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The project logically follows on the footsteps of
the Committee’s longstanding concern the exercise of fundamental
human rights, especially of vulnerable groups of population. Being
the first NGO to conduct monitoring of social care institutions
catering for beneficiaries and special psychiatric institutions, the
Committee has been alerting a variety of stakeholders – domestic and
international – of deplorable situation of institutionalized persons
and calling for urgent and radical reforms of the country’s
healthcare and social care. The situation is particularly alarming
when it comes to the protection of and support to persons with
mental disorders.
Bearing in mind Serbia’s obligation to commit
itself to counteracting all forms of discrimination and improving
protection of human rights, as well as that ongoing accession
negotiations with EU and access to IPA funds should considerably
strengthen its capacity for these commitments, the Helsinki
Committee holds there are no more excuses to postpone the process of
deinstitutionalization.
The Strategy for the Development of Mental Health
adopted in 2007 practically failed while the long-prepared Law on
the Protection of Persons with Mental Disorders was passed as late
as in 2013 and regardless of considerable criticism from some expert
circles, the Citizens’ Ombudsman and civil society organizations. To
all appearances, the Law, itself contrary to the Strategy and
principles of community-based services, was adopted under the
pressure from powerful interest groups, especially those from the
healthcare system. As expected, psychiatrists and other medical
officers are those who mostly oppose the reform of the mental
healthcare, but there are other aggregative factors as well –
uninformed professionals in all domains, the state’s unwillingness
to transform psychiatric and other institutions catering for
beneficiaries into community-based services, public prejudice and
deep-rooted stereotypes, economic difficulties and financial
challenges, etc.
The project “Civil Society Advocacy for Efficient
Protection of Persons with Mental Disorders” is meant to encourage
the establishment of mental healthcare centers throughout Serbia,
reduce the number of institutionalized beneficiaries/patients and
assist in gradual closure of these institutions and their
transformation, urge amendment of relevant legislation and adoption
of reform-oriented law and bylaws to ensure systemic protection of
persons with mental disorders, strengthen the capacity and communal
action of civil society organizations, and win public support to
their campaigns, etc.
Over the first months of the project
implementation the partner organizations – the Helsinki Committee
and IAN – established a work group assembling representatives of a
number of organizations and institutions /Citizens’ Ombudsman,
Provincial Ombudsperson, OSCE, EU Delegation to Serbia, UNDP,
Caritas, Ministry of Healthcare, Ministry of Labor and Social
Policy, MDRI, Belgrade Center for Human Rights, YUCOM, associations
of psychiatric patients, etc. /. Over its informal meetings the work
group – open to all organizations concerned with protection and
situation of persons with mental disorders – discusses the issues
that, directly or indirectly, relate to mental healthcare reform and
deinstitutionalization. It also scrutinizes the project team’s
reports on fact-finding missions to psychiatric hospitals, and
analyses all compiled information about beneficiaries/patients
diagnosed with mental disorders, institutional personnel, relevant
legislation, and initiatives by responsible ministries, and models
of good practice and so on.
By the end of 2013 the project team of experts
paid fact-finding missions of all the five special psychiatric
hospitals in Serbia: “Kovin” in Kovin, “Dr Slavoljub Bakalović” in
Vršac, “Sveti Vrači” in Novi Kneževac, “Gornja Toponica” nearby Niš
and ”Dr. Laza Lazarević” in Belgrade.
The team of experts realized that some
professionals in the monitored institutions were fully aware of what
was it to urgently reformed in the domain of psychiatry – and what
encouraged the team was the fact that most of them were younger
professionals. Unfortunately, their older colleagues are generally
adamant: hospitalization and institutionalization are, they claim,
the only way of catering for the great majority of psychiatric
patients and persons with mental disorders.
Their stance, noted the team, is more often than
not based on ignorance – or to put it more precisely – on blindness
to contemporary methods of treatment, but also on the longstanding
practice build for their own needs rather than the needs of those
they should treat. Therefore, it’s no wander why pharmacological
approach is still predominant and, along with excessive measures of
restraint, results in serious breaches of fundamental human rights.
Instead of individualized treatments, paternalistic attitude towards
persons with mental disorders is characteristic for most
institutional personnel despite the fact that, the same as their
patients, they are socially marginalized. The five monitoring
missions were especially focused on institutional situations and
needs in the context of gradual abolition of asylums and the
beginning of sustainable deinstitutionalization. A well-thought-out
and professionally conducted reduction of accommodation capacities,
along with establishment of community-based, would create by far
better conditions for treatment of patients but also for
professional work and engagement of new professionals. Some of the
monitored hospitals have already taken certain steps in that
direction: now it is on the state to support their efforts and
ensure conditions for efficient and sustainable community-based
services.
Findings of the monitoring missions, along with
recommendations, will be presented to the Ministry of Healthcare by
the end of the project implementation, as well as circulated to all
institutions catering for persons with mental disorders and
organizations concerned with their situation.
A group of five psychiatrists from each of the
monitored hospitals, together with representatives of partner
organizations, paid a study tour to the “Franco Basaglia” Trieste
Mental Health Services, Italy, in late December 2013 /PROGRAM OF THE VISIT ENCLOSED/. Preceding this tour – and within the
project realized with the assistance of the Royal Netherlands
Embassy – the Helsinki Committee organized a study tour for
representatives of several social care institutions to the
Netherlands. The purpose of both tours was to instruct domestic
professionals in “models of good practice” in mental healthcare and
social care, and contemporary methods of treatment of persons with
mental disorders. On January 28-29, 2014, at the close of two
compatible projects – “Strengthening NPM and Advocacy for the Rights
of Institutionalized Persons” and “Prison Reform Monitoring” –
realized with the assistance of Civil Rights Defenders and the Royal
Netherlands Embassy respectively – the Helsinki Committee convened a
two-day professional conference under the title “Cooperation between
the Civil Society and the Government in the Process of
Deinstitutionalization.” The conference assembled representatives of
ministries of healthcare, education, labor and social policy, the
Republican Bureau for Social Protection, Citizens’ Ombudsman and
Provincial Ombudsperson, and, above all, professionals from
specialized hospitals and social care homes, associations of former
psychiatric patients, physicians, psychologists and other
independent experts, and civil society organizations concerned with
this complex problematic.
The Helsinki Committee had planned the project
“Civil Society Advocacy for Efficient Protection of Persons with
Mental Disorders” as a three-year endeavor: for the period in which
civil society organizations, hand in hand with the state
administration and institutions catering for beneficiaries, should
prepare the terrain for a functioning system of community-based
services for persons with mental disorders/disabilities.
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