"Attention paid to the mental condition of a delinquent in the country can serve as an indicator of its civilizational development."
Richard Ormrod
Ph.D., Research Professor, Crimes Against Children Research Center, University of New Hampshire
Juvenile delinquency is not a widely discussed issue, while mental disorders among young convicts appears to be a taboo topic altogether. Attention to the problem would not only improve the situation with human rights but also increase public security.
The creation of a separate institution to provide medical treatment and constant medical supervision for underaged convicts is an initiative proposed by Sergey Shum, head of the forensic psychiatry department at the Ukrainian Association of Psychiatrists.
The essence of the problem
If a juvenile delinquent with mental disturbances receives medical assistance in prison, the chance of that individual committing a crime in the 12 months after being released is 30%. With no treatment, the risk of backslide is at 80%.
Meanwhile, global statistics show that 95 percent of delinquent adolescents suffer from at least one mental disorder, while 80 percent suffer from more than one, the World Health Organization reports. In Ukraine, there are almost no such teenagers, according to the country’s official data.
Moreover, the statistics of pre-conviction forensic medical examinations in Ukraine over the last four years put the level of disorders among suspects at around 50%. Thus, close to zero percentage of convicts with disturbances means that either only healthy people are found guilty, or they get cured in the course of serving the punishment, or, most probably, the penitentiary statistics is lying.
“We should probably invite international experts to learn from our experience in addressing this problem, it looks like the Ukrainian system is the most efficient in the world,” Shum said ironically. In reality, it’s just the ignorance and lack of attention to the problem with poor statistics. The absence of a response system makes authorities try to look better by just sweeping it all under the rug.
In juvenile prisons, proper medical examinations are not conducted, disorders are not diagnosed, and there are no special institutions for medical treatment in place, while even if provided, care often comes from adult therapists. Children need special treatment from specially trained specialists, which the Ukrainian system fails to provide, adds Igor Martsenkovsky, head of child psychiatry department at Ukrainian Association of Psychiatrists.
The absence of specialized child forensic psychiatry in Ukraine leads to human rights violations of the most vulnerable social groups united in one: children, prisoners and mentally challenged.
Sergey Shum,
Head of forensic psychiatry department at Ukrainian Association of Psychiatrists
Not only for human rights, but for reasons of social security, convicts should be entitled to the best possible medical assistance, as this is proved to halt their further socially dangerous actions. Instead, they have very limited access to treatment, medications, and a limited voice in choosing treatment methods.
“Problems in Ukraine are by far the result of the lapse of major spheres of psychiatry: weak school and institutional framework lead to the common treatment of children and adults, civilians and delinquents. At the same time, the school of child psychiatry is underdeveloped and the essential concept of child forensic psychiatry is absent as such,” says Shum.
Children with mental disorders convicted of wrongdoings too often stay with healthy juvenile delinquents, not receiving any form of treatment, which puts the healthy children under threat and increases the chances of backslide for both categories.
Meanwhile, both inside and outside the penitentiary system, teenagers with detected disorders are often placed with adult patients, while just a separate chamber in a common hospital is designated for smaller kids.
“There is a tragedy with child psychiatrists in Ukraine too,” says Semyon Glusman, the president of Ukrainian Association of Psychiatrists. “They are not taught to rehabilitate patients and there is no specialized training for child therapists.”
Sergey Shum: Where we see diagnosis, investigators see crime elements
| Symptoms of mental disturbances among children | Crime classification by Criminal Code of Ukraine |
| – lack of social connections – rebellion, violence and disagreement in relationships with adults – hooliganism – brutality, bad temper, impulsive decision making – uncontrolled rage, violence, asset destruction, arsons | – robbery – deliberate destruction of third party property – health and life threatening behavior – hooliganism – physical attacks |
Many young law-breakers suffer hyperactive behavior syndrome, which was not even diagnosed 10-12 years ago. It is characterized by impulsive actions, lack of responsibility and often results in the child’s inability to realize the consequences of their actions. Many of the minor crimes they commit are just symptoms of this disorder.
Unlike other mental disturbances, hyperactivity is curable even without medicines, just with psychological help, while sometimes drug therapy is still needed. In the U.S., Europe, Australia, even in Latin America, such treatment is provided and most of these kids, usually boys, grow up being well-adjusted people.
