Getting in is Easy, Getting Out – Very Difficult: Marijana Ristić on Living in Residential Institutions in Serbia

Posted on by Marijana Čanak

There is certain malicious irony in the very term ‘residential institution’. While ‘a residence’ has a connotation of a representative dwelling place and luxurious lodging for dignitaries (bishops, ambassadors or presidents of countries), a residential institution is anything but. It is a collective lodging for the rejected, neglected and deprived, a home of those living a civic death. A home, yet not in the sense of a place where we are free to be whoever we truly are, but a home as a place of oppression. Living in an institution is a life without the possibility of choice or decision-making, not only concerning where you will live and with whom you will share the privacy of your room, but also concerning your bedtime, the clothes you will wear and whether (and with whom) you will take a bath. It is living without knowing if you will ever leave or get stuck in there for life cutting your steak with a spoon because someone has assessed that it is in your best interest. How much effort is needed to transform institutions from within and what are all the malfunctions within the system that prevent (or dispute) it? How to provide for the people who have spent twenty years in a home, in which they have been degraded to such an extent that they have forgotten everything they have ever known, and for their return into the community? Marijana Ristić, a social worker in the Čurug Home and an activist of the Patria Citizen’s Association, a CSO dealing with mental health and protection of the rights of persons with psychological disabilities, talks about all these missions less possible. She came to the Čurug Home four years ago, with the launch of the Open Embrace deinstitutionalization project. It was her first employment and she was engeged as an expert associate on preparing six residents of the Home for living in an supported housing scheme.

Tell me about your first days in this Home…

The way I came to the Home was pretty strange. I came with prejudices, with no prior experience and no clear image of what living in an institution was like. Actually, I had no idea about the location of Čurug since I moved over from Smederevo, central Serbia. The first thing I remember were the various comments and warnings upon my arrival: ‘You must be very alert! There has been a murder here! Take care and don’t turn your back to anyone!’ I remember wondering:  ‘How to do it, unless crawling on my back?’ Despite all I had already heard, I was stunned when I finally arrived. I learnt that the Home used to have a barbed wire gate only three years before my arrival. I saw people with their heads shaved (because of lice) living in eleven-bed rooms with no wardrobe closets or cupboards. Only perhaps twenty of them had a permission to go out of the Home perimeter, but only until four o’clock in the afternoon. This was mostly the privilege of persons who came to the Home as homeless. The first six months were the most difficult: I could only start feeling the ground because no one listened to what I was saying. Most of the staff had a generally autoritarian attitude, yet the management, as well as some staff, were pretty good and interested in the process of deinstitutionalization. My first confrontation with the staff happened when one of the caretakers brought a woman to me and said: – I will shave her head. I’ve never seen so many lice! I confronted her: No, she does not want to have a haircut! We can try to comb the lice out or do something else. It did not go smoothly that time, far from it, but the woman did not have her head shaved. This practice stopped gradually. Within the Open Embrace Project, we cooperated with experts from the Social Work Faculty in Slovenia and their students introduced major changes to the institution: from a rock concert to a protest march. Staff education implied a new approach, both in administration and documentation, as well as in beneficiary treatment. For many of the seasoned staff it was in this period that they sat down with the beneficiaries for the first time and listened to what they had to say.

What are the most common people’s reactios and comments when you tell them where you are working? How does it reflect on your personal image with people?

The reaction is always the same: – Oh, poor you! I don’t know how people are picturing it, but I have a need to set things straight for them. During four years of my employment there, I didn’t have a single incident with the beneficiaries, but I had major confrontations with some employees, those who named the Open Embrace team the Europeans because they believed it was the EU paying us to kiss and hug with the beneficiaries. No matter now hard it was in such situations, we have persevered because we are a very good team. People of various professional profiles in it have created a base for the deinstitutionalization process. The atmosphere in the Home has changed. Earlier, it was unimaginable that an employee would let a beneficiary into her or his home. Now they organize social weekends to spend time with the beneficiaries. People and their thinking can change. We convey this idea wherever we are. There is no reason to pity anyone among us.

