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'Sweet freedom': remarkable recoveries in a mental health project in Croatia

This article is more than 6 years old

Lives that were dominated by medication and restraints behind the locked doors of an old-style asylum in Osijek are being transformed. Now many of its residents are enjoying greater independence in shared apartments in the nearby community, with carers to give them support when they need it

Photographs by Robin Hammond/NOOR for Witness Change/The Guardian

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Stjepan Getto, 83, lived in an institution for 27 years. He went in to tackle his alcoholism, the only help offered by social welfare. Getto could have left at any time, but there was never a realistic option where he could live outside but still have the mental health support he needed.

In 2014 he was given a flat in Osijek, eastern Croatia, where he lives with Jelica Getto, a woman he met in the mental health centre and married in 2016.

“In the institution it was impossible to have the chance to recover, to have freedom,” he says. “I now have the right to love, because I married the person I love.”

  • Stjepan and Jelica Getto in the flat they share in Osijek

Jelica, 61, was in the institution for 17 years. She said she was labelled “mad” by psychiatrists and her family, and was institutionalised by force. “They took my will to choose,” she said. In 2015 her legal capacity was returned to her by the courts. When asked about her life now, she quotes Croatian poet Ivan Gundulic: “Oh beautiful, oh dear, oh sweet freedom.”

61-year-old Nada Sobasic lived in institutions for 20 years; Gabriejela Butorac, 78, for 53 years and 38-year-old Hrvoje Sebalj for eight years. They all last stayed at a centre for providing services in the community in Osijek, before being offered an apartment as part of a programme of organised housing with support. The programme is led by Ladislav Lamza, a former social worker who transformed what was until recently an old-style asylum, and began moving many of its residents – or “beneficiaries” – into shared flats around the city.

When the Guardian met Sobasic, Butorac and Sebalj, they had just been out shopping, buying winter coats in matching styles but different colours. For Butorac – who chose crimson – it was the first time she could remember buying her own clothing, and the first time she has needed a coat in more than five decades.

They all appreciate their newfound independence. “I can now watch the TV series I like,” says Butorac. “In the institution we all had to watch the same TV programme.”

“I like that it is not crowded here,” says Sebalj. “In the institution there was always someone yelling.”

  • From left: Nada Sobasic, Hrvoje Sebalj and Gabriejela Butorac

Sobasic says her nephew now visits her and they talk on the phone every week. “When I was at the institution he never visited me.”

Their housing assistant, Zeljka Bircic, says that the residents often say they like that they can cook what they want. “In the home they didn’t get to choose what they wanted to eat.”

Butorac is proud to be able to cook soup and risotto. “It’s great,” she says. That night, the three flatmates are planning a supper of cornflakes and milk.

“They are more relaxed, and feel more at home,” says Bircic. “There is a significant improvement in their wellbeing … We can focus much more on their individual mental health needs.”

Occupational therapist Nera Frank agrees. “It’s not just popping pills and going to the psychiatrist. [Before] we didn’t have the time. We had 130 people waiting. Now a lot of our beneficiaries can significantly reduce their medication just [because we are] giving them more time and an individual approach.”

Ivica Vojtulek (left), aged 57, spent 10 years inside a mental health institution before moving into an apartment in Osijek in 2012. “I was diagnosed as a paranoid schizophrenic,” he says. “I thought that the Americans were following me, controlling me from a distance. The Russians and Chinese too.”

He describes life in the institution: “The first day I arrived, everything was so strange. One of my roommates was obviously sick. In the middle of the night he shouted, ‘Police, police!’ Are they going to arrest me, I wondered? I was frightened. We lived in a pigsty. The toilets were very dirty. I got used to it but I was nervous all the time.”

One day he got into a violent confrontation with another resident, Damir Samardzic. Vojtulek stabbed the man. “It’s no wonder I got in a fight with Damir,” he says. “Every night there were fights. We were fighting because it was like we were in a prison. You couldn’t spend your time usefully. There was no occupation. I was just reading the papers. Before I was in the institution I had a family and land … I felt useful.”

Five times he tried to kill himself: “Three times I took pills and twice I tried to hang myself. My children didn’t come to see me. My ex-wife remarried and had another child with another man. I felt like I was abandoned. I thought I would stay in an institution for the rest of my life.”

38-year-old Slavica Hip lived in the mental health centre in Osijek for 10 years, but moved into an apartment in 2014 as part of Lamza’s programme, where she now lives with her boyfriend. “He is very kind and nice.” She is currently using an exercise bicycle to try to lose weight. People who lived with her in the institution say she has put on a lot of weight since moving into the apartment: “The food is much better here,” says one of her flatmates.

“It is better here in the apartment,” Hip says. “I get up when I want. I can sleep longer. I can listen to music in my bedroom. It’s peaceful. The worst thing about the institution is people would steal clothes from my wardrobe and my makeup.” She says that in the centre she had to take more pills. “Now my medication has been reduced. I feel better.”

Osijek had two centres for people living with mental health problems. One of these, on the outskirts of the city in Cepin, is now closed, thanks to Lamza’s efforts to rehabilitate patients: nearly 500 people passed through its doors in the 20 years it was functioning. Tatjana Ilic, 50, spent seven years there before moving into an apartment in Osijek.

“I was taken to Cepin against my free will,” she says. “I had taken some medicine prescribed by the doctor without food. I couldn’t wake up the next day. My mother called the police when I didn’t answer the phone. The police came, took me to the hospital, and the doctor in the hospital sent me to the institution. They took my legal capacity from me.

“I woke up lying on a bed there. They put me in a room with four or five other women. One was shouting all the time – day and night. I couldn’t sleep. She hit me. We were fighting and yelling all the time. I was so desperate. I became depressed and I didn’t want to eat or drink. I stopped having any contact with other people in the institution. Despite all the people there I felt all alone in the world.”

