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Last Updated: Thursday, 12 May 2005, 10:31 GMT 11:31 UK
Desperate plight of Russia's mentally ill
By Oleg Boldyrev
BBC, Moscow

In Russia's psychiatric institutions known as "internats", there is not much in the way of facilities or medical care, and as Oleg Boldyrev has discovered, most of the inmates will never be able to leave.

A patient
The patients include elderly people with dementia and even children
On the edge of Pervouralsk, a small town in the Urals, past the brick-making plant, the streets get smaller, the tarmac turns to dirt and the wooden houses give way to tall spruce trees.

Then, all of a sudden, you are confronted by a long grey building, four storeys high.

It is an "internat", a final destination for thousands of people who are mentally ill, have learning difficulties or who simply have nowhere else to go.

Once you are here, it is almost invariably forever.

Internats are supposed to offer psycho-neurological treatment, but that is not really the case.

They do not come under a medical authority and so are chronically short of nurses and doctors. There is little treatment on offer.


When I first visited the internat at Pervouralsk three years ago, it was immediately clear why even seasoned Russian psychiatrists grow uneasy when you mention places like this.

In the long, dark corridors, 400 bored inmates were shuffling back and forth along brown linoleum floors.

Their only entertainment, if you can call it that, was provided by a flickering black and white television with the sound turned off, suspended on the wall in a plywood cage.

The place looked fairly clean, but the stench of faeces followed me everywhere, even to the canteen where a group of inmates were eating their lunch from metal bowls.

There was no point in decorating the place with flowers, said the staff, as the patients would smash the pots or eat the plants.

And why give them sofas or armchairs to sit on? They would only rip them up.

Rehabilitation unit

So imagine my surprise when I returned this year to find not only plush sofas but a fancy colour TV, a washing machine, a modern fridge, even a poster of Eminem and a few cassette players in the rooms.

Rehabilitation unit patients
Life is a little better for patients in the Rehabilitation Unit
"This is now a rehabilitation unit," Galina Sazhina, the deputy director, proudly told me.

"We choose the patients who are the most capable and give them the chance to look after themselves. And look what they can do!"

She pointed, a little uncertainly, to a large contraption on the wall.

"We made a weight-lifting machine," explained Andrei, one of the patients.

I remembered, from my first visit, one of the girls here, also coincidentally called Galina, wheelchair-bound but loud and exuberant.

She was eager to show me around the few rooms which make up the rehabilitation unit. They were making soup on the stove.

Many of the patients will have entered the hospital as children
"We bake cakes and pastries," she said. "We throw parties, life's great, just like home!"

But the truth is, Andrei, Galina, and many of the others have only a vague idea of what home is.

Like a lot of the younger patients they arrived here when they became too old, at 17, to remain in an orphanage.

Adults often come after long spells in mental hospitals. Quite often older people, many suffering from dementia, also end up here.

For years Russian society's view of the disabled and the mentally disabled in particular was "out-of-sight, out-of-mind".

This is one reason why this internat, like many others, is sited on the edge of town.

'Beyond help'

The rehabilitation unit seems a great step forward.

But I wanted to know what plans the authorities have to help the patients move away, to live lives outside the internat.

Galina Sazhina, the deputy director, sighed deeply and told me there was simply no way these people could move out.

"There are no places where they can live independently," she said, "and no social workers to help them."

"And besides," she adds, "the patients in the rehabilitation unit are only a tenth of those who live in the internat."

The rest, she told me, are simply beyond help.

Signs of improvement

The other parts of the internat are just as miserable as before.

Patients in faded robes and nightdresses crouched on the floor; a girl rocked backwards and forwards on a chair. Another screamed. A nurse came to calm her down.

Nikolai Shengur, the internat's director, was slightly more hopeful than his deputy.

The windows of the rehabilitation unit were crammed with patients watching me go
He said that up to 40% of his patients, would show some signs of improvement with the help of a psychiatrist or a social worker.

But with salaries being so low, there is a perennial shortage of these professionals.

At the moment, he just wants more people to see what rehabilitation can do and to take their children and relatives back home.

Last year four patients returned to their families, he said with some pride.

As I left the large building, rather against my better judgement, I looked back.

The windows of the rehabilitation unit were crammed with patients watching me go.

I waved and hoped that, against all the odds, some of them would be able to turn their backs on this dark, sad building.

From Our Own Correspondent was broadcast on Thursday, 12 May, 2005 at 1100 BST on BBC Radio 4. Please check the programme schedules for World Service transmission times.

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