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English Language Page Neuro-psychiatric boarding homes or homes for people afflicted with chronic conditions are part of the general system of psychiatric care in the country and are at the same time social welfare institutions. Neuro-psychiatric boarding homes (NPBH) are significantly different from psychiatric institutions of the health care system — both in their primary goals and objectives, as well as the structure of the patient body and the overall organization of patients’ work and life mode. They are home to people who due to their mental conditions are incapable of living in their families and the society at large because their abilities to service themselves, provide for themselves, and effectively socialize with others are either lost or underdeveloped. Patients of neuro-psychiatric boarding homes do not just undergo therapy; they “reside” in them. Such a notion as “discharge” practically does not exist there. In essence, people come to neuro-psychiatric boarding homes to stay there for good, until their natural demise. The situation of “residence” implies a special organization of patients’ everyday life which combines elements of a hospital on the one hand and a hostel on the other, as well as the involvement of patients in labor activities. There are approximately 400 neuro-psychiatric boarding homes in Russia and currently they are in an extremely short supply. In some regions of the country patients wait for spots in a neuro-psychiatric boarding home for several months and even years. The most numerous group of residents of neuro-psychiatric boarding homes are patients with deficient intellect (oligophrenia, dementias of various kinds) who constitute over one half of all the residents of neuro-psychiatric boarding homes (totaling 68.9%). Note that patients suffering from oligophrenia are mostly young people who have been transferred to neuro-psychiatric boarding homes from boarding schools for mentally deficient children (43%), families (25%), psychiatric clinics (20.76%), and other institutions. Such patients are transferred from boarding schools for mentally challenged children because they reach the age of majority (18), and from families — because it becomes impossible for their parents to take adequate care of them in domestic conditions. Once 18 years old the graduate of the boarding school for mentally challenged children is examined by a socio-medico-pedagogical commission. If the commission decides that the young person is capable of living independently he or she must be discharged from the boarding school and provided with housing. In all other cases such people are transferred to neuro-psychiatric boarding homes for adults. For a person whose intellectual development is insufficient and who had spent several years in a home and has no independent living skills, independent living becomes impossible without special preparation and support. Because there is not enough rehabilitation programs in children’s homes and because rehabilitation centers for post-boarding school education are virtually nonexistent it becomes impossible for the young people to realize their rights to independent life, education, and employment. It should be noted that one’s “mental deficiency” identified in children’s boarding schools is associated sometimes not as much with the real degradation of intellectual capacities, as with the so-called pedagogical neglect and lack of proper education and upbringing in the pre-school and school ages. Patients reside in neuro-psychiatric boarding homes for 15-20 years and more. Severe mental conditions characteristic of residents of neuro-psychiatric boarding homes make the majority of them unable to defend their rights and adequately respond to various violations. Intellectual incapacity combined with the conditions of living in neuro-psychiatric boarding homes prevents NPBH residents from the realization of their civil rights and freedoms. According to the law theory the foundation of subjective rights is the free expression of one’s will, respect of this will, and its practical implementation in real life. Individuals suffering from chronic mental conditions are unable to implement their will (it is either pathologically altered — insufficient, or nonexistent) and are thus deprived of this right in their everyday life. Therefore, it will be impossible to speak about the observation of the rights of patients of neuro-psychiatric boarding homes as long as the society itself does not undertake to protect and safeguard the rights of these individuals. Neuro-psychiatric boarding homes especially require state and public control over the observation of the rights if citizens residing in them. However, control exercised by the state frequently turns out to be insufficient, while public control is practically nonexistent. General state guarantees of the respect for the will and freedom of citizens suffering from mental conditions require that the rights of invalids be protected in a stable and comprehensive manner ensuring that the real capacities of the state correspond adequately with the needs of each particular individual. The majority of these guarantees however remain unrealized and mental patients residing in neuro-psychiatric boarding homes have their rights violated continuously throughout their lives. Violations begin to occur at the point when patients are forwarded to neuro-psychiatric boarding homes. According to Federal Law “On the Provision of Social Services to Invalids and Senior Citizens” the placement of individuals suffering from chronic mental conditions and requiring permanent care and observation in neuro-psychiatric boarding homes is conducted