Strict Regime Rehabilitation

Rehabilitation centre Gerda is situated in Tatarstan. However, patients are brought here by their parents from all across the country. As stated on the website, the organisation is concerned with the rehabilitation of deviant teenagers from ages 10 to 18 suffering from drug addiction, alcoholism, game addiction and inhalant abuse.

The advertisement says: 'We will help children in hardships', enumerating the following symptoms: 'Your child behaves strangely as if they are on something? Sitting in front of a computer all the time? Doesn't want to study and has become unmanageable? Has fallen into bad company?' If one is true: 'Call immediately!'

As soon as we dial the specified phone number and introduce ourselves as the mother of a troubled teen, the employees suggest that we bring the child to the centre and sign the agreement, without asking any further questions. No additional consultations, no delay. Payment amounts to 70,000 roubles for the first month and the last month each.

That is exactly how Veronica, the heroine of our story, got here. She was sent to Gerda by her mother. For serious reasons: self-harm, at least, that is the intentional injuring of one's own body (such as cutting or skin scratching) for psychological reasons. In the majority of cases, suicidal intentions are not responsible for self-harm, but a desire to get rid of mental pain, fear or anger.

When she gesticulates during her speech, some scars can still be seen under the sleeves of her sweater. Veronica says that "treatment" did not help her. She confesses that having come back home from the centre, she 'started cutting [herself] again'.

Slim. Blue hair. She is 16 now, a tenth-grade student. According to her own words, she solves mathematical problems at night to catch up.

Difficulties with studying began right after leaving the centre, where she had spent nine months. School subjects were taught for two hours a day there. However, the centre does not really promise any success at the State Exam. It has a totally different goal.

The "Red" against the "Green"

The centre has two buildings: for females and for males. At any given time, there are 20 to 30 people staying in each one of the buildings, including rehabilitants, consultants, staff members, a psychologist, and a paramedic. Former patients explain that rehabilitation is based on a 12-step program like the one applied in the rehabilitation of drug addicts and alcoholics, but profoundly modified.

The conditions are quite strict: children clean up the dormitory by themselves and help in the kitchen. They are allowed to go for a walk for no longer than 15 minutes a day and only within an enclosed area. Their phones are taken away, there is no access to the Internet, nor is there any other connection with the outside world.

It is strictly prohibited to inform patients about any traumatising events that might occur in their families. Children can call their parents once a week under the supervision of consultants and meet them face-to-face only once a month and under the supervision of staff members too.

According to the staff, the main goal of such a "quarantine" is to pull the child out of a harmful environment. That is why it is not recommended to take rehabilitants out of the centre prematurely: 'It will only hurt them and trigger a relapse'.

The authors of this approach suggest that while consistently completing the "tasks" elaborated by teachers, teenagers analyse their "past life" and reconsider their unsafe behaviour in order to avoid it in future.

There is a strict hierarchy among residents of the centre. Each one's rank is defined by the colour of their neckerchiefs. Red is for confidants of consultants who are junior teaching staff consisting, as a rule, of former graduates. Yellow is for privileged rehabilitants, a sort of "straight-A students". Green is for the rest.

The 'Red' and the 'Yellow' perform all the 'clean' tasks and are obliged to look after other students. The 'Green' do the dirtiest ones. Regardless of the colour of the neckerchief, everybody has to keep a diary (which is handed in to consultants) and, as Veronica puts it, rat on other rehabilitants.

"We had to bring at least four reports concerning other rehabilitants to morning therapy procedures: two negative and two positive ones", she says. "Besides, almost anything could be seen as negative information: coming in with loose hair, refusing to call your group '"family", not putting away a chair".

From "rope" to physical exercises

Any violation of the regulations in Gerda entails 'consequences', that is punishment. Different violations lead to different 'consequences'. The mildest one is rewriting the disciplinary text, the beginning of which many students remember by heart years later, multiple times: "Irresponsibility shows a couldn't-care-less attitude, a personal stance, which suggests the absence of functions and obligations, inability and unwillingness to face the consequences of one's own actions. An irresponsible person is a child who has gotten used to things happening on their own...'

