoses caused by alcoholism (Voronezh city psychiatric clinic, Moscow psychiatric clinic #4, etc.), acute psychoses departments (Krasnoyarsk territorial psychiatric clinic #3, Republican psychiatric clinic of Karelia), intensive therapy departments (Penza regional psychiatric clinic, Republican psychiatric clinic of Bashkortostan), intensive care departments (Kirov regional psychiatric clinic named after Bekhterev, Perm regional psychiatric clinic, Sverdlovsk regional psychiatric clinic #1), and emergency care departments (Irkutsk regional neuro-psychiatric dispensary). Such diversity of department specializations enables one to account for peculiarities of each patient and place them into an environment that corresponds with their condition and requirements. 25 hospitals (27%) (Irkutsk regional psychiatric clinic, Novokuznetsk city psychiatric clinic of the Kemerovo region, Kurgan regional psychiatric clinic, and some others) have put together day-care facilities. This allows patients to choose a more convenient for them regime of residence at the institution that is associated with less significant limitation of their freedom. As far as the ward size is concerned, the only hospital that disposes of a one-bed ward is the Vladimir regional psychiatric clinic #4. Seven other institutions (Regional psychiatric clinic of the Jewish autonomous district, Kaliningrad city psychiatric clinic, Central Moscow regional psychiatric clinic #1, Ukhta city psychiatric clinic of the Komi Republic, Republican neuro-psychiatric dispensary of Khakassia, Khabarovsk territorial psychiatric clinic #2, Cheliabinsk regional psychiatric clinic #1) dispose of two-bed wards. The rest of the surveyed institutions were found to be unable to provide their patients with opportunities of solitude. Recreation rooms In the conditions of lengthy residence in a department it is very important for patients to spend time outside of their wards. At the same time the majority of institutions did not have recreation rooms in their departments. As a rule, hospitals use canteens (Perm city psychiatric clinic, Samara regional psychiatric clinic, Stavropol territorial psychiatric clinic #1, etc.), halls (Orenburg regional psychiatric clinic #2, Sverdlovsk regional psychiatric clinic #1, etc.) and hallways (Belgorod regional psychiatric clinic, Pskov regional psychiatric clinic) in the capacity of recreation rooms. Recreation rooms of the hospitals that do have them are oftentimes not decorated or specifically designed (Astrakhan regional psychiatric clinic, Moscow regional psychiatric clinic #2, psychiatric department of the Altai republican hospital, Republican neuro-psychiatric clinic of Kalmykia, Ulyanovsk regional psychiatric clinic named after Karamzin, Chita regional psychiatric clinic #1); sometimes they even lack soft furniture (Voronezh regional psychiatric clinic, Smolensk regional psychiatric clinic #1). Not only do recreation rooms have to reconstruct a cozy atmosphere of home, but they also are implied to offer various kinds of pastime activities to patients (tabletop games, books, television, radio, etc.). But some hospitals had their recreation rooms practically unequipped, for example the Kirov regional psychiatric clinic named after Bekhterev, which makes the existence of recreation rooms pointless. Sometimes equipment designated for recreation rooms is placed in other rooms which limits opportunities of patients. For example, in the neuro-psychiatric department of the district hospital of the Nenetsky Autonomous District the television set is found in the nurse’s room, whereas in the Tver regional psychiatric clinic #1 named after Litvinov — outside of the department door which has to be kept open for patients to be able to watch television. At the same time well-equipped and designed recreation rooms are not always accessible to patients. In some cases they are made available to patients only during certain hours, which makes them plan their pastime in compliance with requirements of the institution’s administration. In other cases recreation rooms are located outside of department’s limits. The recreation room of the Moscow psychiatric clinic #4 can be entered from the tambour preceding the department where patients are not allowed to independently. Therefore it is quite doubtful that this recreation room is used as designated. Canteens In the majority of departments canteens occupy separate rooms and are appropriately set up for intake of food. Nevertheless in some hospitals there are no separate rooms for canteens and dining tables are installed in halls or hallways of the department (Kostroma regional psychiatric clinic, Central Moscow regional psychiatric clinic #1, Moscow psychiatric clinic #4, Novgorod regional psychiatric clinic). Rooms used for canteens must comply with sanitary-hygienic requirements, but in view of the lack of capital or ongoing maintenance in certain hospitals their canteen rooms are poorly suited for intake of food. For example, in one of the departments of the Vladimir regional psychiatric clinic #1 there is “mould and fungus on walls and ceilings, tiles that are pitted, furniture that is old and in an unsatisfactory condition.” The canteen of the Nizhnii Novgorod psychiatric clinic #1 is “sordid, the furniture is old and broken, kitchen sinks are leaking..” The canteen of the Moscow regional psychiatric clinic #2 was found to have “dark bare walls and rivers on the ceiling..” It is assumed that the canteen’s interior should also carry out a therapeutic function by creating comfortable environment. Nevertheless, in some departments canteens are not at all decorated and are essentially quite gloomy rooms (psychiatric department of the District hospital of the Komi-Permyatsky autonomous district, Tver regional psychiatric clinic named after Litvinov, Irkutsk regional psychiatric clinic, Lipetsk regional psychiatric clinic, Kirov regional psychiatric clinic named after Bekhterev, etc.). Apparently such conditions of the canteens cannot facilitate healthy digestion. Refrigerators are installed in all departments but not everywhere can patients have easy access to their foodstuffs. Usually it is clinical personnel that hands out named packets with foodstuffs to patients during certain hours specifically established for that, but in some rare cases patients access their products independently. Still, patients do have a chance to diversify their hospital menu. |
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