Punitive psychiatry in Russia’s orphanages

How vulnerable children were sent to psychiatric hospitals for bad behavior

In mid-April 2015, a major scandal erupted in one Moscow’s psychiatric hospitals. It became known that staff at an orphanage had been sending orphans into psychiatric care for “corrective purposes.” Children were bound to beds and drugged with various medications. The situation attracted attention from both human rights activists and the police. However, this investigation is unlikely to change the system. On assignment for Meduza, Ilya Rozhdestvensky reveals how the practice of forced hospitalization of difficult adolescents exists in practically every region of Russia. Many cases similar to the latest Moscow scandal have been found all across the country, but none of them have led either to reforms or to criminal proceedings against the doctors and caregivers involved.

In November 2013, a nurse in Children’s Home № 1 in St Petersburg went to the police station and told the officers that a 51-year-old teacher working with her had raped a 9-year-old orphan with epilepsy. According to Vitaly Cherkasov, a lawyer at the human rights foundation Agora, the investigators were unable to gather sufficient evidence and the case was soon closed. Meanwhile, the director of the children’s home decided to actively defend the teacher. She then sent the girl to a psychiatric facility. This was done to put pressure on the child, discredit her and force her to recant her previous testimony, says Cherkasov.

Igor Ledebev, head of the NGO Breakthrough North-West which monitors compliance with children’s rights, agrees with Cherkasov. He has no doubt that the child was hospitalized in order to “brainwash” her and convince her that she had imagined everything. The girl was kept under observation for several months. After being discharged from the psychiatric facility, her condition deteriorated significantly. She became extremely aggressive and was unable to recognize even her own grandmother. Human rights activists went through great hurdles, but eventually managed to get her released back to her family, who wished to take her in. Lebedev maintains that this instance of punitive psychiatry for orphaned children is far from unique.

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According to the state statistics authority Rosstat, there are 80,000 children currently living in care facilities in Russia. There are no data on how many children have been sent to psychiatric clinics. The majority of of requests for information sent by Meduza to the local children’s rights commissioners in various Russian regions went unanswered. However, one can get a general idea of the situation from the answers Meduza managed to get. Since 2010 in Ivanovsk region, 67 orphans from children’s homes have been hospitalized. In Orenburg Region, 285 have been hospitalized. In Tomsk Region, the figure is 141, and in Novosibirsk, 59 children have been put under psychiatric observation. Officials maintain that escapes from psychiatric facilities are rare, but the reality may be different.

According to Grigory Sergeyev, a coordinator with Liza Alert, an organization that works on finding missing children, orphans run away from children’s homes relatively often, while staff at these facilities often delay filing missing persons reports in order to avoid attracting attention to issues at the facility. Instead, the children’s homes wait a few days for the child to return. Care workers turn to the police only in instances where the child is missing for a long time, and even then they often give misleading information about when the child disappeared.

There are no statistics on how many cases of harsh treatment or abuse of children take place during hospitalization, but dozens of cases make it into the media. In December 2010, 13 patients were sent to to Children’s Home № 19 in the Krasnogvardeisky District of St Petersburg from a similar facility in Moscow. Within two weeks of their arrival, four children had been sent to a psychiatric hospital. All had been removed after seven o’clock at night. The children’s rights commissioner for St Petersburg, Svetlana Agapitova, explained that that the minors had been sent to psychiatric facilities for bad behavior. This became public knowledge only in March of 2011, when one of the patients, a 16-year-old boy, ran away from the children’s home. Seeing that staff from the psychiatric facility were coming to take him, he jumped out the second story window – wearing only slippers, a T-shirt and shorts – and ran to a former caregiver, who contacted a human rights organization. According to the commissioner's report, the adolescent exhibited difficult behavior and had poor self-control. He had been put on probation in the children’s home and given a month to sort out how he was acting. He was tested for a variety of personality disorders and was found not to have a discipline problem, but they planned on sending him to a psychiatric facility anyway, with the aim of teaching him a lesson. Having spoken to other children in the home, Svetlana Agapitova came to the conclusion that this method of “education” was a common practice.

“How were children allowed to be sent to a psychiatric facility without the necessary paperwork in their medical records and without any obvious reason? Why didn’t the social facility director, the legal guardian of these orphans, know where his children were taken and why?” asked Agapitova. The commissioner promised to conduct a full investigation, but it had no effect on the overall situation. At the end of October 2013, four children in full-time care at four different children’s homes, ranging in age from 11 to 14, staged a fight with two other children in order to escape from a Petersburg facility called “Children’s Psychiatry.” One of them was found almost immediately. The others were found the following morning. They had fled the hospital on foot in pyjamas and slippers and walked a considerable distance to get to one of the children’s appartments.