It may seem like a trifle, but, according to Veronica, the punishment can last all day long. "Our pens could run out of ink three times while writing. There were no breaks, we weren't even allowed to go to the toilet", she recalls.

A more severe consequence is "physical", that is physical exercises. Push-ups or squats. These can be either individual or in groups. "Once they punished us with two thousand reps for the group, and we were done only by 2 a.m.", our interviewee says. But she immediately remarks that these were not the most unpleasant things. Psychological interventions like the "hot seat" or an "information group" are far worse.

The first kind of "punishment'" as Veronica calls it, consists of the following: students read out loud to the punished one sitting on a chair at the centre of the room (hence the name) their positive traits and then their negative ones under the supervision of adults. "And the negative ones generally outnumber the positives three-fold".

With the "intervention group", the procedure is similar, with the exception that no positive traits are mentioned. As the girl claims, in that case it was allowed to shout at the one being punished, swear and even throw things at them.

The aim of both measures is to harass the rehabilitant's mind to the greatest possible extent and give them "feedback".

Another type of punishment is a "rope". In that case the patient's hand is tied to another child's hand so that they have to be together all the time, while cleaning up or doing tasks. "After I fell in love with a girl and told other students about it, the girl and I were punished with the "rope". Of course, we couldn't talk to each other after that," Veronica tells.

According to her, any emotional relations are strictly prohibited in the centre, let alone falling in love. "If one of the spies notices that there is a friendship emerging between some people, they can be prohibited from approaching each other closer than three meters, because "they chat too often"', says the former patient.

Pressing the defiant

"All the tasks in the centre are aimed at humiliating the person. In the SDB (self-destructive behaviour) test, there is a question whether we have relatives who lead such a way of life. I had to lie about an alcoholic uncle just to make them leave me alone. For if you don't want to lie, consultants would keep telling you: "Don't lie, you have such relatives, that's exactly where you get it from!". "And they make you write it," Veronica complains. "If you mention friends, you must say that they used you to get money. Such things never happened to me, but at the end of the day, I almost started to believe it," Veronica recalls, looking down at the table and smiling nervously.

As a result, she made her first attempt to escape the centre a month after she had been brought there. The girl was taken to the hospital for suspected HPV infection. It was a chance.

"I remember only two moments: a staff member holding my hand and me running somewhere along the other side of the street. At first I hid myself near garages. My heart was beating so heavily, it seemed as though everybody could hear it. Then I ran up to some people fixing a car and said that my father beat me up at home. They saw cuts on my hands and gave me a phone to call my mum".

However, the escape attempt failed: "My mother promised to take me back home during the week if I returned to the centre. So I did, and that was a mistake. I spent another eight months in the centre", says Veronica.

She adds that consultants threatened to chain her with handcuffs on the way to the centre, but they did not keep their promise in the end. They did not go beyond the "group" session.

"Some guys threw a window handle, keys and some other things at me while performing the punishment. They missed, but even if they had hit me, they would not have been punished. Parents would not come soon, wounds would have healed by that moment," the girl says. "After the escape I was taken to a psychiatrist who works with them. He prescribed tablets that were supposed to calm me down: Neuleptil and Lamictal".

Bag of resentments

Medical staff of the centre consists of a paramedic only, but prescription medicines including the strong ones are administered to many rehabilitants. Sometimes without even consulting a doctor.

"Boys were punished with the "rope" too. We were forced to squat, push up. At first I couldn't put up with it, this attitude was killing me. I even thought about escaping but then decided to sit out my time," another rehabilitant confirms what the girl says. Despite being only 15, Daniil looks much older than he is. Slim body, trendy haircut. He was sent to Gerda because of drug abuse. After he was once again detained by the police in January 2018, his parents sent him to the centre where he stayed till September of the same year.