on the basis of their personal written applications and should they be acknowledged to be incapable — on the basis of applications submitted by their legal representatives. The paperwork required to admit a patient to a neuro-psychiatric facility is processed by employees of territorial social welfare bodies. Article 8 of Federal Law “On the Provision of Social Services to Invalids and Senior Citizens” requires that social workers provide the citizen with comprehensive and reliable information on the concrete type of the establishment as well as the legal consequences that ensue as the result of their placement in a neuro-psychiatric facility. The fact that such information has been provided to the patient must be supported with an appropriate record made by the social worker on patient’s personal application and their material status assessment act that is later forwarded to the receiving institution. Thus, the social worker must establish and confirm the fact of the free, conscious, and informed consent of the individual to their admission to a neuro-psychiatric facility. This matter is quite complicated and requires a significant amount of time and skill which social workers do not always possess. As a result, in a significant number of cases the informing tends to be quite superficial and the obtained consent turns out to be a consequence of fallacy or coercion of patient’s relatives. In addition, Federal Law “On the Provision of Social Services to Invalids and Senior Citizens” accounts for a possibility of placing senior citizens and invalids suffering from mental conditions in neuro-psychiatric facilities without their consent or that of their legal representatives. Such a decision may be made by a court of law at the petition of social welfare bodies if the person in question is unable to independently take care of themselves and at the same time is not taken care of or supported by their relatives. Participation of judicial bodies in the review of such cases however is not provided for by either the federal law itself, or the current Civil Code of the Russian Federation which is why courts frequently make decisions on them without carefully reviewing them first and in the absence of the person whose placement in a neuro-psychiatric facility social welfare bodies petition for. Such a state of affairs grossly violates the right of individuals suffering from chronic mental conditions to the just review in the court of law and may lead to unjustified limitation of their freedom. In addition, this norm contradicts Federal Law “On Psychiatric Care and the Guarantees of the Rights of Citizens in Therapy” which forbids involuntary placement of citizens in neuro-psychiatric institutions. According to Federal Law “On Psychiatric Care and the Guarantees of the Rights of Citizens in Therapy” the placement of legally capable citizens in neuro-psychiatric institutions is conducted on the basis of their personal applications, and legally incapable — on the basis of the decision of a patronage and custody authority made on the basis of the decision of concilium which includes a doctor of psychiatry. The custodian does not have the right to independently place the individual in question in a neuro-psychiatric institution; he or she is only allowed to raise this issue in a petition to patronage and custody authorities. This norm better safeguards the incapable person from unconscientious actions of their custodian. The placement of a legally incapable person (of age) in a state-supported neuro-psychiatric institution is associated with the provision of this person with a list of social services guaranteed by the state, including the responsibility of the institution’s administration to act in the capacity of trustee with respect to individuals requiring custody (Article 21 “Responsibilities of the Administration of the Social Welfare Institution” of Federal Law “On the Provision of Social Services to Invalids and Senior Citizens,” Article 7 “Representation of Citizens Receiving Psychiatric Care” of Federal Law “On Psychiatric Care and the Guarantees of the Rights of Citizens in Therapy”). Therefore, when deciding to place an incapable individual in a neuro-psychiatric institution the patronage and custody authority usually relieves the former custodian of their responsibilities and transfers them onto the administration of the relevant social welfare institution. In certain cases patronage and custody authorities take into account specific interests of the incapable person and allow the person who has been acting in the capacity of their custodian heretofore retain their custodian functions. Unfortunately according to the data provided by human rights organizations custodians frequently wish to retain their custodian functions to be able to take advantage of their ward when sending them to a social welfare institution (by occupying their living quarters, illegally using their property, etc.) Administration of the social welfare institution must oversee the custodian as they fulfill their custodian obligations (whether or not they visit their ward on a regular basis, how they spend their ward’s money, etc.) and regularly report the results of their observation to the patronage and custody body. Should the custodian fail to fulfill their obligations adequately the patronage and custody authority may decide to revoke their custody privileges and transfer them onto the administration of the social welfare facility. It would seem that this rule should be able to prevent custodians from taking advantage of their wards, but in practice rights of incapable individuals are frequently violated due to the lack of proper control over the actions of custodians. One of the