Human rights violations in closed institutions

1. Human rights violations in closed institutions Egle Rimsaite 3-4 October 2005, Tbilisi

2. Construction of institutions for adult individuals needing care was started with the best intentions, believing that individuals with special needs are serviced more efficiently when they are concentrated in one location. Consequently, the duty to take care of disabled members of the society disappeared; in many cases they were excluded so successfully that external world fully forgot about their existence (Kroeger 2001).

3. Developments in Western countries In eighties and nineties of the last century they started substituting institutional care with community services. Though different countries chose quite different paths, all of them tried to emphasise possibilities of the beneficiaries of care services to choose, openness of care service institutions for the community, involvement of family members, necessity to ensure the rights of beneficiaries and similar provisions. Most European countries strive for strengthening care at home, deinstitutionalisation and decentralisation of services for geriatric and disabled individuals.

4. Developments in Central and Eastern Europe countries Despite governmental obligation to carry out the policy of deinstitutionalisation, CEE, not only invest into improvement of physical conditions in sheltered accommodations/asylums, but even expand them, since the existing need for care services is vast and institutional care is often understood as the only alternative. Walker 1997: avoiding such unpopular conceptions as “sheltered accommodation, asylum, institutional care” politicians started manipulating with “community-based care” so often that made it seem existing.

5. In CEE countries and other post-soviet countries there are about 1,3 million children, disabled and elderly persons living in confined institutions counted in this region to amount to about 7.400. A Lithuanian sample is often applied - 1.75% of our national budget is used for institutional care, a gigantic amount of money is assigned to maintain and strengthen the system, which is not humane, contradicts human dignity, violates human rights, trifles money away in vain and creates both a financial and organisational barrier for formation of community-based services.

6. Human rights monitoring project Donnors: • European Commission • The US Embassy in Lithuania, Coalition partners: Global Initiative on Psychiatry, Lithuanian Welfare Society for Persons with Mental Disability Viltis, Vilnius Centre for Psychosocial Rehabilitation Institute for Monitoring of Human Rights Period: November 2004 - March 2005.

7. Human rights monitoring project Experts: Arunas Germanavicius (psychiatrist) Dainius Puras (psychiatrist) Lina Malisauskaite (lawyer) Dovile Sakaliene (psychologist) Robertas Povilaitis (psychologist) Egle Rimsaite (social worker). Institutions: 9 residential institutions for mentally disabled 5 psychiatric hospitals.

8. The right into information The quantity of information received by residents of social care homesoften depends on goodwill of individual staff members. Formal in-home mechanisms of complaint review do not ensure enforcement of the right to lodge complaints and to receive answers thereto. Though the law obligates staff members of psychiatric hospitals to provide the patients with information about their illnesses, information giving has been depending so far on doctors’ goodwill and respect to the patients. At present, informing the patient about his/her illness, as well as maximal involvement of the patient into decision making is more episodic than usual practice.

9. Respect of private life This right ofresidents of social care homesis being violated in essence: their entire lives are public, enduringly watched by the personnel and other residents. Their right to make and maintain intimate relations is being violated. In psychiatric hospitals, the right of patients into respect of private life is limited to a maximal extent, and is absent in acute wards. This right is being violated in terms of adhering to requirements applied to security of personal data of patients, making it available for patients to do personal hygiene and to use telephone privately, adhering to requirements as to the number of patients in a ward..

10. Discrimination Obedient residents of social care homes, actively co-operating with staff members are encouraged and given privileges inaccessible to other residents. Extremely severe residents are most often exposed to discrimination and placed in the poorest wards. Some patients in psychiatric hospitals, too, are obviously given privileges. Staff members like obedient patients and give them more freedoms and privileges not accessible to other patients.

11. Torture and inhumane behaviour Most frequently met forms of improper treatment of residents by staff members are neglect, too frequent restriction of residents’ freedom of movement, psychological, physical, sexual violence against the patients, decision taking on behalf of the patients on the issues of their personal life. One of the most brutish violations of human rights in social care homes is forced interruption of pregnancy.

12. Torture and inhumane behaviour Most psychiatric hospitals don’t have a standardised procedure for imposition of physical exclusion, physical or chemical restrictions as well as a mechanism for revocation of the mentioned measures. On the other hand, in hospitals, where the mentioned procedures are officially regulated, a number of shortages in implementation thereof have been detected. There are cases of preventive fixation in order to prevent outbursts of likely aggression. Fixation is also applied as a penalty.

13. The right into ownership In principle,this rightis not limited in residential institutions, but cases of violation of this right have been recorded. In psychiatric hospitals, the right into ownership is subject to stricter limitation; there are cases when patients are not allowed to keep personal things that are not dangerous; usage of sanctioned personal things is often restricted.

14. The right into education This right is not exercised by residents of social care homes. Out of more than 3000 residents, as few as 7 individuals have acquired education through the help of institution staff. It is difficult to speak about reintegration of individuals with mental disorders, where patients treated in psychiatric hospitals for five or seven years have not been educated, trained profession or skills necessary for their reintegration to the society. Visit to a children department in one psychiatric hospital revealed that patients there are not trained at all.

15. The right into employment • This right is very rarely exercised by residents of social care homes. In most cases official employment contracts are not made with residents employed thereat, no opportunities are looked for to employ them, there is no mechanism how to protect residents hired by neighbouring farmers from exploitation. • Only in one psychiatric hospital patients of a production-rehabilitation department have an opportunity to work and to receive workpay, and such employment is not ensured on a regular basis, but only when the hospital gets orders.

16. After the report was published • Reaction of politicians and officials • Reaction in media • Reaction in the society • Few months later.