Across much of the world, governments have been moving away from large residential institutions housing people with disabilities, where the very structure of care can foster abuse — and where many residents could, with the right support, live and work independently. In Russia, however, change has been slow and often superficial, despite years of pressure from nonprofits. A new analysis by the think tank To Be Precise, based on official data, expert interviews, and policy documents, takes a closer look at how these institutions operate in Russia today — and what kind of support is actually available to the people who live in them.
One in ten residents confined in Russia’s “neuro-psychiatric” homes is fully dependent on staff care. As of 2024, some 139,000 people lived in these institutions across Russia, in 466 facilities. The total number of institutions has declined in recent years, but experts say this reflects administrative consolidation rather than real closures: facilities are being merged, with some reclassified as branches of others.
Since the late 1990s, the number of residents in state neuro-psychiatric institutions had generally been rising, peaking at 161,000 in 2018. But in 2023, the figure dropped sharply by 26,000 — a 16 percent decrease. Analysts from To Be Precise say they found no clear explanation for the change, suggesting it may be due to shifts in reporting methods.
Russian neuro-psychiatric institutions house people with and without intellectual disabilities — including those with conditions such as epilepsy or cerebral palsy. About 74 percent have been declared legally incapacitated by a court, meaning that in most cases their legal guardian is the institution’s director.
As of 2022, the latest available data, 65 percent of residents are over the age of 45. One in ten is completely dependent on staff, confined to bed and unable to move independently — at least under current conditions.
Efforts to reform the system began in the 2010s, but so far they’ve brought little real change
In the second half of the 20th century, many countries began to move away from large institutional facilities. One reason was that the closed nature of such institutions fosters abuse and does little to help people live ordinary lives. Alternatives have centered on independent living with varying levels of social support, or small group homes.
In Russia, systemic reform efforts gained momentum in the 2010s, as reports of abuse in these institutions increasingly surfaced in the media. The underlying principle of such reforms is a shift in perspective: a person is no longer defined primarily by a diagnosis or “deviation from the norm,” but as someone capable of living much like anyone else — provided they are given the necessary support. In other words, the main barrier to integration is not a person’s condition, but the lack of adequate social support.
A decade after the Ministry of Labor and Social Development began drafting its first reform roadmap, experts interviewed for the study say that only the earliest signs of this shift are now emerging — and even these changes may be largely superficial. In 41 regions, neuro-psychiatric institutions have been renamed “social care homes,” “social houses,” or similar terms, in an effort to remove references to medical diagnoses and institutional regimes.
Some cities — including St. Petersburg, Nizhny Novgorod, and Moscow — have made more progress than others. But in smaller towns and rural areas, experts say, institutions lack the resources to implement such changes.
At the same time, the state continues to invest in building new large-scale institutions that function much like the existing ones. Meanwhile, the size of current facilities has been reduced only marginally. In one St. Petersburg neuro-psychiatric institution, for example, the number of places was cut to 996 — after which officials declared that the city no longer had any institutions with more than 1,000 residents, the study’s authors note.
According to To Be Precise, the average institution houses 289 residents. As of 2022, Russia’s neuro-psychiatric institutions were operating at 98.6 percent capacity.