most important aspects of organizing life of residents of neuro-psychiatric institutions is the involvement of patients in labor activities which is regulated by a normative document which specifically emphasizes that citizens may be involved in labor-therapeutic activities only on a voluntary basis depending on the state of their health, their interests, and desires, as well as on the basis of recommendations of their physicians (for invalids — in compliance with recommendations of the socio-medical expertise). Clause 15 of this Resolution specifies that “Coercion of citizens into labor-therapeutic activities is prohibited.” In practice in institutions where patients with severe chronic mental conditions reside the legal and clinical approaches to the interpretation of the notion of “coercion” constantly diverge. The fact of the matter is that patients with chronic mental conditions frequently lose the volition resources of their psychics at some point or other, as well as imperative motivation for activity, including labor activity. Restoration of the lost labor and other social skills is only possible when actions of the rehabilitation specialist become intensively recommendatory, pressing, and conditionally coercive. Human rights activists sometimes regard this approach as violating the right of the human being to the freedom of choice, as coercion of patients to engage in labor activities. Physicians however are of the opinion that such “coercion” is necessary for the restoration of old or acquisition of new labor skills. The material base used to facilitate labor therapy in social neuro-psychiatric boarding homes usually consists of labor-therapeutic workshops (LTW), farms, and specialized shops. The distribution of these resources among neuro-psychiatric boarding homes is uneven: at present only a small number of neuro-psychiatric boarding homes (11.4%) dispose of labor-therapeutic workshops, farms, and specialized shops; a significant number of institutions (57.5%) dispose of labor-therapeutic workshops and farms. A significantly smaller number of homes (24.8%) dispose of only a farm and still more rarely — only labor-therapeutic workshops or specialized shops (4.6% and 0.7% respectively). Labor-therapeutic workshops are the primary base for the organization of patients’ labor-therapeutic activities the main focus of which is to enable the patient to see results of their work and receive remuneration for it. The most popular types of work done in labor-therapeutic workshops include sewing (74.4% of neuro-psychiatric boarding homes), carpentry (41.8%), and pasteboarding (13.8%). Depending on the available local resources that enable one to obtain raw materials and market the manufactured products one can also meet assembly, carpentry, shoemaking, basket-weaving, etc. Working at labor-therapeutic workshops patients have always earned very little (due to the shortened workday, low production output, doing low-paid jobs, etc.) but for many of them participation in this labor activity was a necessity. In 1992 in view of the changed socio-economic situation in the country the labor-therapeutic workshops stopped receiving raw materials and orders from local industries. As a result, the invalids residing in neuro-psychiatric boarding homes became unemployed. The violation of the right to labor negatively affected both clinical and socio-psychological indicators: conflicts between the invalids became more frequent, the frequency of psychopathic manifestations increased (escapes, thievery), addiction to alcohol became more pervasive. The new socio-economic conditions in the country urgently require that the outdated normative base be modified to enable the organization of labor-therapeutic workshops on different grounds that take into account the requirements of invalids who work in them. In addition to working in labor-therapeutic workshops and farms patients of neuro-psychiatric boarding homes may also do some of the following: 1) engage in daily servicing of the facility, 2) work outside the facility (as members of mobile brigades working in fields or on construction sites), 3) work as facility staff members or staff members of other entities. The daily servicing of the facility includes cleaning and order maintenance in living quarters and auxiliary premises, caring for patients with severe conditions, etc. This type of work is not paid for and must be carried out exclusively on the voluntary basis. However, in the condition of acute deficit of junior personnel the “voluntary” labor often turns into “coercive” and the patients are utilized in the capacity of orderlies. Physicians call it “labor therapy.” Lately opportunities of people residing in neuro-psychiatric boarding homes to do specific jobs they once have been trained to do, both inside and outside the facility, have become extremely scarce. Employment difficulties plague other categories of the population as well but for people with defects in intellectual development participation in labor activities is a requisite part of the therapy and rehabilitation process. Thus, in fact they lose their right to rehabilitation. Mental patients have the right to intellectual development, improvement of their social experience, and acquisition of labor and professional skills . Education of individuals with mental deficiencies requires specifically designed programs of training in socially important professions that take into account the degree of intellectual defect. Social welfare institutions permanently experience the need in repairing buildings, furniture, kitchen utensils, linens, footwear, etc. This circumstance accounts for the necessity of training young invalids so that they could acquire