Locked away forever
Sitting in her apartment in the suburbs of Kiev and looking down at her hands, Olya Federova recalled: ‘When my mother brought me to the hospital, she said to me: ‘I’m going to pay and you’re going to serve your time.’
In 2012, Olya, a 45 year-old a shop assistant from Kiev suffered from depression after a divorce. Her mother sent her to the Pavlov psychiatric institution in Kiev, where doctors diagnosed Olya with schizophrenia. She claims she did not have schizophrenia and that the diagnosis was paid for by her mother who no longer wanted to live with her ‘difficult’ daughter, that her mother simply wanted legitimize her detention.
Olya says her legal incapacitation benefitted her mother in other ways: it allowed her to take full possession of the apartment that was in Olya’s name, and to receive 25 per cent of Olya’s disability pension. She also says the doctors did not give her any treatment for her supposed ‘schizophrenia’ – a condition treated throughout the world with antipsychotic drugs and psychotherapy.
In 2014, after 18 months of living in the Pavlov institution, Olya was admitted to the Svyatoshinsky psycho-neurological care home in central Kiev, Ukraine’s largest mental health institution where about 700 women receive full-time care. Olya says that in Svyatoshinsky as in Pavlov, she was not given any medication.
In April 2018, Olya was able to leave the institution for a few days’ holiday but she refused to return, unable to bear the conditions any longer. Although now free, she currently faces a legal battle to obtain her legal documents. Olya’s son – now her guardian since her mother passed away two years ago – has refused to help her gain legal capacity. ‘She’s an alcoholic who needs to be locked away,’ he told the New Internationalist over the phone.
Named and shamed
In 1882 Friedrich Nietzsche said: ‘Creating new names is enough to create new things’. In Ukraine’s mental health system, facile psychiatric diagnoses are destroying people’s lives.
Olya’s story is not unusual. Activists and lawyers, including Robert Van Voren, Head of Federation Global Initiative on Psychiatry (FGIP) said thousands of unwanted relatives and orphans have been condemned to psychiatric institutions in Ukraine, and falsely diagnosed with a mental health illness just to legitimize the internment. Some have wrongfully spent over 20 years in psychiatric institution among those with serious mental health conditions, completely stripped of their rights in dehumanizing living conditions.
Van Voren told the New Internationalist that in some institutions, residents are given high dosages of medication, punishment with physical abuse, and slave labour. He said some of the more physically able residents were forced to do agricultural work in nearby land. The institution staff take what little pay residents received.
‘We heard stories of residents being beaten, chained naked to a radiator for long periods of time.’ Said Van Voren.
Van Voren recalls meeting a woman in Svyatoshinsky, 31, who was put in an orphanage when she was 9 years old. She was later moved to a children’s social care home where she lived until the age of 25, when she was diagnosed with schizophrenia, put under guardianship and subsequently transferred to an adult social care home. ‘It seems she has no future but to live in the care home.’
According to Van Voren, institutions profit from psychiatric internment: the more beds occupied the bigger the income. When someone is interned and legally incapacitated, most of their pension goes to the institution. Medical staff are supposed to help the patients to use the pension properly, but Van Voren said in many cases, the person never sees the money and does not even know how much he/she has. ‘It’s a major problem that the doctor who makes the diagnosis is employed by the institution/hospital. They are linked in the same chain and one ‘helps’ the other. Since we don’t have access to the financial records, so we can’t know where this money is really going.’
Even Svyatoshinsky’s Director, Dr. Tynok, confirmed it was quite possible to have unwanted relatives admitted to the institution and given a mental health diagnosis simply to legalize the process: ‘there is no predictable or reliable mechanism to safeguard a person from forced admission at random,’ said Tynok, as written in the FGIP report.
‘Strong stigma surrounding mental health disorders combined and a lack of education about different psychological treatments justifies the internment. Financial incentives to fill up social care homes, corruption and a severe lack of independent safeguarding mechanisms enable it,’ said Van Voren.
Drugs, labour and submission
Patients are said to be unnecessarily drugged. Alla Karpova, the acting head of the social care homes from the Ministry of Social Affairs told Van Voren that in one institution she visited virtually all women get haloperidol – an antipsychotic drug – in the morning, as if it were a sort of ‘vitamin’. Karpova said that she and other compliant residents who clearly did not have a mental disorder were not drugged. But as a general rule, according to Van Voren, staff use excessive amounts of drugs to keep patients quiet and submissive.
Olya Federova says that nurses recognized she did not have any mental health issues and put her straight to work. One of her jobs involved collecting and washing patients’ bedding. ‘It was exhausting because I was constantly running around. But I’m glad I had something to do.’
Olya told me that she became good friends with one of the nurses who let her use her phone. ‘At night, we’d go to the top floor and have a few drinks, smoke and play cards.’
By law, the institute should annually assess patients, and only if their condition is considerably improved can the director apply to the court for their release.
But Olya and several other patients claimed that in all their years at the institute they had never undergone a psychiatric assessment. Officially, a patient can file a request for a psychiatric assessment with the Director. Olya said, however, that she and many others were given no opportunity to do this.
The FGIP report noted that over past 21 years, only two people have successfully applied for their release from the Svyatoshinsky social care home all others have remained in the institution until the end of their lives.
Van Voren report grave human rights violations by medical staff in psychiatric institutions across Ukraine. ‘In this system, people are no longer seen as human beings but reduced to incompetent, damaged objects beyond repair.’
‘When patients started to shout, run around and become hysterical the staff would hit them or tie their wrists to the beds. They could be there for half a day before anyone untied them,’ said Olya.
Patients who expressed a wish to leave the institution are said to be discouraged by staff, or punished for attempting to do so.
Olya talked about one patient’s failed attempt to escape Svyatoshinsky, climbing over the gate. ‘It was obvious she’d been given a high dose of drugs afterwards. She wasn’t herself for weeks.’
Medical personnel also hinder patients from accessing legal services, according to Olena Protsenko, a lawyer specializing in mental health rights from human rights NGO, the Ukrainian Helsinki Human Rights Union (UHU).
Protsenko told New Internationalist staff have tried to stop her from meeting with clients at various psychiatric institutions. ‘Sometimes it’s only after I call the police, who put pressure on the staff, that I can see my client.’
She claims she recently went to an institution after a patient failed to turn up for his court session only to find that he had been placed in isolation and his phone taken away. ‘There was no reason for him to be there and I strongly suspect the staff did it to prevent him from going to court. It’s criminal.’
Olya said all she wants now is ‘a good job – a permanent job, which I can’t get without a full legal status. Until then, I don’t know what I’ll do.’ When I ask who’ll support her until she finds work, she replied as if slightly offended, ‘I can manage myself.’
It’s especially concerning that Ukraine, a country that considers itself pro-European and aspires to join the European Union (EU), should violate basic human rights in the mental healthcare system.
The problem is not confined to Ukraine. According to a 2012 paper for Public Health Review, social care homes throughout the former Soviet Union are still tainted with paternalistic, disempowering and abusive practices.
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