October 10 - World Day mental health. This day is practically unknown in our country, and do we need it? What do we know about the processes occurring in our soul? Where do love and hate, happiness and sadness, sympathy and anger come from? If we are honest with ourselves, not only can we not explain this, but we often lose control of ourselves. Each of us sometimes feels inexplicable sadness, boredom, anger, or, conversely, unreasonable euphoria. Most people manage to cope with painful manifestations of the psyche, but, alas, not everyone.
According to statistics, every 100th of us suffers from a severe mental illness, and every 4th has had mental health problems during their lifetime. If we add 2-3 members of their families to the sick, it turns out that about half of the population is affected by mental disorders. They know about it, but don’t talk about it because “it’s not accepted” and “it’s shameful.” Meanwhile, the dynamics of the spread of mental illness are such that we should not talk, but shout about the problem.
The attitude of society towards the mentally ill is characterized by the capacious disparaging word “psycho”. At best, they don’t want to notice them; at worst, they are considered dangerous and harmful to society. The media cultivates the image of a mentally ill person as a mass murderer, despite the fact that modern research in psychiatry they confirm that the percentage of socially dangerous persons among mentally ill people is no greater than among healthy people. With all the attention that today in Russia is paid to the issues of supporting people with disabilities, creating a barrier-free environment, and employing people with disabilities, not a word is said about the problems of people with mental illnesses. But the number of the latter is equal to the number of people with disabilities for all other reasons combined. The bulk of young and middle-aged disabled people are precisely mental disabled people.
In professional language, society’s attitude towards the mentally ill is called “stigmatization”, from Greek word"stigma", mark. As a result of stereotypes prevailing in society, a person with a mental illness experiences shame and guilt for his condition. He tries his best to convince himself and everyone around him that he is normal. Seeking help from a doctor is regarded as a death sentence: even educated people It is often believed that psychiatrists do not treat, but only “stab” their patients with injections and “turn them into vegetables.” Many people think that disorders such as depression come from weakness, that depression can be interrupted by willful efforts. Relatives, friends and colleagues behave similarly, and with the best intentions: no one wants to offend loved one suspicion that he is a “psycho.” As a result, time is lost, and a mild disorder can develop into an acute and chronic illness.
It's hard to fight stereotypes, but you have to start somewhere. First of all, you need to understand that mental illness is not a sin, not a consequence of a “bad” character. At one time I was greatly impressed by the phrase of one experienced psychotherapist: “Mental illnesses are usually good people: thin, open, sensitive. They simply suffer too much from the imperfections of this world and therefore prefer to escape into a parallel reality.”
Secondly, society must come to understand that many mentally ill people suffer greatly and need our help. Mental pain can be sharper and more severe than physical pain, and suffering can last for months, years, sometimes a lifetime. For example, many depressed people compare their condition to a “black hole” where not a single ray of light, love, or joy penetrates. And often the only way out of this hole seems to be suicide. But “the light shines in the darkness,” just don’t be ashamed to carry this light. Society can and should help those millions of mentally ill people who live among us.
Unfortunately, in Russia there are still very few public organizations who would constantly and purposefully engage in this type of charitable assistance. And the field for activity is huge: information support, social rehabilitation, promoting employment, spiritual care, providing hospitals with new generation drugs, protecting the rights of the mentally ill and simply communicating with them. Some of these tasks are set by professional communities of psychiatrists and regional public organizations of patients. However, compared with Western countries, the volume of assistance provided is disproportionate to the needs.
Says Natalya Yakovleva, chairman of the RPO “Club for the Strong in Spirit” at the 13th Moscow Psychiatric Hospital: “If half of the patients in the department are visited by relatives, then this is a very lucky department. The rest are simply left alone. Over my many years of practice, I have more than once observed cases when those closest to a sick person do not come to see them for months - they refused various reasons: ashamed, tired, etc. As a result, people in white coats collect the whole world for transmission and quietly pass it on “from mom.” How important and necessary is the support of such “non-visitors”. A wide and almost clear field for philanthropists. We are ready to help sick children and orphans with the whole world. But believe me, a mentally ill person can be more defenseless and unhappy than a sick child and an orphan combined.”
