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Outdated tree stumps: how they will change the lives of people with mental disabilities
At the V Scientific and Practical Conference "The Value of everyone", which was held in Moscow in April, the problem of alternative forms of living arrangements for people who now live in neuropsychiatric boarding schools (PSNI) and other similar institutions was discussed. Both the Ministry of Labor and experts call escorted accommodation the most promising alternative, which can accommodate up to 90% of those living in the PSNI. However, so far 177 thousand people live in adult and children's neuropsychiatric boarding schools, while only 1.7 thousand people are on permanent support. Izvestia investigated the prospects of this form of lifestyle for people with mental disabilities and how the stumps will be changed.
How many people are in the PSNI
Olga Batalina, First Deputy Minister of Labor and Social Protection of Russia, recalled at the "The Value of Everyone" conference that in 2023 the concepts of accompanied accommodation for the disabled and social employment for the disabled were enshrined in law, last year the rules for organizing accompanied accommodation for the disabled were approved, and this year methodological recommendations.
However, for now, Olga Batalina noted, accompanied accommodation is mainly a training format — when people with mental disabilities are taught to live independently.
"We probably can't do without it either, but it's not our goal," the deputy minister said.
According to her, as of October 1 last year, almost 7 thousand people were in the escorted accommodation format, but only 1.7 thousand of them were in permanent escorted accommodation. She added that these numbers are growing, and interesting experiences are emerging in different regions, which the Ministry of Labor hopes to systematize and summarize.
However, so far this is a drop in the ocean: currently there are 732 neuropsychiatric and boarding schools in Russia (622 of them are adults), in which 177 thousand people live. Olga Batalina stressed that now they are trying to reformat the work of such institutions, creating all possible forms of social services there. However, the ideal is still far from being achieved — scandals in various PSNI periodically become public, and many of the boarding schools remain closed institutions.
Why are the numbers so low so far
Margarita Urmancheeva, President of the St. Petersburg Association of Public Associations of Parents of Disabled Children, GAOORDI, notes that with the current interest of the regions, the number of people in assisted living may increase by 30% within a year. But, she emphasizes, it is important that permanent assisted living, and not just educational, develops. In the meantime, educational education is developing more successfully in the regions, confirms Elena Zablotskis, a lawyer at the Center for Curative Pedagogy (Moscow) and a member of the working group of the Russian Ministry of Labor.
Educational programs for the development of home-living and self-service skills are being developed in two directions. The first is for residents of boarding schools who have a high potential for independent living. If their studies are successful, they can be discharged, and orphaned children can be given an apartment. The second is for people with disabilities living in families, because the more self—care skills a person with disabilities has developed, the easier it is for the family to take care of them.
Maria Ostrovskaya, President of the Perspektivy Charity Organization, explains the difference in statistics on academic and permanent assisted living by saying that in the latter case, a person needs to be discharged from a boarding school.
— And this means that some organization must take responsibility for the fact that it will continue to accompany him throughout his life, — says Maria Ostrovskaya. — And educational assisted living is a format where a person is taken from a boarding school or directly to a quasi—apartment in the PSNI, and he lives there for a while, after which he returns.
She notes that this can be a problem: it is difficult for a person to return to their previous conditions when they have tried a completely different quality of life, and it is not known whether the skills they have acquired in the learning process will be preserved if they return to their former social environment.
There are much fewer projects of permanent assisted living, confirms Elena Zablockis. At the same time, there is a request from the families of people with disabilities: there are usually several hundred people in the PSNI, it is difficult to expect an individual approach to everyone there. Accompanied accommodation, on the other hand, involves living in the usual conditions of our home, that is, in an ordinary apartment in an apartment building.
— Basically, it is possible to provide this in a group form, when up to five people with disabilities live in one apartment, but each in his own room or, by agreement, in a room for two, — the interlocutor told Izvestia. — This is a mini-dormitory, which is usually referred to as an assisted living apartment.
