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Study Tour to Trieste Mental Health Services
A Valuable Experience
In late December 2013 the Helsinki Committee and
its partner organization, IAN, took a team of domestic professionals
for a study tour to the Trieste Mental Health Services. The study
tour was organized with the assistance of the Norwegian
Embassy/Norwegian MFA within the project “Civil Society Advocacy for
Efficient Protection of Persons with Mental Disorders”
In the period December 17-21 five psychiatrists
and two project coordinators from partner organizations toured all
mental health services in Trieste, internationally recognized for
successful deinstitutionalization completed by the end of 2000. The
psychiatrists from five special psychiatric institutions 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) have never seen the Trieste model in
practice before. Among other things, this was among the criteria for
the selection of participants in the tour: the organizers wanted as
many as possible professionals from Serbia to experience psychiatric
approaches and treatments of persons with mental disorders differing
from those in Serbia.
The reform of the Trieste mental healthcare was
initiated by famous Dr. Franco Basaglia back in 1970s. He introduced
a modern doctrine and a totally new approach to the treatment of
psychiatric illnesses. His followers in Trieste realized his vision
in practice by establishing mental health services that replaced
psychiatric asylums. Today, Trieste has four such centers that not
only cater for ex-patients but also for the entire population of the
city. The team from Serbia visited three of these centers – the
fourth, the Barcolo Mental Health Service was under reconstruction
at the time. It also had the opportunity to discuss the functioning
of the Emergency Department within the General Hospital, the Mental
Heath Directorate, rehabilitation and housing services and social
communes with their Italian colleagues.
The entire tour was a great experience for
domestic professionals and civil sector representatives. Discussions
with Italian colleagues provided them a deep insight into the entire
process of deinstitutionalization and the opportunity to identify
similarities between the two healthcare systems, and, above all to
witness the outcomes they have been advocating for in Serbia.
Lectures and presentations on the Italian healthcare reform,
including case studies, challenges and specificities – some of which
are still in place – realistically pictured the process of
deinstitutionalization; nevertheless, all this greatly encouraged
the professionals from Serbia. They realized that the problems
characteristic for today’s Serbia had challenged Italy and Trieste
as well; they learned about the methods for gradual changes for the
better; they got answers to the dilemmas of Serbia’s mental
healthcare. They will be disseminating this new body of knowledge
and experience among their colleagues and other experts, and in
institutions in charge of mental health reform.
The five psychiatrists say they were encouraged to
learn that resistance to reforms – especially from professionals in
big psychiatric institutions – had been similar to that Serbia’s
reformists are faced with today. The story about a small circles of
Prof. Basaglia’s committed supporters doing all in their might to
convince their colleagues, politicians and people in general that
persons with mental disorders are able and should live in the
community was most inspiring to them. The story itself was a lesson
on how to proceed in Serbia.
The most significant discussions the team had were
with doctors and other professionals of mental health services.
Organizational structures of these centers, professional capacity
and the number of persons they employ, their attitude towards
persons with mental disorders, methods of treatment they use, and
concrete information about patients’ benefits and the system’s
financial sustainability only testify of the pressing need for
radical reform in Serbia’s psychiatry. Italy’s experience proves
that less drugs but more social support and rehabilitation are by
far more efficient in the treatment of psychiatric patients –
including those with grave diagnoses – then Serbia’s widespread
pharmacological approach. Treatment is more effective when a person
lives in a community, but only under the condition that necessary
services are available to him or her. Over this tour domestic
psychiatrists witnessed effective functioning of these services that
are still a kind of taboo in Serbia where the great majority of
professionals still claim that the approach other than
hospitalization will be a mission impossible.
In this context the five professionals from Serbia
discussed yet another dilemma of domestic mental health system:
methods of restraint of agitated patients. Such methods are still
considered indispensable in Serbia despite frequent cases of
malpractice the Helsinki Committee has been alerting a variety of
stakeholders. Seeing with one’s own eyes a practice that so much
differs from Serbia’s – the approach that excludes any form of
restraint, being it physical, pharmacological or spatial, but
increases not suicide rates or cases of violence – provoked many
second thoughts. The fact is that methods of restraint of agitated
persons are never used in Trieste – moreover, they are banned under
the law. Many other issues related to the protection of persons with
mental disorders were also discussed on these occasions, and lessons
learned. The team hopes to see the Trieste models of good practice
implemented in Serbia in foreseeable future. The professionals in
the team were unanimous: the process of deinstitutionalization in
Serbia should not be so much protracted as it is now.
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