INSTITUCIJA OMBUDSMENA/OMBUDSMANA ИНСТИТУЦИЈА ОМБУДСМЕНА/ОМБУДСМAНА ZA LJUDSKA PRAVA BOSNE I HERCEGOVINE ЗА ЉУДСКА ПРАВА БОСНЕ И ХЕРЦЕГОВИНЕ

Grbavi ka4,BA-71000 Sarajevo Tel:+38733666006 Fax:+38733666007 E-mail:ombudsmen@ombudsmen.gov.ba Slobodana Kokanovi a7, BA-78000 Banja Luka Tel/Fax: +387 51 303 992 E-mail : bl.ombudsmen@ombudsmen.gov.ba

SPECIAL REPORT

ON THE SITUATION OF HUMAN RIGHTS

IN THE INSTITUTIONS FOR ACCOMMODATION OF MENTALLY DISABLED PERSONS

Prepared by

The Institution of Human Rights Ombudsmen of

Bosnia and Herzegovina

Cc. 1. All competent BiH, Entity and cantonal ministries and the Government of District Brčko, 2. Financial Inspection of FBiH and Federation Administration for Inspection Businesses, 3. Cantonal Prosecutor’s Office of Canton Sarajevo, 4. Relevant Social Work Centers, 5. All visited institutions for accommodation of mentally disabled persons, 6. Agency for Sex Equality 7. Embassy of UK and Northern Ireland, Royal Embassy of Denmark, German Embassy,

Embassy of USA, Embassy of Swiss Confederation, Royal Embassy of Sweden, Royal Embassy of Norway.

8. The Office of Representative of the Council of Ministers before European Court for Human Rights (Ms. Monika Mijić, Ms. Zikreta Ibrahimović).

Banjaluka, 10 September 2009

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I – INTRODUCTION

1.1. Basis for preparation of Special Report

Recalling basic human r ights pr inciples that all human beings are free an equal in

dignity and human r ights, the Inst itut ion of Human Rights Ombudsmen o f Bosnia

and Herzegovina (BiH) assessed that it was necessary to evaluate situat ion in

Social Protect ion Inst itut ions where mentally disabled persons from the terr itory

of BiH are accommodated. Due to exist ing sit uat ion happened to exist in t hese

intuit ions, significance and urgency o f the issue and expressed necessit y for a

broader examinat ion of exist ing problems, includ ing urgent intervent ion by

competent organs, in accordance with Art icle 34, paragraph 2, o f the Law on

Human Rights Ombudsmen o f Bosnia and Herzegovina 1 , BiH Ombudsmen decided

to prepare present Special Repost .

On the occasion o f dec iding to prepare spec ial report , BiH Ombudsmen had in

mind the fact that BiH accepted “Standard Rules for Equalizat ion o f Opportunit ies

for Disabled Persons” (Standard Rules). This basic internat ional document sets up

rules t hat are to be complied with by the states in order to ensure living condit ions

and exercise o f r ights of disabled persons.

According ly, pursuant to the provis ions o f Standard Rules, governmental organs o f

all levels are obligated to ensure t hat all c it izens exercise enjoyment and

protect ion o f a ll human r ights and fundamental freedoms guarant ied by

int ernat ional inst ruments. Mentally disabled persons are ent it led to the r ight to

protect ion against any form o f ill and degrading t reatments. Presence o f phys ica l

and intellectual failures does not just ify any form o f discr iminat ion. Freedom and

r ights o f mentally d isabled persons may be limited only by law, if it is necessary

for the sake o f health and secur it y o f respect ive person or other persons. BiH

Ombudsmen staff therefore visit ed all mental hea lth inst itut ions where mentally

disabled persons are mainly accommodated for the rest of their life, frequent ly

forgotten by their families.

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Bear ing in mind that monitor ing of the r ights of mentally disabled persons,

inc luding monitor ing o f how these persons are t reated in the inst itut ions to which

they are most frequent ly accommodated by decisions o f competent organs, exist ing

situat ion in mental health inst itut ions should be seen as a essent ials indicator for

development o f modern and democrat ic society based on the rule of law and human

r ights protect ion. Therefore, BiH Ombudsmen, within the st ructures of the

Inst itut ion, created, among other departments, Department for Protect ion o f the

Rights of Disabled Persons.

With a view to full assessment of the situat ion, BiH Ombudsmen formed a team

that visit ed the fo llowing mental health inst itut ions:

1. Inst itut ion for protect ion of the children and the youth „Pazar ić“;

2. Mental Health Inst itut ion „Bakovići“;

3. Mental Health Inst itut ion in Fo jnica: „Drin“;

4. Inst itut ion for t reatment , rehabilitat ion and social protect ion o f chronic

mental pat ients „Jakeš“, Modr iča;

5. Inst itut ion for protect ion of female children and the youth „Višegrad“;

6. Home of children and the youth retarded in developing „Pr ijedor“;

7. Center for acceptance of the elderly and infirm and homeless persons “Duje”,

Municipality Doboj Istok.

Regarding the specific status o f this inst itut ion and due to situat ion happened to

exist in it , Inst itut ion for t reatment , rehabilit at ion and social protect ion o f chronic

mental pat ients „Jakeš“, Modr iča shall be subject o f considerat ion o f present

spec ial report .

Due to compressive analyses o f the situat ion o f human r ights o f mentally disabled

persons, this Report contains a number of segments divided to:

­ legal status of the inst itut ions;

­ managing and funding o f the inst itut ions;

­ accommodat ion capacit ies and availabilit y of the inst itut ions;

­ r ights o f the persons accommodated in ins t itut ion (users) ;

1 “Official Gazette of BiH”, no: 32/00, 19/02, 35/04 and 32/06

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­ Social protect ion o f the users (standards of accommodat ion, food, hygiene,

work therapy, educat ional work, contacts with family, free t ime, out ings and

other act ivit ies ) ;

­ Health protect ion, medic ines, specialist examinat ion, phys ical, speak and

mult i­ sensua l therapy

­ educat ion;

­ pr ice of accommodat ion and cadre st ructures;

­ managing o f the intuit ions, t rade unions of t he employees,

­ t ransparence of the work and expenses ,

­ exercise o f the r ights of the employees,

­ human relat ions.

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II – INTERNATIONAL STANDARDS AND NATIONAL

LEGISLATION

Rights of mentally disabled persons and their accommodat ion in the inst itut ions

are determined by a number of int ernat ional documents on human r ights and by

nat ional legislat ion

Cons ider ing the r ights o f this category o f cit izens o f BiH, it is important to have

in mind relat ions between nat ional legis lat ion and int ernat ional human r ights

standards. So, the Const itut ion o f BiH declarat ively contains the highest level o f

recognit ion for human r ights, which is st ipulated by Art icle II . „Human Rights and

Fundamental Libert ies“. By this Art icle it is st ressed that BiH Const itut ion is a

far­reaching document st ipulat ing „the highest level o f enjoyment o f

int ernat ionally recognized human r ights and fundamental libert ies“. 2 Further, the

Const itut ion st ipulates that European Convent ion on Human Rights and

Fundamental Freedoms (ECHR) and its Protocols are direct ly applied in BiH and

that „they shall have pr ior it y above all other laws“ 3 , and basic human r ights are

listed in a separate paragraph. 4 Exact ly this fact was one of the bases for

considerat ion o f the posit ion o f mentally disabled persons in BiH.

2.1. International standards

Internat ional documents protect ing human r ights are based that each human being

has inher ited, equal, ina lienable and universal r ights spr inging from dignity o f al l

human beings. 5 A state may establish mechanisms regulat ing exercise of these

r ights and freedoms, includ ing ensur ing of equalit y of a ll persons.

2 The Constitution of BiH (December 0f 1995, adopted within Dayton Peace Agreement), Article II: Human Rights and Fundamental Liberties (paragraph 1) 3 Id, Article II (2) 4 Id, Article II (3) 5 Preamble of UN Univerzal Declaration on Human Rights adopted on 10,12.1948 stresses: “Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world…”, while Article 2 stipulates: “Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

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Apart from r ights contained in Universal Declarat ion, UN adopted two legally

bind ing documents: Internat ional Covenant on Civil and po lit ical Rights and

Internat ional Covenant on Economic, Social and Cu ltural Rights. These two

Covenants define r ights and establish implementat ion mechanisms. So, speaking

about social r ights, it is necessary to draw at tent ion at basic pr inc iple common for

all UN human r ights standards and that is that enjoyment o f social r ights in a state

must be ensured without any discr iminat ion.

The r ight to social protect ion is determined by the fo llowing UN documents:

1. Internat ional Covenant on Civil and polit ical Rights (1966) (ICCPR)

2. Internat ional Covenant on Economic, Social and Cultural Rights (1966)

(ICESCR)

3. Convent ion on the Rights o f a Child (1989) (CRC)

4. Convent ion on Prohibit ion o f all Forms of Gender Discr iminat ion (1979)

(CEDAW)

5. Convent ion on Prohibit ion o f all Forms of Racial Discr iminat ion (1966) (CERD)

6. Convent ion on Prevent ion o f Torture and Other Cruel, Inhuman or Degrading

Treatments or Punishments (1984) (CAT)

All listed documents are rat ified by BiH and have const itut ional applicabilit y,

since they are integral part of BiH Const itut ion. 6

Lobbyist for r ights in the area o f social protect ion could call on ment ioned

inst ruments, since these documents are: (1) legally binding (2) may request court

protect ion o f these r ights. Where several internat ional documents define or

protect the same individual r ights, an ind ividual is ent it led to protect ion according

to: (1) all exist ing (adopted) inst ruments and (2) t he most effect ive protect ive

provisions, i.e. in accordance with document which ensures the highest level o f

protect ion.

A list of economic and social r ights, according to internat ional standards, is quite

extensive, yet with the purpose to make state to understand al dimensions o f it s

obligat ion to ensure r ights o f mentally disabled persons we shall quote some o f the

social r ights enjo yment of which was subject of considerat ion by BiH Ombudsmen

on the occasion o f vis its to mental health inst itut ions:

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• Everyone is ent it led to economic, social and cultural r ights, enabling dignity

and freedom, and individual development (UNDHR 22; CEDAW 11:1 e: CERD

5e; CRC 27) ;

• Everyone is ent it led to right to adequate standard o f living, including food,

cloths, apartment and health protect ion ( ICESCR 11; CEDAW 14h; CERD 5e,

III , CRC 27:1)

• Parents have pr imary responsibilit y to ensure t hat their child has adequate

standard o f living, and state is obligated to assist , s ince it is responsible for

applicat ion o f this r ight (CRC 27:2,3)

• Everyone is ent it led to right to social secur it y (UNDHR 22; ICESCR 9;

CEDAW 11:1 e, 14C, 13a; CERD 5e, iv; CRC 26)

• Everyone is ent it led to right to social services and secur it y in the case o f

disease, age or other circumstances, including a child, too. (UNDHR 25;

CEDAW 11:2 c; CERD 5e, iv; CRC 18:2,3)

2.1.1. UN Univerzal Declaration on Human Rights

Article 1.

• All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Article 2. • Everyone is entitled to all the rights and freedoms set forth in this Declaration, without

distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non­ self­governing or under any other limitation of sovereignty.

2.1.2. European Convention on Human Rights and Fundamental

Freedoms

Article 3

No one shall be subjected to torture or to inhuman or degrading treatment or punishment.

6 Annex I to the Constitution of BiH – Additional agreements on human rights that shall be applied in BiH

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Article 6, paragraphe 1.

1 In the determination of his civil rights and obligations or of any criminal charge against him, everyone is entitled to a fair and public hearing within a reasonable time by an independent and impartial tribunal established by law. Judgment shall be pronounced publicly but the press and public may be excluded from all or part of the trial in the interests of morals, public order or national security in a democratic society, where the interests of juveniles or the protection of the private life of the parties so require, or to the extent strictly necessary in the opinion of the court in special circumstances where publicity would prejudice the interests of justice.

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Article 8

1 Everyone has the right to respect for his private and family life, his home and his correspondence.

2 There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well­being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

Article 13

Everyone whose rights and freedoms as set forth in this Convention are violated shall have an effective remedy before a national authority notwithstanding that the violation has been committed by persons acting in an official capacity.

Article 14

The enjoyment of the rights and freedoms set forth in this Convention shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.

Protocol No. 1 to the Convention for the Protection of Human Rights and Fundamental Freedoms

2.1.3.

Article 1

Every natural or legal person is entitled to the peaceful enjoyment of his possessions. No one shall be deprived of his possessions except in the public interest and subject to the conditions provided for by law and by the general principles of international law.

The preceding provisions shall not, however, in any way impair the right of a State to enforce such laws as it deems necessary to control the use of property in accordance with the general interest or to secure the payment of taxes or other contributions or penalties.

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Article 2

No person shall be denied the right to education. In the exercise of any functions which it assumes in relation to education and to teaching, the State shall respect the right of parents to ensure such education and teaching in conformity with their own religions and philosophical convictions.

Protocol No. 12 to the Convention for the Protection of Human Rights and Fundamental Freedoms

1. The enjoyment of any right set forth by law shall be secured without discrimination on any ground such as sex, race, color, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.

2. No one shall be discriminated against by any public authority on any ground such as those mentioned in paragraph 1.

2.1.5. Convention of the Rights of Persons with Disabi lities

Article 1

The purpose of the present Convention is to promote, protect and ensure the full and equal

enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to

promote respect for their inherent dignity.

Persons with disabilities include those who have long­term physical, mental, intellectual or sensory

impairments which in interaction with various barriers may hinder their full and effective

participation in society on an equal basis with others.

Article 5

1. States Parties recognize that all persons are equal before and under the law and are entitled

without any discrimination to the equal protection and equal benefit of the law.

2. States Parties shall prohibit all discrimination on the basis of disability and guarantee to persons

with disabilities equal and effective legal protection against discrimination on all grounds.

3. In order to promote equality and eliminate discrimination, States Parties shall take all

appropriate steps to ensure that reasonable accommodation is provided.

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4. Specific measures which are necessary to accelerate or achieve de facto equality of persons with

disabilities shall not be considered discrimination under the terms of the present Convention.

2.1.6. UN Convention on the Rights of a Child

Article 3

1. In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration.

2. States Parties undertake to ensure the child such protection and care as is necessary for his or her well­being, taking into account the rights and duties of his or her parents, legal guardians, or other individuals legally responsible for him or her, and, to this end, shall take all appropriate legislative and administrative measures.

