Moscow doctors have signed a petition against the reorganisation of the capital’s psychiatric clinics

Anna Bessarabova

Moscow doctors are preparing to hold a rally in protest against the proposed changes. For doctors, reorganisation means the destruction of hospitals – a major blow for both medical staff and patients. The Moscow Department of Healthcare, conversely, has framed it as “a process of improving mental health provision for the city’s residents.”

In Russian society, discussions around mental health facilities tend to go hand in hand with anecdotes, jokes and chiller-dillers – remarkable in the context of a country with an estimated 360,000 mental disorder sufferers. And, true to form, the closure (optimisation, reorganisation) of the capital’s psychiatric hospitals has been greeted online by reactions ranging from tongue-in-cheek fear (“That’s it then, the crazies are going to the people”) to brazen vileness (“Get the popcorn ready, the talk-show’s about to start”).

Doctors have not, as of yet, taken part in any public debates about their own problems: they’ve been forbidden from doing so. They didn’t speak out for a while, wondering what tomorrow would bring, what would become of their clinics, staff and patients. They waited for the Moscow Department of Healthcare to inform them whether staff would be cut or kept on, and to apprise them of the situation with the hospitals: would they be liquidated or reformed, and who would stand to acquire the vacant premises? After the staff of Kannabikh Psychiatric Hospital No. 12 were invited to resign “by mutual consent,” while those of Hospital No. 15 were advised that fifty psychiatrists and ten psychologists were to be made redundant, petitions protesting the destruction of hospitals sprang up online. Doctors and patients are currently discussing when and where they will stage a protest. 

 “Just not in front of the cameras”

We paid a visit to Kannabikh Psychiatric Hospital No. 12 following a letter to the editorial team: “Our hospital has been formally merged with Solovyov Neurosis Clinic – we’ve lost our independent status. It’s expected that we’ll stop receiving patients after the New Year. The majority of our staff are to be made redundant: the reorganisation will render them surplus to requirements […] The second floor of the medical building, now fully vacated, will, it would appear, be temporarily occupied by an infectious diseases hospital currently undergoing renovation. Rumour has it that the premises are being eyed up by the men in uniform. The last ten years have seen innumerable attempts to shut the hospital down, but staff and patients have always managed to fight them off. […] We have different treatment paradigms here at Kannabikh Hospital, we’re uniquely proficient. We’ve helped people suffering from borderline disorders. Patients have been admitted here following the death of their loved ones, in the wake of [the] Nord-Ost [theatre siege] and after the Metro bombings. The hospital is being destroyed on the eve of its 100th anniversary: it has been in operation since 1917, and no comparable institution exists in Moscow.”

The hospital is set in the grounds of the magnificent Pokrovskoe-Streshnevo Park; among its buildings is an authentic mansion dating from 1906. Hardly surprising, then, that it has been forced to ward off unwanted attention for years on end. The ex-mayor’s wife, a federal official’s daughter and assorted businessmen and politicians have all laid claim to the land – but no one knows who ended up getting their hands on it. Responding to an official Novaya Gazeta enquiry, the Moscow Department of Healthcare declined to comment on the matter.

Though gladdened by the visit of our reporters, hospital staff are afraid to talk: “Just not in front of the cameras. They’re hung up in the corridors.” Someone reels off a list of doctors prepared to speak to the media regardless of the consequences. Ultrasonography specialist Alexander Belugin shows us a written notice from the hospital administration regarding the “reorganisation of the institution” and its obligation “to comply with internal labour regulations.”

“In the event of refusal to work under the new conditions, the labour contract will be terminated as per paragraph 6 of Article 77 of the Labour Code of the Russian Federation,” says Belugin, reading off the paper. “This notice was issued to everyone. But why, and what for, we don’t know.”

“Nothing will change but the name.”

If an organisation changes ownership, its administration and accounts department can be legally dismissed, but any other employees cannot. Nevertheless, once the transfer of ownership has been officially registered, the Labour Code permits downsizing and redundancies. Hospital staff do not, therefore, believe acting chief doctor Dmitry Chumakov when he insists that “the workforce will remain untouched” and that “nothing will change but the name.” Chumakov had claimed in an interview with a local newspaper that the hospital would not be relocating, and yet a floor in the medical building was vacated soon after.

Some former patients arrive at the hospital specifically to meet us journalists. We head to the canteen together – talking there is more convenient. But when we start shooting, hospital management personnel and security guards enter the room; we’re promptly ushered from the premises, though Dmitry Chumakov does grant us a final brief interview. Its general gist is this: “The hospital isn’t being shut down; the merger is taking place in the context of mental healthcare provision reforms in Moscow. The number of outpatient clinics in the capital is increasing, which will serve to de-stigmatise patients, contributing to their socialisation and liberating them from stereotypes and labels. Not everyone requires inpatient facilities: some people can be treated without hospitalisation. The neurosis clinic has excellent scientific and technical resources, and the city wants to make use of them while combining the two institutions.”

A controversial decision

Kannabikh Hospital was a facility with 90 beds (of which 10 were for war veterans, and another 10 for patients with suicidal tendencies) and 210 day-care places for borderline patients. The Solovyov Neurosis Clinic boasts 570 beds (120 of them for critical patients) and 150 day-care places. What will happen after the merger?

