Psychiatric hospitals – a yet untouched corner of post-Maidan Ukraine

The notorious High Security Hospital in Dnipropetrovsk. Photo of the author 

Analysis & Opinion

Article by: Robert van Voren

These are eyes I will not forget for many years to come: the sad eyes of men and women broken by a system that is said to be there to cure, but in reality limits itself to punishment. Some of them have been in for four years, others up to eight, nine, even eleven or twelve. They all are counting how much they have to go, and the sadness is that most of them know they won’t be home for another four-five years.

At the end of November a group of foreign experts toured forensic psychiatric facilities in Ukraine, including the notorious High Security Hospital in Dnipropetrovsk. It was a multi-disciplinary group, including a director of a forensic psychiatric hospital, a chief forensic psychiatric nurse and a prison director, looking at facilities from different points of view. Our mission was not to uncover abuses, but rather to collect information that would help us to formulate a way out of the current situation and come up with a reform plan.

There was no need to uncover abuses. Within the first hours it became totally clear to us that what we were facing was a so-called “total institution”, in which everything centers on issues of control, subordination and punishment. In fact, not only the patients were hostage to this system, also staff had become a hostage, including the directors that had either maintained the system as it was, or had tried to “perfection” it, inventing more rules and regulations to keep the patients “under control”.

Not only our goal was an unusual one, less focusing on what was wrong but more on what could be changed. Also our way of operating was not very standard. To the surprise and concern of the doctors we insisted on talking to the patients in their own wards, without any staff around. We also insisted on talking to staff without superiors around, sometimes in groups, sometimes individually. What emerged was a heartbreaking picture of people lost in a system, both patients and staff alike. Even the occasional director, who angrily responded to the suggestion that he might not see anymore what monster he had created, seemed to have lost himself in his own labyrinth of rules and regulations.

People are committed to a forensic psychiatric hospital after committing crime while being mentally ill. Yes, some of the crimes are heinous, often involving physical assault at fathers, mothers or spouses, sometimes during a psychosis or a state of complete drunkenness. The perpetrators are sent to an institution because they are considered dangerous, and need to be treated. Yet when treatment works, and the person is no longer dangerous, a process of resocialization should commence that helps the person to go home as soon as possible and create a safety net that helps prevent recidivism.

All research data show that in most cases recidivism is very rare. A parent or sister is killed as a result of great emotional stress, often after years of bitter fighting or desperation. Some of the women hospitalized killed a man after attempted rape, or years of physical abuse. There are many reason why a person can be triggered to resort to a physical “solution” to the problem, and often the death of the victim was unintentional, a sad outcome of an emotional explosion.

In Ukraine, persons are not sent to forensic psychiatric hospitals to be treated and cured. They are sent to these institutions to be punished. They are given medications, usually high dosages and several at a time. They are locked up 23 hours a day. They have nothing to do, except smoke and read books, which in itself is difficult because medication makes reading sometimes impossible. They are poorly fed, as a result of bad financing of the system, and they have very little communication with the outside world as visits are rare and telephone communication is severely restricted to maximally once a week. They do not know their rights, and nobody cares to tell them. They live in a prison, but under much worse conditions: in prison you know how long you have to serve, and in prison you are not given pills to keep you calm and drowsy. Here they know nothing, expect the fact that their “treatment” will last at least as long as what they would have been sentenced to if not being mentally ill.

For twenty-five years this Soviet punitive system continued its life unobstructed. Now, thanks to a new Chief Psychiatrist of Ukraine, things are starting to move. If not for her, these men and women would continue to sit there for years, without any future and without any hope of rejoining their families any time soon.

