Potential of Human Rights Standards for Deinstitutionalization of Mental Health Services in Russia: a Comparative Legal Analysis
Background
Russia is undergoing a significant reform of its mental healthcare system in consistency with building the rule of law and democracy. Mental health legislation provided for the background of this reform, but enforcement mechanisms are very weak. The provisions of the 1992 law on psychiatric care requiring mental health care facilities to establish services for protection of the rights of the mentally disabled have not been implemented to date in any hospital or other facility. Hence the Russian Ombudsman admitted that enacting of these acts had not resulted in positive changes in the state policies affecting people with mental disabilities.
Although the situation in mental health care in Russia has changed considerably since the collapse of the Soviet Union advocacy for the rights of the mentally disabled still remains quite a new issue and does not receive the required amount of attention either from health authorities or from the local NGOs.
People with mental disabilities still remain invisible and excluded from the society. Mental disability is still considered to be almost entirely medical problem and social, cultural and other interrelated implications are not taken seriously. The Russian mental health policymakers place no emphasis on community-based care initiatives and fiercely rely on institutionalized mental health care: in 2003 the number of mental hospitals in Russia increased compared to previous years. Consequently there are no alternatives to the existing system of psychiatric hospitalization or segregated social care in “internats” (specialized social care homes for people with intellectual or mental disabilities). The experience of other countries has proven that there are strong medical and economic incentives encouraging the movement of persons with mental disabilities out of large residential facilities into smaller home-like settings.
At the same time there are virtually no mental disability advocacy NGOs in Russia, nor there significant public discussion about relevant governmental policies or strategies for deinstitutionalization of mental health care and strengthening equal participation of people with mental disabilities in society.
There is an increasing number of non-governmental organizations in other post-communist countries in Europe providing services to the mentally disabled based on the principle of inclusion and offering alternatives to institutionalized care. Their experience does not receive sufficient attention in Russia and the policies behind this movement have not been studied yet. It is indicative that the Russian Ombudsman failed to recognize that segregation of the mentally disabled is a rights issue: the detailed report on the rights of the mentally disabled does not address the issues of deinstitutionalization, mental disability advocacy and the most important demand of the advocacy group: transition from segregative care to community-based services. Over the last ten years, international organizations, such as Mental Disability Advocacy Center (MDAC), OSI Mental Health Initiative (MHI) and Mental Disability Rights International (MDRI), Moscow Helsinki Group (MHG) have identified the particular vulnerabilities of people with mental disabilities who are detained in institutions for people with intellectual disabilities, psychiatric hospitals, orphanages, social care homes, prisons and jails. However, these issues are not addressed by Russian human rights NGOs either.
Understanding legislation and policies fostering participation of the mentally disabled and their integration into society can become an important first step in designing the system of health and social care based on universal human rights values. The process of deinstitutionalization which can be examined from the perspective of mental health professionals, social workers, sociologists and historians, in this study is analyzed from the perspective of human rights advocates. Although legislation is not an alternative to mental health policies it offers an important mechanism to ensure adequate and appropriate care and treatment, protection of human right of people with mental disabilities and promotion of mental health of population.
Thus, the overall goal of the present study is to review the legal background of the recent reforms which are aimed at moving away from institutionalized mental health care in selected Western countries and Central and Eastern European countries in transition in order to formulate policy recommendations for the Russian mental health stakeholders.
Research objectives
Review international and foreign legal instruments designed to strengthen the individual's position in mental health care by promoting its delivery in the least restrictive settings.
Give an overview of mental health care reforms aimed at bringing national policies in conformity with international human rights standards in terms of fostering social inclusion of the mentally disabled through deinstitutionalization.
Identify possible benefits and applicability of the gained results to reforming Russian legislation in the field of mental health within the framework of providing mental health treatment in the most integrated setting appropriate (provide policy recommendations).