In 2000 the So­ros Foun­da­tion-Lat­via (SFL) began its first ac­tivi­ties in the field of men­tal dis­abili­ties, sup­port­ing 4 pro­jects. Based on a needs as­sess­ment on men­tal health care, a pro­ject for a three-year Men­tal Dis­abil­ity Ad­vo­cacy Pro­gram (MDAP) in Lat­via was devel­oped and sub­mit­ted to OSI-New York. The pro­gram was ap­proved by the OSI Human Rights and Law Sub-Board and has been in op­er­ation since 2001. The pro­gram is im­ple­mented by the Lat­vian Cen­tre for Hu­man Rights and has aimed to change pol­icy by mov­ing the health care sys­tem from 100% re­li­ance on institutionaliza­tion to a sys­tem that pro­vides var­ious al­ter­na­tives to in­sti­tu­tion­ali­za­tion.

The program consisted of two main units:

• Deinstitutionalization and the development of community based services;
• Provision of patients' legal rights protection and advocacy.

The aims of the program are to promote deinstitutionalization and to support the development of community based services for mentally disabled and to develop advocacy for mentally disabled.  For further information look in program description.

Further in description:
Some of the pi­lot pro­jects
The main ac­tivi­ties of the ad­vo­cacy unit
Col­labo­ra­tion with OSI net­work pro­gram – MDAP (Bu­da­pest)
Policy outcomes
Program Evaluation and Presentation Mechanisms

MDAP has pi­loted pro­jects geared to cre­at­ing posi­tive ex­am­ples that would sup­port such a pol­icy shift (e.g. a sup­ported em­ploy­ment pro­gram, day care ser­vices, sup­port and self-help groups, life skills pro­grams). The pro­gram also spearheaded ad­vo­cacy of the rights of mentally disabled, or­ga­niz­ing train­ing semi­nars for law­yers, NGOs and men­tal health care pro­fes­sion­als on hu­man rights, as­sist­ing the gov­ern­ment in draft­ing new leg­is­la­tion on men­tal health care. A first case for impact liti­ga­tion has been initiated. 2003 is the last funding year for the program, but activities will continue into the spring of 2004. The total pro­gram fund­ing for 2001-2003 was USD 300 000.

Grants com­pe­ti­tions were or­gan­ized on de­vel­op­ing com­mu­nity-based ser­vices for mentally ill and peo­ple with learn­ing dis­abili­ties every year. There were 15 pro­jects on to­tal sum USD 94.827 sup­ported in 2001 and 14 pro­jects on to­tal sum USD 82.876 supported in 2002. The grant com­pe­ti­tion of 2003 has been started and will end by the end of July 2003.

The aims of the program are to promote deinstitutionalization and to support the development of community based services for mentally disabled and to develop advocacy for mentally disabled.  For further information look in program description.

Some of the pi­lot pro­jects

1. “Re­storing and Strengthening the Fam­ily Ties of Men­tally Dis­abled Peo­ple and Training for Their Re­la­tives", Akniste Men­tal Hos­pi­tal, USD 10.500

The goal of the project was to promote patients’ deinstitutionalization. The project applicant is a mental hospital for long-term chronically ill people with 450 beds. The hospital is located far away from Riga (the capital city), near the Lithuanian border. There is very poor public transportation, therefore it is difficult for relatives to visit the patients. Many of the patients have been in the hospital for many years. Questionnaires were sent out to the relatives and it was find out that many families wanted to restore the family ties with their relatives. The project idea was to bring patients by van to their families. There was also some hope that at the end of project some families may want to take back their relatives from the hospital. At the end of the project there have been 92 patients’ visits to their families. The project currently is continued with the hospital’s financial support. Several families have expressed the will to take out their relatives from the hospital and to provide the care at home.

2. De­vel­op­ment of Life Skills Pro­gram for the Re­in­te­gra­tion of the Men­tally Ill into the Com­mu­nity (for liv­ing in group apart­ments and fami­lies), Akniste Men­tal Hos­pi­tal, USD 3.603

After initial activities in Akniste (support for Patients’ Council activities, restoring the family ties), a life skills program was developed in Akniste hospital in order to prepare institutionalized mentally disabled for life in the community. The program included such issues as planning of leisure time, budget planning, medication and their side effects, anger management, the first signs of crisis. The program was offered to and afterwards taken up by other institutions in Latvia.