3. States Parties shall ensure that the institutions, services and facilities responsible for the care or protection of children shall conform with the standards established by competent authorities, particularly in the areas of safety, health, in the number and suitability of their staff, as well as competent supervision.

Article 23

1. States Parties recognize that a mentally or physically disabled child should enjoy a full and decent life, in conditions which ensure dignity, promote self­reliance and facilitate the child's active participation in the community.

2. States Parties recognize the right of the disabled child to special care and shall encourage and ensure the extension, subject to available resources, to the eligible child and those responsible for his or her care, of assistance for which application is made and which is appropriate to the child's condition and to the circumstances of the parents or others caring for the child.

3. Recognizing the special needs of a disabled child, assistance extended in accordance with paragraph 2 of the present article shall be provided free of charge, whenever possible, taking into account the financial resources of the parents or others caring for the child, and shall be designed to ensure that the disabled child has effective access to and receives education, training, health care services, rehabilitation services, preparation for employment and recreation opportunities in a manner conducive to the child's achieving the fullest possible social integration and individual development, including his or her cultural and spiritual development

4. States Parties shall promote, in the spirit of international cooperation, the exchange of appropriate information in the field of preventive health care and of medical, psychological and functional treatment of disabled children, including dissemination of and access to information concerning methods of rehabilitation, education and vocational services, with the aim of enabling States Parties to improve their capabilities and skills and to widen their experience in these areas. In this regard, particular account shall be taken of the needs of developing countries.

2.2. Relevant BiH provisions

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Regarding status of disabled persons in BiH, there exist an issue to what extent

competent BiH organs through adopted legislat ion ensured enjoyment o f the r ights

guarant ied by int ernat ional standards and effect ive social protect ion o f this

category o f the cit izens, since competences are divided between d ifferent level o f

the author it ies.

Social protect ion which meets social and cultural needs of t he people is consisted

of social benefits and services. Services are consisted o f full supply in social

protect ion inst itut ions provided to users to meet their exist ent ial needs. All

cit izens are potent ial users o f social protect ion regardless o f their economic,

family and social status, due to which considerat ion o f enjoyment o f the r ight to

social protect ion by mentally disabled persons, as a small and part icular ly

vulnerable category, and it can provide realist ic ind icator of the situat ion in t his

area. Social protect ion is organized as specialized social service in funct ion o f the

society, however, all o ther services also deals with social protect ion (elements o f

social protect ion in: educat ion, housing, health protect ion, socia l insurance, etc.) .

Fund ing is the key issue, which ear lier came from contr ibut ions for social

protect ion but in BiH today it is determined different ly than before.

According ly, key segment for assessment of enjoyment of t he r ights by mentally

disabled persons can be found in the level of established socia l protect ion in BiH.

2.2.1. The Constitution of BiH

Article II.

„3. Enumeration of rights

All persons within the territory of Bosnia and Herzegovina shall enjoy the human rights and fundamental freedoms referred to in paragraph 2 above; these include:

c . The right not to be held in slavery or servitude or to perform forced or compulsory labor.

4. Non­Discrimination.

The enjoyment of the rights and freedoms provided for in this Article or in the international

agreements listed in Annex I to this Constitution shall be secured to all persons in Bosnia and

Herzegovina without discrimination on any ground such as sex, race, color, language,

religion, political or other opinion, national or social origin, association with a national

minority, property, birth or other status“

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2.2.2. Standard Rules on Equalization of Opprtunities for Disabled Persons 7

Rule 2. Medical care

1. Competent authorities of BiH, Entities and District Brčko should ensure the provision of effective medical care to persons with disabilities.

2. Competent authorities of BiH, Entities and District Brčko should work towards the provision of programmes run by multidisciplinary teams of professionals for early detection, assessment and treatment of impairment. This could prevent, reduce or eliminate disabling effects. Such programmes should ensure the full participation of persons with disabilities and their families at the individual level, and of organizations of persons with disabilities at the planning and evaluation level.

2. Local community workers should be trained to participate in areas such as early detection of impairments, the provision of primary assistance and referral to appropriate services.

Rule 15. Legislation

Competent authorities of BiH, Entities and District Brčko have a responsibility to create the legal bases for measures to achieve the objectives of full participation and equality for persons with disabilities.

2. BiH legislation, embodying the rights and obligations of citizens, should include the rights and obligations of persons with disabilities. States are under an obligation to enable persons with disabilities to exercise their rights, including their human, civil and political rights, on an equal basis with other citizens. States must ensure that organizations of persons with disabilities are involved in the development of national legislation concerning the rights of persons with disabilities, as well as in the ongoing evaluation of that legislation.

2.2.3. The Law on Prohibition of Discrimination 8

Article 6

1. „This law shall be subject of application by all public bodies at the State­level, Entities and District Brčko of BiH, general institutions and bodies and legal entities with public responsibilities, including all natural and legal persons in all and particularly in the following spheres of life: c) social protection, including social insurance, social benefits, social aid (housing subventions, youth subventions, etc.) and manner of actions towards users of social protection;“

2.3. Competence to act

7 “Official Gazette of BiH”, no: 41/03

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Competence to act upon the issues o f r ights o f mentally disabled persons is

defined in several pieces o f legis lat ion, which is , from the aspect of obligatory

compliance with Ombudsmen recommendat ion, o f importance for present Report

2.3.1. The Law on Ministries and Other Bodies of Administration of BiH 9

Article 15 The Ministry of Civil Affairs shall be responsible for:

­ Citizenship, citizen registration and records, personal data protection, residency registration, identity documents, travel documents and vehicle registration process,

­ mine action.

This Ministry shall be responsible for carrying out tasks and discharging duties which are within the competence of BiH and relate to defining basic principles, co­ordinating activities and harmonizing plans of the Entity authorities and defining a strategy at the international level in the fields of:

­ health and social care; ­ pensions; ­ science and education; ­ labour and employment; ­ culture and sport; ­ geodetic, geological and meteorological affairs.

2.3.2 The Law on Federation Ministries and Other Bodies of the Federation Administration 10

Article 10

„Federation Ministry of Social Policy, Refugees and Displaced Persons, performs administrative, professional and other professional tasks determined by law applied on Federation competences in the area: social policy, displaced persons, work, pension and disabil i ty insurance.”

2.3.3. The Law on the Ministries of Republika Srpska 11

Article 11

8 “Official Gazette of BiH”, no: 59/09 9 “Official Gazette of BiH”, no: 5/03, 42/03, 26/04, 42/04, 45/06 and 88/07 10 “Official Gazette of FBiH”, no: 8/95, 3/96, 9/96 11 „Official Gazette of RS“, no: 70/02, 33/04, 118/05, 33/06

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“The Ministry of Health and Social Protection carries out administrative activities and other professional tasks related to: protection and improvement of citizens’ health and monitoring of health conditions and health needs of citizens; health protection system; organization of health protection under all conditions; professional training and specialization of health workers; health inspection; organization of supervision over the expert work of health institutions; health insurance and provision of health insurance from public revenues; production and trade of medicines, toxic and narcotics, medical equipment and medical appliances; health propriety of water, food and products of general use; inspection supervision in sanitary field; social protection system; social care over families and children; activities of public organizations and citizens’ associations in the socio­ humanitarian sphere; provides information through the media and other public means and performs other tasks in accordance with law and other regulations of the RS and BiH.”

2.4. Legal framework regulating accommodation of mentally

disabled persons in the entities

2.4.1. Legislation of Republika Srpska

Exercise o f the r ights o f mentally disabled persons and the ir accommodat ion in the

inst itut ions o f Republika Srpska (RS) is regulated by the fo llowing pieces o f

legislat ion:

• The Law on Social Protect ion 12

• The Law on Ha lth Protect ion 13

• The Law on Protect ion o f Persons with Disabilit ies 14

• The Law on the System o f Public Services 15

2.4.2. Legislation of the Federation of BiH

Exercise o f the r ights o f mentally disabled persons and the ir accommodat ion in the

inst itut ions o f the Federat ion o f BiH (FBiH) is regulated by the fo llowing p ieces

of legis lat ion:

12 „Official Gazette of RS“, no: 5/93, 15/96, 110/03 33/08 13 „Official Gazette of Republika Srpska“, no: 18/99, 58/01, 62/02 14 „Official Gazette of Republika Srpska“, no : 46/00 15 „Official Gazette of Republika Srpska“, no 68/07

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• The Law on the Taking Over o f Rights and Obligat ions by the Founders o f

Social Protect ion Inst ituion in the Federat ion o f BiH 16

• The Law on Basis o f Social Protect ion, Protect ion o f Civil Vict ims o f t he War

and Protect ion o f Families with Children 17

• The Law on Health Protect ion 18

• The Law on Health Insurance 19

• The Law on Protect ion o f the Persons with Mental Disorders 20

2.5. By­Laws

2.5.1. Republika Srpska

• Rules on supervis ion o f professional work and provis ion o f professiona l

assistance in t he social protect ion inst ruct ions o f Republika Srpska („Offic ial

Gazet te of Republike Srpske“, no: 67/02)

• Rules on elaborated condit ions related to space, equipment , necessary

professional and other workers needed for founding o f social protect ion

inst itut ion.(„Offic ial Gazet te of Republike Srpske“, no: 26/03)

• Rules on classificat ion o f persons with difficult ies in phys ical and Psychica l

Developing („Officia l Gazet te of Republika Srpska“, no: 115/03)

• Rules on educat ion, work and funding of the Commission for Protect ion o f

Persons with Mental Disorders („Offic ial Gazet te of Republika Srpska“, no:

15/06)

• Methodo logy guidelines for supervis ion, professional work and provision o f

professional assistance to social protect ion inst itut ions o f Republike Srpske

(„Offic ial Gazet te of Republika Srpska“, no: 78/02)

• Guidelines for fir st instance procedure of classificat ion o f persons with

difficult ies in physical and Psychica l Developing. („Offic ial Gazet te of

Republika Srpska“, no: 15/07).

16 “Official Gazette of FBiH”, no: 31/08 17 “Official Gazette of the Federation of BiH”, no: 36/99, 54/04, 39/06 i 14/09 18 “Official Gazette of the Federation of BiH”, no: 29/97 19 “Official Gazette of the Federation of BiH”, no: 30/97 20 “Official Gazette of the Federation of BiH”, no: 37/01 i 40/02

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III. SITUATION IN MENTAL HEALTH INSTITUIONS IN

BOSNIA AND HERZEGOVINA

3.1. Introduction Representat ives o f the Inst itut ion of Human Rights Ombudsman o f BiH conducted

invest igat ion and analyze o f exercise o f human r ights in mental health inst itut ions

in BiH. This research result ed in present Special Report which is pr imar ily based

on vis it s to the inst itut ions 21 . It is based on the fo llowing segments:

• Interviews with management and staff o f the inst itut ions;

• Visit s to all rooms where persons accommodated in t he inst itut ions stay or

work;

• Interviews with persons accommodated in social protect ion inst itut ions,

according to their possibilit ies for communicat ion;

Fo llowing the visits to the inst itut ions BiH Ombudsmen Inst itut ion’s Team held

the consultat ive meet ings with representat ives o f competent minist r ies and certain

social work centers. The meet ings were held with the representat ives o f t he

fo llowing minist r ies and social work centers:

1. The Minist ry o f Health and Social Policy o f FBiH, Ivica Mar inović,

Minister ’s advisor for social po licy;

2. Public inst itut ion “Cantonal Social Work Center“ Sarajevo, Mirsada

Poturković, Director;

3. Public inst itut ion “Social Work Center” Zenica, Nurka Babović, Director;

4. Minist ry o f Work, Social Po licy and Refugees o f Canton Zenica­ Munir

Babić, Assistant Minister ;

5. Public inst itut ion “Cantonal Social Work Center“ Travnik, Niko la

Lovr inović, Director;

6. The Minist ry o f Health and Social Po licy of Canton Central Bosnia, Vlatka

Komšić, the Minister ;

21 Visits by staff of the BiH Ombudsmen Institution were performed during July of 2009. The visits are performed according to the schedule presented in Annex I of present Report.

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7. The Minist ry o f Helth and Social Po licy o f RS, Ljubo Lepir, Assistant

Minister.

Since the s ituat ion happened to exist in the inst itut ion Pazar ić was very specific

one, the consultat ive interviews were held with:

1. Zuferom Derviševićem, Director of Financial Inspect ions o f FBiH;

2. Nives Kanevčev, Main Prosecutor of Canton Sarajevo

3. Ibrahimom Tirkom, Director of Federat ion Administ rat ion for Inspect ions;

The Team o f BiH Ombudsmen Inst itut ion was composed o f:

• Jasminka Džumhur, Human Rights Ombudsman o f BiH,

• Nives Jukić, Head o f Department for Protect ion o f Persons with Disabilit ies,

• David Tomić, Head o f Department for Eliminat ion of all Forms o f

Discr iminat ion,

• Amira Krehić, Pro fessional Assistant for the Pro ject „Strengthening o f

Capacit ies o f Department for Protect ion o f the Rights o f a Child o f BiH

Ombudsmen Inst itut ion,

• Aleksandra Arsenijević­Puhalo, Professional Assistant for the Pro ject

„Strengthening o f Capacit ies o f Department for Protect ion of the Rights of a

Child o f BiH Ombudsmen Inst itut ion,

• Andrea Raguž, t rainee.

Bas ic method of research was interview aimed to collect ion of informat ion on

subject ive relat ion o f the individuals (opinion, belief, posit ions) concerning certain

social forms, in t his case concretely regarding condit ions o f work, accommodat ion

of users, problems present in ensur ing of their r ights protect ion, at t itude o f staff

regarding accommodated persons, as well as int errelat ions among accommodated

persons, as well as human relat ions among staff. The Ombudsmen were specially

focused on hea lth protect ion, food, working therapy, cases o f eventual abuses by

staff or other accommodated persons and hyg ienic condit ions in the inst itut ions.

