|
Serbia has not developed yet an action plan
defining the deadline for, the structure of, responsibilities for or
financial resources that would ensure deinstitutionalization.
Special psychiatric hospitals and social care institutions catering
persons with mental disorders are left to their own devises and any
action taken depends on their initiative. However, no matter how
inventive they might be, their initiatives are wasted unless
strongly supported by institutions and local self-governments. In
many cases neither the families of persons with mental disorders
want their members back home in surrounding still considering them
unwelcome. Everything is even tougher for forensic patients having
spent their time in prison in psychiatric institutions. All in all,
persons with mental disorders are probably the most vulnerable
social group, psychiatric hospitals are burdened with social care
beneficiaries and complicated administration, while the state of
Serbia still has no plan for how to solve any aspect of these
problems – nor social, legal, the one of security or even medical.
The paragraph above summarizes the actual
situation of psychiatric and forensic patients in Serbia, addressed
in detail on November 19-20, 2015 at the two-day conference “Life in
Community: A Fundamental Human Rights” in Belgrade’s Zira Hotel. His
Excellency Arne Sannes Bjørnstad, the Ambassador of the Kingdom of
Norway, Brankica Janković, the Commissioner for Equality, Sonja
Biserko, the Chairwoman of the Helsinki Committee, and Ljiljana
Palibrk, coordinator of the project “Civil Society Campaign for
Persons with Mental Disorders – Phase II,” delivered opening
addresses and welcomed the participants.
Focusing on the reform of psychiatric treatment
toward community-based care Professor Dr. Vladimir Jović argued
against the existing system he called inadequate and incapable of
meeting the needs of persons with mental disorders and the community
alike. This obsolete system is being left behind by all developed
countries, he said.
So far Serbia has made a tiny step towards
deinstitutionalization, concluded directors of special psychiatric
hospitals in Novi Knezevac and Vrsac, Jovanka Petrović and Tatjana
Voskresenski. Two recently opened mental healthcare centers (in
Kikinda and Vrsac) and the Counseling Center in Kragujevac are
coping with day-to-day problems and solving them only thanks to
enthusiasm of people working there, while at the same time depending
on human and other resources from psychiatric hospitals they make
part of. Enthusiasm of the staff, however, cannot in itself ensure
sustainability of these pioneering community-based institutions that
should operate independently. Professional ties and personal
friendships with institutional personnel cannot compensate
non-existent systemic approach to the step-by-step movement towards
deinstitutionalized treatment of patients.
Despite all declarations in favor of
community-based care – crucial for the survival of mental healthcare
centers – nothing has been done so far. True, some medical centers
such as the Sombor Medical Center as doing their best to establish
community-based care on their own. The Sombor Medical Center has
developed a model of mental healthcare services. Director of the
Center Emeshe Uri argued that primary healthcare institutions were
“unutilized resources” – all they need to be capable of developing
an efficient system of support to patients and their families are
some in-service course of training for their staffs and support from
the Ministry.
Costly though often ineffective
institutionalization of psychiatric patients, speak for the
necessity of developing community-based care. Such care provided to
patients in developed countries generates by far better outcomes:
both financial and medical. Besides, better living conditions for
persons with mental disorders and the respect for their fundamental
human rights humanize the entire society and make it more
democratic.
Marko Đorić, the expert delegated by the Ministry
of Healthcare and EC to work on the feasibility study for
deinstitutionalization, presented the data indicating good
preconditions for deinstitutionalization in Serbia: a developed
system of primary and secondary healthcare, favorable territorial
organization, sufficient number of professionals, “decent”
legislation, etc. Nevertheless, the progress made so far is hardly
noteworthy, he said. Community-based care is still beyond horizon
for the great majority of patients hospitalized for year and even
decades.
Risks of hospitalization are especially high when
it comes to forensic patients. Their families often do not want them
back home for being mentally ill, while chances for resuming normal
lives for those who had committed serious crimes (such as family
violence or homicide) are almost non-existent. People in the outside
community are looking at them with askance: they are afraid such
persons would commit crimes again and are taken aback by their
illnesses beyond their comprehension though subject to their bias.
Prof. Dr. Đorđe Alempijević of the CPT, Dr.
Mirjana Baždar of the Special Prison Hospital and Dr. Albina
Vlastelica, the director of the Special Psychiatric Hospital “Gornja
Toponica” addressed the problem of inadequately defined “dualism” of
medical and security aspects: this dualism actually condemns
forensic patients to a life in closed institutions for periods much
longer than the sentences they got. However, according to
statistics, the risk of crimes committed by persons with mental
disorders is by far smaller than the risk of crimes by offenders
coming from general population. Statistics or not, the fact remains
that citizens are afraid of forensic patients although there are by
far less recidivists among them than among “mentally stable.” Jelena
Mirkov, coordinator of the project “The Prison Reform and Forensic
Psychiatry” presented an analysis of domestic legislation for the
protection of persons with mental disorders and those sentenced to
“mandatory security measures” (forensic patients) comparing her
findings with the Netherlands’ practice. In this domain, Serbia is
lagging behind developed countries: to start with, it should at
least adjust its legislation to European standards and models of
good practice. Otherwise, Serbia will be faced with huge problems
not only in the area of legislation but also the respect for
fundamental human rights and freedoms.
Jelena Unijat of the Ombudsman Office and Milica
Đorđević of the OSCE Mission to Serbia addressed the respect of
international human rights standards in psychiatric asylums and
torture.
The second day of the conference was mostly
dealing with systemic and sustainable solutions to the problem as
seen from the angle of civil society organizations, social
entrepreneurship, professional rehabilitation and employment of
persons with different forms of disability, as wells as with the
role of local self-government in the process of
deinstitutionalization. Biljana Petrović of the International Aid
Network /IAN/, Jovana Krivokuća Milovanović of the Forum of the
Young with Disabilities and Jasmina Tanasić of the Department of
Healthcare and Social Policy of the Standing Conference of Towns and
Municipalities came out with rather stunning information about
persons with mental illnesses’ integration into society: most
institutions are republican and local level are not only unaware of
the problematic and ignorant about it but also unwilling to do
anything for its solution.
All participants in the conference actively joined
in the debate. Representatives of associations of beneficiaries of
psychiatric services came out with most useful “insider” overviews
and recommendations to be submitted to the relevant ministries.
GALLERY::: |