Like in Veronica's case, parents took him back because of school: they did not want him to miss classes.

"People said that boys were treated way harsher than girls", Daniil explains.

However, he did not manage to sit out his time totally calmly. Once he refused to clean up the kitchen yet again and was given a "bag of resentments" (another disciplinary measure) - three 5-kilo weight plates tied together with a rope and tape.

"I had to clean the kitchen carrying those plates, but it was uncomfortable to keep the "bag" in hands, so I tied it around my waist", Daniil recalls. Within a minute the weight came off, fell on a foot and broke a finger. "No one even thought of taking me to the hospital. I could not sleep all night because of the pain. In fact, there were a lot of these injuries: somebody broke their tailbone, and others would fracture something else. And you shouldn't expect any help", the young man states.

The Tatarstan mass media have been watching Gerda closely for several years already. Publications on a couple of regional web-portals generally confirm the teenagers' stories. In August 2018, the website 'Realnoye vremya' even reported about inspections against the work of the centre initiated by the regional prosecutor's office.

According to Daniil, there really were inspections, but none of the rehabilitants wanted to tell inspectors the truth. They were afraid. While the police were questioning rehabilitants, the centre's psychologist was present there all the time. "We told the inspectors that it was the best centre on Earth, because they would leave but we would stay", Daniil smirks.

Over the course of time, the fuss has indeed subsided, and even a petition started with some positive feedback on change.org in support of the centre. However, "consultants" could have had their hands in the launch of the petition. At the same time, feedback on yell.org is not so favourable. There is a comment  which is almost similar to what Daniil and Veronica said in their interviews to AIDS.CENTER.

Plastic bag with herring

Both Daniil and Veronica have told us about a girl, who had spent more time in the centre than anybody else: 25 months and 9 days. She came in 2016, when she was 15, and left only in 2018. Her name is Sofia Gorbachyova. She confirmed what Daniil and Veronica had said and agreed to tell her story to AIDS.CENTER.

AIDS.CENTER found her and asked to comment on the words of her fellow sufferers. As she is the only one who is already 18, the girl agreed to talk about Gerda overtly. Not anonymously. Not hiding her surname.

The former rehabilitant says that much of what the others have described is absolutely true. Her own story is even more tough. And, unsurprisingly, this story is about punishment as well.

In 2016, the centre had no separate buildings for male and for female patients. They all lived together. So at some point she got involved in a relationship (an "emotionally important" one) with a boy. "I had to crouch for a day because of that. It wasn't allowed to get up to eat, drink or use the toilet. Maybe that's the reason why I have problems with my knees and my legs swell now", says the girl. There was also another punishment. "I was taken to the bath and cold water was poured over me. Fifteen buckets of water were slowly spilled on me in the freezing cold in winter".

Nonetheless, after that incident the girl had sex with another guy undergoing treatment in the centre. The consultants immediately learnt about it and went to extremes. "They gave me a bed sheet, thread, and demanded that I sew a prostitute's dress. Then it was triumphantly burnt", Sofia recalls. "I also had to make a side cap. They put a plastic bag with a rotten herring in it and made me wear it for a week".

However, Sofia believes the centre has actually helped her to get rid of addictions.

"I was drinking 24/7 before coming to the centre", she says. "If it had not been for Gerda, I would have probably never stopped". He adds: "Now I don't drink at all".

According to her, the director of the centre Lyutsia Ibraghimova is an "adequate woman", and many of the trainings do really "work". "Sometimes it goes too far, that's true, but the consultants are to blame here in the first place, not the director", she says.

In order to give the centre an opportunity to comment on the former patients' stories and communicate with them publicly, AIDS.CENTER has sent Lyutsia Ibraghimova transcripts of their interviews and questions in advance by e-mail. Alexander (he refused to reveal his surname), an employee of the centre, who answered our phone call, confirmed that the director had received and read the letter.