“Thanks to specific drugs, nobody around such people in other countries even notice they are different. This is a tragedy of our children, who grow up being different without access to support and treatment,”Glusman believes.
Such children are much more vulnerable than usual patients, moreover, they need to be treated as suffering people, not guilty in their illness and requiring help.
Igor Martsenkovsky,
Head of child psychiatry department at Ukrainian Association of Psychiatrists
Unfortunately, psychiatric care is often disregarded both by the Ukrainian government and international donors, who are more concerned with contagious diseases, HIV or tuberculosis. Ukraine’s state budget expenses on child psychiatry were cut almost twice last year, according to Martsenkovsky.
Solution
By failing to provide a viable solution, Ukraine not only demonstrates an inhumane attitude toward children, but also violates the international obligations of providing help to such children, particularly the UN convention it ratified in 2013.
Igor Martsenkovsky
According to Martsenkovsky, children with psychiatric disorders should be treated as sick children, not delinquents. In Germany, this is solved by a health care institution with ensured security measures connected to potential threat the patients may pose to others. In other countries, like the U.S., it is implemented in the form of a penitentiary facility with organized medical assistance.
At least one psychiatrist per prison is required by international standards adopted by the UN. They also require a diagnosis of all disorders that might prevent a convict’s rehabilitation and reintegration into society.
The father of one of such child who received proper treatment and new medication told the doctor: “Thank you, you brought my sense of life back to me. I used to believe that my only son is scum.”
Semyon Glusman
President of Ukrainian Association of Psychiatrists
It’s not important how the scheme will work, administrated by the healthcare or penitentiary system, the key is that such juveniles should stay under doctors’ control, undergo forensic medical examinations and receive adequate aid if needed, in line with all internationally recognized human rights principles and legal mechanisms.
“We will not be able to change the whole system, but we need to scream about this problem. Our task is to ensure that most of these children never end up in prison, because prison only consolidates their behavioral patterns and no good ever comes of it. They get a second criminal record, they become delinquents and crime bosses because they have all it takes,” Glusman claims.
The government should pay attention to the problem and finally conduct research on problems of such patients, as well as on the state costs for their treatment, maintenance in different institutions
Medical assistance should also be scientifically based and adhere to the highest quality standards while otherwise it may become a one more refined punishment method, Martsenkovsky warns. To avoid that, society should be aware of the current state of affairs and benchmarks.
Action plan
Association of Psychiatry has been long working to solve this problem, addressing responsible people like ombudsman for children, already in the times of ex-president Viktor Yanukovych, but no response or interest came from the governmental side at that time.
Since the summer of 2015, Sergey Shum has been actively working on raising these issues among responsible authorities, writing program suggestions and organizing round tables. Civil council at penitentiary service, human and children rights ombudsmen and ministries are involved in the discussion and Shum is working hard to move it further.
Our task is to understand and to ensure that most of these children never end up in prison, because in prison they will become delinquents and crime bosses even easier.
Semyon Glusman
The latest success came with support of the parliamentary committee on law enforcement, subcommittee on penitentiary service. The lawmakers acknowledged the need for new system for convicted children with mental issues.
Together with Shum, the committee is working on changes to the criminal procedural code. It would embed the concept of obligatory constant medical monitoring for mentally challenged prisoners in a specialized institution, separately for children and adults.
The form in which the institution will be established – under control of the penitentiary service or in the framework of Health Ministry – is not that important for the Association of Psychiatry advocating the change. One of the possible solutions is redesigning one of the six juvenile prisons in Ukraine into a specialized institution.
“Even if there is only 15 such children in Ukraine, this is already a reason good enough to create an institution. And believe me, they are way more,” says Sergey Shum.
Adequate training for therapists specialized in child psychiatry and deep research in the area are among the main priorities.
The preliminary screening conducted by Shum and his colleagues in one of the juvenile prisons in Ukraine confirmed the global pattern of at least 80% of prisoners having mental problems, but more detailed research on wider sample is essential.
The association has also established cooperation with San Diego University specialized in the topic and is ready to conduct joint study on specific disorders, their causes and best treatment methods.
The association is actively looking for donors to support the first of a kind research in Ukraine.
 | Ukrainian Association of Psychiatrists
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