Psychiatry and the community in Slovenia: an outsider's view
| Pages | 36-42 |
| Date | 01 June 2006 |
| Published date | 01 June 2006 |
| DOI | https://doi.org/10.1108/17465729200600017 |
| Author | Jo Lucas |
| Subject Matter | Health & social care |
This paper looks at current developments in the provision of community mental health services in the
context of the history of the psychiatric system in Slovenia, based on ten years of experience working
with non-governmental organisations and the School of Social Work in Slovenia. It looks at what can
be learned from both the strengths and weaknesses of what is happening in Slovenia and the
implications for broader debates about the future of public mental health and the treatment of people
with mental health problems.
Psychiatry and the community
in Slovenia: an outsider’s view
Jo Lucas
Kastanja Consulting
Correspondence to:
Jo Lucas
74 Eastwood Road
London E18 1BU
jo.lucas74
@btinternet.com
PROFILE
36 journal of public mental health
vol 5 • issue 2
Slovenia’spsychiatric system has a history
of institutional care, dominated by a
medical and biological understanding of
mental health and illness. People with
mental health problems were locked away
–out of sight and out of mind – just as they were in
the rest of western Europe. Yugoslavia was well
known for bio-medical research and little attention
was paid to people’ssocial or psychological needs.
This was reinforced during the periodof communist
rule, when people with all kinds of disabilities were
seen to be of no value to the ‘workers state’ and,
again, were placed in institutions. This practice is
common across all the countries of the former
Soviet Union, where large institutions and the
public assumption that people with disabilities can
make no contribution to society still prevail.
Research into the history of psychiatry in
Slovenia shows that: ‘Slovene psychiatry and other
forms of care for mentally ill persons followed the
pattern of development in the rest of Europe’
(Flaker, 1995). The first psychiatric hospital opened
in 1821, and was seen to be a relatively advanced
service at the time. Later, as Flaker (1995) observes:
‘… between the wars Slovene psychiatry kept
pace with the lower edge of the European
average only with difficulty and its therapeutic
possibilities were practically limited to the
recently introduced insulin coma therapy and
ECT.’
He describes how during the second world war the
system was devastated by the Nazis who took over
the hospital in Celje and killed 430 patients. Later
another 429 died as a consequence of hunger,
overcrowding and poor conditions. Thus, by the end
of the war, the Slovene psychiatric system, which in
the early 1940s had 1370 beds, was now reduced by
over 50%. By the early 1950s the system was
becoming more institutionalised as old buildings –
primarily castles – were adapted for use as ‘social care
homes’ (that is, large, closed institutions, offering
long-term residential care to people with all kinds of
disabilities), and at the same time the first out-
patient clinics were opened and the first psychiatric
social workers employed.
In the 1960s and 1970s radical psychiatry had an
influence in Slovenia, as elsewhere, particularly
because of the direct connections with Franco
Bassaglia and the Psichiatrica Democratia movement
in northern Italy. Flaker describes a number of
innovations, including the unlocking of hospital
doors, a more permissive attitude to patients and the
introduction of psychotherapeutic and socio-
therapeutic techniques. He suggests that the impact
of this movement was limited to a conflict between
those who believed in the medical model and those
who took a more psychotherapeutic perspective. It
seemed to have had little impact on actual services
or the lives of people who experienced mental health
problems. An interest in different traditions of
psychotherapy and the development of group work
by some professionals again had little impact on
actual services offered by the state to people in the
hospitals and social care homes.
By the end of the 1980s a number of activities
resulted in a de-institutionalisation project at
©Pavilion Publishing (Brighton) Ltd
Key words
Slovenia
psychiatry
community mental
health services
user movement
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