Six social care institutions for around 2,000 clients currently operate in Moldova. Four of these are formally for adults (Balti, Brinzeni, Badiceni and Cocieri) and two for children (Hincesti and Orhei) where, however, a significant proportion of the clients are actually adults. “Earlier projects have shown that workers at the institutions do not differentiate between clients based on their illness or disability. They do not know that people with mental health problems and people with intellectual disabilities have differing needs and cannot be treated in the same way. A biological approach – and one often burdened with many prejudices – is prevalent. Although a stay at such institutions should be voluntary and restrictions on clients’ personal freedom should not be routine practice, in many institutions clients are forced to stay in closed wards. There are practically no clients with mental health problems currently allocated to groups intended for integration into the community. The assessment of all clients with a psychiatric diagnosis focusing on the “threat” they represent is being prepared as part of the action plans for deinstitutionalisation. Our experience from communication with the psychiatrists connected to these institutions has made us justifiably concerned that their views and assessments may be conservative and restrictive,” says Martina Kratochvílová, project manager at the Centre for Mental Health Care Development.

The current project therefore focuses on four areas. The first relates to improving the quality of care in sheltered accommodation through consultation on service methodology and supervision meetings. The project will continue with this type of support, and as the qualifications of the Moldovan partners improve, more emphasis will be placed on independent work in Moldova itself. The functioning and quality of care in sheltered accommodation will also be supported through the design and implementation of quality audits.

“In the first years, the project followed on from pilot projects from the Keystone and Trimbos Moldova organisations. Transformation plans were created for four institutions, 32 workers at the institutions were trained in an individual approach to the client, community housing and legislation, while internships related to service transformation were arranged for 17 experts. The next year, seven sheltered accommodation projects for 42 people were set up, while clients undertook financial literacy and employment training and were provided with material assistance related to sheltered accommodation, such as greenhouses for growing vegetables, and shoemaking, barber and hairdressing equipment,” Martina Kratochvílová adds.

The next and step is now the professionalisation of the National Agency for Social Assistance (ANAS), responsible for the deinstitutionalisation and transformation process in Moldova. ANAS has obtained support in the form of workshops, internships in the CR, and the creation of a methodology. Improving the lives of people with mental health problems through the transformation process and the identification of obstacles preventing them integrating into the transformation process is also an integral part of the project. The fourth project area concerns increasing public awareness in the regions, as the ignorance and prejudices of the local population – in particular as regards people with mental health problems – can complicate the deinstitutionalisation process. The project therefore includes training for ‘peer ambassadors’ (people with experience of mental health problems) who will focus on destigmatising work through workshops at schools and for the public. A “destigmatising flyer” and video commercial will also be created for these purposes.

Last year the implementation of this project was significantly impacted by the coronavirus pandemic and the related government measures on both the Czech and Moldovan sides. “The Czech implementer could thus only make two trips to Moldova, both in February 2020. Together with the Moldovan partners, Jan Pfeiffer visited and mapped out the situation at the social care institution in the city of Balti. Myroslava Bubela provided methodological support at the sheltered accommodation in Cocieri, met local methodologists and a Keystone representative to discuss the sheltered accommodation methodology, held a workshop with ANAS, and met potential peer ambassadors. The other planned trips had to be cancelled. However, it proved possible to fully transfer the majority of activities online,” says Kateřina Kutková from the Czech Development Agency, responsible for the projects in Moldova.

All communication has taken place online since March, including supervision, while online cooperation with ANAS representatives was established, and now regular meetings and workshops for the creation of a new ANAS methodology are being organised. Some peer ambassador training has been carried out by Czech peer teachers. This online training ran from April to December and thanks to it, the Moldovan peer ambassadors are now able to speak openly about their personal stories, and address the public and students. Some activities could not be implemented “remotely” and so have been shifted to this year. Nevertheless, these changes have not significantly influenced the long-term objectives and outputs of the project.

The project implementor is the Centre for Mental Health Care Development. In addition to the Moldovan branch of People in Need (PIN Moldova), responsible for the implementation of the project in Moldova, partners also include the Ministry of Health, Labour and Social Protection, the National Agency for Social Assistance, and the Trimbos Moldova and Keystone Moldova organisations.