3. Es­tab­lish­ment of a Train­ing Apart­ment in Akniste for Men­tally Dis­abled Per­sons – the First Step To­wards a Group House, NGO Pas­parne, USD 10.000

The training apartment was established in order to provide half-way housing and to prepare the consumer for returning to the community. The program is foreseen for 3-6 months depending on each individual’s needs. Initially, the program is offered to those consumers whose families have agreed to take them back. In the future, the training apartment will be used to prepare possible clients for a group home, which will be started to be establish as pilot project in the Akniste community in 2003.

4. Es­tab­lish­ment of Sup­port Groups for Per­sons with Sui­ci­dal Ten­den­cies Af­ter Sui­cide At­tempts, Psy­chia­try Cen­tre, USD 11.977

In 2002 an extensive program of assistance to persons who have been tried to commit suicide and have been placed in the Riga Mental Hospital was started. The program offers individual assistance or support groups after leaving the hospital. The assistance is organized and provided in the community (Crisis Center “Skalbes”). The project applicants intend to use project’s results for convincing the government to allocate funding and start a special State program on suicide prevention by the end of 2003.

In 2001 and 2002 the to­tal budget for this part of the pro­gram was USD 16.000, which was spent on sev­eral ad­vo­cacy ac­tivi­ties car­ried out by the Lat­vian Cen­tre for Hu­man Rights and Eth­nic Stud­ies. There were sev­eral ac­tivi­ties car­ried out ac­cord­ing to the pro­gram strat­egy, as well ad­di­tional ac­tivi­ties, which were funded by other do­nors. In 2002 the pro­gram had co-fund­ing from the Vil­nius Re­gional Of­fice of the Ge­neva Ini­tia­tive on Psy­chia­try (the Neth­er­lands), the Em­bassy of Great Brit­ain in Lat­via, the Men­tal Dis­abil­ity Ad­vo­cacy Cen­tre (OSI fund­ing), the Swed­ish East Eu­ro­pean Com­mit­tee. The to­tal co-funding was USD 6.105.68; GBP 3.995; SEK 52.093.  

The main ac­tivi­ties of the ad­vo­cacy unit:

1. Liti­ga­tion – Cur­rently a case is being prepared regarding a person’s compulsory commitment to a social care home for the mentally disabled. The person was admitted to social care home against his will, so that interested parties could get his apartment. Currently the materials for initiating the case have been gathered.

2. Initiating changes in legislation – In 2002 the gov­ern­ment fi­nally ap­proved and sent to the Par­lia­ment the draft law On Psy­chi­at­ric As­sis­tance, which was meant to be the main law for the pro­tec­tion and pro­mo­tion of the rights of the men­tally ill. For pro­ce­dural rea­sons the law has to be sub­mit­ted to the Par­lia­ment once more. Moreover, as the draft law was not in com­pli­ance with in­ter­na­tional hu­man rights norms, the Lat­vian Cen­tre for Hu­man Rights and Eth­nic Stud­ies ap­plied to Men­tal Dis­abil­ity Ad­vo­cacy Cen­tre (Bu­da­pest) and pro­fes­sor Toma Bir­mon­tiene (Lithua­nia) and asked for le­gal ana­ly­ses of the draft law from hu­man rights per­spec­tive. The com­ments were sub­mit­ted to the Min­is­try of Health in March 2003 and they will be used in or­der to re­vise the draft law be­fore re­sub­mit­ting it to the Par­lia­ment.

3. Training seminars on legal advocacy

In 2002 LCHRES or­gan­ized two train­ing semi­nars on le­gal is­sues in men­tal health care. Thus in June 2002 LCHRES to­gether with Men­tal Dis­abil­ity Ad­vo­cacy Cen­tre (Bu­da­pest) or­gan­ized train­ing semi­nar for law­yers and NGOs on the Eu­ro­pean Con­ven­tion on Hu­man Rights re­garding the men­tally dis­abled. The semi­nar was funded by the Brit­ish Em­bassy in Lat­via and Men­tal Dis­abil­ity Ad­vo­cacy Cen­tre (OSI fund­ing). Around 39 participants at­tended the semi­nar.