3.2. Social Protection Institutions in the Federation of BiH

19

According to the Law on the Taking Over o f Rights and Obligat ions by the

Founders o f Social Protect ion Inst itut ion in t he Federat ion o f BiH 22 , the fo llowing

inst itut ions are taken over in FBiH

1. Inst itut ion for accommodat ion o f mentally disabled persons in Fo jnica,

2. Inst itut ion for accommodat ion o f mentally disabled persons „Bakovići“,

3. Inst itut ion for protect ion of the youth and children in Pazar ić,

4. Inst itut ion for educat ion o f male children and the youth in Sarajevo,

5. Inst itut ion for educat ion o f female children and the youth in Ljubuško.

3.2.1. Appointment of the boards of Directors And Supervisory Boards

The Minist ry o f Work and Social Po licy of FBiH, with consent of the Government

of FBiH, appo inted Board of Directors and Supervisory Boards. Composit ion o f

these bodies contains no representat ives of staff o f the inst itut ions, alt hough there

were such candidates 23 or representat ives of social work centers, except in the

Inst itut ion Dr in, 24 or parents or other relat ives o f accommodated persons.

Appo intments are done in accordance with the Law on Minister ial, Government

and Other Appo intments in FBiH 25 Remunerat ion o f members o f the Boards is KM

100,000 and resources for that purpose are gained from a part of pr ice paid for

accommodat ion o f users, paid by from cantonal budgets. Members o f ment ioned

Boards determined the ir net remunerat ions themselves and it is on the level o f

average salary in FBiH, which is KM 792.88 for June o f 2009, and payment is

from the resources paid by social work centers for accommodat ion of users. 26

3.2.2. Funding and supervision of the institutions

Fund ing o f the work o f intuit ions is ensured from the pr ice o f services, a part of

resources is ensured through donat ions, humanitar ian and other pro jects and

22 „Official Gazette of FBiH”, no: 31/08 23 Three employees of the Institution Bakovići applied 24 1 member of the Board of Directors 25 The Law on Ministerial, Government and Other Appointments of FBiH, (Official Gazette of FBiH, no: 35/03) 26 BiH Ombudsmen Instituion requested the competent minister to provide relevant documentation for process of selection and appointment of members of the boards of directors and supervisory boards of the instituions, however, up to date of completion of this Report requested documentation was not provided.

20

through work on the farms possessed by the inst itut ions. Donat ions in food and

cloths, bed sheets, hygienic and other appliances are mainly provided by cit izens

at the t ime o f religious ho lydays. The inst itut ions get no resources by the

Federat ion which is the founder o f the inst itut ions.

There is not supervision o f pro fessional work and supervis ion o f lawful work of

the inst itut ions, according to Art icle 10 of The Law on the Taking Over of Rights

and Obligat ions by the Founders of Social Protect ion Inst itut ions in the Federat ion

of BiH, since the Minist ry o f Work and Social Protect ion o f FBiH, the Minist ry o f

Just ice o f FBiH, the Minist ry o f Health of FBiH and the Minist ry o f Educat ion,

Science, Culture and Sport of FBiH do not perform any supervis ion. No

inst itut ion is subject to supervision o f the work of staff. At the same t ime,

members o f the Boards o f Directors and Supervisory Boards o f the inst itut ions,

over which the r ight of the founder is overtaken, are employees o f the Minist ry o f

Work and Social Po licy o f FBiH, and which, according to the Law, should perform

supervis ion. This fact opens the issue o f conflict of interests.

3.2.3. Normative and standards of the work of the institutions

In FBiH there is not normat ive or standards o f categorizat ion o f the users,

regulat ions on the way o f accommodat ion o f separate categories of the users in

separate inst itut ions, nether categorizat ion o f t he inst itut ions is done and,

consequent ly, there is not normat ive for preparat ion o f appropr iate normat ive acts

on systemat izat ion o f working posts, professional educat ion o f the employees,

normat ive on number and accommodat ion o f the users, normat ive on food,

hyg iene, normat ive on the work of the employees and number o f users t reated by

the employees. Exist ing work in the inst itut ions is per formed according to

int ernal acts adopted by the inst itut ions themselves and orders by directors, which,

pract ically, may be a source o f misuses and arbit rary behaviors.

In all inst itut ions there is not a single director that is appo inted, and to some

act ing directors t ime o f temporary appointment expired as well, which br ings

under quest ion lawfulness o f the work of these inst itut ions. Vacancy not ices for

the post of directors take place, which is to a great extent non­t ransparent

21

procedure and which const itutes a form o f basic character ist ics o f poor

administ rat ion.

3.2.4. Institution for accommodation of mentally disabled persons „Bakovići“ Act ivit ies per formed by Institution for accommodation of mentally disabled persons

„Bakovići“ (the Institution Bakovići) are social and health care, training for independent life and

work, according to skills and affiliations remained, and work activities for adult persons with

disabilities older than 25, persons with moderate difficulties in physical developing of moderately

difficult and very difficult level, persons with combined difficulties, as well as persons who

completed medical treatment in health institutions.

3.2.4.1. Capacities and avai labi lity

Before the war the Inst ituion Bakovići was a branch unit of the Institution “Fojnica” for

accommodation of persons with lower level of disability. In that period in the Institution Bakovići

sometimes there were accommodated up to 760 persons and average number was 660 persons.

Today’s total capacity of the Institution Bakovići is 375 places. In collective accommodation there

are 347 beds, in 4 housing units of center „Budućnost“ there are 20 beds and in dis located

unit 8 beds. At the t ime o f vis it to the Inst itut ion Bakovići there were 344

accommodated persons in 8 departments, 20 accommodated persons in 4 housing units of center

„Budućnost“ and 8 in dislocated unit in suburbs o f Fo jnica. Men and women live

together, and there are separated rooms fo r men and women.

3.2.4.2. Fulfi llment of basic needs of accommodated persons

a) Health protection

In the Inst itut ion there are not doctors pr imar ily due to the fact

that Inst itut ion Baković i is social protect ion inst itut ion. However, as externa l

associates, there are: neuropsychiat ry specialist working in the Inst itut ion one day

weekly, a general pract ice doctor, two days weekly, and internist who comes to the

Inst itut ion twice a month and a dent ist who comes monthly.

Treatment of the pat ients with place o f residence in other cantons is qu iet difficult

when it comes to hospitalizat ion and procurement of prescr ibed medic ines.

Regarding urgent cases, services o f medical post Fo jnica are used. The nurses

apply therapy according to the inst ruct ions of doctors.

22

Once a year syst emat ic hea lth examinat ion is organized for a ll accommodated

persons, and in the Inst itut ion Bakovići there is permanent ly employed one

phys iotherapist .

According to the employees, there is a rare need for iso lat ion or fixat ion o f

pat ients and iso lat ion is executed according to the Rules on Iso lat ion o f

Accommodated Persons 27 and before iso lat ion measure consu; ltat ion with

neuropsychiat ry specialist is required. In iso lat ion room there are two beds and

day and art ificia l light ing.

b) Work and sport activities

Regarding occupat ional t herapy, there are act ivit ies related to

hyg iene and clear ing o f the rooms, invo lvement and agr icultural work in

surrounding places, for which accommodated persons are remunerated. Within t he

Inst itut ion Bakovići t here is a pork farm, and at the t ime o f occupat ional therapy

accommodated persons are invo lved in kit chen extra jobs, laundry and sewing.

Training for work is organized within paint ing workshop in framework of which

the pat ients produce postcards, ornaments of glass, dray flowers and paper. Work

is also organized in the workshop for handworks o f wool, t read and text ile,

embroidery, crocheted works and tapestries.

Depend ing on degree o f mental disorder, accommodated persons have a possibilit y

to part icipate in sport act ivit ies, where tournaments in check and table tennis are

organized. Addit ionally, accommodated persons part icipate in sport

manifestat ions organized outside o f the Inst itut ion Baković i.

c) Education

Although in the Inst itut ion there is developed program for professional t raining o f

the employees, it is not implemented. The employees t ry to maint ain ear lier

27 The Instituion for Accommodation of Mentally Disabled Persons Bakovići, Instruction no: 02­34­1001/07 of 30.11.2007.

23

established good relat ions with certain inst itut ions in Slovenia, who come in

working vis it s, and cooperate with associat ions from Croat ia and t rying to

implement their exper ience and projects in the Inst itut ion Baković i.

d) Visits

About 20% of accommodated persons do not have contacts with the ir families and

vis it s or interest of competent social work centers is also negligible, so, in this

sense, socia l work centers from Sarajevo and Livno are good examples. Certain

number of accommodated persons is from t ime to t ime vis it ed by their relat ives

3.2.4.3. Price of accommodation

By Decision o f the Board of Directors, no: 02­14­368/09 of 27.02.2009 the pr ice

of accommodat ion is changed and now it is KM 25.50 daily with addit ional KM

3.20 for social protect ion. Total average pr ice o f accommodat ion in the Inst itut ion

Baković i is KM 775.00 which is increased for 10% for immobile or difficult y

mobile accommodated persons. In re lat ion to previous pr ice the pr ice is now

18,7% higher than before. Some cantons, which pay services for accommodat ion

of persons from these cantons, did not agree with increase o f the pr ice, since they

believe that the increase is unjust ified and caused by expenses spent for

remunerat ion of members o f the Board of Directors and Supervisory Board.

Consequent ly, the Inst itut ion Baković i st ill has the o ld pr ices 28 of accommodat ion

for persons from Canton Central Bosnia.

3.2.4.4. Staff

There are 108 employees in t he Inst itut ion Bakovići, out of which there are 4

social workers, 1 pedagogues, 1 speak therapist , 52 medica l workers, 1 of them

with higher educat ion. Besides permanent ly employed persons, there are 3 social

workers employed as t rainees.

28 Insight in bill of accommodation of persons from territory of municipality Travnik (Canton Central Bosnia) for June of 2009.

24

3.2.5. Institution for accommodation of mentally disabled persons in

Fojnica

Inst itut ion for accommodat ion o f mentally disabled persons ­ Dr in (the Inst itut ion

Dr in) is an inst itut ion o f social protect ion and health care, t raining for

independent life and work, according to remained capabilit ies and affiliat ions, and

implementat ion o f work therapy for t he persons with difficult ies in developing, o f

moderate or ser ious degree, persons with combined d ifficult ies, as well as persons

that completed t reatment in health inst itut ions.

In the Inst itut ion there is act ing director, and the director is st ill not appointed.

For the posit ion o f director two employees o f the Inst itut ion submit ted

applicat ions but it is not known whether these two are proposed for the funct ion.

In the Board o f Directors there is only one of the employees o f the Inst itut ion.

3.2.5.1. Capacities and avai labi lity

At the t ime o f visit to Inst itut ion Dr in, there were 520 persons accommodated

there, mainly with more difficult and ser ious disorder, psychiat r ic pat ients and

forensic, among which 120 persons who commit ted cr imina l o ffences o f homicide.

In the Intuit ion there were also 70 children o f all ages and diseases.

3.2.5.2. Fulfi llment of basic needs of accommodated persons

a) Health protection

In the Inst itut ion Dr in basic health protect ion is ensured by presence of one doctor

and one dent ist permanent ly employed and who at the same t ime work on their

spec ializat ion. Alternat ive doctor and dent ist are not ensured, so that the level o f

ensured health care is quest ionable. Specialist examinat ions are done in medica l

post in Fo jnica. In the Inst itut ion Dr in, as well as in other inst itut ions in FBiH,

there is a problem o f health protect ion for accommodated persons from other

cantons.

According to Report on Work for 2008, general pract ice doctor did 2.743

examinat ions. I f urgent intervent ions are needed, they are performed by medica l

post in Fo jnica.

25

According to statements of the employees, fixat ion and iso lat ion are rarely applied

and with appropr iate medicines, and only in the sit uat ion when accommodated

persons are dangerous for themselves and the others. There are not internal rules

on fixat ion or iso lat ion.

b) Work and sport activities

Work and occupat ional therapy are in accordance with degree of disorder o f

accommodated persons, and according to data from 2008 about 50% of

accommodated persons were subject to ment ioned therapy, while such t reatment

was impossible for other accommodated persons due to ser iousness o f their

disorders or diseases.

In the department of work and occupat ional t herapy there are 5 groups: a small

group, classroom and space for t raining for independent life, creat iv worksshoop,

mail and femail work ocupat ion.

In t he small group there are young children who are pr imar ily occupied with

playing games. In the classroom and space for training for independent life there

are person with realist ic perspect ives for independent life. In the creat ive

workshop there are children engaged on preparat ion o f var ious ornaments. In male

and female occupat ional room accommodated persons are occupied in maintenance

of personal hyg iene, cleaning o f the room and product ion of ornament s.

Within the Inst itut ion Dr in t here is a workshop for product ion things o f text ile and

leather and workshop for product ion o f small t hings of wood, within which a

number of accommodated persons are involved according to their capabilit ies and

possibilit ies.

For it s users the Inst itut ion Dr in organizes var ious cultural and sport act ivit ies and

accommodated persons part icipate in manifestat ions organized outside o f the

Inst itut ion. So, on the day o f Ombudsmen vis it , users o f Inst itut ion’s services

were ready to go to watch a cu ltural fo lklore event in Fo jnica. They themse lves

also organize cu ltural events.

Summer t r ips, out ings, concerts are also organized for persons accommodated in

this Inst itut ion and all o f it is funded from resources possessed by the Inst itut ion

Dr in.

26

c) Visits

According to employees, about 170 users are regular ly visit ed by their families.

The relat ives mainly vis it the users monthly, and a certain number o f users go to

vis it the ir families. Through telephone a certain number o f relat ives show interest

for health condit ions of members o f their families. Representat ives o f some social

work centers vis it accommodated persons under their jur isdict ion 1 – 5 t imes per

year.

3.2.5.3. Price of accommodation

Currently, the price of accommodation is KM 25.36 per day plus KM 3.98 for health protection.

Total cost of accommodation in the Institutuion Drin is KM 29.61 per day.

3.2.5.4. Staff

According to data contained in t he Report on Work for 2008 (current data is

approximately the same), in the Inst itut ion Dr in there are 198 employees, out of

which 106 are people who take care about persons with difficult ies in developing,

16 therapists, 24 medical workers, 2 social workers and 2 speak therapists.

3.2.6. Instituion for protection of chi ldren and the youth in Pazarić

Inst itut ion for protect ion o f children and the youth in Pazar ić (the Inst itut ion

Pazar ić) is an inst itut ion o f social protect ion and health care, educat ion and

t raining for independent life and work according to remained capabilit ies and

affiliat ions and implementat ion o f work act ivit ies o f the children and youth wit h

disabilit ies – with difficult ies in psychical developing o f moderate, difficult or

ser ious degree and persons with combined difficult ies ­ younger than 25

There is also available space for accommodat ion o f persons with disabilit ies o lder

than 25 with difficult ies in psychical developing o f moderate, difficult or ser ious

degree and persons with combined difficult ies, as well as for persons who

completed t reatment in a health inst itut ion.

