Plans to concentrate psychiatric care in the home from 2018 in Moscow
In Moscow, there have been discussions on reforming the system of psychiatric residential institutions.
Hearings with a discussion took place on 22 December, as part of the Month in Support of People with Additional Psychiatric Needs, announced in the capital by the charity Kachestvo zhizni (Quality of Life)and the Department for Labour and Social Security of the Moscowadministration. Directors of psychiatric institutes took part in the event, along with specialists, representatives of family groups, NGO staff and volunteers.
“It is no coincidence that the hearings about reforming psychiatric residential units were the final event of the Month in Support of People with Additional Psychiatric Needs and the project STOPSTIGMA,” the President of the Kachestvo zhizni foundation, Maria Kulik, commented. “In the past month, a multitude of events have taken place: lectures, master-classes, discussions, creative competitions. Each one of them called on all of us to look anew at the problems facing people with additional mental and psychiatric needs. The more we know, the less fear there will be and the more creative participation. And then each special person, with professional support, will have the chance to live a normal life.”
The organisers of the hearings presented the results of an online survey carried out by them in which 613 respondents took part, chosen from various social and age groups, the majority of whom were not directly affected by psychiatric issues. 40% of those surveyed believed that reform of the mental health system and the creation of alternative structures for living should take place in parallel; 25% are sure that psychiatric units need not only to be reformed, but that the institutions should be completely changed; 4% believe that reform is necessary but should lead to solving certain problems “in these institutions”. Practically all representatives from the expert community, as well as those taking part in the online survey, expressed the opinion that psycho-neurological institutions should cease to exist in their current form.
A year ago, a working group under the Ministry of Labour started to develop a plan to reform psychiatric units in Russia. A road map created by representatives of civil organisations was adopted as the basis for the project. The project seeks not only to change the work of psychiatric units, but also to widen their help for people with disabilities who are in such units.
“At the moment, we cannot say that significant changes have taken place in the system, but in the first quarter of 2018 we will switch from developing the project to implementing it,” the deputy director of the Department of Labour and Social Security of the Population of Moscow, Pavel Keller, said. “We will work in three main areas: destroying stereotypes about and within the system; increasing the autonomy and legal status of recipients of social services; and developing in-patient technologies. Essentially, these changes are aimed to stop people ending up in psychiatric units who should not be there. If we can guarantee a person help at home – we should do it.”
Assisted living is one of the most effective ways of supporting people with disabilities who can live outside a residential unit but periodically need help. It can help to reduce the number of inpatients. Member of the working group, Co-Chair of the Coordinating Board for Children with Disabilities in the Public Chamber of the Russian Federation, Elena Klochko, told the auditorium about pilot accompanied living projects which have already been trialled in Pskov and Nizhny Novgorod.
Despite a number of successful pilot projects and initiatives, the real situation in the residential psychiatric system remains most difficult. Along with the need for legal changes and financial barriers, participants in the hearings admitted that many of the problems lie within the institutions as well as on the level of decision-making directly linked to the stigmatisation of people with mental health issues. Negative public opinion about them leads to difficulties with socialisation and recognition of their rights.
According to data from the Russian Ministry of Labour, there are currently 150,000 people living in psychiatric units. More than a third of them were raised in specialised children’s homes, which do not prepare people for an independent life, 20% lived previously in families, and almost 40% were referred to a residential unit from a psychiatric clinic. Despite the popular opinion that inhabitants of residential psychiatric units are seriously disabled, many of them have legal capacity, retaining their intellect, and can carry out suitable work. Up to 70% of them can be socialised and, with appropriate assistance, can live in society.