We had been trying to reach the centre on the phone for two weeks, during which Gerda's management either promised to make comments or threatened to turn to their lawyers. In the end, they refused to explain their methods publicly and address the complaints of the teens who had spent months incarcerated at the centre.

Discipline for adults

Many of the practices described by the students are considered to be standard methods and are applied everywhere, both in state-run and private rehabilitation facilities.

"Public diaries", "hot seat" and "interventions" are among them. Consultants who previously were rehabilitants, "quarantine", that is the prohibition to call your parents and use the Internet, are, in fact, widespread techniques. On the other hand, they can play different roles in the rehabilitation process, and their use requires high qualification and personal culture of the staff. At least, "shake-ups" should not turn into swearing and throwing things, and disciplinary measures should not end up with humiliation and vulgarity (remember the rotten fish in the cap).

We have talked to several experts, both from the capital and the region who apply similar schemes. Having asked not to mention any names, they all said that Gerda does indeed have a controversial reputation.

Alik Zaripov, the senior officer of the Tatarstan fund Ostrov, a psychologist and a member of the local public oversight committee on human rights, shares the opinion of his colleagues. However, he has his own explanation of the reasons for the situation.

"Gerda does not have and has never had any precise programme for troubled teenagers. Many of their disciplinary practices have been developed not for teenagers but for drug users and, as a rule, are applied to "disobedient" clients who either overtly or passively attempt to derail the rehabilitation process", he explains. "And parents are afraid to seek help from state services as they don't want to have their child "go on the record". That's why commercial centres appear that claim they help deviant children, but their methods turn out to be limited to the ones appropriate for adult drug users". He adds: "They just don't have any working experience with children".

Zaripov agrees that "extremes" at the location may to a large extent be connected to the low qualifications of consultants. "It is difficult to work with children, with their resistance and lack of understanding. This is the reason. "If an ordinary, unprepared person has to deal with a difficult teenager who may be trying to get them mad on purpose, the only thing that this person can the counter teenager's aggression with is punishment. This is the only tool available to them with their experience, because they were also punished in their childhood. However, applying disciplinary measures without thinking is unprofessional. It means letting a difficult teenager push you around".

Besides, a public centre can just expel a trouble-maker who does not want to follow the rules, while a commercial centre has one goal: making profit. Consequently, it's impractical for them to get rid of the children, with which they do not know how to work. "That's why these centres keep them for as long as possible even if they do not know what to do with them", remarks the psychologist.

Transparency problem

"I don't believe that anybody there sincerely wanted to help us", Daniil says. However, he agrees that rehabilitation in Gerda is beneficial for the "really wasted' ones, those "who can pull out their penis and piss right there in the room". But he advises others against getting into the facilities of the centre, no matter whether it is the girls' or the boys' building.

The fact that Gerda keeps its doors closed for external observers and is unwilling to respond to complaints publicly is likely to be one of the main reasons for the "controversial" reputation of the centre.

Oleg Zykov, the head of the Institute of National Narcology Health and former chief narcologist for children in Moscow, refused to comment on that particular case but, nonetheless, agreed that transparency is one of the key features of a good rehabilitation centre. No matter whether it is a centre for adults or for teenagers.

"When some kind of secrecy occurs, one may assume that there have been incidents of patient's rights violation", he comments. "When a centre provides services professionally, everything is compliant with laws and standards, it doesn't aim to hide something, quite the opposite, it is interested in letting the public know what and how it does".

"Although it may sound harsh, any closed space can turn into a place of psychological or sexual violence. I know the facts of violence in closed boarding schools that are considered elite, or in military academies. The same things happen here", underlines the expert.

According to him, both rehabilitation centres for adults and for children in Russia are now controlled rather poorly on the legislative level. That is why it would be useful to develop relevant public control standards for such institutions. For example, self-governing organisations could be established to inspect the work of such centres for compliance with national standards on a voluntary basis.