LAW Mental health law in PROFILE Lidija Injac Stevovic,1 Tatijana Perunovic Jovanovic2 and Aleksandra Raznatovic3

1Psychiatric Clinic, Clinical Centre This paper discusses the services and treatments Centres for mental healthcare (CMCs) were of Montenegro, email injacl@t- com.me that are offered in Montenegro to persons who formed in the period of reform of primary health- 2Psychiatric Clinic, Clinical Centre are mentally ill. A short history is given. The care, which started in 1991, in line with efforts to of Montenegro law on the protection of the rights of patients deinstitutionalise the provision of mental health- 3Psychiatric Clinic, Clinical Centre who are mentally ill is described, along with care and to promote the principles of community of Montenegro the regulations governing voluntary and forced psychiatry. The Centre for the Rehabilitation of treatment. An action plan for promoting mental Psychoactive Substance Addicts was founded in health has been partly already realised but 2008. some of its aims still need to be accomplished. The regulation of mental healthcare Montenegro did not have an official policy on mental healthcare, nor a national programme for The Mental Health Programme in Montenegro its promotion, until 2004, when the Strategy for is being implemented in accordance with ethical Improving Mental Health was brought in. This principles and the laws related to the protection set general health policy goals and represented and rights of people who are mentally ill. Bearing the first step towards the development and im- in mind the link between mental health and social plementation of a national strategy to promote cohesion, the promotion of mental health is recog- mental health and integrate existing programmes. nised as a priority within the integrated framework Action plans for the prevention of drug programme set up by the United Nations and in children and young people were created and set Montenegro. Through this programme, resources in motion in 2003. Two such projects introduced have been made available for the recruitment of a by the Ministry of Health were the Prevention of team of experts with a mandate to draft an action Drug Addiction in Elementary­ Schools in Monte- plan and set up a pilot programme for the provi- negro and the Long-Term Plan and Programme sion of mental health in primary healthcare. The for Addiction Suppression in Montenegro. project was guided by the World Health Organiza- tion (WHO) and adapted to the national context Law on the Protection and Realisation of the and needs. Rights of the Mentally Ill Mental health services The Law on the Protection and Realisation of the Rights of the Mentally Ill was passed on 27 May History 2005 (official document RCG, number 32/2005). In former times in Montenegro, the primary re- Through this law, the pathway for protecting the sponsibility for a person with a mental illness was rights of people who are mentally ill was secured undertaken by the person’s family and to some and conditions were created for the institution of extent the community in which the person lived. appropriate measures against discrimination. In The first psychiatric was founded at the accordance with international laws and regula- beginning of the 20th century, in Danilovgrad. tions, people with mental illness were enabled to Those whose brought on aggress­ gain their rights and freedom. They now have ive behaviour were admitted to the psychiatric the right to be treated in the least restrictive en- hospital, and those who were not prone to aggress­ vironments, without intrusive or forced methods ive behaviour were left to roam the streets (Van of treatment, and with the mandatory inclusion Mandere, 2002). A department of neuropsychiatry of family members and/or a legal representative. was founded in the 1950s within the hospital of In the past, those who were mentally ill were Krusevac in Podgorica. Montenegro’s special psy- most often treated in inadequate institutions or chiatric hospital started its work in 1953. were resident in mental health for long periods of time. The inclusion of family members Current institutions now ensures the support so needed in the process The institutions that provide mental healthcare in of treatment and rehabilitation. Montenegro fall under the remit of the Ministry The Law regulates voluntary and forced of Health. There are three hospitals that serve hospitalis­ation. Patients who can understand the people who are mentally ill, the most important of purposes and consequences of their admission which is the special psychiatric hospital in Kotor. must sign a voluntary consent to hospitalisation. This institution, besides having wards for patients Patients who are not capacitous and are unable to with acute and chronic conditions, also has wards give consent because they do not understand the for treating addiction dis­orders and a forensic nature of the situation, or the consequences and department. dangers of the suggested medical procedure, and

