Yekaterina Chatskaya: Saving Mental Healthcare in Moscow

Campaign Opposing Closures of Moscow Psychiatric Hospitals Kicks Off
Yekaterina Chatskaya
Action Trade Union
December 6, 2016

Moscow has been witnessing another round of “optimization” of public healthcare. This time, officials have targeted the mental healthcare system. At present, Psychiatric Hospital No. 12 (Kannabikh Hospital), Psychiatric Hospital No. 14, and Psychiatric Hospital No. 15 are endangered. Experts and relatives of patients have been sounding the alarm. The actions of the “optimizers” will harm patients and generate a new threat to society. In addition, hundreds of qualified specialists will lose their jobs. Yekaterina Chatskaya, a Moscow physician and co-chair of the Action Interregional Healthcare Workers Trade Union, has summarized the information the trade union has collected on the “optimization” of the psychiatric clinics.

The authorities have dubbed the virtual closure of three hospitals “reorganization measures.” In particular, the Moscow City Government has already issued a decree on the reorganization of Psychiatric Hospital No. 12 (Kannabikh Hospital). It will be merged with the Solovyov Neuropsychiatric Research and Treatment Center. The reorganization of the hospital, staffed, until recently, by approximately 300 people, has come amidst psychological pressure on employees and their “voluntary” resignations or, at best, their resignation by mutual agreement and payment of two months’ worth of salary. Management has been concealing from staff the fact that severance pay in the amount of two months’ average salary is owed to employees in the event of dismissal on grounds of redudancy. Moreover, employees retain their old jobs for at least two months from the date they were officially notified of layoffs.

Psychiatric Hospital No. 15, which employs more than a thousand people, has also been threatened with mass layoffs as part of reorganization. The Moscow Health Department plans to convert it into a neuropsychiatric residential care facility. G.P. Kostyuk, Moscow’s chief psychiatrist and deputy head of the municipal health department, announced these plans at a meeting with hospital employees. However, 16 doctors and 102 nurses will remain on staff at the residential care facility. The health department could provide no written guarantees that salary levels would be maintained or other staff members would be provided with jobs.

We already know there are plans to convert Psychiatric Hospital No. 14 into a hospital for patients with chronic mental illnesses. The Moscow City Government, however, has yet to pass decrees on the reorganization of Hospital No. 14 and Hospital No. 15.

At the meeting with the employees of Hospital No. 15, officials said the decision to close the hospital had been taken personally by Deputy Mayor Alexei Khripun. However, officials provided no other weighty arguments for the decisions, and the arguments they made were patently absurd. In particular, the officials claimed that the hospital, located near Kashirskaya subway station, is unable to serve patients from the city’s Northwest Administrative District, although the hospital has in fact been serving patients from northern and northwestern Moscow for fifty years. The officials were unable to provide specific calculations showing why this had suddenly become unfeasible. Nor did they respond to doctors who argued that a residential care facility would be unable to replace the shuttered hospital. By the way, residential care facilities, unlike hospitals, are part of the social welfare system, not the healthcare system.

It is telling that reforms of such a socially significant area of medical care in Moscow as psychiatry should be launched without broad public discussion. The only document on the topic I could find in the public domain was “The Development Concept of the Moscow Municipal Psychiatric Service: Expert Comments by the Moscow Health Department’s Research Institute for Healthcare Organization and Medical Management.” It was published on November 29, that is, after people had begun to be fired and information about the reorganization had gone public.

Fifteen years ago, the Russian Federal Health Ministry announced a policy of “decentralizing inpatient psychiatric care, strengthening its outpatient component, and employing inpatient-substitution techniques” (Russian Federal Health Ministry Decree No. 98, dated March 27, 2002, “On s Sector-Wide Program for Reorganizing the Psychiatric Care Network in the Russian Federation, 2003–2008”). Most experts agree that shifting some of the burden from inpatient facilities to the outpatient component is warranted. However, even supporters of the policy recognize that Russia’s outpatient and day patient facilities can hardly offset a reduction in the number of beds at psychiatric hospitals and hospital closures. In particular, in November 2010, Valery Krasnov, director of the Moscow Psychiatric Research Institute, told the 15th Russian Psychiatric Congress that “2010 was marked by a decrease in the number of neuropsychiatric treatment centers and a deficit of social workers.” The resolution of the 16th Russian Psychiatric Congress, which took place in 2015, stated, “During the period between 2005 and 2014, a significant decrease in the number and capacity of psychiatric institutions, both outpatient and inpatient, occurred.” In other words, there has been no shift of institutional capacity towards the outpatient component, but a reduction of all components of mental healthcare.

The Action Interregional Healthcare Workers Trade Union believes that in order to decide the future of these hospitals a working group involving members of the Moscow City Government and employees of the affected hospitals should be organized. Public hearings on the matter where all interested parties could speak their minds should be held. In addition, there is no doubt that healthcare workers who are being laid off should have written guarantees they will be given new jobs at the same pay grade.

The union warns that attempts to make employees resign “voluntarily” are unlawful. Under current labor laws, reorganization cannot be grounds for terminating someone’s employment. Employees may refuse to sign letters of resignation without fear of the legal consequences. Even when employees are promised transfers to other institutions, they should not sign letters of resignation. Transfers are effected through a supplementary agreement to existing work contracts. Otherwise, employers are freed from the obligation to maintain the same working conditions and wages at the new workplace.

Furthermore, even if an employer claims dismissal is due to downsizing, we must remember that downsizing of this sort is legally possible only after the reorganization (the merger of hospitals) has been completed. After the reorganization, the employer must notify employees of possible dismissal at least two months before layoffs and offer them all available vacant positions. After dismissal, employees are entitled to payment in the amount of the average monthly salary for two months, or three months, if they have registered with the employment bureau.

The plans to close the hospitals have sparked outrage. The first petitions against the closures of Hospital No. 12 and Hospital No. 15 were posted on the web in mid November.

On December 1, a pressure group of healthcare workers from the three “optimized” hospitals, relatives of patients, and leaders of the Action Interregional Healthcare Workers Trade Union held a joint meeting. They founded a temporary Committee for the Defense of Healthcare in Moscow and decided to launch a campaign. Today, December 6, relatives of patients will kick off a series of solo pickets outside the Moscow Health Department. A full-fledged picket outside the department has been announced for November 9 at noon. A protest rally has been scheduled for December 18 on Suvorov Square from one to four p.m. City authorities are now reviewing applications for the rally as part of the approval procedure.

Translated by the Russian Reader. Thanks to the Confederation of Labor of Russia (KTR) for the heads-up