С докладом об итогах Координационного совета Уполномоченных по правам человека в субъектах Российской Федерации в республике Крым 15-18 мая 2018 года выступил Уполномоченный по правам человека в Орловской области Александр Лабейкин. главный врач ОПБСТИН Министерства здравоохранения Российской Федерации, член Экспертно-консультативного совета Александр Шпак представил доклад о защите прав граждан с нарушениями психического здоровья в Орловской области.

 

 

 

В обсуждении проблемы приняли участие — руководитель Департамента социальной защиты населения, опеки и попечительства Орловской области Ирина Гаврилина, главный врач БУЗ Орловской области «Орловская областная психиатрическая больница» Игорь Кочергин, главный врач БУЗ Орловской области «Орловский психоневрологический диспансер» Олег Силаев, прокурор отдела Управления по надзору за исполнением федерального законодательства Прокуратуры Орловской области Дмитрий Клёнышев, врач – психиатр, руководитель «Экстренной психологической помощи», член ОНК Александр Докукин, член Президиума и Совета Адвокатской палаты Орловской области Галина Клочкова, доцент кафедры теории и технологий Института педагогики и психологии ОГУ имени И.С. Тургенева Валентина Андриеш, председатель ОРОО «Совет солдатских матерей» Валентина Старовойтова.


Участники совместного заседания отмечают, что вопросы реализации и защиты прав граждан с нарушениями психического здоровья, носят чрезвычайно важный характер. На заседании были рассмотрены следующие вопросы: соблюдение прав лиц, страдающих психическим заболеваниями; обеспечение прав граждан с нарушениями психического здоровья, содержащихся в учреждениях уголовно-исполнительной системы, специализированных судебно-психиатрических стационарных отделениях (т.н. «стражных отделениях»); доступность психиатрической помощи; проблемы недобровольной госпитализации; защита материальных и имущественных прав; социальные аспекты психиатрии.

В настоящее время состояние психического здоровья населения Российской Федерации характеризуется отрицательными показателями. По данным статистики, в медицинских учреждениях на диспансерном наблюдении состоит около 4 млн. человек. Согласно исследованиям, психическое или невротическое (депрессивное) расстройство наблюдается у каждого третьего россиянина.

Это официальная статистика. Реально таких людей намного больше. Специалисты предполагают, что из-за стигматизации психических расстройств в России люди обращаются за психиатрической помощью только в самых крайних случаях, и огромное количество больных остаются без обследования и квалифицированного лечения. Большую роль в отрицании психического расстройства у русского человека играет и его своеобразный менталитет: больным быть стыдно, а особенно стыдно быть психическим больным. Ситуация усугубляется и недостаточным количеством врачей-психиатров.

Складывается тревожная картина, вместе с тем, этим проблемам не уделяется должного общественного и государственного внимания, меры по предотвращению дальнейшего распространения психических расстройств и адаптации пострадавших от них россиян пока не принимаются.

По мнению специалистов, основными причинами роста заболеваемости психической патологией являются неблагоприятная социально-экономическая обстановка, социальная незащищенность, безработица, межнациональные и этнические конфликты, вынужденная внутренняя и внешняя миграция и другие факторы, которые способствуют развитию стрессовых и непсихотических состояний.

Охрана прав и законных интересов лиц, страдающих психическими расстройствами, является одной из важнейших задач в области оказания психиатрической помощи населению. В особой правовой защите, в том числе с помощью принципиально новых, нетрадиционных для российского законодательства методов и средств, нуждаются лица, находящиеся в психиатрических стационарах. Это обусловлено, в первую очередь, ограничительным режимом содержания пациентов в психиатрических больницах и необходимостью применения к ним в ряде случаев мер принуждения. В данных условиях возникает реальная угроза их правовой защищенности, ущемления их интересов и гражданских прав, унижения чести и достоинства. Ситуация усугубляется тем, что психически больные не всегда способны самостоятельно защитить свои права и интересы и потому нуждаются в создании четкого и эффективно действующего механизма, который гарантировал бы такую защиту.