“Pour water from one overflowing glass into another and see what happens,” the doctors advise. “The Solovyov Clinic has its own set of practices. Our hospital, though, developed beyond the confines of Russia’s traditional authoritarian system of treating patients with mental disorders. In addition to medical care, patients here were also prescribed therapy: hypnotherapy, art therapy, Gestalt therapy, body-oriented therapy, cognitive therapy… Rehabilitation was a priority, as was the work of psychologists. Ordinary and famous people alike – artists, musicians, writers, politicians, officials – have come here for help. We didn’t discriminate between anyone. The merger of the hospital represents an arduous challenge for the Solovyov, and it spells destruction for us. But what does it mean for Moscow as a whole?”

According to psychiatrists, there were 89 beds per 100,000 people in the capital as recently as 4-5 years ago; today, that number has dropped to 62. Western European cities, by way of comparison, boast 130-155 beds per 100,000 people. The number of patients in Moscow is rising, but the number of inpatient facilities is falling. Last year, two of the capital’s hospitals (No. 2 and No. 10) became residential care facilities. As such, they were transferred from the healthcare system to the social welfare department, which, in terms of personnel organisation and remuneration of labour, staff responsibilities and workload, is a totally different kettle of fish. Also being converted into a care facility is Hospital No. 15, where the Psychiatry and Narcology Department of the Moscow State University of Medicine and Dentistry is based. Of its 1100 beds, a mere 300 (and social beds at that) will survive, while its 1000-strong staff will be whittled down to 16 doctors and 102 nurses.

“Psychiatry is being destroyed. Services are disintegrating”

“Psychiatry is being destroyed. Services are disintegrating,” laments Yuri Savenko, president of the Independent Psychiatric Association of Russia. “Not only are patients being chucked out onto the street, we’re also witnessing the degradation of our professionals. Psychiatrists are allotted no more than 15-20 minutes for initial conversations with their patients, which isn’t an appropriate amount of time. Inpatient facilities are closing. Optimisation and reorganisation are just pure hypocrisy. At a major international conference, we held discussions with European experts who’d been conducting an experiment into replacing inpatient facilities with outpatient clinics. They said that full-fledged outpatient services were more expensive to fund than inpatient hospitals, but our officials believe that the reverse is the case.”

“Many years ago, I was already speaking out about the reorganisation of the system as a whole and and Kannabikh Psychiatric Hospital in particular. Today, I can only reiterate that a single neurosis clinic isn’t enough for Moscow and its millions of inhabitants,” says Tamila Lesovskaya, the former head of Psychiatric Clinical Hospital No. 12. “Perhaps opening 40 neuropsychiatric outpatient clinics in the capital isn’t a wholly irrational endeavour – people needn’t always leave their jobs, homes, and families behind to get treatment. But there are situations where inpatient facilities are absolutely essential.”

An atypical hospital

Tatyana M. ended up in Kannabikh Hospital in 2009. “I’d been through a period of severe stress,” she says. “I was almost killed, some people were trying to seize my apartment. Immediately after the incident, which involved threats and guns, I fell into such a panic that I didn’t know what to do with myself. Over time, the condition worsened, and my colleagues – I work as a television producer – advised me to go and seek help from the doctors of Hospital No. 12. The doctors saved me. It’s an atypical hospital: the attitude there is respectful, with a competent approach to each individual patient. They reassembled many of us piece by piece.”

Rita, 37, recalls how she sought treatment for depression. “I went to see the doctors here of my own accord. I got stronger and learned to cope with my problems. Prior to my admission, I was a different person to the one I am now…  I don’t understand – what’s the point of merging the hospital with the Solovyov Clinic? Moscow’s Northern and North-Western Districts will be left without access to skilled care.”

We listen to story after story: people tell us about losing their loved ones, about panic attacks, accidents, injuries… We speak to men and women of various ages and different social backgrounds. But one refrain remains constant: a facility that infuses patients who have lost themselves, with a renewed desire to live mustn’t be destroyed.

“Muscovites are being deprived of the right to seek psychiatric help beyond the framework of ‘big psychiatry,’” says Yekaterina Sobchik, a former Hospital No. 12 staff member and the founder of its psychological service. “Anyone who’s suffered a nervous breakdown following a divorce or bereavement will now be faced with a choice: either check into a nut hospital with bars on the windows, or seek solace in friends and booze. Outpatient facilities cannot provide the wide range of psychotherapeutic assistance we provided here in Hospital No. 12. We offered around twenty types of group psychotherapy aimed at increasing the patients’ socialisation. Are outpatient facilities going to give them that? All you can expect there is a consultation and a prescription thrown in your face.”

“What’s going to happen next?” asks Lina Yegorova, a clinical pyschologist at Hospital No. 12. “The building will most likely be rented out or sold at a profit. Some doctors and psychologists will be offered work at the neurosis clinic, but the bulk of the staff will be made redundant thanks to a convenient regulation that prescribes the ratio of doctors to patients. Where will patients – ours, and those from other hospitals – go now? These developments are reflective not only of a desire on the part of Moscow’s officials to replenish the budget, but also of certain trends in psychiatry. We’re witnessing cuts to hospitals and wards specialising in the treatment of neurotic and borderline patients. But there are more and more of these patients with every passing year – that’s the way life is here.

“Why shut us down if the replacement exists only on paper? Where are they going to get staff for their outpatient clinics? And they’ll have to be trained up as well. We have specialists with experience of working with precisely this type of patient, but now they’re being discarded. It’s an ill-considered, uneconomical decision.”

This is an abridged version of a report first published in Novaya Gazeta