Sida 1 av 12 2013-10-02
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Psykiatrisk vård i Ryssland
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Hur ser den psykiatriska vården ut i Ryssland?
Är vården gratis både för vuxna och barn?
Diskrimineras etniska minoriteter gällande psykiatrisk vård?
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Psykiatrisk vård i Ryssland ... 1
Lagstiftning ... 2
Psykiatrisk vård genom NGOs ... 3
Bestraffande psykiatrisk behandling ... 4
Psykiatrisk vård för barn ... 5
Psykiatrisk vård för dementa och äldre personer ... 6
Diskriminering och korruption ... 7
Sjukförsäkring och vårdkostnader ... 8
Källförteckning ... 11
Lagstiftning
Human Rights Watch, Barriers Everywhere Lack of Accessibility for People with Disabilities in Russia, September 2013:
Sid. 6
“Russia’s Federal Law “On the Social Protection of the Disabled”
provides important guarantees for people with disabilities, including benefits such as pensions, subsidies, and entitlements to assistive devices and rehabilitation services. Human Rights Watch has not undertaken a comprehensive analysis of the law; instead, we have identified some concerning aspects of the law, including a lack of clear enforcement mechanisms at the federal level whereby enforcement is left up to the discretion of regional and city governments.”
--- Sid. 16
”Russian laws and policies concerning people with disabilities emphasize protection, statesponsored financial and other benefits, medical treatment, and, in some cases, isolation in closed
institutions. These policies have roots in the Soviet period.
Beginning in 1932, the Soviet government established a three-tiered system of “group one,” “group two,” and “group three” disability that classified people with disabilities primarily according to their perceived ability to work. People with group one disability status were deemed to have the most severe disabilities, and people with group three disability status the least severe disabilities. The government maintains an identical system today which determines not only whether people can work and in some cases in which specific types of employment they can work, but also the types and amounts of state benefits they are eligible to receive.
Federal benefits include monthly pensions, free transport passes, rent subsidies, and entitlements to assistive devices and ehabilitation services, in addition to other allowances.”
--- Sid. 74
“Article 13 of the law “On the Social Protection of the Disabled”
entitles people with disabilities to free medical care as part of Russia’s larger state insurance system. Article 10 of the law guarantees people with disabilities access to certain federally approved and funded rehabilitation devices and services.”
--- sid. 97
"Article 49 of the Law establishes pedagogical employees’
responsibility to take into account psychophysical development of students and their health state, to adhere to special conditions necessary for persons with disabilities in order to obtain education, and to interact with medical institutions, if deemed necessary, while implementing content of educational programs.
The following projects have been implemented within the framework of the Program:
dissemination of information on progress and results of measures implemented to form a tolerant attitude toward people with disabilities and dissemination of models of their social integration; design and piloting of programs of professional development for managers and specialists of psycho-pedagogical and medical-social assistance centers (PPMS) centers that provide comprehensive psychophysical and medical-social assistance for minors; implementation of educational activities for psycho- medical-pedagogical commissions’specialists; educational
institutions on issues of implementation of individual rehabilitation programs for children with disabilities into regular educational institutions."
World Health Organization, WHO Mental Health Atlas 2011 - Russian Federation, 2011:
“An officially approved mental health policy exists and was approved, or most recently revised in 2007. Mental health is also specifically mentioned in the general health policy.
A mental health plan exists. The mental health plan components include:
● Timelines for the implementation of the mental health plan.
● Shift of services and resources from mental hospitals to community mental health facilities.
● Integration of mental health services into primary care.
Dedicated mental health legislation exists and was initiated, or most recently revised, in 2010. Legal provisions
concerning mental health are also covered in other laws (e.g., welfare, disability, general health legislation etc.).”
Psykiatrisk vård genom NGOs
International Organization for Migration (IOM), Tyskland. Bundesamt für Migration und Flüchtlinge (BAMF), Country Fact Sheet. Russian
Federation, 2013-06-01:
Sid. 22
"In framework of gender projects in several regions of RF non- government shelters of NGOs are opened. Most of these NGOs and shelters are financed by international and foreign organizations.
Unfortunately because of insufficient financing not very few people can receive such assistance. Crisis women centers currently work in many Russian regions. They are sponsored by government
institutions (social service) and international programmes. Such centers provide consultations of psychologists, lawyers, social workers:
• women suffered from domestic violence (including minors)
• women who lost close relatives
• women with disabled children
• disabled women
• single mothers
• pregnant women (including single women and minors)
• women with children from single-parent families
• women who are in conflict with family
• women who are on maternity leave"
--- Sid. 23
"NGOs are focused on work in the field of humanitarian activity and development. Their activity promotes development of social
structure, independence and a level of self-organizing of a society, helps to create new workplaces for young active workers and gives more various kinds of the help (including psychological, in the field of health services of a primary part) at a micro-level to vulnerable groups of the population.
