Mikhail Kosenko was sentenced to compulsory treatment in a psychiatric institution. Source: ITAR-TASS
A court last week ordered activist Mikhail Kosenko to undergo compulsory psychiatric treatment for attacking a riot police officer during the May 6, 2012 protest rally on the eve of Vladimir Putin's inauguration. The ruling sparked concerns among rights activists that Soviet-era punitive psychiatry, when dissidents were found to be insane and confined to institutions, was returning. It also raised questions about what exactly happens to a person sentenced to compulsory psychiatric treatment.
At the mercy of doctors
If a court rules that a suspect was "insane" while he committed the crime, as it did in Kosenko's case, there are four different types of compulsory treatment that he can be ordered to undergo, according to Yury Savenko, president of the Independent Psychiatric Association, an organization that protects the rights of psychiatric patients.
The lightest form of treatment is ambulatory, when the person is treated as an outpatient. Persons ordered to undergo compulsory confinement can be placed in three different types of psychiatric hospitals: those with normal supervision, increased or specialized supervision and strict supervision (high-security psychiatric hospitals).
Laws passed after the breakup of the Soviet Union aimed at preventing punitive psychiatry being used as a political measure, sought to bring these psychiatric facilities under the control of the Health Ministry rather than the Interior Ministry.
Today, according to lawyer Pavel Chikov of the Agora human rights organization, psychiatric hospitals with specialized or strict supervision answer both to the Federal Prison Service and the Health Ministry. That means that while federal authorities will guard the ward from the outside, on the inside, only doctors are responsible for patients' security, and for determining how long they will spend at any given facility.
"Today, paradoxically, special hospitals [for compulsory treatment] are perhaps even better than average ones because they are financed via the state budget and get better funding," Savenko said. "They have rehabilitation programs with foreign specialists."
The downside, Savenko said, is that the 1993 law guaranteeing psychiatric patients their rights isn't actually enforced.
"There is neither government control, nor public control in these facilities," he said. "They are left at the mercy of the personnel who get tiny salaries."
According to the Health Ministry, compulsory treatment is not a prison sentence.
"Patients are not released, they are discharged," Tatyana Klimenko, an aide at the Health Ministry, told The Moscow News. "Compulsory treatment is not punishment. It is treatment which is carried out if the patient requires it."
According to Klimenko, however, an evaluation which determines which type of facility a person is placed in must be ordered by the court or the investigators in order to be valid.
According to Savenko, Mikhail Kosenko, who has been treated for mental disability as an outpatient for more than a decade, should have been allowed to remain an outpatient.
Based on the official evaluation, Kosenko was ordered to undergo confinement at a psychiatric hospital with normal supervision, which will likely place him in Moscow Psychiatric Hospital No. 5, according to Savenko.
However, Kosenko's lawyer, Dmitry Aivazyan, said it was too early to determine which facility his client would be sent to. That decision will be made once the court ruling goes into effect following appeals, and could be months away.
If Kosenko is sent to Hospital No. 5, "the conditions aren't that bad," Aivazyan told The Mosocw News. "I've been there. At least, they allow lawyers to be present and we can watch [to make sure] his rights are protected."
At psychiatric hospitals with specialized or strict supervision, lawyers are not allowed inside. Inmates can be held indefinitely at these facilities, and the length of their stay is at the discretion of the psychiatrists. Once they are released, they must spend at least six months in a psychiatric hospital with normal supervision before they are fully discharged.
Yelena Stepanova (her name has been changed to protect her son's identity) spent three years trying to get her son out of a high-security psychiatric hospital in Kazan.
Her son, who suffered from a moderate schizophrenia-like disorder, was placed there after trying to escape from a normal hospital, where he was confined after a court found him guilty of passing on a dose of heroin to an acquaintance.
Stepanova's son was released last year after she complained to the European Court of Human Rights and Russia's Justice Ministry got involved in the case.
"It's hell," Stepanova said about the conditions at her son's second psychiatric hospital in an email to The Moscow News. "Small cells where people with light and severe forms of mental disorders are kept together, spending at least 18.5 hours a day there."
Instead of a toilet, each cell was equipped with two buckets, Stepanova added.
But at normal security facilities, like Moscow Psychiatric Hospital No. 5, patients still describe conditions like those of a prison - with the difference being that patients do not know when they could go home.
"[My brother's been there for] five and a half years," Yelena Sviridova, whose name has been changed to protect her brother's identity, told The Moscow News. "They don't want to let him out. Every time I ask when they will let him out, they say it's up to the psychiatrists. Every time they schedule a court hearing, they don't call us."
Currently, there are a total of 24,003 people undergoing compulsory psychiatric treatment, according to figures provided by the Health Ministry. Of these, 7,624 people are outpatients, 6,310 are patients at facilities with normal supervision, and 5,870 and 4,199 are patients, respectively, at specialized facilities and those with strict supervision.
According to Agora's Chikov, Kosenko's ruling marks the first time since the Soviet era when a political activist has been sentenced to compulsory psychiatric treatment.
While political activists facing criminal charges are sometimes forced to undergo psychiatric evaluation, actual psychiatric confinement of activists is rare. "In practice, a psychiatric ward is used as a threat," Chikov told The Moscow News.
Compulsory psychiatric treatment for people accused of dissent, once a mass phenomenon in the Soviet Union, is sporadic today, Savenko said.
More frequent, however, is when compulsory psychiatric confinement is used as a means of pressure in business dealings, according to Lev Ponomaryov, head of the For Human Rights movement. Frequent cases involve "someone wanting to take over real estate," Ponomaryov said. "In some cases, in raids on a business."
In his practice, Ponomaryov said he has come across children from orphanages forced into psychiatric hospitals as punishment. "I've had to get perfectly healthy kids out of psychiatric wards," he said. "[They're placed there] without a court order."
Such cases of abuse of the punitive psychiatry system have grown more widespread since the fall of the Soviet Union, according to Ponomaryov.
"[Abuses] have always gone on [since the 1990s]," Ponomaryov added. "It's just that Kosenko's case is interesting and drawing attention to the issue."
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