Thousands of people with intellectual or psychosocial disabilities are living in segregated institutions and psychiatric hospitals in Croatia, with little control over decisions that affect their lives, according to Human Rights Watch (HRW) in a report published on Monday.
The World Health Organization (WHO) says governments around the world, including in Africa and Asia, are failing those who live with mental health disorders.
Ladislav Lamza is director of the Home for Mentally Ill Adults in Osijek, a social welfare home for adults with psychosocial disabilities in Croatia.
He says life inside the institution is similar to living in a prison.
Lamza says patients cannot have their own lives. They cannot demand any privacy. They do not have any choices. They cannot even choose the person with whom they would want to share a room.
Human Rights Watch says, despite the grim conditions in some mental hospitals, the Croatian government is making progress in protecting the rights of people with psychosocial disabilities.
Eleven of 46 state institutions have started the process of deinstitutionalization, and more than 500 people have been moved into the community. But HRW says the process needs to move faster and reach more people.
It says more than 8,000 people are still living in what the rights group deems “institutions."
In Osijek, those who are moved into the community are offered support and given assistance if it’s needed. Lamza says many learn very quickly how to cope alone.
They make progress by themselves, he says, and recover so quickly that in a matter of months some are fully independent: shopping, paying bills, fulfilling their needs in the community.
For its report, HRW interviewed over 80 people in three regions in Croatia.
Shantha Rau Barriga, Director of Disability Rights at HRW, says deinstitutionalization makes sense.
“It is a better investment of money to move people into the community because over time they are going to be able to live on their own without all of the support services that are paid for in institutions,” says Barriga.
Shekhar Saxena, Director of the Mental Health and Substance Abuse Department at the WHO, says science has developed enough for health experts to be able to do much more for people who are staying at home, within their communities.
Mental hospitals cost little money, he says, but they do not provide the treatment needed.
And yet across Europe, he says, there are still far too many institutions in operation.
“Many European countries have developed economies and their health systems have become much better, but their mental health systems are still lagging behind and mental hospitals, large ones, are really a very bad example of how economic development does not necessarily lead to improved welfare of people with mental disorders,” says Saxena.
Many other regions of the world have an equally difficult situation, he says.
In Africa, he says, there are very few psychiatrists and mental health professionals. Countries need to train their general doctors and nurses to look after people with mental disorders, especially in communities and not in mental hospitals, he says.
In Asia, very large mental health hospitals are widespread, he says.
He says many countries spend less than one percent of their health budget on mental health, despite the widespread prevalence of mental disorders.
“It is larger than the prevalence of diabetes and cancer put together, even for serious mental disorders, minor mental disorders are very much more common,” says Saxena.
In 2013, 194 World Health Organization member states adopted the Mental Health Action Plan, which sets a number of key targets to be reached by 2020. One of the basic pillars of the plan is to provide care in communities, not in institutions.