If you look back, starting from the time of its foundation until today, how has the Home changed from within?

From the middle of the last century until the 1990’s, it was a residential institution for the elderly. There were different periods in its history and much praised managers that mobilized funds for it, organized social events and accompanied beneficiaries during their visits to their families. A kind of collapse happened during the 2000’s, when inappropriate measures and mass lockups ruled. The functioning of the Home depends primarily on the attitude of its management. When I had just arrived, the most frequent beneficiary question used to be: – When can I go? When will I go home? It was evident that they did not feel that the Home, the place they had spent the last twenty years of their lives, was their own home.

The changes are difficult regardless of the size of the group advocating for them, even if the group is a big one. A plan for transformation of the institution by 2021 has been submitted to the Ministry of Labor, Employment and Welfare. Everything went well during the discussions phase, but it didn’t go any further than that. The plan was to build twenty housing units for four to six people. During such a transformation process, logically enough, no new residents should be admitted into the Home. If there are conditions for a beneficiary to return to her or his family, this person should be supported troughout the process. The idea was to transform the entire Home into an occupational center as a form of social enterpreneurship venture, a daycare and drop-in housing facility as a common service. The plan has no support yet, but we are working in this direction. At the time when we were not admitting new beneficiaries, new space started to open. The beneficiaries arrange and decorate their rooms the way they want, they have got wardrobes, clothes and personal items, proper bed linen that’s not of the hospital-like kind. Currently, we are fighting a battle to get forks and knives into the dining room because the spoons are still the only cutlery regardless of the meals on the menu. I know it sounds terribly basic: – Wow, we’ve introduced a procedure on how to enable people to eat with a fork and knife. To have their own bed linen and clothes. Not to have fifty of them take a shower together. Yet, this is the reality and a stepping-stone for all major changes. 

What is an illness of the spirit[1], as it says in the official name of the Home?

In eralier times, any psychological difficulty was considered an illness of the spirit. There used to be also medical criteria for placing people in residential institutions (from a mild anxiety disorder to any condition diagnosed in a psychiatric ward). The name of the Home in the classification of residential welfare institutions is Residential Home for Persons with Psychological and Intellectual Difficulties. The fact that changes are difficult and slow to introduce is reflected in the terminology used in official documentation. Welfare centers are still sending us reports for admission of new beneficiaries with phrases such as mentally challenged at the level of imbecility. We often come across the Home for socially ill[2] in the documentation – way too often to interpret it as a misprint. I suppose that socially ill individuals are perhaps persons considered unbecoming to be a part of the society.

How does one become a resident of the Home?

A procedure for placing someone in a residentioal institution might also be initiated by someone who has committed violence against the prospective resident, a relative who wants inhertiance after placing someone in an institution, or by an institution that has no more capacities for providing further support to someone… We often get admission requests for persons suffering from alcoholism, requests from residential centers for the elderly, psychiatric institutions and children’s residential homes, because it is a common practice that a person is sent from one institution to another once someone has outgrown the previous one. It all happens through the local welfare center in charge of collecting all documentation and sending a request to residential instiutions. A team made of three social workers (all of them women), a male psychiatrist, a GP and a lawyer (the latter two being women) assess the requests received and decide on admissions into the Home. The admission used to be done without a prior meeting with its prospective resident. It happened several times that we had to send back the people who came to us because it was evident that they needed no support of any kind. Now it is a common practice to meet with the prospective beneficiaries because it has happened before that people arrived absolutely clueless about where they were going. They were told that they were going to a top-ranking hotel and they ended up in the Čurug Home. Once we went to accompany a woman on her way into our institution from a psychiatric ward. They had told there before our arrival that she was going to her child’s birthday party. She was so happy. We insisted that the true information was shared with her and, once we had a joint conversation about it, the woman agreed to it. She had no other options, actually, because she had already been deprived of her legal capacity. The beneficiaries who are not deprived of their legal capacity don’t know their rights, yet no one will tell them: – You are free to go out of the Home today if you want to. No one points to options available to them. They are just being told: – You’re going to a place where it would be better for you. It happens that people who have just arrived to the Home call their local welfare centers to ask: Why am I here? What is this? The most common reply they get is: – Calm down, it’s a good place for you. The legal guardian hath spoken. It often happens that their legal custodian is a local welfare center employee, although it is a conflict of interest. I do not recall a person who came into the Home without asking the following question: – Does it mean that I will never get out of here? What are my chances and options to leave? Getting in is easy, getting out – very difficult. We get countless requests because hospitals got new regulations ordering them to relocate, aka discontinue permanently hospitalizing patients who had been on extended hospital treatments lasting thirty years. Last year, as compared to the year before the last, we had twice as many requests. From the beginning of this year, we must have received at least a 150-200 residential placement requests. The assessment is done according to a revised rulebook, the one taking into account the beneficiaries’ position on their own placement into a residential institution. This is the first time ever that it is happening because earlier the legal custodian’s consent would suffice for the placement to take place. As the legal custodian and the person filing a placement request is usually the same person, the placement consent actually used to be no issue at all. The first thing that we take into consideration is the position of the beneficiary. The assessment of the potential difficulties this person might have, as well as the capacities of the institution to meet the beneficiary’s needs, are the priorities. If there are services in the local community that can meet her or his needs, the beneficiary is refered to them because the Home is the most restrictive possible measure. We are focusing on admitting persons who have absolutely no social resources within the community, which is possible when the team includes social workers instead of medical professionals.

