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At the mercy of doctors

If a court rules that a suspect was "insane" while he committed the crime, as it did in Kosenko's case, there are four different types of compulsory treatment that he can be ordered to undergo, according to Yury Savenko, president of the Independent Psychiatric Association, an organization that protects the rights of psychiatric patients.

The lightest form of treatment is ambulatory, when the person is treated as an outpatient. Persons ordered to undergo compulsory confinement can be placed in three different types of psychiatric hospitals: those with normal supervision, increased or specialized supervision and strict supervision (high-security psychiatric hospitals).

Laws passed after the breakup of the Soviet Union aimed at preventing punitive psychiatry being used as a political measure sought to bring these psychiatric facilities under the control of the Health Ministry rather than the Interior Ministry.

Today, according to lawyer Pavel Chikov of the Agora human rights organization, psychiatric hospitals with specialized or strict supervision answer both to the Federal Prison Service and the Health Ministry. That means that while federal authorities will guard the ward from the outside, on the inside, only doctors are responsible for patients' security, and for determining how long they will spend at any given facility.

"Today, paradoxically, special hospitals [for compulsory treatment] are perhaps even better than average ones because they are financed via the state budget and get better funding," Savenko said. "They have rehabilitation programs with foreign specialists."

The downside, Savenko said, is that the 1993 law guaranteeing psychiatric patients their rights isn't actually enforced.

"There is neither government control, nor public control in these facilities," he said. "They are left at the mercy of the personnel who get tiny salaries."

According to the Health Ministry, compulsory treatment is not a prison sentence.

"Patients are not released, they are discharged," Tatyana Klimenko, an aide at the Health Ministry, told The Moscow News. "Compulsory treatment is not punishment. It is treatment which is carried out if the patient requires it."

According to Klimenko, however, an evaluation which determines which type of facility a person is placed in must be ordered by the court or the investigators in order to be valid.

According to Savenko, Mikhail Kosenko, who has been treated for mental disability as an outpatient for more than a decade, should have been allowed to remain an outpatient.

Based on the official evaluation, Kosenko was ordered to undergo confinement at a psychiatric hospital with normal supervision, which will likely place him in Moscow Psychiatric Hospital No. 5, according to Savenko.

However, Kosenko's lawyer, Dmitry Aivazyan, said it was too early to determine which facility his client would be sent to. That decision will be made once the court ruling goes into effect following appeals, and could be months away.

If Kosenko is sent to Hospital No. 5, "the conditions aren't that bad," Aivazyan told The Mosocw News. "I've been there. At least, they allow lawyers to be present and we can watch [to make sure] his rights are protected."

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