Again, you have to start somewhere. There is no need to be ashamed to help the mentally ill, it is a good, good deed, in best traditions Russian charity! “We,” writes T., a patient at a psychiatric clinic, “want to be optimists, full citizens. We know that the people around us have a lot to learn from us (in terms of the same resilience, mental and spiritual resources), we want to be accepted. We hope that society will move towards us.” It is no coincidence that in Rus' the mentally ill have always been treated with respect and care, calling them “God’s people.”
Marina RIS,
private philanthropist
Every person suffers from a mental disorder at least once in their life. Recently, a schizophrenic was arrested in Moscow for killing and eating his drinking buddy. A few days earlier, another man had been running around a gas station with a knife at night, stabbing everyone he met. Psychiatrists admit: it is possible to prevent exacerbations in mentally ill people only with the help of relatives, and those living alone end up with doctors after they have done something wrong, writes “Criminal Ukraine”.
Doctors also say that mental illness At least a quarter of the population is ill throughout their lives, but most patients do not consult a psychiatrist even if they have obvious symptoms.
...Parts of the body of Ilya Egorov, who was killed and dismembered by Nikolai Shadrin, who was registered with a psychiatrist, were collected in different areas capital all last week. Finally, last Saturday, a head was found in Filevsky Park, and Shadrin himself was detained in his apartment while he was preparing Yegorov’s liver for dinner. The lawyer tried to attribute the cannibal's actions to his illness, but the court arrested Shadrin for two months. The judge did not take into account either the cannibal’s statement that “people” were to blame for what he had committed (the accused did not explain which ones), nor his memory disorder: Shadrin could not say what he had already been convicted of.
The crime could have been prevented if Shadrin, who suffered from schizophrenia, had been admitted to the hospital without waiting for an exacerbation. However, in modern Russian conditions this is impossible, explains Lyubov Vinogradova, executive director of the Independent Psychiatric Association: in order to be admitted to a hospital, a person must “commit some action - physical aggression, running around with an ax.” Other citizens can only hope that they will not find themselves in the wrong place at the wrong time. What happened to workers at a gas station on Butyrskaya Street in Moscow. On the night of May 11, a bald, two-meter man with a knife came there, killed two and seriously wounded two more gas station workers, and (this was filmed by surveillance cameras) calmly left without stealing anything.
There are 1.67 million people registered with psychiatric patients in Russia. These are those who have been diagnosed with mental illness. Another 2.16 million people are listed as applying for advisory assistance": these are formally healthy people who, nevertheless, are forced to go to a psychiatrist. According to the World Health Organization (WHO), the situation is much worse: at least 10% of Russians (14–15 million people) suffer from mental disorders. The most common disorder is depression, the symptoms of which are persistent sadness and loss of interest in everything.
WHO experts say that depression is one of the leading causes of disability and main reason suicides, the number of which in Russia is all last years is among the leaders (27 per 100 thousand population per year versus 4–5 in Western Europe). About 20% of Russian adolescents aged 14 to 19 years have mental disorders, and over a million older Russians suffer from various forms senile dementia.
According to WHO estimates, there are about 900 thousand patients with schizophrenia in Russia; another 250–300 thousand are characterized by “ manic state" - uncontrollable excitement. Obsessions (when a person becomes fixated on a thought or action), phobias (fear of something, such as heights, enclosed spaces) and pathological attractions (satisfying sexual needs in a perverted way, such as pedophilia) are also common.
According to WHO forecasts, at least a quarter of adults will experience some kind of mental disorder at least once during their lifetime.
WHO experts confirm: 35–45% of cases of absenteeism are associated with manifestations of mental disorders. At the same time, there are widespread myths in society that “persons with mental problems violent, dangerous, poor, stupid and incurable." According to WHO, up to 70% of Russians suffering from mental disorders do not receive help or treatment, and neuroses and psychoses have caused at least 20% of premature deaths in the country.
Today an open day was held for journalists at the Serbsky Scientific Center for Psychiatry. Doctors spoke about their achievements and provided statistics. Unfortunately, they are disappointing: the number of people with disabilities has increased by 13% in recent years due to mental disorders. There are many suicides: among children and adolescents, for example, every 12th person attempted to die. And every five thousand succeeded.