How many women are there in the Home? What is the life of women with combined disabilities like in it?

There are currently 205 beneficiaries in the Home, and the proportion of women and men is equal. Most of them are fifty to sixty years old, the youngest resident being twenty-four; 185 beneficiaries are residing in the Home, while 20 are using the service of supported community housing. Persons with combined disabilities most often have a form of an intellectual and mental disability. There is one blind woman among our beneficiaries, as well as three persons with psychological and physical disabilities. Beneficiaries of the Home with sensory and physical disabilities spend most of their time in bed. It is a fact that they are subject to double isolation. There are only two caretakers in a shift, which is not sufficient for providing quality assistance with even the most basic activities. Nowadays, we usually turn down placment requests for persons with combined disabilities because we are aware that we have no conditions for providing adequate support to them: there are no handrails, the space is not accessible to wheelchair-users; there are no tactile paths or sign language interpreters. The admission request assessment being solely documentation-based, a thousand of other issues come to the surface: from who produced the documentation in the first place – and with what attitudes in the back of her or his mind – to who made the diagnosis, how and on what grounds.

What is a usual day in the Home like?

It runs fairly strictly, we have a program because we are bound by law to have house rules: getting up at seven-thirty, morning therapy at seven-forty-five, breakfast at eight-thirty. More or less everyone observes the routine and most people are awake since five o’clock in the morning. All meals are served at certain times. If someone is late, it happens that we have to mediate it with the staff: – Please give him the meal, he overslept. Such scenarios are rarer by the day thanks to various trainings. Everyone is questioning their actions and are starting to change spontaneously. There are beneficiaries who just gulp their medicines down and get back to sleep. The Home offers occupational therapry for persons who are interested in it: creative workshops, arts and crafts, working in the greenhouse. The problem is that persons deprived of their legal capacity cannot be paid for the work they are doing, but all their earnings are automatically spent on their housing expenses. This is why we have come up with a financial and in-kind rewards system. There is a Promotion and Integration Center in the village where we organize various activities aimed at increasing their independence (such as social skills and communication, English classes, a journalists’ group, activities of the Street Face magazine). It is a common knowledge that local communities offer next to nothing to beneficiaries of residential institutions because the policy used to be establishing such institutions in small settlements off the beaten track. People living in institutions are rejected, otucasts, yet the society needs to understand that they have the right to come back (in)to it.

To what extent are the beneficiaries independent within the Home and outside of it? Are they actually allowed to leave it?