В Орловской психиатрической больнице специализированного типа с интенсивным наблюдением осуществляется принудительное лечение психически больных (по решению суда), совершивших общественно опасные деяния (ООД) и представляющих по своему психическому состоянию и характеру содеянного особую социальную опасность.

Не углубляясь в структуру данного лечебного учреждения, следует отметить, что все пациенты ОПБСТИН, находясь на лечении в данной больнице, имеют возможность на получение всех видов лечения по медицинским показаниям. Психиатрическая помощь оказывается им в условиях, соответствующих санитарно-гигиеническим требованиям. Для этого учреждение оснащено всем необходимым оборудованием. В штате достаточное количество высоко квалифицированного медицинского персонала и консультантов для обеспечения каждого пациента необходимой медицинской помощью. Это

является основой, создаваемой руководством больницы, для возможности пациентов в реализации своих прав, зафиксированных в ст. 5 ФЗ «О психиатрической помощи и гарантиях прав граждан при её оказании».

Все проводимые в больнице диагностические, лечебные и реабилитационные мероприятия отличаются этапностью от преимущественно биологической терапии при поступлении больного в больницу до широкого комплекса социо-терапевтических и медико-педагогических мероприятий, проводимых на фоне поддерживающего медикаментозного лечения к периоду выписки больного из больницы. Этой цели служит принцип профилизации отделений, а также созданные с 2011 года и действующие по настоящее время полипрофессиональные бригады в каждом отделении больницы.

В состав полипрофессиональной бригады входят врачи-психиатры, психологи, специалисты по социальной работе, социальные педагоги, культ организаторы и медицинский персонал.

Основной целью работы специалистов отдела является обеспечение наиболее безболезненного выхода в общество пациентов больницы, восстановление их социального статуса после длительного лечения в психиатрическом стационаре.

Для решения поставленных перед отделом целей по восстановлению социального статуса вытекают основные задачи:

— обеспечение материальной независимости пациентов (помощь в вопросах назначения, перерасчета и получения пенсии и иных видов выплат, оказание помощи в рациональном расходовании денежных средств)

— разрешение жилищных проблем (путем переписки с соответствующими организациями и ведомствами). Под этим понимается не только подтверждение факта регистрации пациента по месту жительства для решения в будущем вопроса о переводе его в психиатрический стационар иного типа по месту жительства. Сюда входят и вопросы по сохранности жилплощади, восстановлению права на жилье в случае незаконной её утраты, вопросы, связанные со вступлением в наследство, приватизацией жилья, получением жилья с учетом льгот, предусмотренных законодательством и другие.

В соответствии со статьей 5 Закона РФ от 2 июля 1992 г. № 3185-I «О психиатрической помощи и гарантиях прав граждан при ее оказании» лица, страдающие психическими расстройствами, обладают всеми правами и свободами граждан, предусмотренными Конституцией Российской Федерации и федеральными законами. Ограничение прав и свобод граждан, связанное с психическим расстройством, допустимо лишь в случаях, предусмотренных законами Российской Федерации.

Каждый имеет право на медицинскую помощь в гарантированном объеме, оказываемую без взимания платы в соответствии с программой государственных гарантий бесплатного оказания гражданам медицинской помощи.

Нарушения психического здоровья, по сравнению с другими формами патологий, в большей степени сопровождаются нарушением социального функционирования: искажением привычных форм деятельности, общения, дестабилизацией личностных отношений, отрывом от семьи и общества.

Психические заболевания имеют одни из наиболее высоких показателей инвалидности. Уровень жизни психически больных значительно уступает по сравнению с прочими социальными группами. Больные имеют серьезные трудности с трудоустройством, самообслуживанием, часто полностью теряют социальные связи, страдают алкогольной и наркотической зависимостью, туберкулезом, ВИЧ-инфекцией и другими социально-опасными заболеваниями, склонны к совершению общественно-опасных деяний. Свыше 50% лиц, страдающих психическими расстройствами, находятся в социально активном возрасте. В связи с особенностями течения заболевания, граждане с нарушениями психического здоровья значительно чаще сталкиваются с нарушениями своих социальных, гражданских и экономических прав, поэтому возникает особая социальная значимость в защите их прав и интересов.