One of the reasons for the increase in incidence, doctors believe, is that people are afraid to admit that they have mental problems. According to research, approximately every third person has depression or neurosis. But the prevailing stereotype that these problems do not deserve attention prevents them from seeking help. Meanwhile, a timely visit to a specialist will help, at a minimum, improve your life, and in some cases, perhaps, prevent a tragedy.
In the yard where two babies died a little over two months ago, it seems that it has never been so quiet before. Galina Ryabkova, who threw her sons from the 15th floor balcony, was declared insane. Instead of prison, she will face compulsory treatment.
“She is a very private woman, it was clear. She is all to herself, that is, apart from everyone else,” neighbors say about her.
"An attempt to get away from contacts, to retire - this is always fraught with the formation depressive states", notes the director of the Moscow Research Institute of Psychiatry, Doctor of Medical Sciences Valery Krasnov.
Depression is the most common mental disorder, estimated to affect 10% of Russians, or 15 million people. And 70% of them have never sought help from specialists.
Anna was sure for 10 years that she had heart problems. Relatives advised to consult a psychiatrist when, due to constant nervous breakdowns the woman lost her job.
“My blood pressure and heartbeat were very high. At first I went to all the doctors, a cardiologist, a neurologist. But it turned out that it was in my head,” says a patient at a psychiatric clinic.
“With our diseases, quite often a phenomenon occurs called anosognasia - a lack of understanding of one’s illness,” says psychiatrist, Doctor of Medical Sciences Alexander Bukhanovsky.
Anna asks not to show her face. Fundamentally. She hides from her friends that she is being treated in a psychiatric clinic and is very worried that this will prevent her from finding a new job. Psychiatrist Alexander Bukhanovsky is trying to destroy stereotypes on the pages of a newspaper that he and his colleagues publish in a small circulation.
"They believe that our specialty is helpless. Nothing of the kind. Today psychiatry is a science like other medical specialties. They are afraid of us, they believe that our patients are dangerous,” notes psychiatrist, Doctor of Medical Sciences Alexander Bukhanovsky.
None medical documents they don't prove it anymore ex-husband Olga that everything is fine with her again. The woman was diagnosed: postpartum depression. Treatment in a psychiatric clinic improved his health and ruined his life, in which only his mother remained nearby.
“When I got sick and came here, my husband decided to divorce me, leave me and take my child away from me. Since I’m supposedly sick, I don’t have the right to care for the child,” says Olga Chuiko.
In the United States, one in four Americans seek mental health care. Jane Goldberg explains: often Bad mood- already a cause for concern. The patient is on the sofa, on soft pillows. Jane is in the chair behind, so as not to be embarrassed by her gaze when they talk about personal things.
“It’s becoming a lifestyle. Like going to the gym. Psychoanalyst sessions are exercises for the inner “I”; they teach you to listen to yourself,” says psychoanalyst Jane Goldberg.
According to the World Health Organization, by 2020 mental disorders will be among the top five factors leading to disability. Even surpassing cardiovascular diseases here. In this case, the main cause of disability will be depression.
Elena has suffered from panic attacks since childhood.
“Every morning I woke up in this panic, anxiety, I could not understand what was happening. I suffered terribly,” she says.
The woman went to many doctors for several years, but the correct diagnosis was made too late. Now Elena is doomed to regularly undergo intensive therapy.
"In many countries, the first thing people do is see a doctor. primary practice. He has the necessary set of knowledge and skills to figure out mental health problems, to at least touch on them. Our therapists try not to touch this area of activity,” notes Valery Krasnov, director of the Moscow Research Institute of Psychiatry, Doctor of Medical Sciences.
In Russia, 40% of healthy people have mental disorders that have not yet developed into illnesses. Psychiatrist Valery Krasnov is ready to question the sanity of the heroes of some Internet videos that break viewing records.
“I don’t find anything funny in this. This worries me. If a lot of Internet users watch this for entertainment, it only saddens me, as evidence of insufficient culture,” says Valery Krasnov, director of the Moscow Research Institute of Psychiatry, Doctor of Medical Sciences.
Patients with mental disorders On average, they live 15 years less. Neuroses and psychoses are the cause of 20% of premature deaths in the country. True, the reason is indirect. From depression and panic attacks don't die. They turn life into a nightmare, where cancer or a heart attack is no longer a cause for concern.
