Silent and fake deinsitutionalisation in Macedonia

Besides these developments in last two decades outlined above there were other experiences that were related to deinstitutionalisation– either in developing approaches useful for deinstitutionalisation or staging various kinds of resettlements. In children home 11. Oktomvri they have reorganised the groups in a way so that they have more identity and be more family-like. In infants home in Bitola they have made infants groups heterogeneous and introduced key workers in order to enable attachment process and provide more comprehensive and individually suitable service (UNICEF project). Similarly, in Demir Kapija on the location of the annexe there was a richness of activity, good teamwork and improved organisation of residents’ life and employees work. Quite recently, in an UNDP project there was input in staff abilities to work in a more empowering ways and residents were encouraged in self-advocacy in Banja Bansko institution for people with physical disabilities.

Some institutions have, along the lines of deinstitutionalisation and in order to improve living conditions of the residents, established home-like units within their compounds. One such unit was in Demir Kapija before 2008 on the site of the annexe, which is now abandoned, the ‘new building’ in Demir Kapija was also planned as a set of apartments. Likewise, the new building of Banja Bansko has the layout of a series of bed-sits, in which couples of residents live in quite an intimate space. In Topansko Pole they have in 2016 established My Home (Moj dom), a self-directed housing unit within the complex of the institution with seven residents. Residents were included in renovation of the facility. These units allow individualisation, the degree of choice and control of residents is greater and they are included in daily household activities.

These developments are not really deinstitutionalisation since the residents remain with the institution and its system, nevertheless they are considerable improvement in some residents’ condition and, if a part of the begging of a more thorough deinstitutionalisation process, can be an encouragement for real resettlements that ensue. They demonstrate to the staff, and also to the residents and other audiences that people can have a better life, that residents have greater capacity and potential than the service providers thought and, above all, that a just change of the setting changes behaviour and increases abilities and capacity of the residents. If these improvements are not part of a deinstitutionalisation processes and if the further resettlements do not follow on, they become just part of institutional privilege system and are seen more or less as a ‘reward’ for some residents. In the analysis below, we term these as ‘internal resettlements’.

In children institutions, children regularly experience resettlements in a way of discharge as residents outgrow the age limit set for an institutions or when a better solution is provided. In the infants’ home in Bitola, for instance, children stay until conditions in their own families improve or an adoptive family is found or placement in foster care secured. If none of these happens, children are moved to one of the children institutions (11. Oktomvri) or to an institution for people with disabilities (Demir Kapija or Banja Bansko). In the institutions for older children, the case is similar although resettlements to adoptive and foster families are rarer. The ex-residents, when they grow up, “are discharged to their families, which works well or, just put on the street, which is sometimes disastrous.” What these resettlements, or better discharges, have in common, is that there is no ‘after care’ provided by the institution. The notion is that the residents are institution’s responsibility only when they reside in the institution, when they move out, are resettled or discharged, the concern for them is for somebody else.

Sometimes, especially in the institutions for adults, spontaneous resettlements happen. A resident or relatives decide for a return to home or for an adventure of independent living. Or, as in the case of the first cohort of resettlement (Kriva Palanka), a local service has an initiative and provides alternative service pack. These resettlements can be, as in the case of discharged children, a great success but also a disaster resulting in homelessness or premature return to an institution.

An instance of spontaneous resettlements are the cases of residents that have left Banja Bansko to study in Skopje. There were a few such examples and have worked well. An ex-resident gets a room in a students’ dormitory, receives an extra allowance for study period, but does not receive any assistance in kind – not from the institution nor from other services. Fortunately, there is enough student solidarity to allow the ex-residents to find their way around and to be able to continue and finish studies. The problem they encounter is that the student dormitories are closed during the summer, so they have to go either back to the institution or improvise a better solution.

In Topansko Pole institution, we have observed what could be termed ‘silent deinstitutionalisation’. Topansko Pole was established in fifties as a huge institution consisting of 300 residents. In 1965, they were dispersed to Demir Kapija, Banja Bansko and to a home for blind children. The institution became considerably smaller and was meant to be a rehabilitation centre for children. In 2000, there were however still ninety (90) users. In subsequent seventeen years, the number decreased to thirty-seven (37) users, which is a substantial decrease. This happened without a plan and organised effort. When asked for an explanation of how and why this had happened we were told that “diminishing number of the residents is due to deinstitutionalisation processes. Establishment of day centres across the country and parents’ awareness have contributed to diminishing size of the institution.” It was either that the residents from places away from Skopje have returned to their homes because the day centres were opened and their relatives could now care for them, or they, for the same reason did not send their children away from home. And parents from Skopje tend to keep their children at home and just bring them to the day care facility. This kind of effect or trend was not detected (to such an extent at least) in other institutions.[1]

Formation of community services – group homes, day centres and other services (SOS, group home Kavadarci, day centres), which were developed in recent decades can be also considered as a deinstitutionalisation since they provide not only some alternative placements in the community but also because they provide the technology, ways of working and organising that can be used in the resettlement of the residents.

Claimer: This blog is intended as a part of Situation Analysis and Assessment/ Evaluation Report of Implementation of National Strategy on Deinstitutionalisation 2008–2018, which will be soon presented to the public within the EU framework project Technical assistance support for the deinstitutionalization process in social sector. For this blog, Vlado Krstovski is considered to be co-author.

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[1] This phenomenon is in fact quite unusual. Mostly, where an indirect deinstitutionalisation, i.e. by development of community services, was intended, it did not work. The institutions tend to survive and remain unaffected by development of what is meant to be alternative to them.