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

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.