ALL PHOTOS
There is an increase in the number of mentally ill people around the world. According to World Health Organization forecasts, by 2020 mental disorders will be among the top five diseases leading to disability. In Russia, the indicators are worse than the world average. If in the world about 15% need psychiatric care, then in Russia their number reaches 25%.
Experts note: compared to the 90s, the number of clients of psychiatric clinics in Russia has almost doubled. The number of people suffering from serious mental illnesses such as schizophrenia, manic-depressive psychosis and epilepsy has increased. A neurotic disorders and depression acquired widespread status. They have already taken an “honorable” second place after cardiovascular diseases, writes the newspaper "Novye Izvestia".
The increase in the number of mentally ill people inevitably affects the country's economy. Height psychological disorders is directly related to the increase in the number of disabled people and people unable to engage in labor activity. The EU considered that those associated with psychiatric diseases labor productivity losses are estimated at 3-4% of GDP.
Experts believe that the population of Russia has not adapted to the new rhythm of life, due to the consequences of “global post-communist trauma, changes in consciousness, changes in social relations.” In addition, the situation is aggravated by already traditional “Russian” factors: alcoholism, drug addiction, food poisoning, mass poverty, lack of work. The lack of confidence in the future caused by the economic situation in the country also contributes to a weakening of the psyche.
The Russian authorities are also making a significant contribution to the increase in the number of mentally ill people by cultivating the image of the enemy. Russians are beginning to see enemies everywhere: among people from the Caucasus and Asia, and visitors from other regions. Experts also note that many mentally ill people find themselves in politics or become leaders of extremist organizations. In this capacity they begin to “infect” with their crazy ideas(including the “enemy image”) of healthy people.
Mass neuroticism is also associated with the increasing frequency of disasters and terrorist attacks. According to experts, now every eighth Muscovite is afraid to go down the subway, and every twelfth is afraid to use the elevator.
People begin to be mentally crippled from childhood
The increase in the pace of life affects children most of all and causes illness at a very early stage of development. There are statistics showing that 70–80% of babies in Russia are born with mental illness of different nature. And these diseases, which can be cured at an early stage by a healthy psychological climate around the child, are in fact only aggravated due to the unfavorable environment in which children grow up and are brought up.
Women very quickly start working and send their babies to kindergartens or leave them in the care of nannies. For a child this is unconditional stress, because preschool age he especially needs the care of his parents. As a result, fears, phobias, and fear of loneliness appear. In addition, doctors point to an increase in the number of games and toys that provoke aggression and fear.
In addition, in Russia there is a shortage of qualified psychiatrists, on the one hand, and a traditional distrust of people in this profession, on the other. "Soviet psychological school collapsed, but a new one has not yet been created. The number of diseases is growing, and the number of doctors and psychologists is decreasing,” says Yulia Zotova, a psychologist at the Research Institute of Social Psychology and Personality Development Psychology.
Until now, Russian citizens still have a strong stereotype developed over decades of Soviet punitive psychiatry. And if in major cities Even top managers are not shy about seeking treatment in a mental hospital; in the regions, not everyone still decides to make an appointment with a psychotherapist.
By the way, oddly enough, progress in medicine has some Negative influence to the increase in the number of mentally ill people from generation to generation. The fact is that just a few decades ago people with serious psychiatric illnesses did not have the opportunity to start a family and give birth to children, since these diseases pass with constant attacks of exacerbations. Now, with the invention of new drugs, it is possible to maintain a person in a fairly adequate condition. Therefore, people with incurable mental illness can now work and start a family, while such serious illnesses, like schizophrenia, are transmitted only by inheritance.
Russia's chief psychiatrist proposes sending half of patients home
In connection with the latest fires that occurred in psychiatric clinics, Russian authorities are talking about the possible transfer of some patients to outpatient treatment. Experts reject the traditional fear that this will lead to an aggravation of the crime situation in the country.
“The population is disoriented by this information. For one thousand people of the ordinary population, there are as many crimes as a thousand people with severe mental disorders commit,” said Tatyana Dmitrieva, chief psychiatrist of the Ministry of Health and Social Development of the Russian Federation, director of the State Scientific Center for Social and Forensic Psychiatry named after Serbsky.
