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On October 29, 2015 in cooperation with the
Ministry of Healthcare and support from parliamentary committees for
healthcare/family and human rights, the Helsinki Committee staged a
presentation under the title “Community-based Living: Fundamental
Human Right” in the Serbian parliament.
The Committee presented the findings of the
projects – focusing on the community-based support to persons with
mental disorders and forensic psychiatry - it has been implementing
for the past two years in partnership with the International Aid
Network /IAN/. The projects have been implemented with the
assistance from the Norwegian Embassy, the Royal Netherlands Embassy
and the Civil Rights Defenders.
Though it was a non-working day for the
parliament, the presentation assembled more than 30 MPs sitting on
parliamentary committees, representatives of Belgrade-seated
embassies, international organizations and domestic NGOs, as well as
directors of Serbia’s biggest psychiatric hospitals.
To start with, the Committee’s team screened a
“documentary” made of slides taken during two study visits for
domestic psychiatrists to the Trieste Mental Health Services. The
slides were illustrated by the latest data about the success of the
Trieste model of the community-based care entailing minimum sickbeds
and not a single psychiatric hospital. The model testified of
efficient healthcare provided to citizens on the one hand and of
reduced expenditures on the other. Ljiljana Palibrk of the Committee
then presented the team’s observations about the present situation
of mental healthcare in Serbia, including centers for mental
healthcare. The progress made here since the enactment of the Law on
the Protection of Persons with Mental Disorders has been meager to
say the least. Namely, despite the fact that the Law opened the door
to the establishment of community-based centers for mental
healthcare, only one counseling center, in Kragujevac, has been
opened so far meant to prelude other centers. The counseling center
has been equipped thanks to the financial assistance from the
Trentino Association for the Balkans.
Within the EU-funded “Open Embrace” project two
centers for mental healthcare were opened in 2015 – in Kikinda and
Vrsac. Besides not being integrated into the primary healthcare
system as provided under the Law (working as branches of the
psychiatric hospitals instead) both centers are faced with many
problems that impede their proper functioning. They are
understaffed, cover small territories, could cater only for patients
with serious disorders, etc. However, what makes the things worse is
the lack of interest in the community-based model: doctors and
medical officers from hospitals, local self-governments and other
institutions seem to be quite indifferent to it. Ms. Palibrk
presented data testifying of the strong resistance from professional
circles and the state’s option for deinstitutionalization in words
only. The sustainability of the two centers opened within the “Open
Embrace” project is quite deputable.
The audience was also presented the so-called
Sombor model – a possible communication and cooperation system –
developed by the local medical center. Serbia could benefit from
this model the more so since it enables networking of medically
understaffed communities or those far away from bigger medical
centers.
Professor Vladimir Jovic of IAN spoke about the
necessity of transformation of psychiatric healthcare into
community-based care. The factual information he provided testified
that Serbia’s inadequate healthcare system could not cope with
actual needs of psychiatric patients and communities, generated
violations of patients’ rights and mistreated persons who had
committed crimes as forensic patients. Serbia’s system rests on
obsolete presumptions developed countries are gradually abandoning,
said Dr. Jovic adding that many people close to us already are
mentally ill or shall become such (about 4 percent of total
population). No wonder, therefore, that the modern society considers
mental health national treasure.
The decades-long practice of financing big
psychiatric hospitals by the number of sickbeds rather than services
provided, non-existent methods for risk assessment and psychosocial
rehabilitation in forensic wards, underdeveloped community-based
services, etc. are, as he put it, the biggest shortcomings of
Serbia’s healthcare.
Reminding that WHO, EU and all relevant
professional organizations worldwide strongly support
community-based services and approaches prioritizing patients’
psychosocial rehabilitation, Dr. Jovic concluded no professional,
economic, legal or political considerations should stand in the way
of a systematic and prompt reform.
Professor Dr. Djordje Alempijevic, the member of
the CPT team, presented the findings of a global survey testifying
that persons with mental disorders were not threats to societies. On
the contrary, the findings showed that such person were usually
dangerous to themselves rather than to their communities. Serbia
does little to prevent their hospitalization but invests much in
them once they are hospitalized, he said.
As an CoE member-state that has ratified the
European Convention on the Protection of Human Rights and
Fundamental Freedoms, Serbia is duty-bound to take better care of
vulnerable groups of population, especially those in closed
institutions, he explained. He also clarified differences between
the terminology of European and international documents on the one
hand, and domestic perceptions that have caused many
misunderstandings and slowed down Serbia’s movement towards European
integration.
Various countries have solved in their own way the
problem of “dualism” of forensic patients. So, in some countries
they are sentenced to hospitalization that is minimal when compared
to the nature of the crimes committed, while in others they are not
– nevertheless, in all developed democracies long hospitalization of
such patients is considered ill-treatment and violation of their
right to freedom, he explained.
He also summarized the findings of the Committee’s
monitoring of Serbia’s forensic institutions. Despite some progress
made in this domain, he said, there still are no guarantees for
independent and unbiased expertise. The parliament should,
therefore, amend some laws and bylaws so as to make it possible for
a patient to ask for court protection and evaluation, get legal aid
and attend a trial in person.
Jelena Mirkov of the Committee presented a legal
framework for the protection of persons with mental disorders and
forensic patients, including amendments to legislation, developed by
the Committee, IAN, the Citizens’ Ombudsman and NGOs represented in
the working group (MDRI – Serbia, Belgrade Center for Human Rights,
YUCOM, Caritas, etc.).
Amendment of the Law on the Protection of Persons
with Mental Disabilities should be on the priority list, she said.
The present Law provides “mental health units” as additions to the
existing psychiatric hospitals and medical centers rather than the
establishment of autonomous community-based services. Moreover, the
ongoing treatment provided in psychiatric hospitals is inconsistent
to the principles laid down by the Strategy the government had
adopted.
The proposed amendments would prohibit undue and
therapeutically unjustified isolation of patients, clearly set the
period within which courts of law should decide on involuntary
hospitalization, detail the procedure for deciding on a person’s
decision-making capacity, define the term forensic patient (a
patient or a person under sentence), specify the institutions
catering for such persons, etc.
The presentation was followed by discussion and
exchange of views between MPs, Chairwoman of the Committee for
Healthcare Prof. Dr. Slavica Djukic-Dejanovic, directors of
psychiatric hospitals in Novi Knezevac and Vrsac, Dr. Jovanka
Petrovic and Dr. Tatjana Voskresenski, and others.
After the final conference scheduled for November
19-20 in Belgrade, the Committee and IAN will circulate reports on
the protection of persons with mental disorders and forensic
patients to all parliamentary committees – at their explicit request
– and relevant ministries, along with recommendations for legal
adjustments to international standards in this domain.
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