The number of reports of political activists falling victim to the political abuse of psychiatry is increasing. When the USSR first disintegrated, this practice virtually ceased to occur. What came in its place, however, was a disturbing collection of other forms of abuses, including human rights abuses, caused by a lack of resources, outdated treatment methods, a lack of understanding of individual human rights and a growing lack of tolerance in society. The number of cases of political abuse of psychiatry has increased since the 21st century began, particularly over the past few years in Russia, Belarus and Kazakhstan.

After the outbreak of the Ukrainian crisis in the spring of 2014, the former Soviet Union again became front-page news. The sequence of events led to an atmosphere reminiscent of the Cold War. In Russia itself it led to a hunt for ‘national traitors’ and ‘foreign agents’ and observers both inside the country and abroad fear a return to Soviet-style repression. For the outside world this may come as a surprise, but human rights activists have been ringing the alarm bells for a few years. Ever since Vladimir Putin took power, the human rights situation has deteriorated. One of the warning signs was the return of the use of psychiatry for political purposes, to ‘prevent’ social or political activism or to ostracise an activist.

Over the past 2 years the Global Initiative on Psychiatry has developed a wide range of initiatives in the fields of prison mental health and forensic psychiatry in Eastern Europe and the former Soviet Union. Both areas, until recently, were either ignored or deliberately avoided. This is not coincidental. The prison systems in the former Eastern bloc are in essence military organisations with a strict hierarchy and a rather tarnished past. Although some reform programmes in this field were implemented or started during the past decade (e.g. by Prison Reform International and the London Institute for Prison Studies), none of these projects has involved mental health services within the penitentiary system. A society that often limits itself to locking away those who have committed crimes or are suspected of having committed them, and pays only little attention to the physical and emotional well-being of those imprisoned, does not see the mental health of these persons as a priority. Equally unimportant seems to be the mental health of those who guard the prisoners and who are under constant stress.