She noted that only 1% of crimes in Russia occur among persons with severe mental disorders. In her opinion, plans to transfer some patients from psychiatric clinics to outpatient treatment are “not a new invention.” “Russian psychiatry does what has been tested in many countries and in other areas of medicine,” Dmitrieva emphasized.
Measures to create a system of outpatient or semi-inpatient treatment for patients with mental disorders are provided for by the state program for social significant diseases, which is designed for five years and will begin to be implemented next year. Such treatment, according to experts, can be received by 20 to 50% of patients in psychiatric clinics. Currently, according to the State Research Center, in psychiatric hospitals In the country, about 1.5 million people are undergoing treatment; accordingly, about 750 thousand mentally ill people will be sent home.
Will the Ministry of Health be able to simultaneously establish such high-quality outpatient monitoring of patients or will they join the ranks of suicides and socially dangerous elements?
The mentally ill will again be treated without their consent - as was done before, in the USSR. Recently, State Duma deputies in the third reading approved a bill allowing compulsory psychiatric examination of citizens with their subsequent hospitalization in special medical institutions. The problem is really acute, and it had to be solved somehow: in the last few years, the number of Russians who experience mental confusion from time to time has grown at a rapid pace - by 12-15% per year. But the trouble is that legislators, while solving one problem, empty space created another one.
According to the formula proposed by the deputies, in order to commit a patient to a psychiatric hospital, a decision of the court of first instance will be sufficient. How this could turn out in practice is not difficult to guess: potential applicants for rich inheritances will begin a massive prosecution their wealthy relatives. Here, even a healthy person will not go crazy for long. And in order to prove that everything is in order with the head of the victim of the care of his relatives, he will have to go through an unpleasant and, in general, humiliating procedure hospitalization in the “yellow house”. What will the adoption of such an ambiguous law lead to and to what extent its appearance was justified at all, the correspondent of “Our Version” looked into it.
A manufacturer in his prime lost everything overnight
But first, history. Very soon there will be many, many similar stories. So, the “locomotive manufacturer”, famous throughout the country, Major General Sergei Maltsov was one of the most influential industrialists Russian Empire. In the so-called Maltsovsky factory district, located on the lands of the Kaluga, Oryol and Smolensk provinces, hundreds of thousands of workers worked. Maltsov had his own police, his own railway and even his own money - maltsovki. The factory owner's workers lived better than under communism: they were given their own three-room apartments free of charge and treated for free in Maltsov hospitals. Children of workers studied in free gymnasiums. In general, in the 60-70s of the last century, Maltsov, one might say, almost built his own small welfare state in the state. The relatives of the manufacturer’s methods did not share, but they still did not dare to go against Maltsov, known for his tough disposition. Until in 1874 the industrialist entered into an agreement with the Department railways an agreement for the production of 150 steam locomotives and 3 thousand carriages over a six-year period. Maltsov poured about 2 million rubles into the business - by today’s standards this is 1.6 billion (800 current rubles are equal to one ruble in 1874). He built workshops, ordered equipment from Europe, and invited craftsmen from France. And the railway department suddenly canceled its order - without explaining the reasons. Meanwhile, Maltsov’s warehouses had accumulated finished products worth one and a half million rubles. The industrialist mortgaged his estates. And it was then that Maltsov’s wife and children declared him crazy. The manufacturer was declared incompetent in the court of first instance and deprived of all rights to his own enterprises. Decisive factor for the judges was the fact that Maltsov created too much for his workers good conditions labor. In their opinion, mentally healthy man could not act as Maltsov did. And a completely healthy entrepreneur in the prime of his life lost everything overnight. Frankly, do you believe that modern judges will not adopt similar logic when making court decisions on the basis of which people will be forcibly hospitalized?
Official statistics underestimate the number of mentally ill people by four to five times
Meanwhile, there are really too many crazy people in our country, and a number of doctors agree that the Russian official statistics significantly underestimated. About 15 years ago, Russia switched to classifying diseases according to the so-called ICD-10 scheme, used in countries that are members of the World Health Organization (WHO). In this classification the term " low-grade schizophrenia“is absent in principle, and, thus, all patients with this form of mental disorder are automatically recognized as healthy. But during the USSR it was the sick sluggish form schizophrenia formed the basis of the hospital population of all Soviet special clinics - up to 80% of patients.