She says that she had had problems in her marriage which had made her depressed, but it became much worse when she was admitted to the home in Cepin. “Before the institution I got depressed but always found a way out, but in the institution there was no way out. I was depressed all the time in there.”

Now she is outside, Ilic says she is too busy to be depressed. “I feel born again … I feel fine now, apart from that I miss my daughter who is in Austria.” She works at Lamza’s centre doing laundry, and repairing sheets in the sewing workshops.

  • Inside the now-closed home for people with mental health issues in Cepin. The last people were moved out in 2014 and there was a celebration party

Branka Reljan, 55, has schizophrenia. She spent 12 years in a psychiatric institution after she was sectioned. In 2014 she was allowed to move into an apartment in Osijek with her partner. Drazenko Tevelli, 45, spent 13 years in a psychiatric institution. He was sent there by social workers to deal with alcoholism. Since leaving, neither of them has had an episode that required intervention from a psychiatrist.

Branka says the institution was not a good place for recovery. “You felt like you were in chains.”

Reljan and Tevelli adore their small home but most of all enjoy the freedom to leave it at will. “I don’t have to report to anyone,” says Tevelli. It has two bedrooms, so at some point they will have another flatmate move in, when Lamza finds someone they will get on with. In time they hope to find a place for just the two of them.

Luka Bobanovic, 36, caught a fever at the age of seven that left him brain-damaged. His mother handed him over to state care and he has been bounced around from institution to institution across Croatia, ending up in Osijek.

“When he came to us he was very disturbed,” says Lamza. “Eight times Luka went through a door or window, either him chasing staff or them chasing him. The doctor told staff to tie him to his bed. I found him like that, tied to his bed, crying for his mamma. The staff shrugged and told me, ‘We are scared of him.’”

As part of his programme to move residents into the community, Lamza installed Bobanovic into a house with other beneficiaries in 2014. Since living there he has had no violent episodes. The house has 24-hour support from the centre and he has found a father figure in one of the other residents.

  • Ladislav Lamza, the director of the centre, pictured in the building he has already successfully closed down after moving people out into homes in the community

Lamza started as a social worker 29 years ago and for most of his career he considered closed institutions as a part of life for people living with mental health challenges. That changed when he went to Austria and met social workers assisting people living with mental health problems, who had been deinstitutionalised. “The workers there said, ‘We would like to make a bet with you – who is the beneficiary and who is the worker?’ I couldn’t see the difference!”

Presented with remarkable stories of recovery that he had not thought possible, Lamza was racked with guilt. “I had never seen anyone rehabilitated in our institutions … It is a place to confine people – we feed them, keep them, and nobody gets well.” He decided to make “a transition from medical model to inclusive model”.

Darko Kovacic, 53, came to the mental health institution in Osijek in 2001, staying there when it was transformed by Lamza. In all he has lived in institutions since the age of 11. He doesn’t know a name for his mental health problem but does know that he feels more positive about his future since 2012 when Lamza changed the sign on the front of their building: from – “Home for the Insane” to “Centre for People Like Us”.

“It was a very positive move,” says Kovacic. “It removed the prejudice. The last sign said that we were crazy people – it was not correct. We are not marked by this ugly name now.

“Without Ladislav my life would be different. He helped us. He is a man with a soul. A heart for everyone.” With Lamza’s help, Kovacic is buying his own house from the proceeds of his late mother’s house in Zagreb. “I’ll be happy to live alone as long as I have the care and contact of the centre,” he says.

Slavko Kljescik, 53, can remember when he had a good job and a nice girlfriend. An industrial accident caused him to suffer first from headaches, then anger outbursts and finally hallucinations. He was sent to an institution in 2008 where, he says, an experimental course of medication made him very ill.

Kljescik has lived out in the community for the past few years and now has a job a couple of days a week in a local bar. “That past life is lost but I am content with this one, I feel I am in remission. I have good health and I feel useful again.”

Lamza has had little support from his employer, the Croatian ministry for health, and many of his own staff still resist accepting the changes. The majority are convinced by the results they see and have established warm, supportive relationships with beneficiaries.

Lamza said he was himself fearful when he took the first people into their own apartments in the town. “The first day we let them go I didn’t sleep at all. Did she try and stab someone? Have they quarrelled with someone?”

But the results astounded him. People began to heal. “They can’t find a reason for living [in the institution]. When we give them choice of free will, they rehabilitate. They get married, they get jobs, they have almost normal lives.”

With hindsight he sees the damage institutions do: “[They] make you believe you are worthless. Without names, without respect.” Not everyone agrees this is the right approach, he says. “Some of the staff understand. Others think I have become crazy.”

Rada Matos is the director of Ljeskovica home for adults with mental health problems, deep in the Pozega forest, an hour’s drive from Osijek. Lamza describes it as “a warehouse for lost souls” and it struggles to keep staff or to run any kind of rehabilitation schemes. Ljeskovica is where Lamza’s centre was a few years ago. Matos has little option as the institution has no community of any size close by, so people living here could not be supported if they moved out.

Miryama Nikoli, 38, is new to Ljeskovica but has been institutionalised for 18 years. Eyes glazed by medication that hasn’t been changed in all that time, she talks to everyone about her daughter, taken away as a baby. “I was sick because of my nerves but now I suffer because of my baby,” she says. “I drink the medicine, but I want to see her again.”

Matos later pulls out her file; Nikoli’s background is one where she was abused and abandoned as a child. One line mentions that she has had a baby, who will now be 18. She has not seen a psychiatrist for over a decade. The file contains just four A4 pages.

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