The persons needing most support spend most of their time in their rooms. The fact that the rooms are not locked actually makes no difference. Every month, our security staff at the gate gets a list of beneficiaries who have a permission to leave the Home unaccompanied. Earlier we used weekly lists. About half of all beneficiaries has a permission to leave the Home on their own until nine-thirty in the evening and the list is getting longer by the day. There are tests to assess the level of beneficiaries’ functionality. The test are very good, yet they have some shortcomings. For instance, one of the test questions is ‘How does the person use the local public transportation?’ This is absurd taking into cosideration that we are talking about a person who has not left the Home for twenty years, so (s)he has never been in a situation to use any local public transportation. Some seemingly common, ususal things are difficult to assess while a person is in the Home because living in an institution makes people suppress their wishes and forget anything they had ever known. We issue weekend permits for any leave longer than a day. The welfare professionals authorize such permits, while the medical service prepares the necessary mediactions. We have a beneficiary who lives at his home for three months. Once his mother leaves for work to Germany, he comes back to the Home. A lot depends also on the family resources.

What happens if they happen to break the house rules?

If someone doesn’t show up in time for her or his evening therapy, this person bears certain sanctions. If they announce that they will be late, it is tolerated. There used to be a rule that a person has no right to leave the Home for a month after an acute phychological episode and supsequent hospitalization, but this practice, the so-called adaptation period, stopped. The major threat addressed to the beneficiaries used to be that of hospitalization: – You’re off to the hospital! People used to be punished by being sent to a psychiatric ward for treatment, although their misdeed had absolutely nothing to do with their psychological condition. Such a punishment measure is not used anymore. Without a full-time employee who could provide expert support in cases of deterioration of beneficiaries’ psychological health, loss of orientation or agressiveness, each of these incidents used to end in locking the beneficiaries up into the isolation room. A woman had a doctor’s appointment, which required her not to have anything but water before it, so it was the most practical to lock her up in the isolation room. The rulebooks stipulating the beneficiaries’ best interest principle used to be interpreted as justifying such measures. Two years ago, isolation rooms were turned into storage rooms and an office for the cleaning ladies. At the same time, it was a stepping-stone towards supported decision-making. Consequently, we are nowadays not talking about the best interest anymore, but rather about the best interpretation of a certain person’s wish. There used to be many attempts to escape from the Home, which was also punished by treatment or lockup. People told us that they were escaping simply because they wished to go to the local store or to visit their relatives in a neighbouring village. After a risk assessment, the issue has been resolved by introducing short-term leave permits. We have implemented a very restrictive measure fairly recently because it was the only way in the particular situation. Namely, a woman from a supported housing unit in the local community had to return into the Home because she was violent towards another resident of the housing unit they had shared. It is also a fact that none of us has sufficient skills to deal with violence victims. The institutions are reagarded as totalitarian closed systems, so their beneficiaries have no access to other sypport systems, putting welfare professionals in a position to assess the severity of incidents or misdemeanors and decide on implementation of restrictive measures. In cases of violence, the police often does not want to come to the Home when called for an intervention, whereas a violence perpetrator deprived of his or her legal capacity cannot be held responsible for the act (s)he did. In this case, we used the logic of protecting the housing unit resident exposed to violence, while the woman committing it was ordered a mandatory measure of attending all education events concerning violence.

How about the beneficiaries’ privacy in the Home?

There is a schedule with times of mandatory group bathing, while taking a bath in the presence of caretakers happens on certain days. The law still binds the institution to have a high-pressure water hose – for bathing purposes. There are two shower booths and four toilets available per 85 persons. The possibility for someone to have a free shower booth when (s)he would like to have a shower without anyone barging in on him or her meahwhile is mininal. The toilets in the Home used to be without any toilet paper for a very long time. When a woman would get her period, she needed to go to the infirmary and ask for sanitary pads because they used to be considered medical supplies. Why should anyone ask anyone else for sanitary pads or toilet paper? Now it is a common practice that the beneficiaries are buying their own hygiene items from the so-called pocket money, amounting to some two-three thousand dinars they get every month. The system provides funding for institutions, not individuals or families. The mere fact that people are deprived of the possibility to earn their own income is economic vilolence. Currently, everyone is paying the same amount for their lodging in the Home, despite differing individual costs. For the time being, it is incomprehendible that this situation could be changed and that a person could use her or his money the way (s)he would like to.