But even if the official statistics are underestimated, as experts suggest, by four to five times, they are still impressive. A year ago " Russian newspaper” published the following data: there are 3.7 million mentally ill people in the country. Of these, 36 thousand people are recognized as disabled annually. Every fourth Russian suffers from mental disorders in different forms, but mental disorders are a direct path not only to alcoholism and drug addiction, but also to suicide. A third of those registered as psychiatric patients are those “who have been diagnosed with mental illness.” That is, they are clearly sick people, whose diagnoses are beyond any doubt among specialists. Another 2.2 million are those who regularly seek “advisory help.” It seems that these are not mentally ill, but for some reason they are still prescribed to visit a psychiatrist. As for the WHO data, they are even more shocking. According to experts from this respected organization, mental disorders affect at least 10% of citizens in our country. This is 14–15 million people. And among them is every fifth Russian teenager.
As for classical schizophrenics, in Russia, according to WHO, there are about 900 thousand of them. Another 300 thousand are those whose condition doctors call “manic,” patients with “uncontrollable agitation.” As for the exact data on patients with other types of mental disorders - obsessions, phobias or pathological desires - WHO specialists for some reason do not voice them. They are voiced by experts from public organizations - from 5 to 7 million people suffer from such disorders.
We treat diseases - we cripple destinies
Neuroses and psychoses become the causes of every fifth premature death. And the most common mental disorder is depression, known to many. Prolonged depression and loss of interest in the world around you. It would seem that this is not a disease yet - just think, just the blues! But experts are convinced of the opposite: depression is one of the key reasons disability and the leading cause of suicide. By the way, today our country leads in the number of suicides in the Old World - 27 cases per 100 thousand people, with 5 cases in the European Union. But the worst thing is that, according to WHO statistics, about 70% of Russians suffering from mental disorders avoid treatment.
This sad, suddenly revealed circumstance became the reason for last year’s demarche by the Speaker of the Federation Council Valentina Matvienko. It was she who initiated the adoption of a set of measures to urgently prevent the further spread of mental disorders and the adaptation of Russians affected by them. “Due to their illness, these people face misunderstanding and prejudice,” says Valentina Matvienko. “These problems have not yet been given due public and government attention.” And the deputies decided that it was time to pay attention to this.
In April of this year, at the instigation of legislators from the provinces, the Constitutional Court considered the possibility of compulsory treatment of mentally ill citizens. The reason for the consideration was complaints from Krasnoyarsk and Kurgan, in which crime victims were outraged by the inaction of police officers, judges and doctors. And the court rendered a verdict: compulsory treatment is permissible. It's just a matter of appropriate legislative initiative. The first reading of the bill on compulsory treatment took place at the same time, in April. But the haste played a cruel joke on the people's representatives - the bill they proposed turned out to be too crude. “One of the main problems is the violation of the rights of patients when they are declared incompetent,” explained State Duma deputy Valery Seleznev. – This is often done by relatives in order to take possession of the property of a sick person. And in order to protect patients from the claims of such relatives, the concept of “degree of incapacity” should be introduced into the law. And also provide patients with the opportunity to confirm this diagnosis at least once every three years. Now a person is declared incompetent once and for life, which gives the green light to various scammers.”
There is no one to treat patients - there are not enough psychiatrists
Perhaps now the bill adopted by the deputies will be finalized in the upper house of parliament - they say that Valentina Matvienko is personally in charge of this issue, so it cannot be ruled out that the future law will still thoroughly spell out the responsibilities of the patient and the rights of his relatives. In order to eliminate, if possible, cases of fraud and judicial arbitrariness. Let's hope so, but for now let's talk about another equally pressing problem.
The fact is that, according to preliminary data, with the adoption of the law on compulsory hospitalization, the number of visits to hospitals will increase by at least three to four times. But hardly medical institutions will be prepared to deal with such an influx of patients. Judge for yourself: today in our country there are 145 psychiatric dispensaries, 123 dispensary departments of hospitals, 2 thousand dispensary departments at the Central District Hospital, 144 drug treatment clinics and 257 psychiatric hospitals. This is approximately 300–350 thousand beds. Even today, only every fourth patient can undergo hospitalization. Imagine what could happen with the adoption of a new law?