94 BJPSYCH INTERNATIONAL VOLUME 13 NUMBER 4 NOVEMBER 2016 Downloaded from https://www.cambridge.org/core. 30 Sep 2021 at 04:29:59, subject to the Cambridge Core terms of use. cannot make decisions or express their own will, Action Plan was strategically the most important can undergo only medical treatment which is in document related to mental , their best interests. with clear and comprehensively planned activities. Where patients pose a serious danger to another It was created on the initiative of the Ministry of person or themselves, directly or indirectly, Health and WHO offices in Podgorica. they may be referred to a psychiatric institution, The documents which form the basis of this without their consent, in accordance with the law. plan were primarily directed at strengthening Upon their arrival at hospital, the duty psychiatrist the role of non-hospital services, the CMCs and is required immediately to examine them and to the coordination of CMCs with centres for social determine whether they pose a danger to them- work. It was envisaged that these changes would be selves or others due to their mental illness. If the achieved through multi-agency visits, home treat- patient does not agree to voluntary admission, the ment and primary healthcare programmes. psychiatrist will make a recommendation for com- The implementation of the Twinning Light pulsory admission and treatment. The reasons for project for the improvement of mental health compulsory detention are explained to the patient services in Montenegro is in progress. This project in an appropriate manner. is being conducted by the Trimbos Institute (Dutch Under the Law on the Protection and Realis­ation Institute for Mental Health and Addiction) and of the Rights of the Mentally Ill, the recommenda- includes the training of all nurses employed in tion and the grounds for compulsory treatment mental health institutions (Twinning Light, 2014). have to be sent to a court within 48 hours, for a The Action Plan has redefined Montenegro’s hearing that includes the patient’s legal represent- laws and harmonised them with European Union ative as well as representatives of the Centre for and WHO standards. Specifically, the Law on Social Work and the Council for Patients’ Rights. Amendments to the Law on the Protection and In addition, all the hospitals have their own panel Realisation of the Rights of the Mentally Ill, passed for compulsory/forced hospitalisation, composed on 28 June 2013, brought full protection to persons of three psychiatrists and social workers, and very with severe mental illness detained in psychiatric often a judge is present. Following a compulsory institutions, be they voluntary or compulsory admission, each of the panel members is expected patients. Electroconvulsive treatment now requires to visit the patient and make a report regarding consent and the involvement of the Ethics Com- further treatment, which is then sent to the court. mittee. Important changes have also been made in The court, within 8 days, renders a decision on relation to psychosurgery, which has been banned compulsory treatment for up to 30 days. If there from practice. are no more reasons for detention, the patient has to be released within the timeframe given by the Conclusion court. During hospitalisation, patients are given We consider that the newly introduced legislation an explanation of their rights and the procedures. has significantly complemented the normative Patients have the right to request a transfer to framework within which the rights of people with a another psychiatric institution. Current proce- mental illness are secured. The weakest link in the dures are in sharp contrast with past practice (up provision of mental health services in Montenegro to 1980), when forced hospitalisation was imple- are now the CMCs, established at the primary care mented at the recommendation of the psychiatrist level, due to incomplete multidisciplinary teams, and the social worker, who in turn were responsible a lack of integrated services and the absence of for sending the completed documentation on the inter­faces with social services. There is also a lack non-consenting patient to the guardian and court. of in-patient facilities for addiction treatment. Recent changes in legislation have resulted in Further, conditions in existing mental health hos- the establishment of the National Committee for pitals are generally inadequate for patients. It is Mental Health, which procures expert opinions encouraging that there are plans for the construc- and provides suggestions to authorities on the tion of a new psychiatric clinic in Podgorica. steps needed to conform to the measures for the prevention of mental and behavioural disorders. References An Ethics Committee has been set up to monitor Twinning Light (2014) Twinning Light project fiche – proposal. Available at http://www.mzz.gov.si/fileadmin/pageuploads/svez.gov. guardianship arrangements and the protection si/pageuploads/docs/razpisi_tmis/Twinning_MN_10_IB_SO_01.doc of the rights of patients in psychiatric institutions. (accessed 1 September 2016). This is an independent multidisciplinary body Van Mandere H (2002) Podgorica Montenegro. CID. operating at the secondary and tertiary levels of mental healthcare, which ensures that ethical prin- ciples are adhered to in psychiatric institutions. Action Plan for Improving Mental Health In 2011, the National Committee for Mental Health adopted the Action Plan for Improving Mental Health for the period 2011–2014, with the aim BJPsych International on Facebook of supporting the implementation of the national www.facebook.com/BJPsychInternational Strategy for Improving Mental Health. The

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