3.2.6.1. Capacities and avai labi lity

At the t ime o f visit in the Inst itut ion Pazar ić there were 384 accommodated

persons, out of which 20 minors. There are 60 immovable persons. In Zovik there

are 73 persons accommodated, 10 persons in t he family house established within

27

program „Internat ional Village Ramići“, and the rest of them are accommodated in

Resnik.

According to employees, for t he t ime being, in the Inst itut ion Pazar ić there are

more persons than the capacit ies o f the Inst itut ion allows from the aspect of

fulfillment o f their basic needs, since other inst itut ion refuse to accept persons

with less or more ser ious diseases.

3.2.6.2. Fulfi llment of basic needs

a) Health protection

In the Inst itut ion Pazar ić health protect ion is at the level o f basic health protect ion

ensured by one doctor of general pract ice and one nurse. The doctor is at the same

t ime act ing director. Concerning consultat ive and specialist 's or secondary healt h

protect ion, two t imes per month doctors from Clinical Centers in Sarajevo and

Konjic: neuropsychiat ry specia list , gyneco logist , internist and dent ist examine

accommodated persons. Dental health protect ion is reduced to teeth extract ion.

Clinical and hospit al t reatment is a part icular problem. Clinical Center Sarajevo

does not provide services to ill persons whose health insurance is paid in other

cantons and sending ill persons to hospitals according to their place o f residence is

a special problem and takes a lot of t ime.

According to the Report on Work for 2008, doctor of genera l pract ice examined

1.490 persons. According to the employees, animosity between hospital staff is

felt when hospit alizat ion is necessar ily needed, since there exist certain barr iers

towards such category o f persons.

Ident ical problem exists concerning procurement of medicines and the pharmacies

refuse to provide medicines for accommodated persons who are insured in other

cantons. Urgent medical intervent ions are ensured by Medical Post Hadžići.

Fixat ion and iso lat ion is applied when accommodated person is self­danegerous or

dangerous towards the others. According to the employees, iso lat ion is approwed

fo llowing consult at ion with t he doctor and acording to assessment of medica l

worker.

28

On the occasion of visit o f Ombudsmen team, representat ives o f Ombudsmen

Inst itut ion took a look at iso lat ion room and determined that there is not enough

day light ing in this room and art ific ial light does not exist at all, as well as a bed

or a chair. Somet imes iso lat ion took more than 8 hours ( insight in the reg ister of

iso lat ion), yet iso lat ion usually takes 1 – 2 hours.

b) Work and sport activities

Occupat ion therapy is organized according to abilit y o f accommodated persons.

Mainly it is maintenance o f personal hygiene, cleaning o f the rooms and assist ance

in the kitchen and hens farm, and according to data from the Report on Work for

2008 80% of accommodated persons part icipated in ment ioned act ivit ies. Training

for work is organized through product ion o f tapest r ies, embroidery, clay ornaments,

pieces made of wood, graphical workshop, workshop for ergo­therapy and painting workshop.

According to data contained in t he Report on Work for 2008, in this year about

25% of users were comprised by program o f t raining for work. These persons

exercise t he r ight to remunerat ion which is used for procurement o f certain stuff

for Inst itut ion’s cant ina, since the users do not get money.

Accommodated persons able act ively to part icipate in sport act ivit ies taking place

in the Inst itut ion Pazar ić part icipate in sport act ivit ies. They also part icipate in

such act ivit ies organized by similar inst it ut ions.

c) Education

Educat ional segment is not organized in the Inst itut ion. There st ill remains prewar

cooperat ion and exchange o f exper iences between inst itut ions in BiH dealing with

the same issue, as well as cooperat ion with the inst itut ions from the terr itory o f

former SFRJ.

d) Visits

29

According to data contained in the Report on Work for 2008, in t his year there

were registered 800 vis it s by the parents, guardians and relat ives.

In the Inst itut ion Pazar ić there are rooms for contacts between users and vis itors.

Meet ings o f parents are also organized. A certain number of users vis it their

families for short or long per iod of t ime.

3.2.6.3. Price of accommodation

According to the employees, the pr ice o f accommodat ion is determined according

to st ructure of all expenses spent for each accommodated person monthly,

fo llowing which expenses for salar ies and other remunerat ions o f the staff o f the

Inst ituion. Since March o f 2008 the pr ice is KM 657 monthly for mobile users,

wich is increased for 10% for immobile pewrsons.

3.2.6.4. Staff

There are 107 employed persons, out of which there is one doctor (at the same

t ime he is act ing director), 2 speak therapist , 1 psycho logist , 14 educat iona l

persons (teachers o f preschoo l educat ion and school educat ion), 40 persons o f

var ious pro fessiona l t ypes, 6 nurses, 3 social workers, 8 work therapists and 2

phys iotherapist s. Staff mainly works in the Inst itut ion for long years now. Dur ing

ombuds­vis it and according to available documentat ion, there exist mobbing

towards some o f the employees and they are significant ly excluded from the

process o f planning act ivit ies and work with accommodated persons, alt hough they

are pro fessional and qualified workers. Staff is without access to informat ion,

there are not professional meet ings but only meet ings o f closed circle o f the

employees, depending on the ir obedience. Such situat ion is mirrored in human

relat ions, due to which the employees suffer from apathy, exclusion from

community, inabilit y, feeling o f absence from the system and constant rule o f

minor it y. Lately, in the Inst itut ion there is present nepot ism, which leads to

further aggr ieving o f already aggravated human relat ions.

3.2.7. Center for the elderly and infirm, and homeless persons Duje, municipality Doboj

Istok

30

Center for the elderly and infirm, and homeless persons Duje, municipality Doboj Istok

(the Center Duje) is established by the NGO „Forum so lidarnost i“ Gračanica.

This organizat ion is a member o f int ernat iona l network of NGOs „Emmaus

Internat ional“. Main act ivit y o f this organizat ion is assistence to vulverable

categories, so that the Oraganizat ion impplement a number o f act ivit ies related to

refugees, displaced persons, vict ims o f t rafficing and domest ic vio lance, and teir

latest act ivit y is establishment o f the Center for the elderly and infirm, and homeless

persons. The Center accept cit izens according to the contract concluded with

competent minist r ies, and fo llowing procedure conducted by social work center. In

the Center Duje there are accommodated several persons who commit ted cr imina l

offence in t he state of mental incompetence. The Center is situated in the ter itorry

of the munic ipalit y Dobo j Istok and it is 3 km away from the main road between

Dobo j and Tuzla.

3.2.7.1. Capacities and avai labi lity

At the t ime o f ombuds­vis it to the Center Duje, in 7 pavilions there were 324

accommodated persons. Most of them are from Canton Tuzla (275). There are 101

mentally disabled persons, out of which 10 are the minors. 50% of accommodated

persons are mentally disabled persons with job incapabilit y. Immobile persons,

requir ing addit ional care and med ical assistance are placed in one of the pavilions.

Users are accommodated in t hree­beds rooms on the ground floor, containing

sanit ary and hygiene premises adapted for disabled persons. Due to donat ions o f

int ernat ional organizat ion „Emmaus Internat ional“, there is also adjusted

equipment for bathing o f immobile persons. Capacity o f t he Center is broader than

it is actually occupied and it is 450 persons o f all categories ent it led to

accommodat ion.

3.2.7.2. Fulfi llment of basic needs of accommodated persons

a) Health protection

In the Center Duje significant attent ion is paid at health protect ion, since the

category o f accommodated persons is o f such character which requires addit ional

attent ion. Unfortunately, in the Center Duje there are not permanent ly employed

doctor of general pract ice, neuropsychiat ry specia list , lawyer and social worker.

31

They are employed according to contract of work. At the t ime o f ombuds­vis it

general pract ice doctor was in the Center and through contacts between the doctor

and accommodated persons it could be concluded that human relat ions are very

well develop that are result o f high level o f devot ion o f t he doctor towards his

tasks. Although the doctor is employed by the contract of work, the fact that he is

a person who is not employed by any other inst itut ion but he is a pensioner created

the possibilit y for the doctor to work with the pat ients even more than it is

envisaged by the contract , and exact ly this fact was vis ible through his at t itude

towards accommodated persons. Urgent cases are mainly reso lved by Medical Post

Dobo j Istok, and there exist good cooperat ion with health inst itut ions in Dobo j and

Tuzla. The issue of health protect ion in this Center is not that much problemat ic

as in the others, since the main number of accommodated persons is from terr itory

of Canton Tuzla, where they have status o f socially insured person. In large

number of cases the Center cooperates with cantonal health inst itut ions, including

procurement o f orthopedic equipment , and certain number o f such equipment is

donated by internat ional organizat ion „Emmaus Internat ional“, which part icular ly

applies to whee lchairs for immobile persons. .

Regarding accommodated persons from other cantons or Republika Srpska, the

Center concludes contracts with health insurance funds, and in this way the issue

of health protect ion of such persons is resolved.

According to the staff, in the Center Duje fixat ion and iso lat ion is not applied

even in the sit uat ions when accommodated person is self­dangerous or dangerous

towards the others. Such persons are calmed down only by appropr iate medicines.

b) Work and sport activities

Occupat iona l t herapy is organized in var ious forms. Center Duje concluded a

contract with a pr ivate firm on product ion o f small it ems used in industry and the

users are paid o f KM 50 – 70 monthly. There are developed var ious other o f

occupat ional t herapy, which part icular ly applies to work in t he sect ions led by

inst ructors employed by the Center. Training for work is organized through

workshops for product ion o f embroidery, crocheted works and tapestries and clay ornaments.

A small number of persons is engaged in maintenance of hygiene, laundry and production of

vegetable, as well as in graphic and painting workshop.

32

c) Education

In the Center the segment of educat ion is st ill not regulated, however consult at ive

meet ings are already held with the director of pr imary schoo l Dobo j Ist ik.

d) Visits

Visit s by the families, guardians or relat ives are quite frequent , and the main

obstacle for more frequent vis its is financial situat ion of the visitors. 29

In the Center there is a room for visit s. Meet ings o f the parents are organized,

too. The users of the Center have got on their disposal a telephone boot, and

dur ing the weekend the users may use telephones o f t he administ rat ion o f the

Center without any limit s.

3.2.7.3. Price of accommodation

According to the employees, the pr ice of accommodat ion is determined on the

basis o f the t ype o f accommodated person and it depends on whether a user is

immobile or mobile person and according to the degree o f mental disorder. I t is

between KM 500 and 900. Resources got from the pr ices can cover salar ies o f the

staff and maintenance, while significant part of maintenance expenses, part icular ly

those related to food and cloths is covered from donat ion.

3.2.7.4. Staff

There are 105 persons employed by the Center and only 4 persons are of higher

educat ion. As already ment ioned these people have contracts of work. The

greatest number of the employees is medical technicians (51), persons who take

care o f the users (4), ma in nurse (1) phys iotherapist (2) cooks and cleaning women

(10) hair dresser (1) and inst ructors of various t ypes.

3.3. Social work institutions in u Republka Srpska

3.3.1. Home for the children and youth with difficulties in developing in Prijedor

29 The staff emphesized example of the father who visits his son once a month, at the time of gettin the pension.

33

Activities of the Home for the children and youth with difficulties in developing in Prijedor (the

Home Prijedor) ensure male children and the youth with difficulties in developing or autism full

and long­term accommodation, appropriate forms of education and training for work in accordance

with psychical and physical conditions. According to Decision of the Government of RS no: 02­

323 of 22. 08. 1995 30 , which also contained Rules on Economists and Psychiatrists, the founder of

the Institution is Republika Spska. According to the director, cooperation with the Board of

Directors is quite good and the members of the Board hold sessions in the Institution and visit

accommodated persons. The Ministry of health and Social Policy (the Ministry) is competent for

professional supervision and due to determined omissions, the Ministry ordered the Home to

undertake urgent measures. Based on the Report on the Situation of 2007, prepared by the

commission appointed by the Ministry, the Institution renewed and adapted children's pavilion,

kitchen and dining room, and procured required furniture.

3.3.1.1. Capacity and availabi lity

Accommodat ion capacity o f t he Home Pr ijedor is 225 beds, and at the t ime o f

ombuds­vis it there were 211 persons, out of which 30 children.

3.3.1.2. Fullfi lment of basic needs of the users

a) Health protection

According to the employees, health protect ion is ensured adequately, since al l

users are insured through medical post Pr ijedor except those coming from FBiH.

One phys iotherapist is permanent ly employed. According to data contained in t he

Report on Work for 2008, external associates are: one doctor of general pract ice,

psychiat r ist , dent ist and phys iat r ist . In 2008 there were 520 health examinat ions

and general systemat ic medical examinat ion is organized once a year.

In the Home there is iso lat ion room, however, according to director, this room is

not used but aggressive behaviors are t reated by medic ines. I t is prescr ibed by

Decis ion on Establishment of the Rules on Reduct ion/Iso lat ion of Dist ressed

30 This decision has been changed by the Decision of the Government of RS, no: 04/1­012­1808/08 of 17. 07. 2008)

34

Users, no: 01­2535a/07 o f 28. 12. 2007, adopted by the d irector of t he Inst itut ion.

Fixat ion is applied quite rarely and it is executed upon approval o f t he

psychiat r ist .

b) Work and sport activities

Occupat iona l t reatment is organized through maint enance o f personal hyg iene and

cleaning o f the rooms, product ion o f fruit s and vegetables in the open space o f 1,3

hectares. Besides, there is work therapy on pork farm, which is within the

Inst itut ion, and tapest ry workshop, kitchen and laundry. In the Inst itut ion there are

adequate objects for agr icultural act ivit ies and vegetable and grain storage,

inc luding a t ractor for work on the so il. This equipment makes good condit ions for

organizat ion o f work therapy. According to the employees, about 60% of

accommodated persons are invo lved in work and occupat ional therapy.

Sport sect ion is act ive as well and t radit ionally it acquires good results in

organized sport manifestat ions.

c) Education

At the t ime o f ombuds­visit , 18 children were at schoo l „Đorđe Natošević“, where

curr icula is adapted for children with special needs. According to the Report on

Work for 2008, educat ional and t raining act ivit ies were applied towards 19

accommodated persons: development o f psychometr ics and phys ical t raining,

developing o f speak, social development and care, music lessons and paint ing

lessons, environment knowledge and work t raining. Educat ional areas are divided

in 4 levels and each takes 3 years. 31 However, according to the director and the

staff, the Minist ry o f Educat ion and Culture stopped to finance educat ional work,

which resulted in cessat ion of organizat ion o f descr ibed process.

d) Visits

31 In the first year the first level was attended by 4 pupils, third year 5 pupils, while forth year was attended by 10 pupils. Second year was attended by 6 pupils and third by 4 pupils.

