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Out of the Asylum

Judith KleinDragan Lukic is Director for a community-based housing project in Serbia; Judith Klein is Director of the Open Society Mental Health Initiative.

by Dragan Lukic and Judith Klein

Serbia -- long castigated as the land whose late president, Slobodan Milošević, launched a genocide in Yugoslavia -- is not accustomed to finding itself lauded for safeguarding human rights. But in one area of human rights protection, much-maligned Serbia has taken an unprecedented step that puts ahead of all the rest of Central and Eastern Europe, including states that are already members of the European Union.

In September 2006, Serbia’s Ministry of Labor, Education, and Social Affairs made it official policy to integrate into society thousands of people who had been locked away in Dickensian state institutions because they have a mental disability. With this historic move, Serbia adopted a practice that took hold in the rich, Western countries after World War II but was never applied in the Communist bloc.

It is anathema to the concept of a free society to segregate people solely on the basis of mental disability, to ignore their most-basic human rights, to bar them from access to education and employment, to deny them the freedom to choose where and how they live and with whom they can associate.

The policy change aimed at rectifying this grim reality in Serbia came when the Ministry agreed to apply country wide a pilot project that has, since 2003, established a range of community-based support services to enable persons with intellectual disabilities to leave the institutions where they were confined and begin living lives in the wider world. That pilot project demonstrated that people with mental disabilities are capable of living as equal citizens when they receive appropriate assistance.

Based upon the project’s success, the Ministry has committed to purchase more than 130 apartments and homes to house people brought out of institutions and to establish day services to help them cope with the complexities of life beyond the walls that once confined them. Funding for these reforms comes from the privatization of state assets -- not from aid from abroad. To Serbia’s credit, the Ministry made its policy decision knowing that the change would require belt-tightening elsewhere in its budget, but it took the action because it concluded that protecting human rights was more important than saving a few dinars.

Hopefully, Serbia’s decision will inspire the other states of Central and Eastern Europe, including states that have won membership in the European Union, to follow its lead. It is shocking that the EU has done so little to press its members, and candidate-members, to promote community living for people with mental disabilities.

None of the new EU member-states have concrete plans or financing mechanisms to develop networks of community-based alternatives on a national scale. While there are pockets of high quality community-based services in most of the region’s countries, tens of thousands of people with mental disabilities are still living in institutions, and most of them have no prospect of ever leaving.

  • Hungary continues to segregate its most disabled citizens and spent millions of dollars on the construction of a new institutional behemoth which sits empty because it does not meet EU fire and safety standards.
  • Croatia is demonstrating that deinstitutionalization is not a question of money. The Open Society Institute committed over $2 million to assist the government in closing a large institution for people with intellectual disabilities. But, almost a year into the negotiations, the government is still not ready to commit to concrete action.
  • In Romania last year, children were dying of starvation in one institution. The government placed the blame on local authorities; the local authorities blamed the government for allocating inadequate resources; and inmates of the institutions still look out at the world through windows that are locked and barred.

There is an urgent need to change government policies so that providing services for people with mental disabilities in the community is the norm rather than the exception. Such services must be accessible to everyone who needs them. And governments must reallocate resources from institutions -- and the bureaucracies that have a vested interest in preserving their positions -- to organizations that support community-based living.

It is time for the rest of Central and Eastern Europe to catch up to Serbia.

Copyright: Project Syndicate, 2006.

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