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The Treatment behind Bars

November 19-20, 2015


Civil Society Campaign for Efficient Protection of Persons with Mental Disorders - Phase II



Prison Reform and Forensic Psychiatry

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.














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