In No­vem­ber 2002 LCHRES or­gan­ized a two-day semi­nar for psy­chia­trists and other men­tal health care spe­cial­ists on Hu­man Rights in Psy­chia­try. The main theme was the le­gal frame­work for com­pul­sory hos­pi­tali­za­tion and treat­ment. The semi­nar was mainly funded by the Swed­ish East Eu­ro­pean Com­mit­tee and Men­tal Dis­abil­ity Ad­vo­cacy Pro­gram-Lat­via. Around 45 per­sons at­tended the semi­nar.

4. Train­ing semi­nars on Ad­vo­cacy

In 2002 the first work­shop was or­gan­ized for con­sum­ers of men­tal health care ser­vices. The ex-con­sumer Mr. Joel Slack (USA) gave his semi­nar “On Re­spect”. Around 15 per­sons at­tended the work­shop.

In Fe­b­ru­ary 2003 LCHRES or­gan­ized the semi­nar on start­ing self help or re­la­tives sup­port groups for men­tally ill or per­sons with learn­ing dis­abili­ties. Sev­eral MDAP-Lat­via funded pro­jects on self-help groups were pre­sented. Around 85 per­sons at­tended the semi­nar.

5. Sched­uled for 2003 – In 2003 LCHRES will is­sue re­newed book­let on Men­tally Ill Rights in Lat­vian and Rus­sian and will carry out a survey on consumers’ needs and opinions on the quality of mental health care. The results of the survey will be used for developing follow-up activities for the program, as well as the results will be offered to the Ministry of Health.

Col­labo­ra­tion with OSI net­work pro­gram – MDAP (Bu­da­pest)

The OSI net­work pro­gram MDAP each year has al­lo­cated match­ing funds: USD 15.000 in 2001; USD 25.000 in 2002 and USD 25.000 in 2003. All the match­ing funds have been used for fund­ing pro­jects of com­mu­nity based ser­vices. The net­work pro­gram also helped with its ex­per­tise, send­ing its ex­perts to par­ti­ci­pate in in­ter­views on pro­ject pro­pos­als with pos­si­ble grant­ees.

The network program also has funded several study visits (model site training) for several project directors. Latvian grantees have had possibility to participate in model site training in Lithuania, Rumania (Timisoara), Rumania (Cluj-Napoca), Prague and Budapest.

Pol­icy out­comes

The aim of the pro­gram was to in­flu­ence gov­ern­men­tal pol­icy using the pi­lot pro­jects. Most of the pilot projects of the program have received substantial coverage in the national and local media.

In 2001 the program director Ieva Leimane-Veldmeijere participated in a work­ing group convened by the Ministry of Welfare's Social Assistance Foundation to prepare amendments to the Law on So­cial Services and Social As­sis­tance on mentally disabled rights and conditions in social care homes for the mentally disabled. The law was adopted in 31 October 2002 and it entered into force on 1 January 2003.

In 2003 the Min­is­try of Health in­vited program director Ieva Leimane-Veldmeijere to participate in a work­ing group on de­vel­op­ing new strat­egy for re­form­ing men­tal health care in Lat­via.

Program Evaluation  and Presentation Mechanisms

In 2002 a brainstorming session was organized on the program’s priorities in 2002. 20 people participated in the discussion.

The program has had several possibilities to present its activities to the broader public. In October 2002 LCHRES and Vilnius regional office of Geneva initiative for Psychiatry (the Netherlands) organized the 3^rd Baltic Mental Health Forum in Jurmala (Latvia). Around 80 participants attended, including delegations from Latvia, Lithuania, Estonia, Kaliningrad district and St. Petersburg, as well funding organizations from Sweden, Canada, OSI-Lithuania and SFL. There were two workshops on the development of community based services for the mentally disabled organized by Ieva Leimane-Veldmeijere. The workshops included presentations of the most successful pilot projects in Latvia, as well presentations of two Rumanian and Hungarian programs funded by OSI network Mental Disability Advocacy Program.

In 4 April 2003, program director Ieva Leimane-Veldmeijere presented the Mental Disability Program’s pilot projects in a workshop – “No health without mental health!” at the OSI/EPHA conference “Effective Advocacy for Health in Europe”.