How do partnerships function within the Home?

There is a fair number of partnerships in the Home, most often between beneficiaries, while emotional involvement and partnerships between the beneficiaries of the Home and local community members are much less frequent, actually rare. Since we have male and female rooms, the partners cannot share a room, so their right to privacy depends on the agreement with their roommates, who mostly have understanding for such situations. There was a couple among the residents of the second supported housing unit and it was incredibly difficult to get a permit for them to have a room of their own in the house. Currently, the not-pro-medical-approach staff prevail in the Home, so we can arrange for such things. There are often challenging situations and conflicts betweenthe partners, but no one among the staff has sufficient training and skills to deal with such situations. Women have reported violence to welfare staff and persons they confide in. We called the police in such cases, but the police officers only laughed things off: – Let your own security staff deal with it! We are forced to deal with such issues in our own back yard.

Women know next to nothing about sexual and reproductive health issues. Welfare staff give them information about it sporadically, once they have noticed that someone has started a relationship. Residents of the Home have no access to contraceptives simply because only three thousand dinars montlhy are at their disposal. What will they buy first: coffee, sugar, cigarettes or condoms? Due to the fact that most beneficiaries are over fifty, as well as that psychiatric medicines have detrimental effect on fertility, pregnancies are not frequent. Twenty years ago, a woman gave birht to a baby without anyone knowing she was pregnant. The baby died a couple of days later. A couple of months ago, we were in a situation that a woman with an intelectual and mental disability, and therefore deprived of her legal capacity, got pregnant. Her partner is also deprived of his legal capacity, and they are automatically deprived of their parenting rights as well. We insisted that, regardless of all legal implications, every person had the right to decide on her or his own body. We practically faced the impossible. The woman lives in a residential institution, she has legally been deprived of all her rights and her legal custodian from the welfare center has not agreed to her having a baby. Time did not work in our favour because the pregnancy was discovered failry late, so decisions needed to be made fast. We looked for ways for this woman to get as much information as possible about her rights in order for her to make an informed decision, but were eventually in a position to bear witness to the functioning of a collapsing system. Welfare professionals with the welfare center did not find this circumstance was in their interest, so the meeting kept going in the following direction: – C’mon, do you really need it? You have two children already. Medical professionals faced her with the great risks because she had been taking medications that could harm the fetus. We also consulted several gynaecologists. During her first appointment, the woman did not get any information because: – There’s nothing to discuss here. The woman is from an institution, it is quite logical which course to take. The second doctor was horrified by the mere fact that the woman is from an institution and that he was involved in the matter:  – Why didn’t she visit her own gynaecologist in the primary healthcare center in the first place? The only useful information we got was the following: – No one can force anything upon you. Generally, the starting point in such situations is the best interest presumption. Finally, the woman decided to terminate her pregnancy. It is disputable how much choice she actually had with the following messages reaching her from wherever she turned to: – You mustn’t! You will have a sick child! You have no place to live and the child cannot be with you anyway. In such a narrow action field, among people who impose their own attitudes instead of presenting options, the outcome is clear. What else could she have done? After this case, the management was adamant about working on all these issue in the future. Our GP started doing individual talks with the women beneficiaries accordintg to a schedule, both concerning contraception and protection, as well as family planning.

What is the staff structire in the Home and what are their authorities concerning the beneficiaries?

