2021 m. February 18 d.

Investigation: in the majority of care institutions psychological assitance is not available to people with mental or intellectual disabilities

The Seimas Ombudsman, having conducted an investigation into the availability of psychological services for persons living in social care homes, came to a conclusion that only one third of social care homes in the country have a psychologist working in the institution; even worse, often psychological services are allegedly provided to the residents by employees of the institution, who do not have the necessary competence. Having investigated the situation in over 160 social care institutions, the Seimas Ombudsman regrets that the need for psychological services for the residents is still not recognized in most social care institutions of the country, and the psychological services are not available.

The Seimas Ombudsman first of all notes that in order to ensure the social well-being of the residents and provide timely psychological assistance, an assessment of a person’s need for psychological assistance must be performed. Nevertheless, the investigation revealed that the need for psychological assistance of residents is usually determined by monitoring their behavior or upon the recommendation of a doctor; however, there is no specialized methodology for assessing the need for psychological assistance for residents of social care institutions. The Seimas Ombudsman regrets that psychological assistance is seen only as an integral part of social care.

“Elderly or disabled people, who have never been in contact with a psychologist are not always able to adequately understand the need for psychological help themselves, as this is often associated with mental illness or prescribing medication. It is worrying that during the investigation we noticed a flawed practice when the assessment of psychological services is performed by persons without psychological education, which can not only negatively affect the emotional state of the resident, but also be the reason for improper identification of the need for psychological services,” states the Seimas Ombudsman Augustinas Normantas.

In addition, the Seimas Ombudsman notes that, according to the Catalogue of Social Services, social care services encompass psychosocial assistance, which is defined as the provision and organization of social, psychological and pastoral assistance to persons experiencing a crisis or suffering from strong emotional experiences, as well as to their families and relatives. However, at the time of the investigation, the current legislation did not define the terms “psychologist”, “psychosocial assistance”, “pastoral specialist” and “pastoral care”, nor did it specify the requirements to be met by a psychologist and a pastoral specialist.

The conditions for the activities of psychologists, who can work in social care institutions, are not set in the legislation, which not only causes practical problems, but also has a negative impact on the elderly living in social care institutions and people with mental or intellectual disabilities because they do not receive psychosocial or psychological assistance or get improper assistance. Nevertheless, the Seimas Ombudsman also drew attention to the fact that in the course of the investigation, several social care institutions provided information that a psychologist does not work in them; instead, there are pastoral or spiritual development employees, who perform the functions of a psychologist.

“Although the residents of some care institutions, especially religious ones, definitely want such services; however, it is regarded that psychological assistance services and pastoral care, although both are aimed at analyzing a person’s internal mental processes and can complement each other, must not be equated. According to the representatives of the Lithuanian Psychologists’ Association, a pastoral specialist, a clergyman, who does not have a psychologist’s education recognized by the laws and other legal acts of the Republic of Lithuania and who does not engage in a psychologist’s professional activity, cannot and should not replace a qualified psychologist,” notes the Seimas Ombudsman.

The attention should be drawn to the fact that in reality, the municipalities are responsible for ensuring the provision of social services to the residents that live in their territory, controlling the quality of general social services and social care. However, it should be noted that only 15% of care institutions have informed that they have already applied or intend to apply to the municipality in the near future for free psychological consultations, signing of a cooperation agreement with the Public Health Office, organizing training for the employees of the institution and provision of a financial support for such activities, including projects. During the investigation, some municipalities confirmed that the need for psychological services of the population is only partially met or not met due to the lack of qualified specialists.

“Moving to a social care home for elderly persons or persons with disabilities is an emotionally very complicated process, since a person’s environment changes, certain new rules of living in a social care institution appear, that the new residents need to adjust to and get used to. It is very important that all employees of a social care institution surrounding a person during this emotionally difficult period have appropriate psychological knowledge and special communication skills, that would help to ensure a smoother and faster adaptation process of a person, who has moved to a social care institution,” the Seimas Ombudsman expresses his worries.

The Seimas Ombudsman states that in practice the employees of the institutions react differently to the behavior of various residents, they do not have the skills as how to act in case of a conflict between the residents or other situations that negatively affect the social welfare of the residents. Due to the extremely wide range of psychological needs of the residents of social care institutions, it is necessary not only to ensure the availability of psychologist’s services for persons living in social care institutions, but also to constantly improve the qualifications of care institution staff in conflict, bullying, violence or other misconduct and suicide prevention that would help to professionally manage the aggressive behavior of the person as well as to provide him/her  with emotional support.

After evaluating the results of the investigation, the Seimas Ombudsman drew the attention of the Ministry of Social Security and Labour to the need to find out whether psychologist services are available to the elderly and disabled residents of social care institutions, founded by the Ministry of Social Security and Labour, and to determine the need for such services as well as to contribute to the planning, organization and provision of psychological services to the residents of such care facilities.

The Seimas Ombudsman also stressed the need to approve the methodology intended to psychologists for assessing the psychological needs of adults with disabilities and the elderly living in social care institutions, among other things, to ensure that such assessment is performed only with the participation of specialists (psychologists). The Seimas Ombudsman also submitted related recommendations to the Ministry of Health, municipalities and social care institutions for adults with disabilities and the elderly.

The Seimas Ombudsmen protect a person‘s right to good public administration, securing human rights and freedoms, and supervise fulfilment by state authorities of their duty to properly serve the people. The Seimas Ombudsmen also conduct national prevention of torture in places of deprivation of liberty in accordance with the Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. The Seimas Ombudsmen’s Office is a national human rights institution accredited with an „A status“ by the United Nations.

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