User/Consumer  

CONDITION OF THE USER MOVEMENT IN ALBANIA

  Mr. Alkent Birko presentation at the III SEE MH Policy Forum in Sofia - Bulgaria 2006           

During the period between the last year Forum to today, important developments have happened in Albania concerning the users’ movement. Global Initiative on Psychiatry has supported this movement in collaboration with local actors such as Albanian Development Center for Mental Health, and Alternativa Center. However, noticeable is the contribution of WHO in supporting users’ and relatives’ movement. In the following I will describe the recent activities and the plans for the future.

1) Tepla 1

The reason for the organization of Tepla 1 in Albania  was that different stakeholder such as relatives , professionals and users sit together, eliminating the obstacles that exist between the respective groups, and work to take the right steps concerning the mental health situation in our country.
It was very positive the fact that relatives, professionals and users sit together and discuss for the problems related with mental health in Albania.
The problems faced are as follows:

1. Users are not considered capable to represent themselves as a unique voice in connection with what is happening with mental health. 

2. Users having their own organization like relatives (or their co-suffers )

For the first time users from different cities had the possibility to meet together and Tepla gave to them a tool to organize a national user organization.  At Tepla 1 it was decided that in the end of December an workshop will be done only for users with the help of two Dutch representatives, Clemens Huitink and Georgette Groutars. This time in the seminar were going to participate only persons with mental problems without the presence of professionals and the relatives.

2) The workshop for users in December

The objective of this workshop was the empowerment of persons with mental health problems. Another point was taking the Dutch experience in organizing a user association, the way how the patients are organized within the hospitals etc. In the workshop it was showed the idea that the user association should be controlled and directed by them without the influence of professionals and relatives even that they are their co-suffers. The users expressed their willingness and the necessity for the organizing of a user association so that they can express their opinion in front of the government and the public. All agreed that a national board should be established with 4 sub boards ion the cities where are placed the psychiatric hospitals.

3) Users and Relatives’ representation in the National Steering Committee for Mental Health

With the great support of WHO it was made possible that for the first time users have their representative in the National Steering Committee of mental health. This is an excellent possibility for users to express their opinion concerning the implementation of the National Operational Plan that is approved by the Ministry of Health.

4) The establishment of a user group in Tirana

With the support of ADCMH it was initiated the work for the establishment of a unified group of users in the city of Tirana. Without forgetting the good work done by different local actors in the field of Mental health, it is important to have a unified activity which aims supporting the users movement in the country. At the beginning, the aim of the activity was that users meet and know each other, without big objectives, but later they will be supported in order to have a stronger voice and participation in the “privilege” to implement the mental health strategy, which until now has been owned only by high technicians without the participation of grassroots.

Relating to what is done right now concerning mental health users, ADCMH took the initiative to support the establishment of a National User Organization, which is in its first steps. This movement, which has just started, will be led by users themselves, which in the Albanian context is something new, because up to now the organization of relatives and users are initiated by professionals risking that these become their property.

The process will start with the establishment of users groups in the four districts where there exist psychiatric hospitals, or wards, respectively in Tirana, Elbasan, Vlora, and Shkoder. A leader for each user group will be identified which is a user in the respective district. We will create the possibility that users from different districts come and meet together and know each other. Efforts will be done in order to mobilize users to work to compile a statute of the national association and the process will continue to the registration of the organization in the Court. A national board will be established for the national users organization.

The objectives of the national users association are as follows:

1. To raise awareness of the users of services about the importance of their inclusion in the community, and service provision;

2. Provide advocacy and to defend the rights of users;

3. To promote and monitor the implementation of the Mental Health Act.

4. To promote the role of users as a partner with its own impact in the community.

One of the objectives of the users movement is to make possible that they are present in the implementation of the mental health strategy. Often happens that politics for mental health in Albania are compiled and implemented from high technicians like in other countries of East Europe. As the National Policy Document for Mental health and the Operational Plan are already approved by the Ministry of health, it is important that users can be present in supporting and monitoring the implementation of the National Operational Plan, in order to guarantee meeting the rights and needs of the users. One of the issues described in the Operational Plan is, the review of the legislation and the Mental Health Act. This is an important moment where users contribution should be the stronger possible.

Actually some of the problems in our country, which can be changed through a better mental health low, are as follows:

1. The non implementation of the Mental Health Law, approved on 1996. Although it is an old law, if it is going to be implemented and the respective law act were going to follow it, then we were no going to notice bad practices related to the treatment of patients within the hospitals, for example the way the person with mental problem is taken by force to the hospital. Also the use of police when the person constitutes a danger for himself but not for the others, damages the social status of the user in front of the public opinion.  Another thing is the absence of the right to accept or not a certain psychiatric treatment when the patient thinks that is not good for him.
2. Another aspect is the elimination of the non human methods such as electroshocks  or cage beds. Here takes place the organization of the so-called survivors and the advocacy for the people who live in the hospitals. Although that they are in difficult conditions (mental ones) if they are going to be asked they are able to give an opinion about how they are treated by doctors, how is the food etc. The organizing of the people with mental health problems in patient councils, the inclusion of the social workers as potential advocates of patients will improve their social status within the hospitals. 
3. The information of the patient about the form of the treatment it is foreseen in the law but it is not implemented yet. Actually there is an absence of the information about the cure he takes (for example the side effects). The patient does not have any right to oppose the treatment if he thinks that is not suitable for him.

These are only examples, of how the involvement of the users’ movement can improve the quality of services, social status, and life of the users.

The National Operational Plan approved by the Ministry of Health has foreseen the formation of the monitoring units for the implementation of this plan.  Wouldn’t be great for persons with mental health problems to be part of this process. 

As it was described, important movements are happening in connection with the development and empowerment of a national users association. This thing is made possible through the support of local and international organizations present in Albania.  But at the same time different actors in the field of mental health are involved in the process of empowerment of the users’ decision making capability, and they make pressure upon the users groups so that they could implement their planned activities, considering these as the most useful and appropriate. Instead of increasing the decision making capability this has a different impact. Maybe it is the time that users and relatives should be asked about their needs for training, qualification and other activities and so they can coordinate the inputs they have from different actors.