276 KB48 KB198220252025Mezzina, Robertoštevilka:1/2letnik:64str. 5-21ISSN:0352-7956DOI:10.51741/sd.2025.64.1-2.5-21COBISSID_HOST:249073411URN:URN:NBN:SI:doc-OW69HW9GenFakulteta za socialno deloSocialno delocommunity-based carečlovekove pravicehuman rightsokrevanjepsihiatrične ustanovepsychiatric institutionsrecoveryskupnostna oskrbasocial inclusionsocialna vključenostDeinstitutionalization today| person-centered focus and system change toward community mental health|Long term institutions have been for many years considered as relics of the past, but they still absorb the ma- jority of economic resources of mental healthcare and are vehemently resisting to change. Most reforms in Europe are now trying to develop community services, which are integrated within welfare systems and so- cial networks, but they are loosely coupled with a radical institutional transformation. Deinstitutionalization is mentioned in many international charters and documents, as the WHO Report and the UN Committee for Convention on the Rights of Persons with Disabilities. While there is a substantial agreement on the basic defi- nition as far as it is referred to patients (e.g., the release from the institution), nonetheless the process is widely misunderstood. It regards not just the downsizing, and final closure of total institutions, or the discharge of their patients, but a whole system change and moreover a full transformation of psychiatry towards community mental health. Deinstitutionalization must be seen as the main strategy to overturn old forms of oppression of people with mental health conditions and disabilities and to mobilize resources and supports for their recovery and social integration. Community-based services can promote the response to needs and the fulfillment of ci- tizenship rights by catalyzing resources and opportunities. The Italian experience, and especially the one in Tri- este, is a demonstration that this is possible, by acting in a way that fosters subjectivity, empowerment, recovery and social inclusion, while embracing a human rights approach (e.g. principles of open door, no restraint). To complete deinstitutionalization of mental healthcare, we thus need the convergence of human rights, person- -centered and recovery approaches with comprehensive, strong, and responsive community-centric servicesTotalne ustanove že veliko let veljajo za relikte preteklosti, vendar še vedno poberejo večino ekonomskih virov za duševno zdravje in se trdovratno upirajo spremembam. Večina reform v Evropi zdaj poskuša razviti skupno- stne storitve, ki so integrirane v socialne sisteme in socialna omrežja, vendar so slabo povezane s korenito institucionalno preobrazbo. Deinstitucionalizacija je omenjena v številnih mednarodnih dokumentih, kot so poročilo Svetovne zdravstvene organizacije in Odbor ZN za konvencijo o pravicah invalidov. Čeprav obstaja pomembno soglasje glede osnovne definicije deinstitutionalizacije, ko gre za paciente (npr. odpust iz ustano- ve), pa je proces na splošno napačno razumljen. Gre ne le za zmanjševanje števila in zaprtje totalnih institucij ali odpust njihovih pacientov, temveč za celotno sistemsko spremembo, še več, za popolno transformacijo psihiatrije v smeri skupnostne skrbi za duševno zdravje. Deinstitucionalizacija mora biti poglavitna strategija za premagovanje starih oblik zatiranja ljudi z duševnimi težavami in ovirami ter za mobilizacijo virov in podpore za njihovo okrevanje in socialno integracijo. Skupnostne storitve lahko promovirajo odziv na potrebe in uresniče- vanje pravic do državljanstva z aktivacijo virov in priložnosti. Italijanska izkušnja, še posebej ta v Trstu, dokazuje, da je to mogoče, če delujemo na način, ki spodbuja subjektivnost, krepitev moči, okrevanje in socialno vklju- čenost, pri tem pa upoštevamo človekove pravice (npr. načelo odprtih vrat, nobene prisile). Za dokončanje de- institucionalizacije na področju duševnega zdravja potrebujemo sinergijo človekovih pravic, pristopov, osre- dotočenih na posameznika in okrevanje, ter obsežne, učinkovite in odzivne skupnostno usmerjene storitveTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaUniverza v Ljubljani, Fakulteta za socialno delo