The ombudsman finds many shortcomings, but not torture at the QKUK Psychiatric Clinic

The report in question refers to the visit of the National Mechanism for Prevention of Torture (MKPT) on May 17th 2018 to the Psychiatric Clinic of the University Clinical Centre of Kosovo. During the MKPT's visit, Psychiatric Clinic staff offered full co-operation to the monitoring team. The team without delay had access to all spaces and allowed conversations with patients without presence of medical personnel.

The Psychiatric Clinic consists of four separate departments, all departments (except emergency and intensive psychiatric care department) are open and treat patients' will and, in certain cases, without their will based on the decision of the competent court.

Emergency and intensive psychiatric care department (in text “U n The KIP” is closed unit and is the only one on the entire territory of Kosovo. In other regional hospitals, psychiatric departments have failed to function in separate rooms where emergency cases are handled. Such cases from all over Kosovo behave in U department Pristina Psychiatric Clinic KIP.

The MKPT was reported that patients in general are brought to UKIP by family members or police and are patients who are accommodated without their will. The MKPT has noted that the competent court is not announced for the patient's acceptance of involuntari treatment, as is envisioned in Article 22 and 23 of the Law on Mental Health. The MKPT notes that this provision clearly imposes on the health institution that, in cases of the patient's acceptance of involuntari treatment, announces the competent court for further proceedings.

During the visit, MKPT has noted that the general atmosphere at the Psychiatric Clinic in general is relaxing, and reports between personnel and patients are positive. The MKPT has not accepted any complaints of physical mistreatment or conduct of personnel, which would offend the patient's dignity.

Material conditions at the Psychiatric Clinic are generally not good. Patient rooms are large, with two and three beds, had enough light, windows could be opened. Ornunts (the dolls for clothing) were all almost damaged, painted but now outdated walls, and there have been no renovations for six years, while hot water has from time to time. The MKPT has noted that there are no paintings on the walls, there are no computers for personal things, the toilet has no door closing. Cleaning is done by private companies, but it seemed that it was not satisfactory and that there were staffes. The MKPT considers measures must be taken to create as much familiar and therapeutic environment as possible, as well as to have to become renovations as soon as possible.

In terms of activities in general that are implemented in all the Psychiatric Clinic departments, MKPT expresses concern that they are faint and routine. There is no individualised plan of treatment with the patient's involvement and there is no involvement in a more opimal range of therapeutic, rehabilitation and recreation activities. Psychiatric clinic has no social worker, often lacking multidisciplinary team, especially in the U department. KIP. The MKPT considers it essential to develop a greater and more diverse number of rehabilitation, psychosocial and occupational activities that would help enhance their skills for an independent life.

It's obvious that the main treatment is that psychopharmacology. The use of antipsychotic, antidepressive and anxipolitical drugs by examining certain medical files seems to be reasonable and based on evidence. There were numerous shortages, which were one year absent warehouses (Halopperidol and Flufenaz). There were periods that included numerous shortages, such as basic medical materials (weightly lacking syringes). Antibiotics and analgiacs, as well as other medical drugs, provided them only at special request to the USKKUK general medicine. The MKPT considers it a primary obligation of competent authorities to guarantee regular supply of herbs.

As for informing the patients of their rights, The MKPT has noted that the patient's rights card was located in the kitchen. Informative brochures have been spent, and the Psychiatric Clinic has no means of printing other specimens. Patients are usually orally informed of their rights.

The MKPT considers that relevant authorities must meet the legal criteria set out in Article 6 paragraph 1.5 of the Mental Health Law, which stipulates that one of the rights of people with mental disorders is the right to be informed of its rights.

The Psychiatric Clinic does not have any special guides for preventing suicide and any specific prevention plan. The MKPT considers it necessary to draw up a clear guide which will effectively help identify cases of Swedish tendencies, drawing up a particular surveillance scheme with psychological/psychiatic support.

Control of the documentation and interviews with personnel shows that there is no shortage of free and informed consent from patients, stewards, or legal representatives for staying in the clinic, as well as for treatment as defined by Article 19 paragraph 3 of the Law on Mental Health: the informed malpractice provides through discussion with the patient about nature and the purpose of the proposedrapeutic intervention. The contents of the discussion and the form of informed approval are part of the patient's clinical folder. The patient signed for granting approval both in the folder and in the form of informed approval.

Regarding complaints procedures- There is a complaint box in the department of the Psychiatric Clinic, which according to the directorate opens by a responsible office within KKUK. However, it is unclear for the MKPT that the patient's preambles complaint procedure is and we ask the USKKUK to give us a letter on the matter.

Based on the findings and findings reached during the visit, through this report, The MKPT of the Ombudsman has sent competent authorities the following recommendations: to make the necessary renovations at the Psychiatric Clinic; to increase the number of real psycho-Social activities; to function the multi-disciplinary team in the departments of the Psychiatric Clinic; to become the constant supply of the Psikiattic Clinic; to compile the Guide for Pre-Support Suicide; to offer access to personnel; the number of personnel increased; and according to the patient's need to be informed about treatment of the Law; to inform patients of their rights for pre-proliferation; to be used in separate cases; to use the call on-capitational treatment of patients; and to get on-capital seizures.