35

60­70% of users are in regular contacts with their families and, according to the

staff, each accommodated person who whishes to telephone is enabled to do it

from the o ffice o f social worker. The main number of accommodated persons is

from Pr ijedor and Banja Luka, and vic init y o f the Inst itut ion enables frequent

vis it s.

3.3.1.3. Price of accommodation

Pr ice o f accommodat ion for mobile is KM 595 and for immobile persons KM 650,

and for persons from FBiH KM 750. Reason for higher pr ice for persons fro FBiH

is in the fact that competent minist r ies do no co­ financing of accommodat ion.

Social work centers are obligated to pay full pr ice of accommodat ion, yet ,

according to the director, co­financing is also provided by the Minist ry o f Health

and Social Protect ion o f Republika Srpska.

Competent minist ry also provides finances for adaptat ion and equipment necessary

for the work o f t he Inst itut ion and renewal o f children's department , kitchen and

dining room is rea lized from these resources. Financing o f the act ivit ies o f this

Inst itut ion is also ensured from the pr ice of it s services and a part of finances

comes from donat ions and humanit ar ian and other pro jects. Updated charge for

accommodat ion is 80% because the Inst itut ion paying for accommodat ion now

transfers the money through the t reasure. Specific problem o f this Inst itut ion is

financing o f 7 persons from the terr itory of the Republic o f Croat ia (dur ing the

war they happened to be in t his Inst itut ion) and competent organs o f the RH refuse

to take over financial care about these persons in some similar inst itut ions in

Croat ia.

3.3.1.4. Staff

In Home Pr jedor there are 71 employees: 31 persons taking care o f users, 2 work

inst ructors, 2 medical technic ians, 2 physiotherapists, 5 speak therapist s and one

social worker. At the moment the new systemat izat ion is prepared and it is

planned in conformity with users ' needs, since there is a need for larger number o f

professional staff.

3.3.2. Instituion for protection of female children in Višegrad

36

Act ivit ies o f Inst itut ion for protect ion of female children in Višegrad (the

Inst itut ion Višegrad) is to ensure accommodat ion o f children with difficult ies in

developing caused by family circumstances unt il condit ions for return to their

families, adopters or foster families are ensured, i.e. unt il the users are equipped

for independent life. Dur ing accommodat ion care, health care, educat ion and

t raining for independent work for users is ensured. According Decis ion o f the

Government of RS, no: 02/1­020­376/03 of 15. 05. 2003 32 , the founder o f the

Inst itut ion is t he Government of RS. The Board of Directors is established in 2008

and is composed o f 3 members: a lawyer, an economist and a professor of

socio logy. According to the director, he is content with cooperat ion with the

Board. Competent Minist ry supervises the work of the Inst itut ion and approve

recept ion o f new accommodates.

3.3.2.1. Capacity and availabi lity

Capacity o f the Inst itut ion Višegrad is 190 beds. At the t ime o f ombuds­vis it in the

Inst itut ion there were 150 persons accommodated, out of which about 20 of 10­18

years o ld. In cooperat ion with competent Minist ry the management t r ies to realize

project of construct ion of object for alternat ive forms o f inst itut ional care, which

would enable easier socializat ion and adaptat ion for life in the society (so­called

„Houses on the half o f the way“).

3.3.2.2. Fulfi llment of the basic needs of accommodated persons

a) Health protection

According to the employees, basic health protect ion is at appropr iate level, and as

external associates 2 psychiat r ists and 1 doctor of general pract ice re engaged in

the work o f the Inst itut ion. Neuropsychiat ry specialist comes 1 – 3 t imes monthly

or whenever he/she is needed, while general pract ice doctor examines

accommodated persons week ly. The Inst itut ion Višegrad it self ensured space for

medical act ivit ies. Gyneco logy and other specia lists’ examinat ions take place on

regular basis. According data contained in the Report on Work for 2008, genera l

32 This decision has been changed by the Decision of the Government of RS, no : 04/1­012­1811/08 od 17. 07. 2008 godine.

37

pract ice doctor performed 379 examinat ions. According to the employees, iso lat ion

and fixat ion are applied very rarely and only in t he cases when accommodated

persons are extremely aggressive. I so lat ion must be approved by the main nurse

with pr ior consult at ion with neuropsychiat ry specia list . Iso lat ion is applied

according to the Inst ruct ion adopted by the Director of t he Inst itut ion. It is

executed through applicat ion o f magnet ic handcuffs and such fixat ion is less

painful for users.

b) Work and sport activities

Work and occupat ional therapy is organized through embro idery, knott ing,

crocheted works and tapestries production, and through art workshop. Work and occupat ional

t reatment also includes work on pork and chicken farms and maintenance o f

personal hygiene and cleaning o f the rooms.

c) Education

In 2008 5 users of 14­30 at tended educat ional work in t he fo llowing areas:

development o f psychometr ics, development of speak, get t ing acquainted with the

surroundings, self­care and social development , work t raining, paint ing and music

lessons.

d) Visits

About 30% of accommodated persons contact their families on regular bas is and

40% of them regular ly contact their families through telephone. According to the

employees, staff o f t he Inst itut ion put a lot of efforts to mot ivate the relat ives

more frequent ly to contact accommodated persons.

3.3.2.3. Accommodation price

The pr ice for mobile persons is KM 595, immobile persons KM 650 and persons

from FBiH KM 750. The situat ion regarding users from FBiH, is the same as in

the Inst itut ion Pr ijedor: competent minist r ies do not co­financing accommodat ion.

3.3.2.4. Staff

38

According to the Report on Work for 2008, in t he Inst itut ion there are 51

employed persons, out of which 1 is engaged in educat ional work, and there is 1

social worker. Direct care of accommodated persons is per formed by 13

employees, while in health protect ion there are 11 persons and 2 persons are work

inst ructors.

3.4. Consultative meetings

Consultat ive meet ings held between ombuds­de legat ion and representat ives o f

certain competent minist r ies, social work centers and other inst itut ions, which

took place fo llowing visit s to mental health inst itut ions, were aimed to get

informat ion on the manner and problems related to accommodat ion in mental

health inst itut ions. Since t he problems are determined in t he Inst itut ion Pazar ić,

addit ional meet ings are organized with representat ives o f financia l inspect ions o f

FBiH, the Prosecutor’s Office o f Canton Sarajevo and Federat ion Administ rat ion

for Inspect ion Businesses. Due to specific findings, BiH Ombudsmen decided to

elaborate the situat ion in the Inst itut ion Pazar ić in more detail in a separate

Special Report .

3.4.1. The Ministry of Work and Social Policy of FBiH

At the meet ing it was confirmed that The Minist ry o f Work and Social Po licy o f

FBiH did not take any steps towards supervision o f the inst itut ions, since it

considers that appointment of director should be done fir st . Accordingly,

normat ive acts are not adopted neither standards that would proper ly organize t he

work of the inst itut ions, and the fact that remunerat ion o f members o f the Board o f

Directors and Supervisory Boards are paid out of charges for accommodat ion,

which is paid by the cantons. The Minist ry did not establish it s organizat ional

st ructure that could ensure payment to services o f the inst itut ions but the pr ice is

paid by the Sector for Social Protect ion and Protect ion o f Families with Children.

3.4.2 The Ministry of Work and Social Policy of Canton Zenica­Doboj

The Ministry of Work and Social Policy of Canton Zenica­Doboj, in accordance with Article 57 of

the Law on Basic Social Protection, Protection of Civil Victims of the War and Protection of

39

Families with Children of Canton Zenica­Doboj, concluded general contract with the institutions for

accommodation of mentally disabled persons.

This contract is concluded with 19 inst itut ions, and individual contracts are

concluded with the Inst itut ion Duje and the Peace Village Čit luku (church

organizat ion). Dur ing the talks it was st ressed that the Minist ry did not provide

consent for increase o f accommodat ion prices in the Inst itut ion Baković i, however

the new pr ices are paid. All payment s for services provided to accommodate

persons are paid from the budget of Canton Zenica­Dobo j and there are no

addit ional resources provided by FBiH. Through ad hoc commission the Minist ry

performed revis ion of all decis ions on accommodat ion in t he inst itut ions

regardless o f the fact that the members o f the Commiss ion do not have this

responsibilit y in descr ipt ion o f their dut ies. Revision cont inued as a permanent

process on the occasion o f taking decis ion on every new accommodat ion.

3.4.2. Social Work Center Zenica

Social Work Center prepares request and proposal for accommodat ion in an

inst itut ion and it shell be referred with support ive documentat ion (socia l

anamnesis, informat ion on relat ives, property health and other relevant

documentat ion) to the Minist ry o f Work and Social Po licy o f Canton Zenica­

Dobo j.

Most frequent ly Social Work Center appears as submit ter of request for withdrawal

of work capacity in extra­ judic ial court procedure. This as an addit ional burden

for Social Work Center and, before all, financial expense not planned in the budget

and it is related to remunerat ion o f court experts and courts frequent ly request

these payments to be paid in advance. Socia l work centers are competent for

accommodat ion in an inst itut ion only fo llowing complet ion o f medical t reatment in

medical inst itut ions (hospitals). In pract ice, mentally disabled person is

accommodated in an inst itut ion before withdrawal o f work capacit y, since t here is

not any other so lut ion. Due to such pract ice and the fact that inspectors, during

conduct ion o f pro fess ional supervision, found a number o f persons accommodated

in the inst itut ions without withdrawal of work competency by decision o f

competent organ, revis ion o f such cases was conducted by the Minist ry o f Work

and Social Po licy o f Canton Zenica­Doboj and this revis ion procedure, alt hough

40

not established by law, has become a part of regular procedure. Revis io n

procedures related to already withdrawn work capacity also take place.

Guardians are assigned to users of services o f social protect ion inst itut ions and it

is most frequent ly social worker, since the relat ives do not want to take over this

responsibilit y. For responsibilit y o f guardian members o f social work center are

not remunerated, alt hough such remunerat ion is prescr ibed by law. So, in Social

Work Center there is case where 1 social worker is the guardian to 41 persons with

withdrawn work capacity and accommodated in the inst itut ions.

On annual basis t he inst itut ions submit reports to social work centers in which

they inform on all changes o f users. Occasion o f new accommodat ions is used as

an opportunity for vis it s by social workers to already accommodated persons. On

the occasion o f conclusion o f contracts social work centers are requested to

examine whether user possess health booklets, and where secondary health

t reatment is needed, social work centers have to ensure decision for t reatment of

user from other canton.

Concerning accommodat ion, social work centers are not in a possibilit y to select

an inst itut ion and it is done according to the pr incip le o f empty beds, i.e. where an

inst itut ion is in a possibilit y to accept a new user. Sentenced persons with menta l

incapacity are placed at forensic depar tment o f pr ison Zenica. There are 4

persons, registered by social work center, with forwarded final court decisions.

There are 42 persons employed by socia l work center.

3.4.3. The Ministry of Health and Social Protection of

Canton Central Bosnia

The Minist ry o f Health and Social Protect ion o f Canton Central Bosnia (the

Minist ry) supervises the work of inst itut ions o f social protect ion only if they are

in the terr itory o f Minist ry's jur isdict ion and in accordance with provisions o f the

Law on Social Protect ion o f Canton Central Bosnia. So, the inst itut ions Dr in and

Baković i are supervised by the Minist ry since 1998. Cantonal inspector is o f the

posit ion that both inst itut ions are overcrowded by accommodated persons and the

situat ion is worse in t he Inst itut ion Dr in.

41

Persons are accommodated in these inst itut ions based on their d iagnosis or

according to court decision on withdrawal o f work competency where

accommodat ion is recommended by court .

Representat ives o f the Minist ry st ressed the problem o f lack o f cooperat ion

between the cantonal Minist ry and the Minist ry o f the Federat ion of BiH, and there

is also a complaint due to increased pr ice of accommodat ion in the Inst itut ion

Baković i. In this Canton there also exist problem o f accommodat ion person who

commit ted a cr iminal o ffence in the state of mental incapacity and, for the t ime

being, there are 6 such persons registered, out of which 1 is accommodated in the

Inst itut ion in Jakeša and some o f them in the Inst itut ion Duje (Dobo j Istok).

Complaints related to the condit ions in the inst itut ions are more oral than in

wr it ings, which especially applies to the Inst itut ion Duje. Inter­ent it y contract on

payment of services is not concluded.

In the Inst itut ion Dr in, in the same Canton, there are 56 accommodated persons, in

the Inst itut ion Baković i 100, Pazar ić 39 and Duje 3 users who commit ted cr imina l

offence. Representat ives o f the Minist ry vis it the inst itut ions 4 – 5 t imes per year

and in t he Minist ry there are only 18 employees responsible for health and socia l

protect ion.

3.4.4. Social Work Center Travnik

There are 12 employees in the Social Work Center Travnik and according to the

Rules on Internal Organizat ion, there should be 17 employees. Out of 12, 5 are

social workers, one accountant with secondary educat ion and 5 are support ive staff

and the director.

In 2008 there were 91 persons accommodated in a ll t ypes o f inst itut ions by the

Center. Users are accommodated according to the pr incip le o f empty beds. The

Center pays accommodat ion depending on amount received by the Minist ry.

Fo llowing medical examinat ion the doctor prepares recommendat ion in which

inst itut ion to accommodate certain person and most frequent ly these are Dr in and

Baković i.

Some o f the users requested to be accommodated in inst itut ions in Jakeša and

Soko lac but they are put on the wait ing lists. .

42

Employees of t he Center are most frequent ly guardians o f accommodated persons,

since the relat ives are too busy to take over this responsibilit y. The Employees o f

the Center are not remunerated for the ro le of a guardian. Due to lack o f resources

the guardians vis it accommodated persons rarely, most frequent ly when they

accommodate a new person. Regarding health situat ion o f accommodated persons,

the Center is regular ly informed. Persons accommodated in t he inst itut ions are

mainly in legal procedure o f withdrawal of work capacit y. Concerning property,

commission is formed and goes to the spot where it makes inventory o f property.