professional skills in painting, plastering, carpentry, shoemaking, needling, etc. and be subsequently hired by these institutions. The existing programs of professional training of invalids with deficiencies in intellectual development must be realized at specific moments, utilize specifically developed methodologies, and be extended in time. The principle of continuity and permanence of the training is especially important when it comes to educating patients with limited mental abilities. It is not rare however that the personnel of neuro-psychiatric boarding homes regard young invalids as a cheap labor force that can be used to do physical jobs. In real life it is not infrequent that training processes are interrupted by interferences of auxiliary personnel affected by instantaneous necessities of having the patients do certain jobs for the institution (unloading of foodstuffs, cleaning of the territory, etc.). Thus, the right of patients to systematic education is violated which negatively affects rehabilitation results. The solution of this problem is only possible if the personnel are taught to respect people with mental conditions and strictly observe their rights. People whose disability was caused by mental conditions, as well as individuals with mental deficiencies, have the right, just like all other categories of citizens residing in social welfare institutions, to decent living environment, organization of everyday life, and recreation. In the meantime no funds are allotted to improve living conditions in neuro-psychiatric institutions; therefore their residents have to exist in conditions that do not facilitate restoration of their impaired socialization abilities. The atmosphere is monotonous, as is the everyday life; there are no interesting occupations to pursue; interaction with the healthy environment is limited, and patients significantly depend on the personnel. One of the serious problems of the organization of neuro-psychiatric boarding homes is the noncompliance with the established living space-per patient norms. According to legal and normative documents the size of the sanitary area is 7 m2 but in many an institution this area does not exceed 4—5 m2 per patient. The situation is exacerbated by the fact that in a number of institutions 8—10 individuals reside in one room which is not only a legal but also a psychological problem for institutions in which people reside for many years in monotonous conditions. To eliminate such a negative situation one must draft and construct modern buildings that would meet the requirements of invalids with mental conditions and enable them to use their rights and opportunities in compliance with international standards. Today however the construction of neuro-psychiatric boarding homes is not conducted in Russia at all and there is no hope that the situation will improve any time soon. Rehabilitation of young patients in neuro-psychiatric boarding homes is conducted with the view of integrating the invalids in the long run back in the society, which is the right that every person has. To achieve that goal however having good labor skills and a high level of socialization is not enough. Invalids integrated in the society must be provided with a number of conditions: housing, job (employment), and advisory support as they acquire new job responsibilities. The situation in which people with mental conditions could be discharged from the neuro-psychiatric institution at physicians’ recommendation but in view of certain circumstances are not, is a violation of the rights of invalids. Most frequently invalids are denied discharge from the institution due to their having no housing and the possibility of ever solving their housing problem. Citizens residing in a neuro-psychiatric boarding home retain the right to the previously occupied state or municipal housing during the first six months following their admission to the social welfare institution, and if their family members continue to reside in their housing unit — during the entire period of their residence in the institution. Therefore, individuals who have relatives who are willing to accept the invalid who has gone through socio-labor rehabilitation back into the family and assist them in finding employment and initial adaptation in the workplace find themselves in a more fortunate situation. In this case the person has a place to live, a healthy environment, assistance in social and labor adaptation, and consequently — continuation of socialization and enjoyment of equal with other people’s rights. The person who has lost their housing due to their placement in a neuro-psychiatric boarding home has the right to be provided with new housing should their health condition improve. In the current socio-economic situation however one has to wait for such housing to become available for too many years which in the long run simply becomes pointless. Individuals who have no housing also have a possibility of extending their residence in the neuro-psychiatric boarding home while working outside its boundaries (as janitors, loaders, orderlies, etc.). Being employed at external objects such individuals obtain an opportunity to interact with a healthy environment, acquire labor relations skills, and enrich their social experience, i.e., partial socialization occurs. In a number of cases individuals with limited mental abilities, having developed industrial skills within the confines of service-related labor, are transferred for permanent residence to social welfare homes of the general profile and acquire positions as staff members. Although in such cases they find themselves within a predominantly healthy environment the very situation of living in a social