Для реализации прав пациентов в Орловской областной психиатрической больнице проводится комплексная работа по выявлению и решению имеющихся у пациентов социальных проблем:

— установление личности неизвестных пациентов, их социальных связей и ближайшего окружения;

— обеспечение пациентов необходимыми документами: паспортами, видами на жительство, визами, разрешениями на временное проживание, полисами ОМС, СНИЛСами и другими;

— оформление в специализированные учреждения социального обслуживания пациентов, не имеющих жилья, или неспособных к самостоятельному проживанию;

— назначение, восстановление и перевод пенсий, ЕДВ, ФСД, ЕДК и иных социальных выплат по месту пребывания пациентов;

— направление на медико-социальную экспертизу с целью решения вопроса трудоспособности пациентов;

— организация участия пациентов в выборах, референдумах, социологических опросах;

— получение услуг по обеспечению пациентов средствами индивидуальной реабилитации (ортопедическая обувь, опорные приспособления для снятия нагрузки с конечностей, калоприемники, памперсы и др.)

— выявление недееспособных пациентов, нуждающихся в установлении над ними опеки и попечительства, а также кандидатов для установления опеки;

— представление интересов недееспособных пациентов, не имеющих официально назначенного опекуна, в различных организациях и учреждениях по вопросам, связанным с решением их социальных проблем и жизнеустройством;

— своевременная постановка на миграционный учет, контроль сроков пребывания и снятие с миграционного учета иностранных граждан и лиц без гражданства, поступающих на лечение в ООПБ (в соответствии с Федеральным законом от 18.07.2006г. № 109-ФЗ);

— оказание помощи пациентам по вопросам, связанным с вступлением в наследство; реструктуризацией кредитных задолженностей; задолженностей по оплате коммунальных услуг, алиментов; с возмещением материального ущерба.

В целях обеспечения сохранности имущества издан приказ главного врача БУЗ Орловской области «Орловская областная психиатрическая больница» от

23.05.2017 года № 153-ОД «Об утверждении Положения об учете денежных средств, документов, банковских карт, ценностей и вещей пациентов в БУЗ Орловской области «ООПБ»».

Во время свиданий пациентов с родными и близкими находится медицинский персонал, который следит за тем, чтобы пациент не подписывал неизвестные документы.

Органами прокуратуры области на постоянной основе организован надзор за соблюдением прав и законных интересов граждан, страдающих психическими заболеваниями.

Всего в 2017 – истекшем периоде 2018 г.г. органами прокуратуры области в связи с выявленными нарушениями прав и законных интересов лиц, страдающих психическими заболеваниями, внесено 7 представлений, по результатам рассмотрения которых 7 лиц привлечены к дисциплинарной ответственности, в суд направлено 2 исковых заявления, 1 из которых рассмотрено и удовлетворено, 1 находится на рассмотрении.

В ходе проведенных органами прокуратуры области проверок выявлены случаи неправомерного распоряжения имуществом, принадлежащим лицам указанной категории.

Так, Ливенской межрайонной прокуратурой установлен факт продажи в 2011 году доли земельного участка (пая), который принадлежал гражданину К., страдающему психическим заболеванием и признанному 19.04.2000 недееспособным, на основании подписанной им собственноручно 29.08.2011 доверенности, в связи с чем, межрайонной прокуратурой в интересах К. направлено в суд исковое заявление о признании сделки купли-продажи недействительной.

Вступившим в законную силу решением Ливенского районного суда от 13.07.2017 исковые требования Ливенского межрайонного прокурора удовлетворены, доверенность, выданная К., и договор купли-продажи доли земельного участка признаны недействительными, а также применены последствия недействительности сделки.