Decis ion on medica l t reatment outside o f the Canton is needed for exercise o f the

r ight to health protect ion. In pract ice, persons who need an urgent t reatment are

accommodated in hospitals and dec ision on medical t reatment outside t he Canton

is issued later. This procedure takes 10 days. The Minist ry is o f the opinion that

the work of the inst itut ions should be supervised by the inspect ions and it is also

necessary that employees o f social work centers are members o f board o f directors

of the inst itut ions.

3.4.6. Public Institution: Cantonal Center for Social Work of Canton Sarajevo

According to director of Public Institution: Cantonal Center for Social Work of Canton Sarajevo,

(the Center), since 1992 there exist standards and normative of social protection and since the same

year the status of social work institutions is not resolved, due to which the institutions work

according to unwritten rules and based on the Teams that takes decisions independently.

Social work centers know no standards or criter ia according to which to work.

Based on diagnosis, the social r ights centers freely assess, to which inst itut ion to

accommodate the users. As a rule, request for accommodat ion is forwarded to all

inst itut ions unt il some o f them accept to accommodate a person, and if no

inst itut ion is ready to accept a user, the user stays in it s environment . Social work

centers are not sure whether they accommodate a person in the r ight inst itut ion,

since their opinion is that it is bet ter to accommodate a person anywhere than

nowhere.

43

What is current ly happen in the inst itut ion leads to conclusion that there exist to

system or law and that the State does not care about work of the inst itut ions, so

the inst itut ions get around themselves and accept all users for whom payment of

the pr ice o f accommodat ion is ensured, since only in this way an inst itut ion can

funct ion.

With regard to the Inst itut ion Pazar ić, no person without categorizat ion can be

accommodated in t his Inst itut ion regardless o f sex and age. However, this standard

is reserved only because the Inst itut ion has got enough number o f requests for

accommodat ion. Categor ies that are not accepted are people o f less ser ious

disorders and mentally ill persons. The Inst itut ions Dr in and Baković i do not st ick

up with prewar standards, according to which children were accommodated in the

Inst itut ion Dr in and adult persons in the Inst itut ion Bakovići. Regarding social

work centers, they do not have accommodat ion wait ing lists, while such lists are

possessed by the inst itut ions themselves.

For mentally ill persons – whose disorder came from consuming o f alcoho l or

narcot ics – t here is a wait ing list , s ince there are not capac it ies for their

accommodat ion and the Inst itut ion Bakovići ma inly do not accept such persons.

Generally, t he inst itut ions do not st ick up with prewar cr iter ia prescr ibed by the

inst itut ions t hemselves but the directors apply self­prescr ibed standards. Social

work centers from terr itory o f Canton Sarajevo take decisions on accommodat ion

in t he inst itut ions (together with support ive documentat ion) and forward proposals

of contracts to the inst itut ion where a person is to be accommodated. In other

cantons social work centers only take decis ions on accommodat ion and competent

minist r ies conclude contracts.

Such contracts are o f purely obligat ion nature and contain provis ions on obligat ion

of payment o f accommodat ion and supervision o f care for accommodated persons.

Guardianship is determined in accordance with the Law on Mental Hea lth, where

social work centers, upon proposal o f medical team, init iate procedures. Procedure

for withdrawal o f work capacity is init iated if a user does not want to be

accommodated in an inst itut ion o f his/her own will. The main problem is the fact

that no­one from the family or remote relat ives do not wish to be a guardian to

such person. Because o f this social work centers take over this responsibilit y,

alt hough actually t hey no t ime to be commit ted to the ro le o f a guardian as it is

prescr ibed by family legislat ion. For fulfillment o f this obligat ion social work

44

centers get no resources or refunding o f expenses, and having in mind that they are

obligated to be guardians for 10 or more persons, object ively the Centers in their

working hours can not meet this obligat ion. There is not pract ice applied by the

inst itut ions to include guardians and inform them on the sit uat ion o f

accommodated persons, nether on the manner of t reatment and rehabilitat ion.

Each month social work centers pay approximately KM 150,000 to the Inst itut ions

Dr in and Pazar ić, and KM 160.000 to the Inst itut ion Baković i, since the pr ice o f

accommodat ion in ment ioned inst itut ions for the users from Canton Sarajevo is

KM 880, and it could be assessed that the inst itut ions earn fine, and that they

could bet ter finance their act ivit ies. The inst itut ions provide reports on healt h

situat ion o f users only upon request of a guardian and these are three­months or

six­months reports. As it is defined by law, guardians should be remunerated but

actually t hey are never paid and they are content with formal report ing by the

inst itut ions related to health condit ion of accommodated person. 33

3.4.7. The Ministry of Health and Social Protection of Republika Srpska

According to Assistant Minister, Mr. Ljubo Lepir, this Minist ry is since 2006

significant ly invo lved in improvement o f the services provided by the Inst itut ions

in Višegrad and Pr ijedor, and for per iod from 14 to 19.09 2009 it p lans to visit the

Inst itut ion in Višegrad. The Minist ry fulfils it s legal obligat ion of supervis ion o f

the work of ment ioned inst itut ions, so in 2007 it controlled the work of the

Inst itut ion in Pr ijedor, on the occasion o f which certain irregular it ies were

determined. These irregular it ies are later, according to knowledge o f Mr. Lepir,

are corrected. Addit iona lly, the Minist ry is provided with completely elaborated

requests for accommodat ion and the requests are approved by the Minist ry.

With regard to financial o f resources, the Minist ry finances adaptat ion and renewal

works on the objects o f t he Inst itut ion and co­finance a part of expenses for

accommodat ion (procurement of heat ing fuel and mater ial and technica l

equipment).

3.4.8. Public Institution Social Work Center Banjaluka

33 With regard to social protection, there was a body composed of doctors, representatives of social work centres, faculty professors which was obliged to visit the institutions several times a year, prepare report on situation that happened to exist and propose measures for elimination of the problems and at the same time to work on collection and distribution of resources for these purposes and priorities, and, of course, to follow up realization of planned activities. Slovenia and Serbia partly still apply legal solutions from ex­Yugoslavia and Slovenia harmonized mentioned legal solutions with international standards and for the moment Slovenia in the best way regulated issues from the area of social protection in the Region.

45

Director of Social Work Center Banjaluka (the Center) informed representat ives o f

ombuds­ inst itut ion that the Center, when it is about the persons with difficult ies in

developing, provides a system o f protect ion and services in co­operat ion with the

NGOs. In t he Center there is special department for work with children with

spec ial needs and department for accommodat ion o f persons with difficult ies in

developing in adequate inst itut ions. According to director, co­operat ion with the

Inst itut ions in Višegradu is important for improvement that took place in last two

years, i.e. since the per iod when the Center together with the Minist ry conducted

revis ion o f accommodat ion in ment ioned inst itut ions. On the occasion o f revis ion

it was determined that certain number of accommodated persons was in the

inst itut ions, a lt hough they did not meet prescr ibed condit ions. It was also

determined that a large number of relat ives do not meet their obligat ion for

foster ing, due to which the Center put a pressure on the relat ives. The Center

regular ly insist s that the relat ives should vis it the users and show interest

concerning their condit ion. The relat ives who are assigned to be guardians have

obligat ion to provide the Center with reports quarterly.

A smaller number o f accommodated persons, who are within competence of the

Center, are accommodated in similar ins t itut ions in terr itory o f FBiH. And their

t ransfer depends on themselves, that is , those who are for a long per iod in

inst itut ions Dr in, Baković i and Pazar ić do not want to change the environment ,

alt hough it would be rat ional if they were accommodated in Pr ijedoru or

Višegradu because it is cheaper.

Concerning financing o f t he Center, director emphas izes that up to date she was

content with financia l support from the budget of t he cit y however she draw

attent ion at the fact that for next year reduct ion o f budgetary resources is planned.

She says that the Center regular ly pays its obligat ions towards all inst itut ions

where the users o f the Center are accommodated. She part icular ly st ressed that

upon insist ing and in cooperat ion with t he Social Work Center Višegrad a housing

unit was adapted for living within t he project „living with a support“. As to

procedure of accommodat ion, a request is examined by the experts (psycho logist ,

socio logist and lawyer), fo llowing which the council exist ing within the Center

(Council for Children and Council for Adult Persons) takes decis ion on

accommodat ion in the inst itut ions. S ince last year, apart from this procedure,

parallel procedure is conducted related to assessment whether a user should be

exposed to withdrawal o f work capacity, fo llowing which, if needed, appropr iate

46

procedure is init iated before court . Categor izat ion is per formed concerning the

children younger than 15, i. e. evaluat ion o f t he degree o f difficult ies in

developing..

Fina lly, the director drew at tent ion at the fact that the Center excellent ly

cooperates with large number o f the NGOs.

47

IV Observations and Concerns of the Ombudsmen

4.1. Positive observations Funct ioning and long­years existence exclusively t hrough use o f their own

capacit ies and without any support by the author it ies to the inst itut ions for

accommodat ion o f mentally disabled persons, part icular ly in FBiH, is result o f

professional devot ion o f the employees to their jobs. Relat ion of the users towards

employees that occurred dur ing ombuds­vis it s has shown that the employees are

completely devoted to their work in the best interest of the persons accommodated

in t he inst itut ions. Persons employed by the inst itut ions, which also goes even to

the Inst itut ion Pazar ić, where the staff is mainly o f long­years of work exper ience

(20­30 years o f exper ience) and who are evident ially exposed to mobbing by the

management , put maximal efforts to make accommodat ion as bet ter as possible,

which is accompanied with high degree of improvisat ion in t he c ircumstances o f

lack o f systemic approach to accommodat ion o f this category of cit izens and lack

of support by competent governmental organs. It is important to st ress ment ioned

facts, since t he employees o f the inst itut ions do not have possibilit y to address any

inst itut ion and draw at tent ion at problems they encounter in their very requir ing

work. Whenever they emphasized weaknesses o f the system, which has significant

impact on the r ights o f the users, they did not get adequate and legally prescr ibed

effect ive protect ion. This is part icular ly related to the employees of the

Inst itut ion Pazar ić, who for long­years now request competent organs to undertake

measures targeted to cessat ion o f unlawful act ivit ies, mobbing, and depr ivat ion o f

the r ights o f accommodated persons as well. Everything ends up in relat ion

between the employees and the director, even in t he case where director is a „weak

link in t he chain“, funct ioning o f an inst itut ion becomes quest ionable.

48

Concerning all vis it ed inst itut ions, ombuds­delegat ion assessed that the staff

fulfill their dut ies in more than human manner and, as much as possible, alone

reso lve problems faced by the users. Statements by accommodated persons we

int erviewed is a test imony for above descr ibed efforts of the staff and the users

were full o f nice words towards the staff. As to extraordinary personal efforts,

which could be seen only in the work of professionals who love their jobs, the fact

that these humanitar ians and experts are not addit ionally t rained or are t rained

very lit t le speaks for it self.

4.2. General concerns

4.2.1. Lack of defining and categorization

Mentally disabled persons fall in the category o f disabled persons. Var ious names

are used for this category o f cit izens such as “Persons with difficult ies in

developing”, “Persons with special needs”, “Mentally retarded persons”, “Persons

with developing d isorders” and “Persons with intellectual difficult ies”. Exact ly the

fact that there is not legally determined termino logy creates legal confusion, which

opens possibilit y for vio lat ion of the pr inciple o f consistency in applicat ion o f law

and negat ion of certain benefit s, too, i.e. certain r ights of this category.

In the field t here is different understanding o f term mental retardat ion and usage

of definit ion is not regulated. Namely, in different peaces o f legis lat ion and areas

of act ivit ies, establishing the r ight of mentally disabled persons, different

definit ions are used, that is, there not exists clear and universa l definit ion. These

result s in impossibilit y o f categorizat ion of mentally disabled persons from the

aspect whether such persons should be accommodated in health protect ion or

social protect ion inst itut ions. 34

At the same t ime in BiH, in pract ice, there not exist rea l categor izat ion o f the

inst itut ions, part icular ly not according to the degree o f retardat ion o f the users,

alt hough the directors of the inst itut ion presented opinion according to which all

34 Cause is criteria for medical definition, degree of social adaptation is criteria for social definition, education is criteria for pedagogic definition.

49

vis ited inst itut ions are designed for accommodat ion o f certain category of

mentally disabled persons. The situat ion in the inst itut ions, that is, condit ions o f

persons accommodated at the t ime o f ombuds­vis it have shown that the posit ion

according to which the Inst itut ion Pazar ić is envisaged for accommodat ion o f the

children and the youth, the Inst itut ion Baković for accommodat ion o f persons with

less ser ious mental retardat ion and the Inst itut ion Dr in for accommodat ion o f

persons with ser ious mental retardat ion is simply wrong. In all inst itut ions there

happened to be accommodated all categories o f users because there is not systemic

accommodat ion but accommodat ion, part icular ly in FBiH, is per formed according

to the pr incip le o f „empty bed“ and which to great extent depends on decision o f

director of the inst itut ion. Such methodology is therefore mainly established on

arbit rary and subject ive pr inc iple and represents addit ional difficulty to the

directors, part icular ly in FBiH, due to the fact that more available capacit ies o f the

inst itut ions are needed. As to categor izat ion o f t he users, part icular problem in

Republika Srpska is divis ion o f the users according to their sex. 35

4.2.2. Legislation

Legis lat ion determining the status and the r ights o f mentally disabled persons in

BiH is inadequate and not harmonized with int ernat ional standards, part icular ly

with „Stand Rules for Equalizat ion of Opportunit ies for Disabled Persons”. This

fact creates room for arbit rary behaviors and lack o f ensur ing o f the pr inc iple o f

equal t reatment for all mentally disabled persons without discr iminat ion.