welfare home does not provide them with enough opportunities to accumulate sufficient social experience which restrains their socio-psychological development and obstructs their further integration in the society. Special hostels are recommended for such a category of invalids in which they could live on general grounds and still have access to the assistance of a psychologist and a social pedagogue since they require permanent psycho-correctional input. Legislation of the Russian Federation provides that the state guarantees the establishment of hostels for individuals suffering from mental disorders who have lost social connections. And although the establishment of specialized hostels for individuals with limited mental abilities is not only worth the while from the viewpoint of socio-psychological benefits, but it also is economically profitable (invalids do not require medical and expanded auxiliary personnel, they pay their rent and utilities, etc.), their number in Russia is minuscule. Employment of mentally challenged individuals residing in neuro-psychiatric boarding homes is also complicated. Even those who upon completion of a course of rehabilitation and acquisition of professional skills have been discharged to return to their families have oftentimes limited possibilities to realize their right to labor. This is accounted for by the lack of jobs for mental invalids, as well as by the fact that the level of social experience that they have achieved does not always meet the requirements posed by the task of full integration in the society. In such situations it would be worthwhile to continue rehabilitation of this category of citizens in specially established rehabilitation centers for individuals with limited mental abilities. In such institutions invalids obtain an opportunity to undergo labor-related training based on specifically designed programs with recommendations for subsequent employment that takes into account the conditions and nature of labor. A provision on such an institution was approved yet in 1990 but the process of their establishment is still in the stage of infancy which significantly restricts the implementation of the rights of people with mental disorders to appropriate education and employment. Legal issues also arise when patients are discharged from social neuro-psychiatric institutions. According to Article 44 of Federal Law “On Psychiatric Care and the Guarantees of the Rights of Citizens in Therapy” the patient may be discharged from a social neuro-psychiatric institution at their personal request supported by a relevant conclusion of medical concilium including a doctor of psychiatry, attesting that the health condition of the person in question enables them to live independently, and in case of an incapable person — at the request of their relatives or legal representatives who commit themselves to take care of the person in question. In the latter case no decision of a patronage and custody body is required for the discharge. The Model Charter of the State (Municipal) Social Welfare Institution provides for the order of discharge of patients in a similar fashion. It should be born in mind though that when an incapable individual is discharged from a social neuro-psychiatric institution a new custodian must be assigned to them for which an appropriate authorization is required from the patronage and custody authority. The lack of coordination among the existing legal norms with respect to incapable individuals, the difficulties associated with the procurement of a positive decision from medical concilium on one’s ability to live independently, as well as the housing availability issues result in the fact that the number of individuals discharged from neuro-psychiatric institutions is meager. Having entered a neuro-psychiatric boarding home patients usually stay there for the rest of their lives. Thus, neuro-psychiatric boarding homes as part of the country’s overall network of psychiatric institutions in practice fulfill only one function — they provide patients with chronic mental disorders and mental deficiencies with a place to live and take care of their social and everyday needs. The rights of residents of neuro-psychiatric boarding homes to integration in the society, independent living, life in a family, employment, education, etc. are violated practically ubiquitously and constantly. Children’s Boarding Homes 658.1 thousand disabled children were registered in the Russian Federation in early 2002. Among the primary illnesses that result in children’s disability 20.3% are mental and behavioral disorders of which 72.1% are mental deficiencies and developmental pathologies . For children who are brought up in families there are centers of social rehabilitation and rehabilitation departments under social services centers. 29 thousand disabled children with mental disorders are brought up in special boarding homes. In early 2001 there were 155 boarding homes for children with deficient mental development in Russia. Children and adolescents who are brought up in specialized boarding homes significantly differ in the degrees of their mental deficiencies. Some of them are only capable of acquiring elementary skills of hygiene and sanitation as well as self-service types of labor activities, others in addition to basic self-service skills acquire more complex skills in productive labor, and yet the others are capable of acquiring not only labor but also more complex “professional” skills. Children residing in boarding homes undergo labor training that takes into account their abilities, and learn how to work as loaders, janitors, dish washers, auxiliary workers in laundry facilities, orderlies, seamstresses, animal