Afterwards, the children themselves said that they had been mistreated at the hospital. Similar cases have been recorded across the whole country. For example, in Volgograd Region, orphans from the Volgograd Children’s Home were placed in Psychiatric Hospital № 5 in groups of three to six for minor disciplinary infractions. There they were tied to beds and injected without a doctor’s prescription with Promazine, an extremely powerful neuroleptic. The use of of Promazine on people who don’t need it has been categorized as torture by the UN. Some of the adolescents were sent to the local drug rehabilitation center where they were given medications that cause hallucinations and muscle spasms in children. In 2010, the district attorney for the Volgograd Region announced there had been about 20 such cases. In 2011 in Chelyabinsk, approximately 40 children from Boarding School № 13 ended up in a psychiatric sanitarium without any medical testimony. The year before, a 15-year-old girl was placed in a drug rehabilitation hospital after missing classes and injected with Promazine for two months. In 2013, the same pattern recurred, when children from the Rainbow Center Children’s Home ended up at a psychiatric hospital.

Similar sorts of violations were uncovered in the Sofinsky Children’s Home in Narofominsk. Twenty three children from the center were hospitalized without medical documentation. However, thanks to Ksenia Turchak, the journalist who uncovered the abuse, a criminal investigation was launched. The case on children’s rights violations was brought to court only after personal intervention from Duma deputies and from Russia’s Federal Commissioner on children’s rights Pavel Astakhov.

On conditions of anonymity, volunteers from Liza Alert told us about conditions in one of the orphanages in suburban Moscow. They said that children in this facility are terrified of being hospitalized. At the hospital, patients are tied to beds and given unknown medications.

Notably, criminal proceedings are almost never launched against workers in Russian children’s homes. According to statistics from the Russian High Court, in 2014 there were no convictions under the first section of Article 128 of the Russian Criminal Code – “illegal hospitalization in a medical organization, offering psychiatric help in sanitarium conditions.” Six people were acquitted, and three cases were closed due to lack of evidence. Under the second part of the Article – “the same action, but committed by an individual using their professional status, or leading to death by negligence of the victim, or other serious consequences” – there was one conviction, and the accused received a suspended sentence. The situation was the same in 2013. Seven people were acquitted under the first part of the article, another eight cases were quashed, and one person was convicted under the second part of the article. Meduza was unable to find any cases in the Russian state database where someone was convicted for illegal hospitalization of an orphan.

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Until recently, Moscow had not seen any scandals concerning the hospitalization of orphans in psychiatric facilities. The first major case was uncovered in April 2015. In mid-January, it became public knowledge that two adolescents were sent to Psychiatric Hospital №15 from the Rainbow Center for Cooperation on Family Education (formerly know as Children’s Home № 46). The two, known in media reports as G and M, had been enrolled in a special corrective program and had no developmental issues. They spent two months in hospital. After being discharged, G spoke to his former caregiver, Yury Kazadayev, who worked in Boarding School № 80. The 15-year-old gave him photos he had taken on his phone. The photos showed half-naked children in diapers bound to beds. In two of the photos, it is clear that two adolescents are binding a younger child to a bed. G also told Kazadayev that he had been given some sort of medication. Kazadayev called lawyer Kulan Vennikov. Soon, the Investigative Committee, the Prosecutor General, Ministry of Health officials and the offices of the children's rights chairman had all received complaints about child abuse.

Law enforcement began to show an interest in this case only after the G’s photos appeared in the media. According to the material uncovered in the preliminary investigation, the young man was hospitalized for poor behavior. He was neither given a diagnosis or examined by a doctor. In reality, the Rainbow Center’s employees had offered none of the help the were required to give to the adolescents in their care, didn’t bother with their education, and had sent them to psychiatric facilities for “punishment.” When asked why teenagers were tying children to beds, one of the doctors at the clinic answered “the children were simply playing.” This opinion seems to be supported by Moscow’s Deputy Mayor, Leonid Pechatnikov, who oversees social development programs: “The investigation has so far revealed nothing, but is continuing. One gets the impression that this was a sort of act, a game,” said Pechatnokov. Russia’s Children’s Rights commissioner Pavel Astakhov also supports this opinion: “I cannot think of any reason to tie up a child. I believe that child is different from an adult, and thus different methods need to be applied to children.” Astakhov also said that patients’ rehabilitation journals describe a group viewing of the thriller The Silence of the Lambs. Why exactly this film is used in therapy remains an open question.

The Investigative Committee opened a criminal case and demanded all information on patients hospitalized in the last 10 years. Kunal Vennikov hopes the investigation will yield some results.

Vennikov grew up in a children’s home. For the last two years, he has headed the Council on Orphaned Children’s Rights in Moscow’s Department of Social Welfare. He defends the right to accommodation of those leaving children’s homes. He says that many complaints have been filed against the director of the Rainbow Center, Lyudmila Soboleva, over a long period of time. She used to head Boarding School № 55 in Kuzminki and regularly sent children to Psychiatric Hospital № 15. According to Vennikov, this is the same facility she is sending children from the Rainbow Center to, despite the fact these two facilities are across the city from each other. When Meduza asked Soboleva to comment, she said “A criminal case has been opened, therefore, as you know, we are unable comment on anything.”

