Knowledge in Russia about socio-psychiatric care in an open, market-oriented society is undeveloped and insufficient, but a constant improvement is being made.
Problem and background
Since the spring of 2000, Folkuniversitetet has had contacts with Psychiatric Hospital nr 6 in St. Petersburg. We have even been in contact with the North-West Academy, where social workers are trained for work with Russian psychiatric care, among other things. Knowledge in Russia about socio-psychiatric care in an open, market-oriented society is undeveloped and insufficient , but a constant improvement is being made. Hospital nr 6, with a source-area of about 900,000 inhabitants, is centrally located in old, worn-out premises that used to belong to the Alexander Nevskij monastery. The hospital has adjoining outpatient care centres, day centres and workshops. The contacts have been comprised of mutual study visits, along with exchanges of both knowledges and experience. Within the framework of these contacts, Folkuniversietet has carried out an introductory training-scheme in socio-psychiatric methodology and rehabilitation. Representatives of psychiatric clinics and hospitals from all over St. Petersburg took part in the above training-scheme.
The Problem: The Russian psychiatric system is undergoing reform. The major idea is that patients will be treated, helped and supported at home and in the neighbourhood, to a greater extent than is the case today. However, knowledge about social work with psychiatric patients/disabled is either insufficient or totally lacking. There are no social programmes or methods for practical/clinical activities. The patient’s own possibility of influencing his/her situation is very small.
Reasons for the problem:
- It was as late as 1999 that social workers, with insufficient knowledge about work with the mentally ill, started working on a small scale within psychiatry.
- There is a lack of normative guidelines for social workers within psychiatry. In most cases there are programmes/methods that concern work with other target groups such as children and drug/alcohol addicts
- The mentally ill are the most vulnerable group in the Russian society. They are unemployed, often homeless, are poor and have a very low status within society. They are liable to be seen with prejudice.
- Development is moving in the direction where psychiatry takes more responsibility for social questions concerning patients’ life conditions and life quality.
- The ongoing Health Care reform in Russia accentuates the problem. There is a call for shorter inpatient time along with medicinal and social rehabilitation within the home. The experiences made by Sweden within the fields of home support, work, and visiting teams are of interest for Russia.
- The present system is one where patients are hospitalized, isolated from the rest of society. Many patients are afraid of the outside world and a mutual feeling of distrust and fear is built up between the mentally ill and the general public. Much mentally ill risk becoming violent or committing suicide. Most receive no help at home, but with domestic help and support, many could live at home and have a better life.
- The reform of the Russian psychiatric system means that the patient must be in focus to a larger extent, thus calling for the start and development of a democratic process.
Why is help to solve the problem from the outside necessary?
- Knowledge about socio-psychiatric support and rehabilitation is limited. Good examples and the education of staff are needed.
- Sweden has recent experience of reform within psychiatric care. These experiences are valuable for Russia when building a reformed system of psychiatric care.
- Over a number of years, Folkuniversitetet and SDF Gunnared in Gothenburg and Mölndal have cooperated with Hospital nr 6 in St. Petersburg. During this time, executives of the hospital have been able to state that that there are interesting experiences in Sweden that can enable them to avoid mistakes that were made there.
- The medical staff of the hospital are interested in and aim towards a socially oriented psychiatry. This precondition augurs well for the completion of the project.
- One interesting aspect of the project is that it can perform as a reference project for the organization of psychiatry in Sweden. In Russia there will be only one authority over medical and social rehabilitation even in the future. This differs from Sweden where the responsibility was divided between the local and county authorities at the time of the reform. This division is a subject for debate in Sweden.
- User-influence, patient-participation and a pedagogical approach are major cornerstones of the “Gunnared Gård model”. This model can prove to be a useful contribution to the Russian reform of psychiatry.
Project purpose and indicators
The project has the following three goals:
- To organize and initiate a centre for social rehabilitation at Hospital nr 6.
- To organize and carry out a training programme for staff that will be giving social support and help to psychiatric patients in their own homes with the aim of teaching them to be independent and make lives for themselves within society.
- Using the Gunnared Gård’s model as inspiration, to recreate the patient as a subject and actor in her own rehabilitation.
Indications that the goals have been achieved are the completion and the actual work within the rehabilitation centre. These can be measured by interviews in which one inquires as to the achievement of the goals and intentions of the centre.
Positive indications as regards Goal 2 are the achievement of the planned home support and other help and services that facilitate patients’ lives outside hospital. This can be seen by measuring the number of people that manage without inpatient care seen in terms of the number of days in hospital before and after the project. One can also measure the reduced need for care by studying the number of relapses over time.
Carl Toshach, firstname.lastname@example.org