This fact is in the best way confirmed through the issue o f accommodat ion in t he

inst itut ions, since it is unclear according to which cr iter ia wait ing lists are

prepared and since these lists o f mentally disabled persons wait ing for

accommodat ion are quiet extensive Inadequate legis lat ion ar ises the issue o f

access to the r ights o f mentally ill persons, and there also lacks adequate

legislat ion determining establishment and funct ioning o f the inst itut ions for

accommodat ion o f mentally disabled persons, which part icular ly applies to FBiH

fo llowing it s taking over of t he r ights and obligat ion o f the founder without prior

reso lving o f t ransit ional issues or legal reso lving o f these issues, such as the issue

of legal divis ion o f t he Inst itut ion Fo jnica within which inst itut ions Baković and

35 Separation of the usere on the basis of sex is directly contrary to the Rule 9 of Standard Rules.

50

Drin are two separated work branches and not two separated subjects, division o f

balance has never been prepared, process of separat ion is not completed, so it is

unclear what rights and obligat ion are taken over by FBiH. The situat ion is

addit ionally complicated by the fact that these inst itut ions were never a subject to

revis ion and that financia l inspect ion o f FBiH on several occasions determined

unlawful business operat ions of the Inst itut ion „Pazar ić“, which is a subject of

examinat ion by competent prosecutor 's office. It is not clear why there are not

consu ltat ions with cantonal minist r ies of social protect ion, which pays expenses of

accommodat ion, and socia l work centers, which accommodate persons in the

inst itut ions, employees of which are in the largest number of cases the guardians

of persons accommodated in the inst itut ions. Addit ionally, it is part icular ly

concerning that the issue of property o f the inst itut ions has never been reviewed

and the Law on Taking Over o f the Role of Founder does not even contains

preamble, so legal ground for this act ivity is unclear, part icular ly if one has in

mind that , except for appo intment o f the board of directors and supervisory

boards, realizat ion of any other r ight lacks, which also goes for any obligat ion.

Legis lat ion is full o f omissions part icu lar ly in t he segment determining the issue

of supervis ion. So, in FBiH, where obligatory supervision is st ipulated by the Law

(Art icle 10) and where 4 minist r ies never decided on the manner o f supervision.

Consequent ly, 3 minist r ies are not at all invo lved in the process o f supervision.

4.2.3. The rights of accommodated persons

Absence o f adequate legis lat ion determining the r ights o f mentally disabled

persons, as we ll as legis lat ion determining establishment and funct ioning o f the

inst itut ions for accommodat ion o f mentally disabled persons resu lted in aggravated

and unlawful exercise o f the r ights, without clear ly set up pr incip le. This opens

possibilit y for arbit rat ion and the Ombudsmen are therefore deeply concerned

regarding a ll segments o f protect ion o f mentally disabled persons. Before all, th is

applies to FBiH where supervision of professional work and lawfulness of the

work of the inst itut ions, according to law, should be performed by competent

minist r ies. Unfortunately, on the occasion of ombuds­vis its, it was determined

representat ives o f no minist ry vis ited the inst itut ions. In RS there was

int ervent ion by competent minist ry concerning situat ion in the Inst itut ion Pr ijedor

51

in 2007, fo llowing which determined omissions were eliminated. The similar

int ervent ion took place in the Inst itut ion Višegrad.

4.2.3.1. Accommodation and conditions in the institutions

On the occasion o f it s vis its, BiH ombuds­team determined that the main problem

is in the fact that too many people are accommodated in t he inst itut ions,

part icular ly in FBiH. At the same t ime, each inst itut ion st ill has a wait ing list for

accommodat ion Present problem is in the fact that frequent ly complexity o f cases

requires urgent accommodat ion in the inst itut ion, the inst itut ions under pressure o f

social work centers and cantonal minis t ries o f social protect ion in FBiH, are

forced to accommodate certain mentally disabled person, which resulted in

overcrowded inst itut ions. The rooms fo r accommodat ion, regardless of whether

we speak about a smaller or bigger room, there are too many beds, the beds are

frequent ly double­deck beds, so one can not speak about standard o f 4m2 per

person, which is requested for persons serving the sentences in the pr isons. This

leads to conclusion that mentally disabled persons are accommodate in less

appropr iate condit ions than pr isoners who commit ted cr imina l o ffences. Such

condit ions o f accommodat ion vio late r ight to privacy and create condit ions for

eventual progress o f infect ious diseases and hyg iene condit ions, in such

condit ions, can hardly be maintained at sat isfactory level. Overcrowded

inst itut ions create condit ions for conflic situat ions and disable any for o f

therapeut ic work.

In t he inst itut ions there is very small number o f bathrooms. For instance, 40

accommodated persons use just two sanitary facilit ies. None o f the inst itut ions

have bathroom adjusted for needs of persons with disabilit ies. Most of the

inst itut ions do certain improvisat ions and adjustments to enable t he staff to

maintain hygiene o f accommodated persons. What is unacceptable from aspect of

protect ion o f the r ights o f a child, is the fact happened to exist in one o f the

inst itut ions in children's pavilion and it is related to the room which is at the same

t ime used as sanitary facilit y, room fo r relaxat ion and room for changing o f

dresses o f female­employees. In most of the rooms o f the inst itut ions the ambient

is „co ld“. Inter ior is impersonal with few pieces o f furniture, few p ictures or

other decorat ive things on the walls. There lack cheerful co lors, which would

surely impact on mood o f accommodated persons. The ambient is „vividly

co lored“, co lorful only in children's pavilion, alt hough not in all such pavilions

52

and in sat isfactory degree. There lack toys and other didact ic equipment that

could be useful for work with children. Addit ionally, it is noted that courtyards

and playing rooms for children are not adequately formed in main number o f the

inst itut ions.

4.2.3.2. Health protection

Devastat ing fact is that there are st ill not systemic so lut ions for health protect ion

of accommodated persons. Each inst itut ion in FBiH meets the same problem, if a

user needs health service, and if he came from the territory o f other canton where

his/her health insurance is pa id. In urgent cases such person is accepted by

cantonal hospit al o f the same canton where the inst itut ion is situated, however, in

such cases the staff is forced to resolve administ rat ive problems between different

cantons. This procedure requires a lot of t ime and correspondence performed by

the employees of the inst itut ions. Due to descr ibed administ rat ive obstacle, most

frequent ly the inst itut ions t ransport their users to the canton where he/she is health

insured, if it is not an urgent case. Nevertheless, it is important to st ress that ,

when it comes to hospitalizat ion, medical staff o f the hospitals do only t he urgent

int ervent ions. The hospitals frequent ly refuse to accept such ill persons, since

they require special t reatment and the hospitals cla im that they are not equipped

for such t reatments. I f urgent surgery is not necessary, pat ients from the

inst itut ions wait for months or never get required t reatment . There is a large

number o f examples – regarding teeth protect ion, exclusively oral surgery is done

or extract ion o f teeth, so that most of accommodated persons are toothless.

Another concerning fact , having in mind nature o f the inst itut ions, is that

according to their act ivit y, apart from their social act ivit y, ensure health

protect ion as we ll, and in the inst itut ions there are not doctors employed or the

doctor is at the same t ime act ing director of the inst itut ion or they simply work on

their specia lizat ion in some inst itut ion. 36 Number o f persons accommodated in a ll

inst itut ions requires permanent health care by the doctors, part icular ly having in

mind that large number o f users is constant ly under the medic ines therapy.

36 This is contrary to the Rule 2 of the Standard Rules for Equalization of Opportunities of Disabled Persons, which reads: „States should work towards the provision of programmes run by multidisciplinary teams of professionals for early detection, assessment and treatment of impairment. States should ensure that persons with disabilities, particularly infants and children, are provided with the same level of medical care within the same system as other members of society”.

53

Qualit y health protect ion provided through conclusion o f contracts o f work with

doctors is disputable due to the fact that the doctors see t his engagement as an

addit ional act ivit y that should fit in t heir regular work. It would be more logical if

the contracts were concluded with health inst itut ions or if the inst itut ions

permanent ly employ medical specialists of different professions.

4.2.3.3. Education

Right to educat ion is completely neglected by the inst itut ions, which is contrary to

the Rule 6 (upbr inging and educat ion) The Standard Rules for Equalizat ion o f

Opportunit ies o f Persons with Disabilit ies binds states part ies to „to ensure the

pr inciple o f equal opportunit ies for educat ion in pr imary and secondary schoo ls

and higher educat ion inst itut ions to child ren, the youth and the adult persons with

disabilit ies in integrated condit ions“. State part ies must ensure t hat schoo ling for

persons with disabilit ies is integral part of general schoo ling system.

4.2.3.4. Communications with the guardians and relatives

This communicat ion is exclusive ly based on interest shown by parents, which is

frequent ly direct ly connected with their financial situat ion. In most of the cases

accommodated persons are from the families with poor financia l sit uat ion, so that

members o f accommodated persons are not in possibilit y to vis it their

accommodated relat ives. Addit ionally, t he guardians – employees o f social work

centers – due to financial sit uat ion, too much work and the fact that guardianship

is not their regular job, are also prevented sufficient ly to care about the r ights and

int erests of the users or to vis it them. Mainly, these are random visit s when socia l

workers officia lly, or due to some other cause, vis it the inst itut ions. The

employees o f the inst itut ions are aware of importance o f not only t his form o f

communicat ion but also o f communicat ion with other persons, however, t his

standard is not possible to maintain, having in mind exist ing capacit ies o f the

inst itut ions and a who le lot of unreso lved issues.

4.2.3.5. Isolation and fixation

54

Rooms for iso lat ion of aggressive or disturbed persons are not in accordance wit h

standards o f dignity o f this populat ion. There is not possibilit y o f surveillance o f

a user while he/she is placed in such rooms, neither there is protect ion against

potent ial injur ies, since the walls are not coated. The issue o f fixat ion and

iso lat ion is mainly decided by internal rules o f the inst itut ions, and some o f the

inst itut ions never adopted such rules.

4.2.4. The board of directors and supervisory boards

Organs o f management o f the inst itut ions in FBiH are appo inted – there are boards

of directors and supervisory boards and appo intment of directors is ongo ing

process now – exist ing directors have a status of inst itut ion there are parents or

members o f social work centers, and only act ing directors. It is concerning that in

management organs o f no in the Inst itut ion Dr in one member o f the Board of

Directors is employee of t he Inst itut ion. Moreover, members o f boards o f

directors and supervisory boards remunerated and they are paid by the money users

paid for accommodat ion. This means that each inst itut ion monthly must pay each

member o f the boards, including t ravel expenses. To save their resources certain

inst itut ions organize t ransport themselves and some inst itut ions organize sessions

of the boards outside of inst itut ion. Although they are paid for their work, the

largest number o f t he boards in FBiH never visited inst itut ion or eventually talked

to the staff and users to understand the real situat ion.

4.2.5. Staff

Apart from the fact that the staff o f certain inst itut ions are exposed to mobbing

(Pazar ić), completely missed any care for mental health o f the staff working with

mentally disabled persons. In last 5 to 6 years pract ice o f cont inued professiona l

t raining o f the staff completely ceased to exist , so the experts employed by the

inst itut ions do not have opportunity to learn new pract ices applied in t his line o f

work neither they have possibilit y to exchange exper iences with co lleagues

working in other inst itut ions o f s imilar type in the region or third countr ies.

Part icular ly concerning is the fact that there are rare cases of pro fessional

gather ings o f the employees o f the inst itut ions in BiH. Competent minist r ies, with

excuse that they do not have resources for such seminars, conferences, educat ion

55

or other forms o f professional specializat ion do not show any interest for creat ion

of modern methods of work in the inst itut ions subject to present Report .

Programs for prevent ion o f „burnout“ 37 syndrome are not implemented except in

the situat ions when the directors of t he inst itut ions, upon personal requests,

organize seminars for the staff with the purpose of their protect ion against

ment ioned pro fessional disease. As it is well­known „burnout“ syndrome is

character ist ic for support ive pro fessions where the pro fessionals are considerably

personally invo lved so that it is necessary to take measures for their protect ion,

part icular ly protect ion o f their hea lth. Such measures would contr ibute to

improvement of qualit y o f work and product ivit y in the work with accommodated

persons. The situat ion happened to exist in the inst itut ions is a clear ind icator

showing that inabilit y o f pro fessional educat ion and r isks from pro fess ional

diseases are mirrored in qua lit y o f services provided by the employees and their

readiness to take a professional approach to the work. Cadre problems are present

in all vis ited inst itut ions. Insufficient number o f experts and staff can hardly meet

the needs o f t he users. One o f t he illust rat ions is related to the fact that immobile

persons and children can not go out in the courtyard but they are only carr ied to

the verandas and it is quest ionable how often it is carr ied out . And everybody

knows that the stay in the fresh air and change of ambient would very posit ive ly

impact to psychical and phys ical condit ions of such persons.

In some o f the inst itut ions medical staff wears whit e coats, which is a rud iment o f

old­ fashioned modal in t reatment of persons with mental disabilit ies or psychica l

disorders. This creates divis ion line between the health and the ill persons and

opens possibilit y for margina lizat ion o f a who le populat ion with certain specifics

in psychical and physical funct ioning.

4.2.6. Cooperation with other institutions and organizations

Cooperat ion o f the inst itut ions with other professional inst itut ions is not at

sat isfactory level. According to assessment of the employees, such cooperat ion

could be more intensive. The same goes for the NGOs, schools and local

community. Pract ice o f social inclusion of the users is not sat isfactory and must

be intensified. In this way exist ing marginalizat ion o f this specific populat ion

37 Psychological conseqences of the work with people in need or crises are usualy marked with 3 terms: „burnout“, „counter­transfer reaction“ and „indirect traumatization of assisstant“.

56

would be eliminated and would result in decreased prejudices about persons with

mental disabilit ies. This Report prepared by the Inst itut ion o f Human Right s

Ombudsman o f Bosnia and Herzegovina draws at tent ion at the fact that ent it y

governmental st ructures invest almost none or very lit t le resources in construct ing,

adaptat ion, renewal and equipping o f the inst itut ions and one gets impression that

accommodated persons are „forgot ten cit izens“.

Resources at disposal o f the inst itut ions are acquired through pr ice o f

accommodat ion or, eventually, through certain donat ions for ma intenance o f the

build ings, furniture, work equipment , cloths and shoes for accommodated persons.

In main number o f the inst itut ions t he food and medicines have to be bought .

Stable financing of the inst itut ions in which most frequent ly are permanent ly

accommodated mentally disabled persons is not resolved.

From the ent ire Report it is more than obvious that respect for human r ights of

mentally disabled persons in BiH is one of the issues dealt by almost no­one from

governmental st ructures.

4.2.7. Financing and the role of the founder

Non­carrying out of founders ' obligat ions is direct ly mirrored on condit ions in the

inst itut ions, part icular ly to further developing of capacit ies. From accommodat ion

pr ice the inst itut ion can ensure just accommodat ion and fulfillment o f minimum

needs for survival o f disabled person and which is not task of these inst itut ions.