Unsurprisingly enough, the staff of the Home are mostly women because the job is demanding and the salaries low. There is a clear difference in the structure: staff on one side as opposed to the beneficiaries on the other. There are around seventy employees of various expertize and duties in the Home: a doorman and security person, an electrician, a plumber, a barber, the kitchen with women cooks and serving ladies, the laundry staff, a seamstress, bookkeeping clerks, caretakers, cleaning ladies. The medical staff are the head nurse, a woman GP and part-time psychiatrist. The welfare service has a fluctuating staff structure because its financing is project-based. We have three women social workers, a lawyer, a coordinator of the Service Provision Unit, as well as two psychologists working as Advisors for Independent Living. There is only one psychiatrist engaged in this mental health institution with two hundred residents and he comes only once a week. I work in a pavillion with eighty-five residents. It is aboslutely impossible for me to be available to such a number of beneficiaries on daily basis. When I overhear the beneficiaries talking to each other, it is evident that they are never so relaxed when they are talking to us, the staff. For years back, these people have been living in a system making them feel subordinate. They have practically been trained into asking for a permission to do anything they wanted to do. Their apprehension of the staff reaction to their words or actions is omnipresent. Not so long ago, we negotiated about a woman beneficiary spending some time living with her mother. While I was talking to her mother on the phone, the mother said: – When she comes here, she is not with me. She is seeing a man and she spends all her time over there, at his place. I was wondering why she didn’t tell me that herself, because it is completely OK that she has a boyfriend and that they visit each other. This is an indicator of the actual distance between us. Due to being deprived of their basic freedoms, the people at the Home feel fear and guilt because of the most natural things. They are under pressure to do everything in secret. The atmosphere is changing slowly, and I am noticing it in the increased number of their complaints. Of course, we cannot expect them to start trusting us suddenly and fully, opening up to us overnight.

Who can the beneficaries address in cases they hold the staff is treating them inadequately in any respect?

There are several levels, but the first link is usually someone from the pavillion staff, a social worker or a psychologist. The question is what if someone has a complaint concerning one of these two staff members. In that case, beneficiaries can address the lawyer or the Home manager directly. There is a complaint and suggestions box in every pavillion, so everyone can leave an anonymous note in it. If the benficiary is illiterate, there should be a person (s)he trusts to do it instead of her or him. The problem is when the staff member, the one who should forward the complaint relating to her or him, opens the box. Earlier there were no regulations concerning handling complaints. Nowadays, there is a great responsibility with the non-medical staff in this respect. It is most certain that the three welfare professionals will have a different assessment each of the seriousness and urgency of a certain situation. Complex situations require the entire team to meet up with the person who is the subject of the complaint. We have recently had a complaint that one of the caretakers squeezed a female beneficiary on the arm very hard, but there were no visible injuries or physical traces of it. The entire team of our professionals had a meeting about it. Although the staff member in question was not sanctioned, this meeting was a sufficient warning because the employees realized that a situation is being processed and that they needed to change their attitude and approach. Most complaints concern verbal abuse, but it still doesn’t mean that things aren’t happening if people aren’t complaining about them. People have approached us with questions, such as: – Is it possible for me to report violence that happened five years ago? For the time being, everything is being resolved within our institution, but we are determined to expand the system and to include the local police station, because we are not competent enough to discuss or handle violence. It is a serious topic with all Serbian residential institutions, in which there is an evident power disbalance.

To what extent are other forms of support – concerning their physical and psychological wellbeing, legal aid or other – available to your beneficiaries beyond the Home?

Support systems within the Home are most certainly insufficient, so we are doing our best to engage additional support whenever possible. We are collaborating with the IZ KRUGA – VOJVODINA Organization in educating our staff concerning violence against women with disabilities, while our beneficiaries are using their individual psychological support service once a week. We have linked up with YUCOM, the Human Rights Lawyers’ Committee, concerning issues of legal capacity. It is a field we have been trained in, so we are often in a position to provide support to our beneficiaries in various proceedings; we attend regular and court-ordered expert assessment sessions with them, as well as file complaints. Despite our cooperation with partner organizations and educational institutions, the support network for two hundred people lilving under such conditions is underdeveloped. Networking in various aspects, especially with the local community, is necessary in order to pursue in the direction of integration and deinstitutionalization. Speaking about healthcare services, we have developed a good cooperation with the local Primary Healthcare Center in Žabalj, but there are some problems in this respect on the municipal level. It used to happen that we had no access to dentists’ services for up to two or three months. Generally, healthcare institutions are never reliant when it comes to their attitude. We may at times witness severe discrimination there, while at other times they would exercise equal treatment of our beneficiaries. At the pulmology ward in Kamenica[3], they admitted one of our beneficiaries like any other citizen. The gynaecology ward, on the other hand, asked for a round-the-clock presence of a caretaker because the law regards persons deprived of their legal capacity as fourteen-year-olds. We are often facing the situation that hospitals will not admit our beneficaries into regular wards due to the mere fact that they have a mental disability. 