Target groups of the nongovernmental organizations are the refugees, the forced migrants, youth, the people who have suffered owing to confrontations and etc. "
Bestraffande psykiatrisk behandling
Freedom House, Freedom in the World 2013 - Russia, January 2013:
“As many as 50 to 60 people die each year in investigative isolation wards (SIZOs), according to the Moscow Helsinki Group. In some cases, there has also been a return to the Soviet-era practice of punitive psychiatric treatment.”
The European Court of Human Rights, (Application No. 31974/11), Koroviny applicants against Russia respondent. Written comments submitted jointly by European network of (ex-)users and survivors of
psychiatry, European disability forum world network of users and survivors of psychiatry international disability alliance, 2013-03-18:
sid.5.
“A. Disability-based detention prohibited
Article 14.1(b) of the CRPD [United Nations Convention on the Rights of Persons with Disabilities] prohibits deprivation of liberty based on a disability. The Committee on the Rights of Persons with Disabilities has interpreted Article 14 to require states to repeal provisions authorizing institutionalization of persons with psychosocial disabilities without their free and informed consent, and to ensure that mental health services are based on the free and informed consent of the person concerned. As recently confirmed by the UN Special Rapporteur on Torture, disability-based detention cannot be justified by a motivation to protect the person or others, or by a motivation to ensure that the individual receives prescribed care and treatment. “
---
Sid. 9
” CRPD Article 25 requires that health care be provided to persons with disabilities based on their free and informed consent. The Committee on the Rights of Persons with Disabilities has elaborated on the duties of states to ensure free and informed consent in all mental health care and services, and to repeal contrary laws.“
--- Sid. 13
"The World Network of Users and Survivors of Psychiatry (WNUSP) is a democratic organization of users and survivors of psychiatry that represents this constituency at the global level. In its Statutes, "users and survivors of psychiatry" are self-defined as people who have experienced madness and/or mental health problems, or who have used or survived mental health services. ..”
of the UN Special Rapporteur on Disability, and is a member of the International Disability Alliance (IDA)."
Jamestown Foundation, Russia Considering Restoring Soviet-Era Law on Psychiatry, Opening Door to Political Abuse; Eurasia Daily Monitor Volume: 9 Issue: 208, 2012-11-13:
"Russian psychiatrists are pressing the Duma to return the Soviet-era law on psychiatric assistance that allowed doctors at Moscow’s Serbsky Institute and elsewhere to indefinitely detain and treat people whose only “symptoms” were opposition to Soviet leaders and their policies. For more than 40 years, the Communist Party used the provisions of this law against a wide range of dissidents.
That tragic history sparked protests by psychiatrists, human rights activists and governments around the world and ultimately prompted Russian parliamentarians to replace that legislation with laws more in conformity with international practice."
Psykiatrisk vård för barn
UN Committee on the Rights of the Child, Consideration of reports submitted by States parties under article 44 of the Convention; Fourth and fifth periodic reports of States parties due in 2011; Russian Federation [3 June 2011], 2012-08-27:
sid. 25
"Children with disabilities (art. 23)
144. The Constitution, the Fundamentals of Health-Care Legislation, the Labour Code, the Act on Psychiatric Care and Guarantees for the Rights of Citizens Receiving such Care, the Education Act, the Federal Act on Social Protection for Persons with Disabilities, the Federal Act on Social Services for the Elderly and Persons with Disabilities, the Federal Act on State Social Assistance, the Presidential Decree on additional measures of State
support for persons with disabilities and a number of regulatory measures taken by the Government and specifying the procedure for providing social support to families with children make provision for mentally and physically impaired children, including children with disabilities (see paragraphs 78–79 of the second periodic report). 145. State policy on children with disabilities aims to ensure that they have the same opportunities as other children to enjoy economic, social, cultural, personal and political rights."
Psykiatrisk vård för dementa och äldre personer
Ireland: Refugee Documentation Centre, Russian Federation: Information on the availability and quality of healthcare for people with dementia and the elderly in Russia, 2009-11-10:
sid. 4
"In relation to the provision of psychiatric services, this report states:
“It was reported in 2007 that mental health had been a low priority within the Russian health system. While landmark legislation in 1992 guaranteed the rights of individuals with mental health problems, resources to support the system’s modernisation have been insufficient. The need to further improve mental health services was recognised in the federal Psychiatric Care
Network Reorganization programme for 2003–2008. This initiative set 5objectives of improving access to services and conditions in mental health hospitals; expanding outpatient services, day-care facilities and sheltered workshops; and bringing psychiatric dispensaries closer to patients’ homes.