care-takers in agriculture, gardeners, etc. In some specialized children’s institutions mentally deficient adolescents acquire more complex professional skills and learn how to work as punch press operators, thread-carvers, welders, carpenters, etc. At present however the possibilities of obtaining employment in accordance with the acquired profession are significantly limited and the adolescents are forced to remain in conditions of virtual isolation from the external world. Extended confinement of mentally deficient children within closed institutions, as well as monotony of everyday life, deficit of socialization, and lack of development-facilitating information negatively affects them, exacerbating their social immaturity and vulnerability. This especially applies to adolescents whose mental deficiency is mild and whose interests and life demands go beyond the boundaries of the possibilities provided by the boarding home and therefore cannot be satisfied due to lack of appropriate conditions. To effectively solve the issue of labor and social rehabilitation and implementation of the right of the disabled children to subsequent independent life one needs to use a more differentiating approach to the treatment of children with different degrees of mental deficiencies and improve the system of rehabilitation of individuals with mental deficiencies. Whether the level of intellectual defect of the child corresponds with the conditions of the children’s boarding home is determined by the medico-psychological-pedagogical commission. In fact, it determines the fate of the child when deciding whether it is capable of attending a regular school or if it should be placed in a boarding home for mentally deficient children. The solution of this issue depends not only on the degree of the mental defect of the child but also on the situation in the child’s family, as well as other socio-economic factors. The lack of diversity in specialized boarding homes for mentally deficient children oftentimes results in a situation when the medico-psychological-pedagogical commission due to social reasons has to forward children with relatively mild delays in mental development to specialized social welfare institutions for children with advanced intellectual defects thus violating the right of the child to rehabilitation. To solve the problem of rehabilitation of mentally deficient individuals the establishment of institutions of a principally new type is required, i.e., rehabilitation centers that provide for various methods of treatment of patients as well as various training programs that account for the extent of mental deficiency, as well as previously acquired skills. In the course of training at such a rehabilitation center mentally deficient adolescents would be able to acquire professional skills necessary to work as loaders, janitors, orderlies, seamstresses, plasterers, painters, shoemakers, etc., and upon completion of the training program to obtain employment in boarding homes, health care and prophylaxis facilities, and other institutions. Today this problem is not solved at all and one of the main reasons is the lack of specialists who are skilled in working with mentally deficient individuals and capable of conducting classes in accordance with particular programs. The problem of rehabilitation of mentally deficient adolescents is directly associated with the possibility of their integration in the society. It has been established that of all the adolescents discharged from specialized children’s boarding homes only 34% are employed and are able to utilize the acquired skills working in specifically created conditions. As far as this particular group of individuals is concerned one may speak of a comprehensive realization of the right to rehabilitation and full integration in the society. Among mentally deficient individuals who upon reaching the age of 18 have been transferred to neuro-psychiatric boarding homes only 20.4% are employed and employment conditions are not equal: some of them (8%) work in the same institutions (children’s and neuro-psychiatric boarding homes), others (12.4%) are staff members in retirement and disability homes, as well as other institutions. As far as this group of people is concerned, one may speak of a partial integration in the society. Being surrounded by a healthy environment during the workday, using transportation, shopping, and visiting a variety of institutions that serve citizens by responding to their daily needs they expand their social experience and obtain the opportunity to share in social values. At the same time one may not speak of a full realization of the right of mentally deficient people to rehabilitation. These people require special living conditions like the ones that are offered by specialized hostels, halfway homes of the western type with an optimal regime with minimal supervision and predominant self-government and self-service. In essence those are institutions of the intermediate type that facilitate the transition from traditional boarding homes to integration in the society. Today such institutions are practically nonexistent in Russia. One of the key issues that arises with respect to mentally deficient individuals who have been brought up in specialized boarding homes is the one that has to do with their transition to a neuro-psychiatric boarding home (for adults) when they reach the age of majority. At the age of 18 the adolescent becomes legally capable and can determine the further course of his or her life independently. The decisions of patronage and custody authorities pertaining to their confinement to a social neuro-psychiatric boarding home “lose” their legal force. Exceptions