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English Language Page These are fundamental articles which formulate the main guarantee of the realization of the Law as a whole: the responsibility of the state at all levels (from the federal bodies to the bodies of local self government) for providing the persons suffering from mental disorders with “all kinds of psychiatric care and social protection,” “emergency psychiatric care,” “consultative and diagnostic, medical, prophylactic and rehabilitation aid in extra-hospital and hospital conditions,” with “social everyday aid and help in finding employment,” “social settlement of disabled and aged persons and care they need,” “training disabled and underage persons,” “legal consultations,” “all kinds of psychiatric expert’s assessment,” “solving the problems of patronage,” etc., by creating “all kinds of institutions offering extra-hospital and hospital based psychiatric care at the place of patients’ residence where it is possible,” “medical production enterprises for labor therapy,”… “jobs at the enterprises, institutions and organizations,” with “hostels for persons who have lost social ties,” it “organizes the education and professional training of the underage.” The peculiarity of these two articles is in the fact that they simultaneously present both common patterns of legal regulations. Firstly, citizens are provided with legally guaranteed rights, secondly, the authority structures of all levels are obliged to provide the services prescribed by the Law and made responsible for their realization. It seems that both of the above mentioned circumstances were to focus the attention and efforts on the strict observance of articles 16 and 17 as having primary significance for the Law as a whole. Yet the authors of the methodological guide of 1994 accentuated the need to create the “Service for the protection of rights of patients staying at psychiatric clinics” as the guarantee that the Law as a whole is observed, though this service is only one out of a number of control agencies, and the very creation of the Service depends, first and foremost, on the state financing. The authors of the Commentary to the Law (1997 and 2002) also did not note the central meaning of articles 16 and 17. Thus, the guarantees of central significance, the obligations and the responsibilities of the state, was for some reason ignored and substituted with all sorts of other guarantees having partial character. The results of the monitoring revealed with full evidence the fundamental role of insufficient financing. It concerns, first and foremost, the real budget of the hospital which determines the conditions of staying at it, of food and treatment patients get, the observance of their fundamental rights, the creation of hostels for patients who have lost social ties, and jobs, the renewal of main funds, the creation of the Service for the Protection of the Rights of Patients staying at psychiatric clinics, the insurance of the personnel, remuneration of its labor and payment of compensations, ensuring safety for patients and the personnel. According to Federal Law “On Protection of Citizens’ Health,” the sources for the financing of psychiatric clinics are the means of budgets of all levels, and the means of state funds of obligatory medical insurance of citizens and special funds created to protect the health of citizens. Besides that, the financing psychiatric institutions can be realized from the means of various enterprises and public associations, from income produced by securities, from credits, charity grants made by individual citizens and organizations, other sources which are not banned by the legislation of the country. In practice only the budget of local bodies of government is the basic and often the single source of finances mentioned in this list. Practically all examined hospitals are financed by regional and local budgets: regional, territorial, district, etc. depending on their subordination. Only one hospital is fully financed by the federal sources — it is the specialized Kostroma psychiatric clinic with intensive surveillance which conducts forced treatment of mental patients from all regions of the country who committed grave crimes and are socially dangerous. Special conditions were created at this hospital which include enforced security service, it is directly subordinated to the RF Ministry of Health Care, and its financing is substantially better than that of the examined hospitals. Two more hospitals (Penza regional and Tula city clinics), besides local money, receive financing from the federal budget which make up 15% and 12.5% of their total budget correspondingly, and the psychiatric clinic of the Jewish autonomous area was allocated 12 000 rubles in 2002 for a special federal program. Other hospitals had no federal financing. Some city and district hospitals are financed both by the city and regional authorities, but it does not always improve their financial situation. As a whole, city and district psychiatric clinics suffer more from underfinancing. Thus, for example, in 2002 the city psychiatric clinic of Nizhnii Novgorod received 50% of the money it needed from the local budget, the Ukhta city hospital of the Komi Republic received 47%, and the Kuznetsk city psychiatric clinic of the Penza region got only 33%. Grave under financing is characteristics of Shadrinsky neuro-psychiatric clinic of the Kurgan region, Novokuznetsk city psychiatric clinic of the Kemerovo region, Kirov city psychiatric clinic, and