Ukrainian psychiatric hospitals: engraved in my eyeballs

There are some images that remain engraved in your eyeballs for the rest of your life. For me one of those images dates back to 1991, more than 25 years ago, when I for the first time entered a Soviet psychiatric hospital. It was in Kyiv, at the Pavlov psychiatric hospital, or the “Pavlivka”, when the then director Revenok was on holiday and staff was able to show me the geronto-psychiatric department. Some sixty or seventy elderly patients in rags were lying on rusty beds, sometimes without matrasses, sometimes three patients lying on two beds shoved together, literally rotting away in the cellar of one of the buildings on the territory. The image remains with me until this very day, and so does the indescribable stench, the result of broken down sanitation and the stale smell of unwashed bodies and filthy clothes and bed linen. Later, I saw similar situations in social care homes in the vicinity of Kyiv, but that first impression remains with me till this very day. Indeed, Ukraine has come a long way, and surely the situation now is incomparable. In December I toured social care homes in Ukraine with a group of experts from Lithuania, The Netherlands and Sweden, as part of a project to assess mental health care facilities in Ukraine together with the Office of the Ombudsman for Human Rights of the Verkhovna Rada. In the course of one week we visited four social care homes, two in the East close to the frontline, and two in Western Ukraine. The social care homes that we visited were indeed all comfortably heated, very different from what I saw twenty-five years ago. Patients were adequately fed and clothed, at least for the purpose of being inside the institution. Yet when I returned home to Lithuania after the assessment visit, I was ordered to put all my clothes, vests, jacket and coat into the washing machine, because the smell from the institution had permeated all of the cloth and the only way to get rid of it was by means of a thorough cleaning. We were maybe not more than ten hours in the four institutions, yet the specific institution-smell already stuck to us. Can you imagine if one lives there day in day out, week in week out, month after month, year after year, without the hope of ever leaving the place? And mind you, that counts for clients, but likewise also for the staffing – they have also become institutionalized. And again I have images that are engraved in my eyeballs, this time different ones but no less distressing. And what is worse: with eyes showing a total resignation to one’s fate, already afraid to go out and become part of society. Twenty-four years, and probably another fifty-sixty years ahead, and already buried for life. This cannot be. No civilized country can allow this to happen, for whatever reason. This is evil, and is in complete violation of human rights and human dignity. This has to stop. I am not claiming that the staff working at the institutions is violating human rights on purpose. I saw many well-intentioned professionals, some of them sincerely touched by the fate of their clients yet unable to change their fate fundamentally because the system does not allow it. I saw the compassion and desperation in their eyes and understood that they would be the first to support change if it would be allowed or made possible. Of course, I also saw professionals who do not deserve that name, who should be retired immediately and banned from working with human beings, for the very reason that they forgot they are working with human beings and not prisoners, or simple objects like logs or screws. But the shock also has a positive effect – it has strengthened our determination to help Ukraine to end this evil, and to build an alternative system in which people are viewed as human beings with abilities, instead of objects with disabilities. We have sufficient experience in working in this region to understand that this is not an overnight process. It will take years, many years, before the last doors of Ukrainian social care homes will close, but the process has to start today, focused on developing alternatives, closing the front door of the institutions and starting to re-assess the clients’ mental health. In the report that was presented at the Office of the Ombudsman for Human Rights we tried to be as balanced and objective as possible, avoiding assumptions and emotional accusations, but the truth cannot be hidden, and should be faced upfront, in all its naked rawness. Almost 60,000 Ukrainian citizens are deprived of equal opportunities and participation in society, and there is no justified reason to allow this to continue.