Прокуратурой Верховского района установлено, что в нарушение ст. 26, ч.2 ст.27 Закона Российской Федерации от 02.07.1992 № 3185-1 «О психиатрической помощи и гарантиях прав граждан при ее оказании» (далее — Закон от 02.07.1992 № 3185-1) гражданке У., страдающей психическим заболеванием с 2004 года, профилактика, диагностика, лечение, медицинская реабилитация и диспансерное наблюдение не оказывалась. После поведенной проверки и рассмотрения представления прокуратуры Верховского района нарушения устранены, У. постановлена на диспансерный учет.

В ходе проверки проведенной в мае 2018 года установлено, что решением Советского районного суда г. Орла от 26.12.2017, измененным и вступившим в законную силу на основании апелляционного определения судебной коллегии по гражданским делам Орловского областного суда от 06.04.2018, удовлетворены исковые требования гражданина Г., страдающего органическим расстройством личности в связи со смешанными заболеваниями, о признании договора купли-продажи квартиры недействительным и применении последствий

недействительности сделки, поскольку на момент заключения договора купли-продажи квартиры Г. не мог понимать значение своих действий и руководить ими.

Также установлено, что в УМВД России по г. Орлу 02.10.2016 зарегистрировано заявление гражданина М., являющегося братом Г., в том числе о совершении неустановленными лицами в отношении имущества последнего мошеннических действий.

По результатам проведенной проверки ОУР УМВД России по г. Орлу 25.12.2016 вынесено постановление об отказе в возбуждении уголовного дела на основании п.1 ч.1. ст.24 УПК РФ.

По требованию прокуратуры области указанное постановление 15.05.2018 отменено прокуратурой Советского района г. Орла, СО (по Советскому району) СУ УМВД России по г. Орлу возбуждено уголовное дело по признакам преступления, предусмотренного ч.4 ст.159 УК РФ. В настоящее время по уголовному делу проводятся следственные действия и оперативно-розыскные мероприятия.

В связи с выявленными нарушениями уголовно-процессуального законодательства прокуратурой Советского района г. Орла 15.05.2018 начальнику УМВД России по г. Орлу внесено требование, 21.05.2018 — представление.

В психоневрологические интернаты поступают люди, которые по своему психическому состоянию неспособны жить в семье, в обществе в силу утраты либо недоразвития способностей к самообслуживанию, самообеспечению и продуктивному общению. Тяжелые психические расстройства, характерные для проживающих психоневрологических интернатов, делают большинство из них неспособными самостоятельно отстаивать свои права и адекватно реагировать на различные нарушения. Большая часть из них по суду лишена дееспособности. Функции опекуна возложены на администрацию интерната.

4 действующих в Орловской области психоневрологических интерната поделены по гендерному признаку — 2 для женщин, — 2 для мужчин. На сегодня данный тип учреждений является самым востребованным. И если проблемы очередности в учреждения для женщин удалось решить несколько лет назад, то потребность в дополнительных местах для мужчин закрыта в1 квартале 2017 года, путем создания филиала Добринского психоневрологического интерната на 25 мест для тяжёлых психически больных, неспособных обслуживать себя самостоятельно, используя базу Глазуновского детского дома-интерната.

В названных учреждениях в настоящее время проживают 895 получателей социальных услуг с разной степенью психического расстройства, из которых более половины недееспособные.

Социальное обслуживание в психоневрологических интернатах основано на соблюдении прав человека и уважении достоинства личности, носит гуманный характер.

Лица, страдающие психическими расстройствами и проживающие

в психоневрологических интернатах, вправе:

обращаться непосредственно к директору или заведующему отделением по вопросам лечения, проживания, выписки и соблюдения прав, установленных действующим законодательством;

подавать без цензуры жалобы и заявления в органы представительной и исполнительной власти, прокуратуру, суд, к адвокату;

исполнять религиозные обряды;

выписывать газеты и журналы;

получать общее образование, в том числе по адаптированной образовательной программе и т.д.

В соответствии со статьей 4 Федерального закона от 28 декабря 2013 года № 442-ФЗ одним из принципов социального обслуживания является добровольность.

