PNI residents will be discharged and released from boarding schools according to new rules

For the first time in Russia, a document has appeared that regulates the conditions of discharge from a psychoneurological boarding school (PNI), transfer to another institution, as well as the departure of residents on “vacation”. The draft rules were developed by the Ministry of Labor. It is emphasized that this process should be based “on the value of maintaining family, kinship and other interpersonal relationships and the importance of citizen participation in the life of society.” However, representatives of non-profit organizations believe that the document still needs to be improved.

In Russia, the reform of the system of care for patients with psychiatric diagnoses continues. Last week, the Ministry of Labor submitted for public discussion the draft “Procedures and conditions for transfer, discharge and temporary departure from an inpatient social service organization intended for persons suffering from mental disorders.” This is the first time such a document has appeared.

Now all these issues “are entirely left to the discretion of the inpatient institution itself and depend on the goodwill of the director,” explains Maria Ostrovskaya, president of the St. Petersburg charitable organization “Perspective” (helps adults and children with severe mental disorders). Thus, in some PNIs, residents are allowed to study accompanied accommodation for a year at once – while in other institutions they can leave only for two weeks.

The new rules provide that temporary departure – so-called vacations – is possible at the request of a citizen (in the case of an incapacitated person or a minor – upon the application of his legal representatives). The document lists possible reasons: the need to receive medical care, undergo rehabilitation, habilitation or training; undergoing preparation for independent or assisted living; leisure and recreation outside the PNI; the need to visit family members, relatives, friends and other close people “in order to maintain family and other social ties.” However, the final decision remains with the boarding school. Its management may refuse “vacations”, for example, if there is no confirmation of conditions for safe living. Another reason is the absence of a person committed to providing assistance and care to a person who is unable to live independently.

The refusal can be challenged by the medical commission. “However, the final decision still remains with the hospital organization, which has the right to refuse even with positive recommendations from the commission. This raises the question of the proportionality and redundancy of the rights granted to inpatient organizations, which can lead to abuse,” says Konstantin Vorobiev, a lawyer at the Need Help Foundation. It should be noted that the document states that the consideration of citizens’ applications should be based “on the value of maintaining family, kinship and other interpersonal relationships and the importance of citizen participation in the life of society.”

The document also states that a place in the PNI is reserved for a temporarily retired citizen for only 90 days. And the decision on “vacations” beyond this period is made by the “authorized body”. Maria Ostrovskaya believes that this will create additional barriers to accompanying or independent living. Training everyday skills outside an institution can take a year or four years – but people will be afraid to leave the boarding school without a guarantee of return in case of failure, because “in the regions there are waiting lists to move into a PNI.”

Ms. Ostrovskaya draws attention to the legal conflict in the project. Nowadays, the topic of accompanied accommodation is systematically dealt with mainly by NGOs, that is, legal entities – and the document is drawn up in such a way that the person responsible for the resident of the PNI “seems to be an individual.” According to Maria Ostrovskaya, even individual NPO employees will not be able to take on such personal responsibility.

The draft rules also regulate the transfer of a citizen from one social service organization to another, as well as the discharge procedure. This requires a statement from the person and a positive decision from the medical commission. If we are talking about discharge, the commission must submit a certificate about the relationship between the person being discharged and the persons who undertake to provide him with help and care. Moreover, in case of refusal, the commission must prepare recommendations on how to get a positive decision next time. However, the last word will still remain with the PNI administration.

Konstantin Vorobyov indicates that the commission will consist of representatives of various government departments, guardianship and trusteeship authorities, non-profit organizations, as well as a psychiatrist. This is expected to ensure impartiality and objectivity. “But it is important to note that the advisory nature of the commission’s decisions reduces their potential effectiveness in protecting the rights of citizens with mental disorders,” the lawyer warns. Maria Ostrovskaya adds that the law “On the Fundamentals of Social Services” gives a person the right to independently choose a social service provider. And the proposed procedure not only preserves, but also consolidates “the strange phenomenon when a person ends up in an inpatient social service organization upon application, that is, voluntarily, but cannot be discharged from this institution voluntarily.” In her opinion, the document needs to be improved: “In this form, it will most likely have an effect that inhibits the development of the social sphere.” Public discussion of the project will last until February 23.

Let us recall that at the end of January the Ministry of Health of the Russian Federation published a draft “Procedure for limiting the rights of patients in psychiatric hospitals.” It is intended to establish the boundaries of the powers of the administration of medical institutions. The psychiatrist with whom Kommersant spoke believes that this is an important step towards “creating an adequate legislative framework taking into account respect for the rights of patients.” However, lawyers call the document “very vague” and fear that it will not prevent abuse.

Natalia Kostarnova