#2 - JRL 7244
BBC
June 28, 2003
Russia's mental health revolution

Doctors in Russia are spearheading a revolution in the way patients with mental illnesses are treated.

In the days of communism, people who were diagnosed as mentally ill were locked up in psychiatric hospitals and denied contact with the outside world.

Some people were classed as mentally ill because their political views did not tally with those inside the Kremlin.

Psychiatrists were even banned from diagnosing some conditions, such as drug addiction, because they were politically inconvenient.

It was once the official view that drug addiction simply did not exist in the Soviet Union.

Health reforms

Today, the situation is much different

A law passed in January 1993 protected the rights of mentally ill patients for the first time.

A series of reforms have seen the focus of psychiatric care change. Sprawling, stark asylums are being replaced with modern hospitals, with patients allowed to live in the community as much as possible.

"Russian psychiatry was very politicised in the past," says Dr Sergei Kosiakov, who runs the Peveralsk Psychiatric Hospital outside Yekaterinburg in the Urals.

"But now, it's no longer a political tool. It's becoming more open and more accessible to the community."

Rates of mental illness are high in Russia. Doctors believe decades of communist rule have played their part.

"The Russian character has a tendency to develop depression," says Dr Vadim Gourn, who runs the adult outpatient at Peveralsk Psychiatric Hospital.

"There's a strong feeling of repression. Feelings of guilt and shame play a big role.

"For over 70 years after the great socialist revolution, we've been developing these feelings of shame and guilt.

"There have always been so many restrictions - you mustn't do this, mustn't do that; you're told this at home, at school and at work - so whenever one has the opportunity to act freely this creates a kind of conflict inside and you immediately start to feel this guilt and shame."

In common with many other countries across the world, mental illness is stigmatised in Russia.

"The majority of families we know are afraid to tell anyone about their problems at work, even to their relatives," says Nelli Levina, who helps run a patient support group in Yekaterinburg.

"There is some kind of shame if you have someone ill in your family."

Dr Anna Pershanova works for the Russian Ministry of Health. She is leading the reform of mental health services in Yekaterinburg.

"There has been a reform process across the Russian Federation and our focus in this region is now the creation of outpatient psychiatric clinics," she says.

"At the same time, we have been reducing the number of beds at the psychiatric hospitals.

"On the one hand, this is done to improve in-patient care but also to allow us to concentrate on providing better after-care for the patients who are discharged from the hospital."

Government funding is, of course, central to these reforms. Money is in short supply.

"It is a problem across Russia," says Dr Pershanova. "We have no money but we will find it. We are optimistic about the future."

This story is featured in the radio programme Health Matters on the BBC World Service.