Two nurses for forty critically ill patients. Why psychiatric institutions are a sentence for Ukrainians who end up there.

Uninhabitable Facility?

“Guys, don’t poke at him with your fingers,” says the nurse to the residents who have gathered around. They are curious about the newcomer. Despite the noise, the sound of scolding can be heard — the staff member asks them to behave politely.

As of early November, there were 203 men in the institution, 128 of whom were incapacitated. I notice the man from the video: he is lying down again, covered with a blanket — this time on the couch.

Since 2022, the institution has been renting two buildings from the “Regional Psychiatric Hospital in Orlovka.” They moved into one for 5 years, which has been renovated. The other one was not renovated since the lease was for 3 years. This place smells of urine, the floor has broken tiles, and the plaster is peeling off the walls. The smaller rooms are designed for 4 beds, while the larger ones accommodate 11.

The director of the facility, Nikolai Dobrynik, initially denies that the video obtained by our editorial team was filmed there, but then explains:

“Perhaps the nurses, of whom there are two for 42 severely ill patients, didn’t manage to wash and change everyone. Some are in such a state that they constantly try to tear off their clothes, defecate, and smear it on the walls. They might have been placed in a room to prevent them from running away.”

Currently, the room featured in the video is closed. The glass on the doors is missing. Through the holes, it can be seen that both this and other rooms are empty. Residents have begun to be relocated to the renovated building, explains Dobrynik. However, 40 of the most severely ill patients remain in the old building, which was declared uninhabitable by representatives of the ombudsman in the Rivne region on November 1.

However, the head of the facility’s economic department claims — they have done all they could: “We started from such a horror. This building was in such terrible condition when we arrived in 2022 that I sat and cried — I didn’t know what to do. We invested over 2 million hryvnias in it.”

In contrast, the hospital director Alexander Zadorozhny denies everything. He claims that this was the best building in the facility. In particular, there was linoleum on the floor when the institution was handed over, but now there is painted concrete. And the walls were not damaged.

“Our patients can also break windows, but we don’t leave a room without windows. Sometimes toilets and sinks get broken — we replace them,” he reproaches.

“Few will want to work for 7,500 UAH”

Besides the peeling walls, there is another significant problem in the institution. There are only two nurses for all the most severely ill residents. Staff members say that the facility is designed for people with mild mental impairments, such as dementia. But there are extremely complex cases. Even among the “mild” residents, the illness progresses to a severe form over 20 years.

“This is hard work. I wanted to quit on the second day, but I got used to it — just like the guys got used to us. Someone has to work with them too,” says nurse Raisa.

Here, people are not treated; they are merely kept. This is about so-called supportive therapy — if a resident’s condition deteriorates, they are sent for inpatient treatment in a psychiatric hospital, either in Orlovka, with which they share territory, or in Ostrog. Some residents require constant treatment specifically in a psychiatric hospital.

“At the Orlovka psychiatric hospital, they say they have no available beds. We brought several men to the facility in Ostrog, and they also don’t want to accept them because the guys are very severe. It creates a vicious circle: we are being demanded, but no one is meeting us halfway,” complain the staff.

Nurse Raisa’s shift starts in the morning with rounds. The doctor prescribes medications, and the medical staff examines the residents. If there are health complaints, men are taken to the hospital for examinations.

“There haven’t been any cases where the guys have gone on a rampage. Of course, anything can happen, but we have a psychologist. If the residents’ condition worsens, we redirect them to the psychiatric hospital. But they don’t always take them — there aren’t enough beds,” adds Raisa.

In the renovated building, it is lunchtime. In the dining room, the staff has laid out plates with porridge, sausage, and vegetable salad on the tables. There are rooms with new beds and bright walls. The restrooms are renovated and clean.

However, the ombudsman’s inspection found flaws in the renovated building as well — the showers are not equipped for people with disabilities. The staff explains that the inspectors came on a Monday, and the day before, the residents broke the shower, so it couldn’t be repaired in time. Additionally, the repair engineer quit after the director’s remarks.

“A person doesn’t want to work for minimum wage, especially with such responsibilities,” explains the director.

Although the shower holder has been repaired, there is still a shortage of workers in the institution. “Few will agree to work for 7,500 hryvnias; not everyone can handle such a contingent,” adds the head of the economic department.

Inspectors also discovered that blood tests were not conducted correctly in the institution. When patients use certain medications, tests should be done weekly, not monthly.

However, the institution does not have its own laboratory. Previously, a team from the clinic would come to collect blood, but now they are performing other work. So now the institution will independently bring in a lab technician to conduct tests as often as necessary.

Slow Death or Full Life?

15 kilometers from Rivne, near the village of Boyanivka, amidst the forest, there is another branch of a psycho-neurological institution. For women. The buildings are scattered over a large area, planted with maples and pines. In the center, there is a fountain.

“Do you believe in esotericism?” asks resident Tatyana. The nurse leads me to her room and allows me to talk with her — the woman is capable. Tatyana is currently embroidering a towel. She shares the room with her neighbor Larysa. On the walls next to both beds are mats. Larysa’s bed is filled with soft toys, and icons of the Virgin Mary hang above her.

Tatyana is wearing a red hat, with a golden bag and beads around her neck. On her shelf are books titled “Practical Magic,” “The Precious Book of the Modern Witch,” “Illustrated Herbal.” Music plays from the player. Whitney Houston and Michael Jackson are her favorite singers.

“I also don’t believe much in esotericism, but it works, you know? It frees the mind from criticism and discomfort. It levels the spiritual state,” adds the woman.

Tatyana is 57 years old. She has lived in the institution for 21 years, after social services took her in when she left home. She is from Kamianets-Podilskyi. In the institution, she says, there’s no need to worry about food, she can embroider, sell her products, and with the earnings, buy new books. She even sells her works to the staff. “You won’t find shirts like Tatyana’s anywhere else,” says the nurse proudly.

Natalia is elderly. She has short gray hair and large expressive eyes. She has been in this institution for almost 22 years. Her room is modest but bright and tidy. The bed is covered with a pink blanket, and the bedding is floral, with a mat on the floor. She also embroiders and writes poems.

“I didn’t think I would be so well off. It’s warm here. I have a good old age — I have a hobby. This is my microbusiness; clients find me themselves — they are my acquaintances, the staff of the institution,” the elderly woman shares. In the evenings, the nurses join her — together they knit socks for the military.

Cultural activities in Boyanivka are organized by a social worker earning 3,000 hryvnias for part-time work. The residents participate in thematic events: they recite poetry, sing songs, and draw. Public and religious organizations also get involved in organizing such events.

There are also women in the institution whose mental state does not allow them to participate in activities. However, occupational therapy