Smolensk neuro-psychiatric clinic. The situation with financing is practically the same (about 50% or worth) at the Kostroma, Kurgan and Novgorod regional psychiatric clinics, Orenburg regional psychiatric clinics #1 and #2, at the Irkutsk regional neuro-psychiatric dispensary, Volgograd regional psychiatric clinic #2, Republican clinical psychiatric hospital of Tatarstan (Kazan), republican neuro-psychiatric dispensaries of Kalmykia-Khalmg Tangch Republic and Buryatia. Nevertheless, in the country as a whole the situation with the financing of psychiatric institutions has substantially improved for the last three years, and in separate regions the change is really dramatic. Thus, at present in the Chukotka autonomous district, for instance, the financing is 100%, and the psychiatric care is provided to the population on an adequate level. On the other hand, there still are regions where local authorities do not only adopt budgets of psychiatric clinics covering 50—60% of the calculated expenses, i.e. of what the hospital needs, they also do not transfer all the money they have allocated for it. Thus, for instance, the Kurgan regional psychiatric clinic got only 71% of the money that was allocated for it by the budget of the region in 2002, and, as a result it had to feed patients on 13.6 rubles a day. The funds of obligatory medical insurance in the country do not finance psychiatric institutions, but in some regions (for example, the Komi republic, the Udmurt republic, Primorsky territory, Astrakhan region) head doctors said that they got the money to cover medication and food for patients from these funds, and at the Samara regional psychiatric clinic the Fund of the Obligatory Medical Insurance is the main source of financing. Paid services are one of the means to fill the budget of hospitals. Paid services are varied enough, and they are offered both to the patients of the hospital, and to the population of the neighborhood (diagnostic, treatment and various kinds of physiotherapy, psychotherapy, all kinds of narcological aid). Many hospitals have decent equipment which they strive to use. Nevertheless, paid services make up not more than 5% of the hospital budget. 35 hospitals offer paid services to the population, and three hospitals try to improve their financial situation leasing the area they own which is not appropriate for patients to other organizations (Khabarovsk city psychiatric clinic named after Professor Galant, St. Petersburg psychiatric clinic #7 named after Pavlov and Vladimir regional psychiatric clinic #4). The Republican clinical psychiatric hospital of Tatarstan maintains a large boiler installation, and the hospital sells heat to some other organization adding money to its meager budget. Some head doctors said that they could have offered a greater range of paid services but the conditions of the patients at the hospital prevent it. The head doctor of the Perm regional psychiatric clinic said, “many patients are ready to pay for our service but we are not able to provide it.” Some hospitals equipped a small number of one or two bed wards where the conditions are close to domestic environment (curtains on windows, bedside-tables, a table, chairs, lamps, a TV set, a separate toilet) and take money from the patients for the so-called “services.” In fact, patients are made to pay for the elementary human existence, i.e. for something which is to be provided by the state for free to every patient. This money is used to pay additional salaries and to cover urgent needs. As a matter of fact, the budget finances, first and foremost, the so-called “protected” clauses which cover salaries, food and medication. The money to acquire linen, clothes, furniture, and other equipment, to pay for repairs are not allocated for years on the run. Hospitals have to find the means to cover their needs on their own. Some hospitals opened so-called sponsors’ accounts where relatives can transfer money. Sometimes they do it on a voluntary basis, sometimes they are forced to do it. In some cases relatives buy some things a hospital needs, such as, for example, pajamas for patients or detergents. Some plants and factories can help with building repairs, provide transportation, construction materials. The Khabarovsk refinery helped the territorial psychiatric clinic to pave its premises, the Ronex food company allocates 15 thousand rubles a month for fruit and juice for the children department of the Chita regional psychiatric clinic #1, but practically no hospital has permanent sponsors which could substantially improve its financial situation. The results of the monitoring have revealed again the drastic contrast between the use of the rights of patients for adequate life conditions and full treatment at the psychiatric clinic of the common network financed by the local budgets, and at the psychiatric clinics which conduct forced treatment and which are financed by the federal budget. In fact, the enjoyment of all the patients’ rights and the rights of the personnel of the psychiatric service is directly linked to the level of financing, and, despite substantial improvement in the situation of the patients of psychiatric clinics in the course of the last two or three years, it still remains below the tolerable level. Patients are no longer starving, but they are still underfed. They already receive treatment, but it is morally outdated, as a rule. They often know their rights, but they still cannot realize them. |
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