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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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