The aim of the visit, the CPT's second to Ukraine since the beginning of the full-scale military aggression by the Russian Federation in February 2022, was to examine the treatment and living conditions of persons involuntarily admitted to and treated in psychiatric hospitals, and of persons accommodated in social care homes ("internats" and "pensions") for disabled and older age persons. For this purpose, the delegation visited psychiatric hospitals in Lviv (Kulparkiv Hospital), Orlivka (Sarny) and Hlevakha (Kyiv), as well as Hruskhivskyi "Internat" (Lviv region), Vinnytsia "Pension for the elderly and disabled", and Baraboi "Internat" (Odesa region).
The CPT received no allegations of physical ill-treatment by staff at any of the establishments visited. Overall, there was a relaxed atmosphere, and the delegation observed good staff-patient/resident relations. As for inter-patient/resident violence, conflicts did occasionally occur but they were not of a serious nature and staff intervened promptly and adequately whenever they arose.
Living conditions varied in the establishments visited. Good conditions were observed in those wards which have already been refurbished, where patients/residents lived in smaller, well furnished, decorated and personalised rooms. The majority of the wards, whilst not of such a high standard, offered decent accommodation. By contrast, a number of wards which had not yet been refurbished offered quite poor conditions, with austere and cramped dormitories, and a lack of lockable space, privacy and personalisation. There were ongoing works in the establishments visited to gradually bring the living conditions to the standard found in the already refurbished wards.
The healthcare staff complements appeared to be generally sufficient in the psychiatric hospitals, although there were too few psychologists and other therapeutic staff, such as occupational therapists and physiotherapists, and not enough social workers. By contrast, all of the social care homes visited could clearly benefit from an increased presence of doctors, nurses and orderlies. However, here too, the biggest problem was the insufficient complement of other therapeutic and rehabilitation staff.
In the three psychiatric hospitals visited, the treatment was essentially based on pharmacotherapy, which was generally adequate although the dosage and combination of prescribed medicines was sometimes rather high in Orlivka. Other psycho-social therapeutic activities were available in Hlevakha and on most of the wards in Lviv, but were in short supply in Orlivka. The CPT invites the Ukrainian authorities to make intensify their efforts to further develop a range of therapeutic options and involve more patients in rehabilitative psycho-social activities; this will require the recruitment of more qualified staff (psychologists, occupational therapists, physiotherapists, social workers, etc.).
The treatment provided to residents in social care homes was essentially based on pharmacotherapy, with a limited range of mostly first-generation anti-psychotic drugs available. The range of other psycho-social therapies and activities available also appeared to be rather limited. Steps must be taken to develop the offer of psycho-social therapy and other activities for residents of the social care establishments visited.
Seclusion was not applied in any of the psychiatric hospitals visited, while mechanical restraint (fixation) was used infrequently, only applied as a last resort and always for short periods of time. Its use was well recorded on the wards, but there were still no centralised registers. Further, the use of chemical restraint, although employed, was not recorded. The main issue of concern at Kulparkiv and Orlivka Psychiatric Hospitals was that patients were often fixated in view of other patients. Further, at Kulparkiv Psychiatric Hospital the delegation observed that police officers could sometimes be asked by healthcare staff to help restrain a patient. Steps must be taken to eliminate these practices.
The CPT is of the view that, as a matter of principle, means of restraint should not be applied in social care homes. The policy should be to gradually phase out their use and replace them with alternatives such as de-escalation techniques, in which staff working in such establishments should receive adequate training. On those rare occasions when a resident becomes agitated and does not calm down despite the employment of de-escalation techniques, the normal procedure should be to call an ambulance, with a view to transferring the resident without delay to a more appropriate healthcare setting.
The legislation in force concerning involuntary psychiatric hospitalisation and treatment seemed to be duly followed in practice, both as regards the "civil" and forensic patients alike. On the positive side, all patients had access to (mostly ex officio) legal assistance and there was always a court hearing. However, the CPT has misgivings as to whether the consent provided by patients upon admission could genuinely be considered to be free and informed.
The legal framework was duly observed overall in the three social care establishments visited, including the requirement to sign "contracts" between residents (or their guardians) and the establishments' Directors, and to carry out reviews by medical commissions and district medico-social expertise commissions. However, it remained the case that residents were, as a rule, not given a copy of the "contract" and that staff usually did little to explain to the residents their meaning and content, and their right to request discharge from the establishment. The Ukrainian authorities must rectify these deficiencies.
The Committee is also concerned by the fact that, despite its previous repeated recommendations, many legally incapacitated residents in the three social care establishments visited had the establishment's Director performing the functions of their guardian. The Ukrainian authorities must search for alternative solutions which would better guarantee the independence and impartiality of guardians.
In their response, the Ukrainian authorities provide information and outline measures taken in response to the recommendations made by the CPT. Among others, they refer to ongoing legislative and policy reforms (including de-institutionalisation), as well as continuing efforts to improve living conditions and staffing, and offer a wider range of therapeutic options.
- Read the report in English
- Read the executive summary and observations in English, in Ukrainian
- Read the response in English
- Read the visit newsflash
- The CPT and Ukraine