The sad thing is, that keeping these men inside for no other reason than punishment costs the Ukrainian state a lot of money, money that is wasted on control rather than on treatment and resocialization. We set down with “dangerous” men, in their cells, discussing their fates, hopes and desperations, without any anxiety or feeling of being in danger. Most men and women can very well explain their situation, what they did and how, and what they would do if they had the chance, either by being active inside or after finally being allowed to go home. They could be taught a profession, help upgrade the facilities, work in workshops or maintain their bodies by doing sports. By having men and women locked up for long periods of time without any use, Ukraine is wasting money that could be spent on helping the remaining ones to become active and productive parts of society. So much could be done, if lawmakers in the country would understand that this vestige of Sovietism needs to be changed, fundamentally and radically, and that this should not be allowed to continue to exist.

And all the time I see the eyes of the men and women who dared to speak out and share their desperation and concerns, knowing that after our departure they might be punished with extra aminazine or some sort of injection. And I hear them counting the years they think they have still ahead on the inside, while their kids grow up without father or mother, their aged parents die or their spouses find another partner. This should not be allowed to happen in post-Maidan Ukraine. This system is fundamentally inhumane, and needs to be overhauled.


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  • miguel

    In state institutions like this, the mentality of the directors and funding play a large role.
    The nation set up a need for this, and there is.
    The process of reward, or maintaining a budget, is based on how many you house in the building.
    Not how many you reintroduce into society.
    The more people, the more you can demand for funding to take care of them.

    Many of the residents’ crimes, to me, sound like crimes of drunkedness, crimes of passion, crimes of a chemically imbalanced brain, and those who because the Justice System failed them, they chose to take the law into their own hands.

    Many of those should be in regular prison with appropriate sentences metered out by a judge.
    Most crime is a moral issue, they do not know right from wrong, or do not care.

    There are ones that can be ‘fixed’ by adjusting the brain chemistry and the person can be reintroduced to society.
    There are some of low IQ, that nothing will help.
    Some of those should be permanently housed in assisted living centers.

    The decision has to be made where to house the ‘incurables’ and there are some to dangerous to release.
    Should it be in prison?
    And then a decision should be made of reintegration and cures, should that be part of the prison system?
    And than you have the wive or child that killed their family because of abuse retaliation.
    Being a victim of that abuse, wolves of the prison system will flock to the meek like that and create the cycle of abuse again.
    America has a robust prison system, it is not perfect though.
    Neither is Ukraine’s.
    You have a mixture of Low, Medium, High, and Maximum security facilities.
    You have State, or oblast, prisons as well.
    You have local jails, city and county.

    There are a lot of criminals.

    It seems like sentencing guidelines for the judges are part of the problem.
    The mission of this hospital and others seem to have gotten lost, cure and reintroduction.
    The director and administration have a large part to play in this.
    The hospitals seem a lot like the asylums or sanitariums of the 1900s.
    We are past that, by leaps and bounds in modern society.

    The budget of the facility is the driving force for opposing reform.
    If it is tied to how many beds are filled, that does need to change to how many people they successful reintroduce back into society.
    Hopefully the Health and Justice Ministry, and Legislators, and Federal Administers of financing will look into this for a solution.
    The driving force of the budget and mandate should be reintroduction into society SAFELY, that is an important word, and not how many beds are filled, although it is an undeniable factor.
    Administrators, as they always do, look forward to their bonuses and how large they can make them and how they can ‘game’ the system.

    From what it sounds like is they decided they justify their budget by how many beds filled as the primary factor, that does need to change.
    There will be no will of Administration, unless it is tied to the reintroduction and that becomes a stronger factor.

    Interesting thought provoking article, my thanks to the author.
    The days of sanitariums is antiquated and long past, and hopefully the various departments, primarily Health and Justice Ministries, will take up the challenge.

    I would remind you as a journalist and activist, there are insane, or broken, people whose reintroduction represents a threat, and you could interview Hannibal Lecter and he would not give you the impression even in a one on one interview that he is a danger.

    Like RT, their permanent goal is being a habitual liar and to twist the truth to their own goals.
    Especially twisting the truth and declaring their ‘innocence’ to an activist.

    But it sounds like too many are put in that mold according to your article, I believe you are right, and some reform is needed in your system.