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Project Presentation to Parliamentary Committees

“Community-based Living: Fundamental
Human Right”

October 29, 2015


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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