Tatyana Moskalkova will tell deputies about the problems of citizens with mental disorders

The Commissioner for Human Rights in the Russian Federation, Tatyana Moskalkova, will present a report “Respect and protection of the rights of citizens with mental disorders” in the State Duma on Tuesday. The day before, Kommersant got acquainted with the contents of the report. It talks about problems in inpatient psychiatric hospitals and social service organizations for such patients. The Ombudsman’s Office confirms cases of rude treatment of patients by medical staff, speaks of a “widespread” shortage of medicines, clothing and shoes, and also notes an overabundance of premises unsuitable for human habitation. The responsible ministries told Kommersant that they are solving these problems.

In the report, Tatyana Moskalkova points out that the overall prevalence of mental illnesses is increasing every year. Thus, during the COVID-19 pandemic, the number of citizens with anxiety and depressive disorders has increased. The conduct of a special military operation also affected the mental health of citizens: “In all groups of the population, there is an increase in anxiety and depressive symptoms are appearing. Some citizens return or are evacuated from a combat zone with post-traumatic mental disorders, for others it is due to concern for the fate of loved ones and the country.”

From 2020 to 2022, the Ombudsman’s Office received 948 complaints regarding violations of the rights of citizens with mental disorders. In 2020 there were 247 of them, in 2021 – 504 (the reasons for this surge are not indicated in the report), and in 2022 – 197. The appeals mainly concerned three topics. The first is the problems of validity of establishing a psychiatric diagnosis, incapacity and clinical observation. The second is cases of involuntary, according to the applicants, hospitalization in a psychiatric hospital or placement in a psychoneurological boarding school (PNI). The third is complaints about inadequate material and living conditions in inpatient medical organizations and social service organizations, as well as reports of unlawful actions by the staff of these institutions.

The report details violations in medical organizations that provide psychiatric care in inpatient settings (subordinate to the Ministry of Health) and in inpatient social service organizations (area of ​​responsibility of the Ministry of Labor and regional authorities). “Infringement of the rights of citizens in these institutions poses the greatest threat, since the people held in them are in a more vulnerable position,” explains Ms. Moskalkova.

In medical organizations, the ombudsman’s office confirmed violations of the right to voluntarily seek psychiatric help and identified “cases of psychological pressure being exerted on patients to obtain their consent to hospitalization and treatment.” In addition, violations were recorded during involuntary hospitalization and extension of treatment. Often, medical institutions “do not comply with the standards of material and living support for patients.” Thus, the law allocates at least 6 square meters in the chamber. m of living space per person, but this requirement is often ignored, as is the rule on the separate housing of patients with infectious diseases. The principle of privacy is not respected in the toilets, which violates the dignity of the individual. Problems were identified with “nutrition standards for the range and quantity of basic products.” Medical facilities do not have enough shoes and clothing for patients, and what is available “is often very worn out and does not fit properly.” The bed linen is “shabby, gray in color.”

A number of inpatient departments of psychiatric hospitals are “housed in unsuitable pre-revolutionary buildings” that have long been in need of repairs, including major ones. Some hospitals still do not have a centralized sewage system; instead, they have cesspools. There are not enough premises for receiving specialized medical specialists and medical buildings in general. Also, “in many medical organizations” patients are deprived of the right to use the telephone. They also do not have daily walks, partly due to the lack of exercise yards and the lack of warm clothing. Most medical organizations do not have medical and industrial workshops, and there is no social and labor rehabilitation.

“Not all medical hospitals have created conditions for the safe stay of citizens,” the report says. In most cases, we are talking about non-compliance with fire safety standards or the lack of perimeter fencing. But there are unusual violations – for example, one hospital is located in the radioactive contamination zone of the Chernobyl nuclear power plant.