are cases when due to their mental disorder the person is unable to comprehend the meaning of their actions or manage them. Such individuals must be acknowledged to be incapable in the order established by law. It is required that upon reaching the age of 18 young people residing in children’s neuro-psychiatric boarding homes for mentally deficient patients should undergo an examination by a medical commission that must include a doctor of psychiatry, a pedagogue, as well as other specialists (physicians, psychologist, etc.) that allows to make a comprehensive assessment of the psychosomatic state of health and the state of mental development of the individual under examination. The commission must determine in its conclusion how severe the examinee’s mental disorder is, whether they require to be confined to a social neuro-psychiatric boarding facility, or whether they can live in a non-specialized — non-neuro-psychiatric institution; whether they can continue their studies in the conditions of the regular or special system of education, whether they can live independently and service themselves, as well as — which is especially important — whether there are sufficient grounds to petition to court and request that the person in question be acknowledged as incapable. If the commission has arrived at the conclusion that the examinee does not comprehend the meaning of their actions and is unable to manage them this person is acknowledged to be incapable in the order established by law and is transferred to a neuro-psychiatric boarding home for adults the administration of which begins to act as their custodian. If the commission is of the opinion that the examinee is capable of servicing themselves and lead an independent lifestyle they must be discharged from the boarding home and provided with housing. According to Federal Law “On the Provision of Social Services to Invalids and Senior Citizens” “disabled children residing in social welfare institutions… upon reaching the age of 18 shall be provided with housing units by local self-government bodies in the area of the location of the institution or in the area of their previous residence depending on their choice if their individual program of rehabilitation accounts for such a possibility.” Insufficient effectiveness and individualization of rehabilitation programs used in the currently operating boarding homes for mentally deficient individuals combined with the lack of rehabilitation centers which could provide support and assistance to graduates of boarding homes in their independent lives makes it practically impossible for them to embark on independent living upon reaching the age of majority. The solution of the issue associated with the possibility of independent living is also negatively affected by housing problems. If there are no grounds to acknowledge the person to be incapable and the possibility of independent living is out of the question the young person must be transferred to a neuro-psychiatric boarding home for adults or a boarding home of the general type. The transfer to a different welfare institution (neuro-psychiatric or general profile) is conducted on the basis of a personal application demonstrating person’s voluntary and informed consent. Administration of the institution must inform the person of their rights in the course of their stay in the institution (Article 21 “Responsibilities of the Administration of the Welfare Institution” of Federal Law “On the Provision of Social Services to Invalids and Senior Citizens”). Consent provided under the influence of a threat, deceit, or aberration is not considered to be voluntary and consequently must be acknowledged to be invalid. In reality almost all children residing in specialized boarding homes for mentally deficient individuals upon reaching the age of 18 are automatically transferred to welfare neuro-psychiatric boarding homes for adults. Apparently, the administration assumes that their severe mental disorders render them incapable of consciously expressing their will on the basis of informed consent. In addition, such an order of transferring individuals suffering from mental disorders who have reached the age of majority from children’s neuro-psychiatric boarding facilities (children’s boarding homes for severely retarded children) to institutions for adults is accounted for by the Model Charter of the State (Municipal) Welfare Institution (Clause 6.10) approved by order #283 of the Ministry of Labor and Social Development of the Russian Federation of November 4, 1997. According to this Charter “pupils who have reached the age of 18 and are incapable of labor are transferred in accordance with a respective conclusion of a specialized socio-medical commission as well as appropriate decision of a pedagogical board to neuro-psychiatric institutions of social welfare…” No voluntary and informed consent is required. And although this order (provided for by the Charter) does not comply either with Federal Law “On Psychiatric Care and Guarantees of the Rights of Citizens in Therapy,” or with the RF Civil Code, or the Civil-Procedural Code of the RSFSR, or the RF Constitution, it is this very Charter that many administrators of children’s boarding homes abide by when transferring individuals with mental disorders to neuro-psychiatric institutions of social welfare for adults. Thus, the rights of young people with mental disorders are massively violated. In the neuro-psychiatric boarding home for adults they are most likely to spend the rest of their lives, deprived of the right to education, employment, life in a family, full value socialization, diversity of life, etc. |
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