What are the criteria for someone to become a beneficiary of the supported housing service?

During moving into the first supported housing unit there used to be no rulebook whatsoever. At that moment, residents who, according to their independence assessment test results, did not require much assistance entered the program. Yet, bare assumptions about whether someone will find their feet or not often turn out to be false. If someone needs a lot of support, we tend to think that this person cannot do anything. One of the women has serious communication difficulties and, at first glance, it seemed that she would be doing nothing in the common house. However, it turned out that she is excellent in the kitchen. Unverified, unproven presumptions are wrong. The second house was easy for us because a beneficiary’s mother bought it. Therefore, it was implied that he would be living there with his partner, while we were to decide jointly who would be joining them. A rulebook was adopted thereafter, with its guiding principles being that a person wants to live in a certain housing unit, that all residents consent to living together and that what we are offering meets their conditions. People keep asking us every day: – When will I go into the little house, too? It is difficult to make a selection. Everyone should have this opportunity.

How about getting out of the Home? And how about thereafter?

It is impossible to get out of the institution from one day to another. First of all, leaving it is planned and tested. We organize repeated leaves for beneficiaries to visit their families. Then we contact the welfare center in charge, where they usually say: – Well, I don’t know, we heard (s)he likes going to the betting cafe. Or something similar. Then we start negotiating with them: – Well, what if (s)he just had a coffee in the betting cafe? Duration of the preparation period is not pecisely determined. The beneficiaries are being prepared for their leave daily because we are training, instructing them how to handle everything they can on their own. It is imminent that, after twenty years of living in an institution, you forget the most basic things like preparing your food or communication skills. Unless the beneficariy is deprived of his or her legal capacity, (s)he can leave the Home at any moment, but it rarely happens.

How much do you know about the situation in other similar institutions?

There are around 4,500 people with disabilities living in residential insitutions in Serbia, with equal proportion of women and men. Each of these institutions is a small disfunctional town. Some homes have planned to complete the process of their transformation by 2048, which makes no sense. Several homes for persons with psychological disabilities have witnessed deinstitutionalization die on them after their first project. People who had moved out in this period, they remained out. Many have returned into residential homes because they failed to identify functioning support mechanisms. Many institutions admitted as many new beneficaries as they had previously dismissed, which only prolongs the status quo. The Stari Lec Home has around 500 beneficiaries, while the village itself has 430 residents, meaning that the institution is bigger that the entire settlement. Kulina is a residential institution for children with multiple disabilities functioning totally away from the public eye. In winter, the staff changes weekly, not daily, because it is impossible to get there under heavy snow. A good example is one of the institutions in Osijek, Croatia, which got deinstitutionalized in a very short time, reducing the number of its benficiaries from 200 to 60 in two to three years. It is an indicatior that it is possible to do it.

Translation from Serbian: Ankica Dragin

[1] Translator’s note: The official name of the Home in Serbian (Dom za duševno obolela lica) has an outdated, slightly archaic term for mental illness or disorder. Despite expert public considering it derogatory, people still use it commonly because they perceive it as euphemistic.

[2] Translator’s note: The spelling and sound of Serbian words for ‘spiritual’ (duševno) and ‘social’ (društveno) are similar.

[3] Translator’s note: The most renowned regional specialist Institute at the tertiary level of the Serbian healthcare system. It is notorioulsy difficult to get admitted there for exploratory or surgical treatment, except in cases coronary, pulmonary or oncological emergencies.


Tekst je objavljen uz finansijsku podršku Evropske unije. Stavovi u ovom tekstu su isključiva odgovornost programa Zaustavljanje nasilja nad ženama na Zapadnom Balkanu i u Turskoj: primena normi, promena svesti i ne predstavljaju stavove Evropske unije.

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