The Office of the Ombudsman confirms cases of examination and treatment that “do not meet the standards of medical care.” “The problem of unethical behavior of medical personnel (mainly middle and junior) remains: humiliation of human dignity, disrespectful attitude towards patients, rudeness,” the report says. “Many hospitals use restrictive measures and special measures of physical restraint in the form of restraining the patient in the absence of established rules for their application.” There are, however, problems that are beyond the control of employees of medical organizations: “There are difficulties with a shortage of medicines. There is a shortage of psychiatrists, psychotherapists, forensic experts, and qualified nursing personnel everywhere.”

There is also “a widespread lack of social assistance to protect the civil rights of persons with mental disorders”; “there are frequent violations of the right to information about health status, accessibility of medical documentation to patients, their representatives, lawyers and observers”; “there have been violations of patients’ rights to receive qualified legal assistance, as well as to file complaints and applications with authorities, the prosecutor’s office and the court.” Finally, “the issue of organizing training for people with disabilities and minors with mental disorders who have been in medical institutions for a long time has not been regulated.”

The situation is similar in inpatient social service organizations. There are 2,251 of them in the country, but in a number of regions “the issue of queues” to get there continues to be acute. At the same time, “in the majority” of them, “cases of inadequate material and living conditions are identified, their placement in morally and physically outdated buildings with a high percentage of wear and tear, requiring major and current repairs.” According to the Ombudsman, “in many cases there is overcrowding and non-compliance with living space standards.” Also, “poor and poor-quality food, dilapidated bed linen, lack of hygiene products and hot water, violation of temperature conditions,” and lack of footwear (winter, summer, indoor), outerwear, tights, socks, underwear, and hats are also often found.

This part of the report notes “non-compliance with privacy conditions”, “failure to ensure accessibility for people with disabilities and people with limited mobility”, “acute shortage of medical personnel”, “insufficient supply of medicines”, “low availability and quality of medical care”, “disorganization and unsystematic dispensary supervision, preventive medical examinations”, “the universally low quality of rehabilitation programs” and “the lack of vocational training for adults with disabilities”. Finally, “there are isolated cases of rude attitude of staff, physical violence against incompetent persons, and the use of potent psychotropic drugs with severe side effects as punishment.”

The Ministry of Health told Kommersant that it is actively developing cooperation with the office of the commissioner “to ensure the full implementation of patients’ rights.” The press service of the department clarified that the National Medical Research Center named after. Serbsky and National Medical Research Center named after. Bekhtereva “carry out organizational and methodological activities in the regions of the Russian Federation, including visits and assessment of the provision of medical care in boarding schools, psychoneurological dispensaries and other social institutions,” as well as “development of response measures when deficiencies are identified.” Reports are sent to regional executive bodies in charge of psychiatric hospitals.

The Ministry of Labor reported that in 2002, “together with the regions and the expert community, a list of measures was developed aimed at improving the system of psycho-neurological boarding schools,” which includes the issue of building repairs. And in 2023, “a set of measures was developed and approved to reduce and prevent the waiting list of elderly citizens and disabled people for placement in inpatient social service organizations for 2023–2025.” In addition, according to the ministry’s monitoring data, by October 1, 2022, 80 regions were involved in the implementation of assisted living technology.

Psychiatrist, president of the Independent Narcological Guild Ruslan Isaev told Kommersant that 948 complaints over three years are just the tip of the iceberg in the case of the number of possible violations. The founder of the charity foundation for people with psychiatric difficulties, “Simply People,” Marina Rees told Kommersant that about 10 thousand people turn to her foundation every year. And “virtually 100% of clients who have encountered state mental health care complain about violations of their rights or the quality of treatment,” Ms. Rees says.

The Ombudsman points to “the virtual absence of information interaction between medical organizations and internal affairs bodies.” Due to medical secrecy laws, doctors refuse to provide police with “information about persons with mental disorders who are under clinical observation.” At the same time, the police need to know about such people “in order to prevent them from committing socially dangerous acts,” writes Ms. Moskalkova. In the final part of the report, she suggests that the government resolve this “conflict” by changing the law on mental health care. According to media reports, such a bill has already been developed; The commissioner’s office told Kommersant that they have not yet familiarized themselves with it.

Natalya Kostarnova, Alexander Chernykh