Vennikov believes that Soboleva enjoys good relations with the staff of Psychiatric Hospital № 15. It’s likely that in another facility, doctors would refuse to hospitalize orphans without the proper medical paperwork. What’s more, Vennikov believes that other facilities would likely have an interest in actually caring for their patients. However, proving that an illegal hospitalization has taken place is extremely difficult, especially when the child has developmental issues or a troubled history. As Vennikov notes, if a child in a care home is given a diagnosis and exhibits poor behavior, it’s taken as a given that they are very ill and must be placed under a doctor’s observation. In the case of 15-year-old G, the staff at the Rainbow Center had put pressure on the boy, Vennikov maintains. When they took him from Boarding School № 80, he was forced to sign a statement in which he promised to behave well, and asked to be sent to a psychiatric facility if he failed to do so.

Caregivers in these orphanages regularly send difficult adolescents to psychiatric facilities instead of trying to build a relationship with them, says human rights activist Igor Lebedev. He estimates that in every orphanage there are several similar incidents like this every year. The doctors agree to take such patients in order maintain the psychiatric facilities’ statistics, he says. If they stop taking in orphaned children, then their inflow of patients will decrease, and thus the funding they get from the state budget will also shrink.

Roman Dimenstein, head of the Moscow Center for Therapeutic Pediatrics, agrees with Lebedev. He also explains why some adolescents are tying down others in the photos from Psychiatric Hospital № 15: “This is the same system of control that we call ‘hazing’ in the army. To come in, talk with every patient, familiarize yourself with the personalities of the children - for this you need time, strength and will. Because of this, they create a brigade of overseers out of some of the patients, in order to carry out ‘black-ops.’”

This violates all existing protocols – special restraints can be used only by a qualified doctor, and even then for a period of time not longer than 20 minutes. Yury Kazadayev, a former carer at Boarding School № 80, says that forced hospitalization is done for more than just punishment. No one wants to take on difficult or sick children in children’s camps during the summer or winter holidays, and for this reason, minors are sent to psychiatric facilities during that time.

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One of the first attempts to evaluate the conditions of orphaned children in modern-day Russia took place in December 1998, when Human Rights Watch published a 288-page report entitled “Abandoned to the State: Cruelty and Neglect in Russian Orphanages.” As the text notes, “alternatives [to current practices] do not require additional resources, but rather a reallocation of existing funds now devoted almost exclusively to expensive institutional care.”

The author of the report, human rights activist Kathleen Hunt, underlined that many of the children should not be housed in these sorts of facilities. To send them home or to foster families would require significantly fewer resources and would be far more effective. In the orphanages which exist today, no one is concerned with the development of the children, they don’t receive the necessary medical attention, and they are often sedated or injected with psychotropic substances without prescriptions. If they behave badly, the children are sent to psychiatric facilities as punishment for up to three months. During this hospitalization period, adolescents are given medications, and they are unable to recover from the effects of the medicine for long periods of time. “In the summer, kids would go to camp, and our friend Kiril V. would spend all the time at the hospital. They lied to him that he was going to a sanitorium and so he packed his swimsuit and everything for a vacation. Then, he found out he was going to the hospital,” said one child.

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Anatoly Severny, President of the Association of Child Psychiatrists and Psychologists, says the situation can be improved by civic monitoring commissions which would investigate who is being sent to psychiatric facilities and why. A law passed in 1992 makes this possible: the law “On Psychiatric Care” states that “social organizations can carry out monitoring of human rights compliance during the administration of psychiatric care.” Yet no attempts to create such monitoring groups have yielded any results so far.

In 2011, a bill “on social monitoring of the provision of rights to orphaned children, and to children left without parental care” was presented for review to parliament. The bill was introduced for the first reading in March 2012, but in June, the parliamentary council postponed the review of the bill for an open-ended period. The deputies never returned to the initiative. Recently, the Ministry of Justice proposed to charge members of Russia’s Civic Observation Commission with the monitoring of psychiatric hospitals. A similar idea was proposed by the Health Ministry. But both proposals never even made it to preliminary discussions in parliament.

Experts contacted by Meduza generally voiced their support for proposals to allow a civic commission to monitor the activities of psychiatric clinics. Kunal Vennikov says that the Civic Observation Commission hires people who understand how exactly work is carried out in such facilities. Igor Lebedev is more skeptical about the plan. In his opinion, doctors can always prepare for inspections, explain to patients what they have to say when asked questions, and change the paperwork detailing hospitalizations. “We need another approach. We need to prevent caregivers from sending orphans to special facilities,” says Lebedev. “If the caregiver can’t find come to a mutual understanding with the child, cannot understand the child, cannot allow the child to open up and can’t invest in the child, then that person should not be working at an orphanage.”

Ilya Rozhdestvensky

Moscow