Doctors are already admitting that they are not ready for the influx of patients. Not only is it missing hospital beds– there are not enough specialists. Today, approximately 16 thousand specialists work in the field of psychiatric and drug treatment, including about 4.5 thousand psychotherapists, 5.5 thousand narcologists and one and a half thousand social workers. There are no more than 5 thousand psychiatrists for everyone! All over Russia! Two years ago, Tatyana Golikova, who headed the Ministry of Health and Social Development, warned that Russian special medical institutions were staffed with psychiatrists by approximately 65–70%. And today the shortage of psychiatrists tends to 40–45%.
Experts' opinions
Mikhail VINOGRADOV, Russian psychiatrist-criminologist, professor, doctor of medical sciences, former head of the Center for Special Research of the Ministry of Internal Affairs:
– I was one of those who insisted on the return of the old Soviet norm. At the same time, it is absolutely clear to me that it is still not worth returning to the Soviet norm in its previous form; it needs to be adapted to today’s realities. Medicine has managed to make great strides forward. But Soviet law should be taken as a basis in any case - along with the norms that allowed for the forced hospitalization and treatment of patients. Today, it must be admitted, doctors do not have the tools for forced hospitalization. And they should be.
And yet - I’m still against final decision It was not up to the psychiatrist, but to the judge. The patient may be quiet and not become violent or scream that he is going to kill someone. He may talk, say, about the end of the world, but the psychiatrist will understand that this person poses a real danger to society. But the court may not understand this.
Sergey ENIKOLOPOV,candidate psychological sciences, Head of the Department of Medical Psychology Science Center mental health RAMS:
“Deputies are going to push through a law that leaves a huge field for all sorts of abuses. This law will give a free hand to unscrupulous relatives, bosses, and well-connected people. Any person can, if desired, be declared mentally ill and treated. It would be a different matter if, in addition to the returning Soviet norm, criminal liability were introduced for doctors for making an incorrect diagnosis and sending them for compulsory treatment. Then I would see at least some sense in this sentence. The doctor would then tremble a little. Otherwise, what guarantees do we, ordinary people, have that they won’t forcefully treat us when it’s not required? In addition, a huge number of patients will have a fear of turning to psychiatrists, returning Soviet norms It will only spur him on.
As for the exact statistics of the mentally ill, I can say with confidence: there are no exact statistics in this area. Since the times of the USSR, people have not advertised their mental ill-being. A huge number of people are not treated by specialists, resorting to the help of healers and fortune-tellers. The most common disease in Russia and the world is depression. Russia, especially its northern part, is located in a “depressive zone”. In autumn it is cloudy, it rains, in winter it gets dark outside early. Therefore it is noted high level suicides, alcoholism. These are all different consequences of depression. But our people are not used to turning to specialists.
DISEASE HISTORY
In the Russian Empire there was a rule according to which the court could insist on compulsory treatment of a patient. Actually, today State Duma deputies are trying to return this norm. In Soviet legislation for a long time There was no talk at all about compulsory treatment of people with mental illnesses. Evil tongues claim that if such a norm existed, more than half of the Soviet leadership of that time could have ended up in psychiatric hospitals. The definition that the insane should be treated forcibly first appeared in USSR legislation only in 1926. Since criminal liability was not applied to people with mental disorders in those days, as a “measure social protection medical nature”, it was proposed to forcibly isolate patients in hospital wards, and not in prison cells.
It is curious that the decision on sanity or insanity was also made by the court, and not by medical specialists. And the judge did this, of course, by eye. After all, he did not have any special knowledge in the field of psychiatry. Judges began to conduct forensic psychiatric examinations with the participation of doctors only in 1935.
Fundamental changes occurred only in 1961, with the advent of the new Criminal Code of the RSFSR. Compulsory treatment began to be applied to those who committed “socially dangerous acts that pose a particular danger to society.” The list of these acts included anti-Soviet agitation and propaganda, dissemination of fabrications discrediting the Soviet state and social system, desecration of the National Anthem or flag, organization and participation in riots. The decision on hospitalization was made by a commission of three psychiatrists. The consent of relatives and guardians for hospitalization of the patient was not required.