Care remained predominantly institution based, provided in 2004 through 279 psychiatric hospitals and 110 inpatient departments within 171 psychiatric dispensaries, each serving a population of approximately 25 000. Care could be provided in psychiatric departments within general hospitals as well. The Russian
Federation continued to have one of the highest levels of psychiatric beds per capita in Europe at 113.2 per 100 000 population, or more than 161000 beds in 2005. Ambulatory care was provided through 171 psychiatric dispensaries, 2,271 psychoneurological doctors’
offices, psychotherapeutic centres and 1,117 psychotherapeutic offices. There were 15,287 places in day-care hospitals, but community based treatment and care facilities were very limited.
While psychiatrists were numerous (13.3 per 100 000), there were few social workers (1.2 per 100 000).” (Ibid, p.21)"
Diskriminering och korruption
European Roma Rights Center, Russian Federation: A report by the European Roma Rights Centre Challenging Discrimination Promoting Equality; Country Profile 2011-2012, 2013-07-16:
sid. 11
"To date, no comprehensive strategy has been adopted at federal or regional level to tackle the multiple disadvantages facing Roma in many areas of life, including education, access to housing,
employment and health care. Furthermore, Russia is not
participating in the process of the Decade of Roma Inclusion. The lack of initiatives to develop a comprehensive policy at central level is compounded by indifference at the local level. For example, officials in the Ministry of Social Care in Rostov admitted that no social care worker is designated to work with or in isolated Roma communities, and document-issuing authorities do not provide information campaigns or other measures facilitating document acquisition for illiterate individuals or isolated groups."
--- sid. 15
"According to the Rules on State Health Insurance in the Russian Federation the general requirement for obtaining state insurance is to provide ID and proof of place of residence.31 In cases where applicants cannot prove their place of residence and do not have proof of ID, social care institutions and organisations can apply on their behalf.32 However given that in some areas these social care institutions do not exist, or their capacity to support state health care insurance for vulnerable groups is limited, it is difficult to imagine how in practice people without an ID and registration of their place of residence can obtain access to free health care."
US Department of State, Country Report on Human Rights Practices 2012 - Russia, 2013-04-19:
"Official corruption continued to be rampant in numerous areas, including education, military conscription, healthcare, commerce, housing, pensions/social welfare, law enforcement, and the judicial system."
---
"Several laws prohibit discrimination against persons with physical, sensory, intellectual, and mental disabilities in employment,
education, transportation, access to health care, and the provision of state services. However, the government generally did not enforce these laws."
---
"Medical practitioners reportedly continued to limit or deny LGBT persons health services due to intolerance and prejudice."
Freedom House, Freedom in the World 2013 - Russia, January 2013:
"Immigrants and ethnic minorities—particularly those who appear to be from the Caucasus or Central Asia—face governmental and societal discrimination and harassment. Institutions representing Russia’s large Ukrainian minority have come under selective government pressure. LGBT (lesbian, gay, bisexual, and
transgender) people also encounter discrimination and abuse, and gay rights demonstrations are often attacked by
counterdemonstrators or suppressed by the authorities. In 2012, St.
Petersburg and some other cities passed criminal bans on LGBT
“propaganda.”"
Sjukförsäkring och vårdkostnader
International Organization for Migration (IOM), Tyskland. Bundesamt für Migration und Flüchtlinge (BAMF), Country Fact Sheet. Russian
Federation, 2013-06-01
Sid. 6
”The Ministry of Health and Social Development of RF puts into practice the development of state supporting of some groups of citizens who need social assistance. First of all, the State tries to strengthen the social protection of families, elderly citizens and invalids, orphans, children-invalids, etc.
In 2005 a special federal list was formed for persons who have the right to receive state social assistance and a monthly payment. A special program – so called “social package” which includes free medical support, sanatorium treatment and use of suburban railroad transport - was also elaborated. The special attention is given to maintenance of effective interaction of bodies of social protection and employment with non-governmental organizations, whose activity is directed on rendering assistance to vulnerable categories of the population, and also with representatives of business community
.”
--- sid. 8
”1. General Information: health care system
In the Russian Federation medical care is provided both by the state and by private medical institutions. The majority of current medical institutions are run by the state; however the private sector
is developing rapidly. Nevertheless, the situation with the health care in Russia is quite difficult: it is insufficiently financed from the state budget - at the half of the amount required, according to the Minister of Health and Social Development.
About 80% of state medical institutions are financed from the regional and/or municipal budgets which do not have enough financial resources for it and cannot secure a high-level medical care. Medical equipment is usually obsolete; basic medical institutions are understaffed, as only 60% of the required
staff is employed. As a result, the quality of free of charge medical service decreases.
