Behind a closed door: how PSNI's wards are illegally isolated from society
Quarantine and isolation regimes are regularly introduced in Russian neuropsychiatric boarding schools for citizens living there under a variety of pretexts. Most often — for reinsurance or due to the lack of sufficient staff. Experts of the Popular Front's Region of Care project point out that many PNIs still maintain internal regulations that contradict federal legislation. Izvestia dealt with the details.
How to isolate the residents of stumps
The lawyers of the Region of Care have studied more than 100 rules of internal regulations of boarding schools in 57 regions of the Russian Federation. It turned out that 43 boarding schools from 38 regions have introduced their own isolation rules that contradict federal legislation. Lawyer Alexander Gaganov notes that very often boarding schools isolate newcomers to the PSNI in the admission and quarantine department, as well as those who have returned from home leave or hospitalization.
The main contradictions are that the RFP does not specify the conditions under which citizens should be placed in a housing and communal services. The sanitary rules established by Resolution No. 44 of the Chief Sanitary Doctor of the Russian Federation dated December 24, 2020, provide that a person who does not have a certificate of the epidermis can be placed in an isolation ward for a period of seven days. But even people with a certificate and without signs of illness may be in the isolation ward, and for a period exceeding the time limits set by the SanPiN, for example, for two weeks.
Alexander Gaganov emphasizes that in the last two years, the Ministry of Labor has seriously taken up neuropsychiatric boarding schools: much has been done at the level of the regulatory framework, and even more — in terms of changing the consciousness of boarding school directors. All this is in order for the social service system to become human-centered. However, the system continues to operate largely due to inertia, which is determined, among other things, by regulations adopted half a century ago.
— Norms that contradict federal legislation can be found in the educational institutions of many boarding schools, — says Alexander Gaganov. — We have counted about a thousand provisions in 100 TRS that do not comply with the law. The typical illegal clauses were probably borrowed from the expired Regulations on the Neuropsychiatric Boarding School in 1978.
He notes that in the isolation ward a person does not have access to leisure activities, neither a teacher, nor a psychologist, nor a physical therapy instructor, nor a massage nurse can come to him. And this is in the first days after admission to boarding school, when a person's life changes dramatically and he needs help and psychological support the most.
— When the recipient of services is alone in the isolation ward, it can be compared to solitary confinement, — says Alexander Gaganov. — After a week of isolation, the mental state of an elderly person with dementia deteriorates rapidly, so relatives can only wonder later.: What have you done to our grandmother?
How quarantine harms the residents of stumps
Experts of the Region of Care project also face the fact that the right to communicate and visit is being infringed due to quarantine. Alexander Gaganov emphasizes that quarantine can be introduced only when there is a proposal or an order from the chief state medical officer and then an order from the relevant ministry or local authorities addressed to the director. Then the head of the PSNI can issue an appropriate order. However, quarantine is often introduced illegally when a local order from the director appears first, and sometimes even by verbal order.
The lawyer calls quarantines a "favorite excuse" for the leaders of the PSNI not to release the resident and not to let anyone into the boarding school. If you come to most boarding schools, Gaganov notes, you may find that the quarantine has either been introduced or recently lifted.
Svetlana Mamonova, Director of External Relations at the Perspektivy charitable Organization, notes that quarantine is guaranteed to be announced in institutions during the period of increasing respiratory diseases. Sometimes it lasts from October to April or May.
— Some of the directors are quarantining because they do not want to allow volunteers, lawyers, NGO employees to visit their residents. It's very convenient to announce that "from now until spring we have a quarantine for acute respiratory viral infections," she told Izvestia. — And someone from the heads of institutions really wants to ensure the safety of residents. But often, in our opinion, there is no logic in such measures.
At the same time, residents of STUMPS can hardly bear long quarantines. Svetlana Mamonova told about one of the wards, who is very emotionally dependent on close people.
"He had just been transferred from an orphanage, it was hard for him to get used to a new place, and he was genuinely happy and waited for our volunteers to come to him," she says. — A quarantine for acute respiratory viral infections began in this institution, volunteers were not allowed into the department for several months, and it literally melted before our eyes. The young man died without waiting for "his" people.
Pavel Kantor, a lawyer with the legal group of the regional charitable public organization Center for Curative Pedagogy, notes that such quarantines are often introduced for the convenience of staff in order to have a formal basis for controlling the movement of residents and visitors.
"They can file complaints about illegal quarantines with the prosecutor's office or the local authority in the field of social services," he told Izvestia. — But such a mechanism is unlikely to be operational, since the time frame for reviewing complaints is quite long, and while they are being considered, people's specific plans have already been disrupted anyway.
At the same time, Svetlana Mamonova emphasizes that Perspektivy noticed a change in the situation in the post-century times. And thanks to the growing trust in the organization's volunteers, and also because Perspektiva employees began to ask questions about any ban: why can't you visit a person who is ill if the volunteer is ready for it? Why can't volunteers walk with their contacts if they separate the streams? Why are PSNI employees considered safer than volunteers?