How many people can be taken out of the stumps
Margarita Urmancheeva emphasizes that the experience of other countries and charitable organizations in Russia shows that most of the PSNI's wards can now successfully live in accompanied housing. The exception is people with the most severe disabilities who require a large amount of medical care. The status of incapacity should not affect the possibility of living in such a form, she says.
She cites the example of Finland, which disbanded all boarding schools by 2020, leaving only the most serious patients and those who exhibit uncontrollable destructive behavior due to a mental disorder in inpatient care.
— People with disabilities who do not have a high potential for independent living may not want to live in stationary organizations, they want to live in ordinary home conditions, and they would like to be accompanied by group accommodation. But there is no such possibility now," says Elena Zablockis, a lawyer at the Center for Therapeutic Pedagogy.
Maria Ostrovskaya believes that, in principle, about 90% of all people living there can be moved out of the PSNI for accompanied living, and maybe more.
— But not everyone wants to: We have been bringing people from boarding schools for 10 years for trial assisted living, and we see that about a third to a half of people would prefer an inpatient form of social care, when they decide for you what to eat, when they bring you ready—made food, ready-made clothes," she says.
Why is accompanied accommodation beneficial
Elena Zablotskis notes that in Russia it is still only an alternative to stationary social service organizations. But it is important that this alternative exists.
She refers to research by the Higher School of Economics, according to which the cost of escorted accommodation is comparable to the cost of maintenance at the PSNI.
— At the same time, the quality of life of a person in accompanied accommodation is higher in several indicators, — the expert emphasizes. — So far, there is very little format for permanent accompanied accommodation in a group form, and we are already seeing situations where families are solving the issue of housing for a group of people with disabilities at their own expense and expect the region to resolve the issue of financing services necessary to organize escorted accommodation in this residential area.
At the same time, it is important to reform the stumps so that the services provided there are of high quality, Maria Ostrovskaya emphasizes. However, it is very expensive.
— It is necessary to build comfortable buildings where people live according to the apartment type, and not according to the corridor type. We need to double or even triple the number of staff, while retaining the infrastructure staff," she said. — Government spending will increase significantly if we take care of the normal quality of life of people in inpatient facilities. However, the state will still have to make reforms, because it will not be possible to bring all the wards of the PSNI to accompanied accommodation.
How does the State participate in escorted accommodation
So far, assisted living and assisted work are mainly the work of non—profit organizations, as they respond more quickly to local demands from society, says Elena Zablockis. The experience of some of them was presented at the "Everyone's Value" conference. For example, the Krug creative association in Moscow has six apartments rented by the foundation at its own expense, in which 15 people live. Two more were received from the metropolitan Department of Social Support for the organization of educational escorted accommodation. Krug is also engaged in assisted employment: the organization has four secure workshops where people with disabilities who have not found themselves in the open labor market work. 250 escorted jobs have been created there.
Margarita Urmancheeva notes that now accompanied accommodation has begun to be implemented on the basis of state-owned educational institutions, mainly educational or training. Non-profit organizations are in dialogue with the government.
— Another question is that it is necessary to provide reliable financing and control mechanisms for such non—governmental organizations that undertake this, - said Maria Ostrovskaya. — Neither one nor the other has been really done yet. As a non-governmental organization that creates such forms, we receive reimbursement for social services, but using very cumbersome methods from a bureaucratic point of view. In addition, the government is currently financing only the social services that we provide, and support services are not one of them.
According to her, the reality is that so far a non-profit organization in St. Petersburg receives from 30 to 50% of the reimbursement for accompanied accommodation, and gets the rest from charitable sources. In other regions of the Russian Federation, it is even more difficult: the lists of social services are narrower, and tariffs are usually very low, and reimbursement from the state can reach only about 10%.
— Of course, this situation must be changed and support must be charged somehow, - Maria Ostrovskaya is sure.
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