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In April 2013, with the assistance of the Norwegian Ministry of Foreign Affairs/Royal Norwegian Embassy in Belgrade the Helsinki Committee began realizing the project “Civil Society Advocacy for Efficient Protection of Persons with Mental Disorders.”

The project is being implemented in partnership with IAN /International Aid Network/ and in strategic cooperation with the Citizens’ Ombudsman, the Provincial Ombudsperson and the Ministry of Healthcare.

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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