Ukraine’s “psycho-neurological institutions” – out of sight, out of mind …

Andriy Chernousov has written a shocking analysis of the situation with Ukraine’s so-called “psycho-neurological institutions”  for people with serious psychological disorders usually making them unable to cope by themselves. There are 151 such institutions in Ukraine with their residents forgotten and helpless.  The author writes that the public have fenced themselves off from them through physical distance, fences, and labels.

Most of such institutions are a considerable distance from the regional centre with the average distance between 83 kilometres. Only 43 of the institutions are actually in cities, with the other 108 in rural areas or small towns.

Andriy Chernousov gives a brief historical account which shows how the distancing and general attitude to people with special needs goes back to the period immediately after the Second World War, when the “solution” to large numbers of people with disabilities, psychological disorders was to effectively pretend that they didn’t exist.  They were taken as far away as possible.  This, he says, was effectively the beginning of a system for keeping people with special needs far from the workers, so that they didn’t mar the image and didn’t get in the way of those “building socialism”.

Sixty years on the set up for those with permanent psychological disorders has changed very little.  While there are a few whose directors manage to wangle proper medical and rehabilitation equipment etc from the State or benefactors, the majority  - 108 out of 151 remain in isolated rural or small settlement areas, and provide residents with no more than a roof over their heads and minimum sustenance.  Relatives have enormous problems visiting with some of the villages where such institutions are located not having any proper bus or coach connections. There are no facilities for relatives to stay for more than a few hours.  Families are often quite poor and not in a position to take the person to their homes for visits.

In such conditions of isolation, rights violations are rampant. Ill-treatment is for many people in such institutions the everyday reality.  Nor the author stresses is this because the people who work there are real sadists, but they have absolutely no training in working with people with special needs. For that reason injections of sedatives are widespread, as well as tying patients to their bunks or isolating them in rooms by themselves.

Most of the staff lack even the most minimum training for working in the social sphere or providing medical services. These are people who once worked on the land.  When the collective farm system collapsed, they needed to find some kind of employment.  Work in such institutions became a major employer, and if the pay was bad, at least it was stable.

The level of requirements as far as medical knowledge was also very low.  This is also connected, however, with the fact that such institutions are under the Ministry of Social Policy, not the Health Ministry.

Most such institutions are supposed to be socio-medical, with round-the-clock medical care available, and all types of necessary equipment – from hearing devices to wheelchairs and frames, as well as all necessary medication.

This is all theory, however, with the practice quite different. The author writes that full medical examination will be confined to once or twice a year, while the rest of the time there would be emergency care, absolutely basic medication (painkillers, etc) and little more. There is no question of any real treatment, therapy etc.

The reason is brutally simple – inadequate financing.  The amount per person per day is horrifically small.  The directors of such institutions say that if there is an acute worsening of their condition, they will be sent to a psychiatric hospital (under the Health Ministry) for a time, but otherwise they’re basically left to live out their days with illnesses taken on a chronic nature.

There is not enough equipment and what is available is obsolete, with even simple devices to enable walking a rarity. And in fact the conditions are often simply not suited: there aren’t any ramps, or residents can’t get down flights of stairs, the roads are not asphalted etc.

An added problem is the lack of medical personnel. Not every institution has the correct number of doctors, and there is typically no psychologist, therapists, physiotherapists, dentists, as well as a shortage of junior nurses.  The staff often lack any training in working with people with disabilities.  While the doctors and nurses themselves acknowledge the need for such training, few directors of such institutions provide it.

Not only are the institutions physically isolated, but they are also cut off from the world through lack of websites, etc.  The public do not know of their problems, or how they could help, nor do they hear of positive cases involving such help.

Andriy Chernousov writes that the institution’s openness to cooperation with institutions of civil society is largely dependent on the administration.  Some actively seek support and help wherever they can – from the authorities, the local community, NGOs, etc.  Others are passive.

The author sees one possible solution to the present situation as being to optimize the system, merging institutions which have less people than they’re set up for, in order to focus on institutions in regional centres or major cities. This would also make it possible to involve them more in the life of the community and enable people willing to help to play a role, all of this helping to humanize society.

Much abridged from the article by Andriy Chernousov in Dzerkalo Tyzhnya