2. Access to medical treatment
The state guarantees all Russian citizens the right to free medical care through a system of obligatory medical insurance (OMS).
Insurance companies are selected by the state in each region. They are financed from state budgets at all levels, from tax revenues and other sources. Free medical care covers the following services:
· emergency medical care;
· ambulatory care including preventative treatments, diagnosis, and treatment of diseases both
at home and in polyclinics;
· treatment in hospital.”
--- Sid.9
“Foreign citizens in Russia have access only to the basic medical care, i.e. emergency medical care.
Other medical services are provided on a chargeable basis, whether through direct payments to clinics or through insurance companies in case the foreigner has private insurance coverage.
As for the paid medical care, there are private medical institutions that provide medical services to population irrespective of
citizenship. According to the polls, some 35% of the Russian population use private medical services; however, due to high prices this option is not available for the vast majority of the population.
Apart from the system of the obligatory medical insurance, both Russian citizens and foreigners can opt for voluntary medical insurance (DMS) on a paid basis, which is developing swiftly in the country. A net of insurance companies has been set up in Russia to provide these services. The premium for insurance varies from USD 400 to several thousand dollars, depending on the reputation of the medical institution and the range of medical services requested.
These companies prefer to work with legal institutions; however, during recent ten years insurance programs for private individuals are developing rapidly.”
---
“In general all Russian citizens – both those covered by OMS and members of other insurance systems - buy medicines at their own expense. However, there are special groups that are provided with free medication. Russian citizens suffering from certain diseases are entitled to benefits financed from the federal budget, such as the social package which includes free medicines,
sanatorium treatment and transport (city transport and local trains).
Treatment and medicines for some diseases can also be financed from the regional budget. The list of diseases giving patients the right to obtain free medicines is determined by the Ministry of Health and Social Development. It includes: …mental diseases…”
--- sid. 23
"3. Persons with mental disorder
Russian Federation in Federal Law “On psychiatric assistance and citizens’ rights” establishes legal, organizational and economic principles of psychiatric treatment. According to this Law patients
can receive free of charge services: emergency psychiatric aid, consultations and diagnostics; psychoprophylactic and rehabilitation assistance in outpatient department and clinics; all kinds of
psychiatric examination; temporary disability determination; social assistance and employment of people with mental disorder;
guardianship problems; legal assistance in psychiatric clinics;
education of invalids and minors with mental disorder; psychiatric assistance in case of disasters and catastrophes."
UN Committee on the Rights of the Child, Consideration of reports submitted by States parties under article 44 of the Convention; Fourth and fifth periodic reports of States parties due in 2011; Russian Federation [3 June 2011], 2012-08-27:
sid. 12
“Every year, the Russian Federation adopts a programme of State guarantees of free medical care for citizens (paragraph 79 of the third periodic report). Measures to give effect to State guarantees in the area of family, maternity and child support are carried out, in particular, under the compulsory health-care system. Every child permanently resident in the Russian Federation is entitled to medical insurance under the compulsory medical care system. As of 1 January 2010, 26.4 million children under 18 years of age whose parents were either citizens of the Russian Federation or foreign nationals permanently resident in the country had medical insurance under the compulsory medical insurance system.
Medical insurance contributions for children under 18 years of age are paid by the regional government bodies empowered by the authorities of the constituent entities at the highest level.”
--- Sid. 29
“The provision of medicines for the public, including women and children, is ensured pursuant to Federal Act No. 178 of 17 July 1999 on State Social Assistance, in the framework of a centralized
purchase of medication for patients with illnesses requiring
expensive therapy, special federal programmes, the Priority National Health Project and the programme of State guarantees for the provision of free medical care for citizens of the Russian Federation.”
European Observatory on Health Systems and Policies, Health Systems in Transition, Vol. 13 No. 7 2011; Russian Federation, Health system review, 2011:
sid.[19]
"The range of benefits covered is comprehensive. There is no volume limitation for care included in the MHI/state package and only a negative list of care provided for a fee, which is beyond the scope of the guaranteed “basic” package of care. Notable exceptions are outpatient prescription drugs, which must be purchased out of
pocket by all apart from a small number of “vulnerable” groups. The comprehensiveness of the benefit package is, however,
undermined by the persisting scarcity of resources and reported generalized informal payments."
--- sid. 126
"Most patients, however, pay full costs out of pocket for pharmaceuticals prescribed in outpatient care. In theory, pharmaceuticals prescribed in hospitals are free of charge for patients, but shortages and patient concerns about the quality of pharmaceuticals provided in hospitals mean that many
of these pharmaceuticals are also purchased at full cost price by patients."
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