Специалистами органов опеки и попечительства муниципальных образований по месту нахождения учреждений осуществляется выдача разрешений на расходование средств подопечного на личные нужды, обеспечивается контроль за надлежащим расходованием денежных средств

в форме отчетов учреждений с приложением расходных документов.

В учреждениях созданы комиссии по рациональному расходованию денежных средств подопечных. Решением комиссий определяется рациональность и обоснованность заявок подопечных с учетом их потребностей, состояния здоровья, обеспечения их нужд за счет платы, вносимой ими по договору о стационарном обслуживании.

Специалистами органов опеки и попечительства принимаются меры

по недопущению сделок, влекущих уменьшение имущества подопечного.

В случае обращения опекуна или его родственников за разрешением

о регистрации по месту жительства подопечного каждое обращение рассматривается индивидуально с учетом правовых последствий. Недопустимо согласие на регистрацию в муниципальном жилом помещении, если это может привести к уменьшению имущества подопечного

при приватизации. В 2015-2017 годах не выявлялись случаи нарушения имущественных прав подопечных, в том числе использования имущества подопечных при проживании его в психоневрологическом интернате или нахождении на лечении.

Совместно со специалистами стационарных учреждений социального обслуживания и органов опеки и попечительства ведется работа по соблюдению имущественных прав подопечных. Производились приватизации жилых помещений в собственность подопечных, осуществлялись сделки по продаже имущества с обязательным приобретением равнозначного благоустроенного жилого помещения в собственность недееспособным подопечным, осуществлялись постановка подопечных на учет в качестве нуждающихся в получении жилья по договору социального найма.

Опекунами соблюдаются права подопечных на защиту и доступ к правосудию.

В целях соблюдения прав психически больных граждан судебные процессы об ограничении в дееспособности, недобровольной госпитализации в психиатрический стационар или недобровольном помещении в стационарное

учреждение социального обслуживания, признании гражданина дееспособным, продлении или прекращении принудительного лечения рассматриваются при обязательном участии самого гражданина, представителя органа опеки и попечительства, прокурора, адвоката.

В стационарных учреждениях социального обслуживания Орловской области имеются библиотеки, оборудованы места для отдыха и занятий спортом (спортивные площадки, тренажерные залы, приобретены развивающие игры), организованы и работают разнообразные кружки для развития и совершенствования творческих способностей подопечных, организуются экскурсии, просмотры фильмов, посещение подопечных священнослужителем. Ежегодно подопечные участвуют в выставке работ, приуроченной к Декаде инвалидов, становятся лауреатами и призерами, награждаются ценными подарками. В учреждениях ко всем праздникам организуются и проводятся концерты и конкурсы. В распорядке дня предусмотрено время для прогулок подопечных. В учреждениях подопечные в добровольном порядке имеют возможность трудиться на приусадебных участках, помогая в выращивании овощей для нужд учреждения и участвуя в организации ландшафтного дизайна.

Участники заседания обратили внимание, что средствам массовой информации необходимо привлечь внимание общественности к данной теме, а также к проблемам в работе лечебно-профилактических и социальных учреждений психиатрического профиля, в том числе посредством проведения в СМИ антистигматизационных кампаний для преодоления психофобии и формирования правильного отношения граждан к психиатрической службе, её сотрудникам и психически больным.

Подводя итоги Экспертно-консультативного совета, участники отметили конструктивный характер состоявшегося обмена мнениями и приняли резолюцию заседания Экспертно-консультативного совета, которую направят в Правительство Орловской области, Орловский областной совет народных депутатов, Прокуратуру Орловской области, органы государственной власти и местного самоуправления, общественные организации региона, в чьей компетенции находится вопросы, связанные с защитой прав и законных интересов граждан с нарушениями психического здоровья.

В работе Экспертно-Консультативного Совета Уполномоченном по правам человека принял участие исполнительный директор Общественного Фонда Парк «Преображение» Василий Михайлович Паскару, который входит в данный совет.

 

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