—And when you try to clarify the situation in this way, the head of the department begins to understand the absurdity of what is happening," she says. — Then we find a way out of the current situation and agree with the boarding school that the volunteers observe certain safety measures that reduce the risk of morbidity, but continue to visit the wards even during the season of increased morbidity.
The Ministry of Labor of the Russian Federation told Izvestia that the organization of social services in hospitals is under regional jurisdiction, however, the general requirements for organizing visits to residents are defined by the order of the Ministry of Labor dated May 6, 2024 No. 247n. This order explicitly provides for free access to such institutions not only for family members and immediate relatives, but also for lawyers, notaries, human rights defenders, clergy, volunteers and volunteers.
How else are residents of STUMPS restricted
Alexander Gaganov notes that according to the law on psychiatric care in a boarding school, people's right to communicate cannot be restricted: residents of the PSNI can use a telephone, computer, Internet, and receive visitors.
— Many directors of boarding schools, thanks to the educational work of the Russian Ministry of Labor, have already realized that it is impossible to restrict the rights of residents, so now it can be more difficult to detect violations. But the stories about how the staff took the phone from the recipient of the services and did not give it back do not end," the lawyer noted. — And some boarding schools have explicitly written down in their local acts the restriction of the right to use telephones and the possibility of restricting visits.
For example, in the Takhtinsky stumps in the Stavropol Territory, internal regulations allow incapacitated citizens to use mobile phones only from 18:00 to 20:00 in the presence of staff. In the Khayyrakan boarding school in the Republic of Tyva, recipients of social services from the neuropsychiatric department are generally prohibited from using a mobile phone.
Pavel Kantor notes that restrictions on the use of mobile phones are often explained by "concern for health and safety." Such a case was encountered by the Human Rights Protection Service, whose employees visit neuropsychiatric boarding schools in the Nizhny Novgorod region several times a week. In August 2023, a man living in one of the PNIs in the region told lawyers that the orderly had taken the phone and had not been giving it back for a month. It turned out that this was done because he "too often and persistently called relatives who did not want to communicate with him."
— We have sent a recommendation to the institution explaining why these measures are illegal and how this problem can be solved. Additionally, we talked with Mikhail's relatives, connected a psychologist and explained that the man feels very lonely, so sometimes he behaves extremely persistently and often calls. Mikhail's phone was returned, he uses it, and there have been no more complaints from relatives," said Artur Isaev, a lawyer at the service.
According to Alexander Gaganov, boarding schools often explicitly indicate in the rules the possibility of restricting certain rights of residents. At the same time, they refer to the Law on Psychiatric Care, which is inapplicable in the PNR in terms of the possibility of restricting rights. At the same time, the list of rights restricted by boarding schools can be even broader than the law allows for psychiatric hospital patients. Thus, in the Varnavinsky PSNI (Nizhny Novgorod region), according to the PRA, access to the territory of the institution and the right to correspond may be restricted. In the Good House Kolomenskiy (Moscow region), there is a provision on the possibility of isolating a resident if the staff has a "question about the mental (emotional) state" of the recipient of services.
In a number of boarding schools, local rules, in violation of the order of the Russian Ministry of Labor, provide for restrictions on visits. Pavel Kantor showed Izvestia one of these ads about the rules of visiting, which he saw in the Volga PSNI of the Volgograd region. Relatives can come there only by appointment, and the duration of the visit is limited to 30 minutes.
Bondage, straitjackets, and other fixation methods are still often used. They are allowed under the law on psychiatric care, but only in relation to patients who are forcibly placed in a psychiatric hospital. However, the PSNI is not a hospital, and you can legally get there only voluntarily.
— Nevertheless, when visiting boarding schools, we saw people fixed with sheets, completely immobilized children with their legs tied. This is not only illegal, but also inhumane," emphasizes Alexander Gaganov. — And some stumps do not hesitate to openly purchase special straitjackets and sets of locking straps.
In particular, the Derbetovsky Multidisciplinary Rehabilitation and Habilitation Center for Disabled Children Dobry Ruki (Stavropol Territory) recently purchased 14 children's straitjackets, Pokrovsky STUMPS (Primorsky Territory) purchased 10 straitjackets in 2023.
"If purchased straitjackets are used, it grossly violates a whole range of citizens' rights, which should be of interest not only to human rights NGOs, but also to the prosecutor's office," the lawyer noted.
He emphasizes that it can be really difficult for boarding schools to cope with residents who have severe mental disorders. But in this case, it is necessary, firstly, to filter out recipients of services who have medical contraindications, secondly, to seek specialized psychiatric help in inpatient settings in a timely manner, and thirdly, to communicate with psychiatrists who have successful experience working with such patients.
Artur Isaev notes that sometimes restriction of freedom is used as punishment for "guilty people" and for those who show aggression towards themselves, other residents, property, etc. But more often this is due to the fact that boarding schools lack nursing staff and social work specialists. According to him, volunteers help to cope with this problem. And Pavel Kantor notes that the solution to the problem as a whole is possible only if the material, technical and human resources of boarding schools are improved or the number of people living in them is reduced.
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