This fact , too, is put under t he quest ion, since funct ioning o f t he inst itut ions is

st ill s ignificant ly dependent on donat ions, part icular ly by the cit izens, so that the

main number of the inst itut ion in FBiH almost never buy meat but they get it

through donat ions in kurban meat at the time o f relig ious ho liday Kurban Bajram.

According ly, real ro le o f t he founders is really concerning one, part icular ly if one

takes in t he account non­developed capacit ies o f competent minist r ies. This is

part icular ly present in FBiH, where adequate internal st ructure of competent

minist ry is not established, which would ensure exercise o f t he r ights o f mentally

disabled persons and which would also ensure effect iveness o f the work of the

inst itut ions as precondit ion for undertaking measures for further improvement o f

the situat ion in t his ent ire area.

57

V ­ RECOMMENDATIONS

Presence o f inte llectual difficult ies does not just ify any form o f d iscr iminat ion.

Mentally disabled persons are different in their abilit ies however they are equal in

58

their r ights. Vis its to the inst itut ions for accommodat ion of mentally disabled

persons in BiH performed by BiH Ombudsmen Inst itut ion have shown that absence

of protect ion o f qualit y and necessary part icipat ion and assistance o f the society,

inc luding controls and supervis ions by competent organs over accommodat ion o f

mentally disabled persons, made accommodated persons “invis ible cit izens”,

closed in “their” inst itut ions without any networking o f the syst em support or

other support. In one word, they are convicted to ser ious discr iminat ion and

marginalizat ion o f their problems. Therefore, BiH Ombudsmen according to their

powers referred to in Art icle 32 o f t he Law on Human Rights Ombudsmen o f

Bosnia and Herzegovina:

R E C O M M E N D

I Ø Competent organs: The Ministry of Civil Affairs of BiH, the Ministry of

Human Rights and Refugees of BiH through co­ordinat ion with The Ministry

of Work and Social Policy of FBiH, the Ministry of Work and Social Policy of

RS and The Government of District Brčko immediately to take measures to

ensure int roduct ion o f contemporary modals o f support to mentally disabled

persons in order to realize goals o f their rehabilit at ion, i.e. normalizat ion,

social inclusion, individualizat ion, and to the greatest extent to encourage

independency and autonomy o f mentally disabled persons. In that sense it is

necessary immediately to undertake activities on preparation of strategic

document in accordance with contemporary intent ions contained in Plan o f

Act ion o f the Council o f Europe for persons with disabilit ies and Rule 14 o f

Standard Ru les (creat ion o f po licy and planning), all o f it with a view to

t ransformat ion of segregat ion and char ity t reatment of persons with menta l

disabilit ies. The Ru les bind state part ies to init iate and plan adequate po lic y

related to persons with disabilit ies and st imu late and support act ivit ies on

regional and local level, and ensure mechanisms guarantying full app licat ion o f

regulat ions adopted.

Ø Within st rategic document there should be ensured:

a. Determinat ion o f measures for adoption of legal f ramework , which

should in comprehensive manner determine rights of mentally disabled

59

persons with full respect for Standard Rules, since the Standards are

prepared in conformit y with internat ional documents 38 ;

b. Determinat ion o f measures targeted to adoption of legislation which

should fully and in comprehensive manner determine issue of

functioning of the institut ions for accommodat ion o f mentally disabled

persons and with pr ior reso lut ion o f all d isputable issues. For this

measure, part icular ly in FBiH, it is necessary to form team o f experts

composed o f representat ives o f different professions, and with obligatory

consu ltat ions with the inst itut ions ensur ing social services (social work

centers) and cantonal minist r ies which pay funct ioning o f the

inst itut ions. Unt il adopt ion o f adequate legis lat ion in FBiH it is

necessary to refrain from undertaking o f act ivates prescr ibed by the Law

on Taking Over o f the Rights of the Founder, which would lead to further

vio lat ions of already extremely complex relat ions exist ing in the

inst itut ions. Only measures related to r ight to supervis ion should be

undertaken with purpose o f eliminat ion o f unlawfulness;

c. Determination of clear definition of mentally disabled person to ensure

usage o f precise and consistent definit ion in ent ire legislat ion and po licy

in BiH in all spheres o f life. Competent organs should also adopt by­ laws

on categorizat ion o f mentally disabled persons, which is precondit ion for

categorizat ion o f the inst itut ions;

d. Preparat ions o f basic pr incip les with respect for internat ional standards

that determinate the r ight of mentally disabled persons to categorizat ion

of the inst itut ions for accommodat ion o f such persons. It is necessary to

consider possibility of establishment of a triage center, which would,

based on medical, socio logical and pedagogical indicators, decide on

accommodat ion o f each mentally disabled person.

38 Present Report is based on the following international documents: International Charter on Human Rights, Universal Declaration on Human Rights, International Covenant on Economic, Social and Cultural Rights, International Covenent on Civil and Political Rights, Convention on the Rights of a Child, Convention on Elimination of all Forms of Discrimination of Women, as well as in accordance with World Action Program related to persons with disabilities.

60

Organs competent to act in accordance with recommendations

• The Ministry of Civil Affairs of BiH

• The Ministry if Human Rights and Refugees of BiH

• The Ministry of Work and Social Policy of FBiH

• The Ministry of Health ad Social Policy of RS

• The Government of District Brčko

Deadlines

Competent organs are obligated within 60 days to prepare strategic document (Plan of Activities),

which should ensure implementation of the Recommendation, unit 1, and since it is a long­term

measure, the competent organs should inform the Ombudsmen continually and permanently on

further development of implementation of adopted strategic document.

II.

The Ministry of Work and Social Policy, the Ministry of Work and Veterans

and Disabled Persons Protection of RS, The Ministry of Health, the Ministry of

Health and Social Protection of RS, The Ministry of Education, Science,

Culture and Sport, the Ministry of Education and Culture and competent

institutions comprised by present Report, each in it s scope o f act ivit ies should

immediately:

1. undertake measures aimed to improvement of inst itut ional accommodat ion of

mentally disabled persons, with considerat ion o f possibilit ies to increase their

capacit ies (part icu lar ly problemat ic is the situat ion in the Inst itut ion Dr in) or

request change o f facilit y purpose o f other objects ( such as milit ary barracks,

etc.);

2. harmonize systemat izat ion o f working posts with needs o f the inst itut ions o f

alleged types and engage greater number of experts of var ious pro files

necessary for work with the persons with mental disabilit ies;

3. prepare plan and organize systemic supervisions o f pro fessional t raining

programs for the staff o f the inst itut ions;

4. implement programs o f prevent ion o f „wear ing out“ of the staff employed by

the inst itut ions;

61

5. pay a specia l at tent ion at the ambient where the children and adult users

spend their t ime and receive vis it s in t he inst itut ions (should be full o f toys,

pictures, objects paid in cheerful co lors, paint the walls, etc.);

6. enable staff to work in their personal cloths or uniforms which is not a symbol

of medical inst itut ion (to „remove“ whit e cloths) ;

7. prepare normat ive for iso lat ion and fixat ion based on the pr inciple o f

equalit y for all inst itut ion and adjust it to standards exist ing in t radit iona l

democracies;

8. ensure bet ter health protect ion and work with the users, employment of t he

doctors, speak therapists and other professional cadres, also having in mind that

a number of such cadres are registered by the employment bureaus;

9. establishment / int ensifying o f cooperat ion with the inst itut ions o f similar t ype,

the NGOs. Schools, media, local communit ies, to decrease marginalizat ion and

eliminat ion of exist ing pre judices towards this category of cit izens;

Competent organs and the deadlines

• The Minist ry o f Work and Social Po licy of FBiH

• the Minist ry o f Work and Veterans and Disabled Persons Protect ion o f RS,

• The Minist ry o f Health o f FBiH

• The Minist ry o f Health and Social Protection o f RS

Within 60 days all inst itut ions comprised by present Report are obliged to forward

their reports on act ions taken in accordance with present Recommendat ion to BiH

Ombudsmen.

III

The Ministry of Work and Social Policy of FBiH should immediately start it s

work on determinat ion o f funct ioning of mental heath inst itut ions for which it is

competent and the work should be done in accordance with the Law on Tak ing

Over of the Rights o f the Founder with urgent previous reso lving disputable issues

evidenced in present Report .

Unt il adopt ion o f appropr iate legislat ion in conformity with st rategic document

referred to in item I. of the Recommendat ion, it should ensure imp lementat ion o f

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measures related to the r ight to supervis ion with purpose o f eliminat ion o f

unlawfulness and should refrain from all act ivit ies which would addit ionally

aggravate already very complex relat ions within inst itut ions.

According ly:

1. Remunerat ions for members of the board of directors and supervisory boards

from the resources earned through the pr ices o f accommodat ion should be

stopped at once;

2. The way o f appo intment of members o f board of directors and supervisory

boards should be re­considered from the aspect of ensur ing part icipat ion o f

parents/guardians, t he employees and the founders, and respect for the

knowledge and exper ience in this area as a basic cr iter ia for appo intment ;

3. St rengthening o f capacit ies for implementat ion o f the measures for supervis ion

should be in accordance with law, inc luding re­considerat ion whether there

exist conflict of interests o f employees o f the Minist ry from the aspect of the ir

membership in boards of directors and supervisory boards;

4. a ll inst itut ions should be subject to financia l revision and subject to

undertaking of measures aimed to eliminat ion o f unlawfulness determined by

financial inspect ions in certain inst itut ions, which part icular ly applies to the

Inst itut ion Pazar ić;

5. Cons iderat ion o f so lut ions for all opened issues related to taking over o f the

role o f the founder, such as: property, divis ion balance, etc. ;

6. As the firs among the equal t hings, invo lvement of other competent minist r ies,

which according to the Law have the r ight and obligat ion to perform

supervis ion, should be ensured;

7. Organizat ion o f consultat ive meet ings between cantonal minist r ies of social

protect ion and representat ives o f social work centers t hat cover the greatest

number o f accommodated persons in the inst itut ions should be implemented for

the purpose of reso lut ion of all d isputable issues and establishment of the

teams o f experts to decide on accommodat ion and which should be composed

of var ious pro fessionals, with obligatory conso lat ions with social work centers

and cantonal minist r ies that pay funct ioning o f the inst itut ions.

Competent organ and the deadline for action

• The Minist ry o f Work and Social Po licy of FBiH

63

Within 30 days competent Minist ry is to inform BiH Ombudsmen Inst itut ion on

measures undertaken, contained in t he item III. of the Recommendat ion.

IV BiH Ombudsmen recommend all competent inst itut ions and bodies referred to in

present Recommendat ions to establish cooperat ion with internat ional organizat ions

(UNICEF, UNDP, the World Bank, etc.) and other potent ial donors, and to

consider possibilit y o f usage o f pre­accessional funds of the European Commission

with a view to creat ion o f financial precondit ions for implementat ion o f present

Recommendat ions.

Banjaluka, 10.09.2009

The Human Rights Ombudsmen

of Bosnia and Herzegovina

Jasminka Džumhur

Ljubomir Sand ić

Ombudsmeni BiH

___________________________

Jasminka Džumhur

___________________________

Ljubomir Sandić

64

Annex I

Schedule of visits of ombuds­representatives to the instituions of social

protection in BiH

Institution Date of

visit

Composition of

ombuds­team

Remark

The Inst ituion

for

accommodat ion

of mantally

disabled persons

Baković i

02.07.2009. Ø Jasminka Džumhur, ombudsman;

Ø Nives Jukić, Head of Department for Protect ion o f the Rights of Persons with Disabilit ies;

Ø David Tomić, Head o f Department for Eliminat ion o f Discr iminat ion

Ø Aleksandra Arsenijević­ Puhalo, psycho logist

Ø Amira Krehić, coordinator of the project for the r ights o f a child;

Ø Andrea Raguž, t rainee

Ø Ivo Markija, director;

Ø Niko lina Ababović, nurse, ;

Ø Dženana Đozić, lawyer ;

Ø Mar inela Mar ić, social worker;

Ø Katar ina Slomo, pedagogist ;

Ø Mar lena Koštroman, social worker;

The Center for

Accommodation of

the Elderly and

Weak Persons and

07.09.2009. Ø Jasminka Džumhur, ombudsman;

Ø Almedina Kar ić, Public Relat ions Adviser;

Ø Har is Šahbaz, Head

Ø

65

homeless persons

Duje, municipality

Doboj Istok

of the Cabinet of BiH Ombudsmen Inst ituion

The Inst ituion

for

accommodat ion

of mentally

disabled persons

Fo jnica

02.07.2009. Ø Jasminka Džumhur ; ombudsman;

Ø Nives Jukić, Head of Department for Protect ion o f the Rights of Persons with Disabilit ies;

Ø David Tomić, Head o f Department for Eliminat ion o f Discr iminat ion

Ø Aleksandra Arsenijević­ Puhalo, psycho logist

Ø Amira Krehić, coordinator of the project for the r ights o f a child;

Ø Andrea Raguž, t rainee

Ø Ibrahim Katana, director;

Ø Đenita Karahmet – social worker;

Ø Adnan Bubalo, lawyer ;

Inst ituion for

protect ion o f the

children and the

youth Pazar ić

01.07.2009. Ø Jasminka Džumhur ; ombudsman;

Ø Nives Jukić, Head of Department for Protect ion o f the Rights of Persons with Disabilit ies;

Ø David Tomić, Head o f Department for Eliminat ion o f Discr iminat ion

Ø Aleksandra Arsenijević­ Puhalo, psycho logist

Ø Amira Krehić, coordinator of the project for the r ights o f a child;

Ø Andrea Raguž, t rainee

Ø Salko Čengić, director;

Ø Edina Fejz ić, lawyer ;

Ø Radica Slado je, speak therapist , ;

Ø Zijo Kor jenić, socil worker ;

Ø Radmilo Cuca, psycho logist ;

Home o f the 14.07.2009. Ø David Tomić, Head of Department for

Ø Rajko Drinić,

66

children and the

youth with

difficult ies in

developing

Pr ijedor

Eliminat ion o f Discr iminat ion

Ø Aleksandra Arsenijević­ Puhalo, psycho logist

director;

The Inst ituion

for protect ion of

female children

and the youth

Višegrad

08.07.2009. Ø David Tomić, Head of Department for Eliminat ion o f Discr iminat ion

Ø Aleksandra Arsenijević­ Puhalo, psycho logist

Ø Andrea Raguž, t rainee

Ø Zoran Vasiljević, director;

Ø Social worker;

Ø psycho logist ; Ø main nurs;