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English Language Page a. An appearance in person before a court under a specific procedure for determination of the legality of his/her detention shortly after the initial placement; b. Participation of a lawyer already from the moment of detention and obligatory representation during the entire proceedings, including the appeals. A system of adequate legal aid should be envisaged for the patients who are not able to pay lawyers’ fees; c. Conducting of the court hearings for involuntary hospitalization according to the due process standards, including a possibility of the committed to appear before the court in person, to present an alternative expertise, to have sufficient time for the preparation of his/her defense and to cross-examine witnesses. 2. The civil and the criminal commitment to a psychiatric institution for active treatment should be subject to ex officio judicial review periodically and in short periods of time. 3. Placement of persons under guardianship to psychiatric institutions for active treatment or to social care institutions for disabled persons should take place through a court procedure in accordance with the due process standards. 4. The law and the practice should envisage a procedure to seek an informed consent for treatment also from the involuntary patients, as well as a procedure to evaluate the capacity of the patient to give an informed consent for treatment. Advanced directives should be incorporated in the law, as legitimate forms of expression of a specific will. 5. Treatment methods in the psychiatric institutions in Macedonia should be diversified as much as possible and should include more activities. 6. Application of unmodified ECT in the neuro-psychiatric hospital in Negorci should be discontinued. Informed written consent for the application of ECT should be sought from the patients. 7. All means of physical restraint in the psychiatric institutions in Macedonia should be based on law and registered in a special register. Patients should not be restrained in front of other patients. Mechanical restraint and long-term restraint should be avoided. 8. A very high priority should be given to improving the living conditions of patients in the 5-th and 6-th wards in the Demir Hisar Psychiatric Hospital and, in particular, to the renovation of the section’s sanitary facilities and to providing all patients with a lockable space in which to keep their belongings. 9. Macedonian authorities should take urgent measures to improve the living conditions in the wards for patients with severe developmental disabilities in the neuro-psychiatric hospital in Negorci and to offer them appropriate care. 10. The government of Macedonia should develop a program for deinstitutionalization of social care for people with developmental disabilities, including support of families and protected housing, and thus ensure the continuation and further development of the UNICEF project. 11. The capacity of the Demir Kapija institution should be reconsidered and, if there is a need for such institutions at all, they should be established more evenly on the territory of Macedonia. 12. More qualified staff should be appointed in the Demir Kapija social care institution in order to ensure appropriate specialized care for the residents in the “health” ward. 13. The material conditions in the “health” ward in the Demir Kapija social care institution should be upgraded to the standards of the “new object” and the environment for all residents should be individualized. 14. Residents of the “health” ward in the Demir Kapija social care institution should be provided lockers for personal belongings and should be offered individualized clothes (not pajamas). 15. All residents in the Demir Kapija social care institution and especially those in the “health” ward should be offered meaningful activities and rehabilitation programs. |
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