About the hospital
The history of the Hospital officially begun with the Decision for the establishment of a Republic Hospital for people suffering mental disorders in the village of Bardovci, published in the “Official Gazette of People’s Republic of Macedonia” on December 17 1954. The objective of the Hospital stated therein is as follows: “… to admit, accommodate and treat people from PRM suffering mental disorders…”.
The tasks, defined according to another document of I.S. no. 341 are as follows: “… to do scientific and research work and to work on the promotion of preventive and therapeutic activity in elimination and treatment of nervous system and mental disorders and to assure performance of the scientific and research work with didactic objective for the needs of the Faculty of Medicine within the University in Skopje”.
Professor Dr. Bozhidar Niketikj played a crucial role in the establishment of the Hospital and of the psychiatric service in general in the Republic of Macedonia. At the beginning, the professional part of the work was performed by professor Dr. Stefanovski, professor Dr. Fildishevski, Dr. Stojanov Spasko and Dr. Nikola Pandilov who, in 1956, became the first manager of the Psychiatric Hospital “Bardovci”.
According to the first list of employees dating from 1956, the work was performed by 39 employees.
Upon the request of professor Niketikj, suitable literature, personal experience and knowledge, consultations and suggestions of several experts, the well-known architect engineer Kubesh (of Czech nationality) prepares a project for the Hospital that, to this day, remains to be the core structure of the current shape of the Hospital. Two identical complexes (centres), each with 2 symmetric departments and capacity of a total of 220 beds (55 in each department), with separated premises for the personal and remaining infrastructure; central hospital kitchen, laundry room, boiler room, workshops, garage and facilities for the hospital economic activities, were the first facilities of the hospital which today, after having been subject to reconstructions, re-adaptations, preserved their initial purpose.
The further development of the Hospital is in the period 1965-1975. In the first ten years, the capacity was sufficient to meet the needs for inpatient treatment. In 1965 these capacities become insufficient and all available space is used to accommodate hospital beds. In 1968/69, more than 700 patients were treated in the Hospital at daily basis while its space was intended for 260 standard hospital beds.
This was conditioned by several factors such as the constant increase of patients who need psychiatric inpatient healthcare, the constant admission of patient from the then SAP Kosovo, as well as from the fact that until 1968 the hospitalization capacities had not been expanded.
The expansion of the hospital’s room capacities began in 1968. The construction of one pavilion with capacity of 60-70 nonstandard beds began this year. Another such object was built in 1969 with capacity of about 100 patients. However, this does not satisfy the needs and does not the lingering problem of having huge number of patients. Therefore, in 1970 the construction of a new facility begins that accommodates two psychiatric wards (acute male and female ward), laboratory, EEG cabinet, pharmacy and library. The opening of this new facility wraps up the capacity of the Hospital to 700 hospital beds.
This decade marks a new stage as well regarding the professional development of the work of the Hospital.
An alcoholism service is put into function in 1967 with which the treatment of alcohol addiction (afterwards drug addicts are included too) of mental disorders is highlighted. In 1968/69 as promotion of the idea of work therapy, rehabilitation and resocialization that exists and is practice at the beginning of the work of the Hospital, ward for work therapy, rehabilitation and resocialization was founded.
At a daily basis, 120 to 150 users of services are engaged at the ward that would be animated through work in the economic activities of the Hospitals, as well as in the locksmith, carving, shoemaking, clothing industry and manual work performed by women. Their work engagement was organized and supervised by a pedagogue and craftsmen- instructors.
The biochemical laboratory was modernized in 1969 with new methods of laboratory diagnostics.
The 70s bring change of a new therapeutic model, the application of insulin shock therapy is completely abandoned, while new generation neuroleptics are used and a stance for social rehabilitation (according to the terminology then) is developed, an “open door treatment system”, i.e. extra-hospital service is developed. In December 1968, the Dispensary for psychosis was founded with an outpatient and policlinic activity.
The specialist and subspecialist activities were performed at the: Department for psychosis with visiting service for domestic treatment (monovalent visiting service which remains to be the only service of this kind in the country), Department for epilepsies with EEG cabinet, Department for Psychoneurosis and Department for drug and other addictions, special service and psychologist
In April 1973, the Daily Hospital for psychosis with semi-stationary activity and rehabilitation workers started to work while in 1974 the Daily Hospital for alcoholism with semi-stationary activity was put into function.
In the period from 1975 until 1985, the Hospital was almost ready in terms of construction, reconstruction, equipment and introduction of subspecialist services. In 1981 the construction of two hospital sections was completed with a total useful surface of 1600 m2.
In this period the Hospital performs the following activities:
• Outpatient-policlinic level of health protection
• Inpatient health protection
• Medical rehabilitation
There are 6 inpatient centres within the Hospital with departments distributed in the hospital and 3 extra-hospital facilities.
In 1987 the admission outpatient ward with premises for the night-shift medical practitioners was completed.
In the course of the same year, the facility in Kisela Voda was put into function with:
• Department for psychosomatic medicine
• Department for pre-toxicomanic alcoholism
• Daily Hospital for alcoholism that was moved in the new premises from the Karposh neighbourhood.
In 1987, the psychogeriatrics, forensic psychiatry departments, part of the addiction departments in the extra-hospital facility in Kisela Voda and the internal medicine ward obtain the status of centres that offer supreme (tertiary) healthcare protection.
In 1980, the Hospital again received the status of educational basis of the Faculty of Medicine (that ceased in 1965 because of insufficiency in professional staff) and the professors Dr. Jovev and Dr. P. Kirovski, together with the doctors from the Hospital with the title assistants give lectures and practical lessons within the subject Psychiatry.
Here, with the purpose of marking the decade, we shall not give information about the construction of facilities and the development of departments, but we shall point out the more clear awareness for the need for reforms in psychiatry. The reforms in the psychiatric service are needed everywhere where inpatient treatment of mentally ill persons is provided. The reforms mean change of the mental care model, change of the treatment conditions and change of the stance towards mental disorders. The reforms highlight the importance of psychosocial rehabilitation.
The situation of the Psychiatric Hospital “Skopje” in terms of conditions of the treatments is almost identical to the other psychiatric hospitals in Macedonia. It may be stated that the inpatient conditions and the inpatient treatment are insignificantly different from those applied ten, twenty or thirty years ago. The clinical and medical model, i.e. the psychiatric model predominantly characterized with the biological approach in the therapy where the medical personnel is more dominant as the main carrier of the activity is the dominant model of treatment offered to the patients. Such treatment enables reduction of psychotic symptoms, but the recovery from the mental disorders cannot be conducted exclusively with medicaments since the results of this approach will be at the minimum in the institutions where the sole contact of the patients are other patients and the hospital staff. Furthermore, if the importance of different activities of those who suffer mental disorder that encourage the rehabilitation process is neglected, the results will also be minimal.
The social and work rehabilitation are insufficiently developed forms of mental health care or are completely missing. However, where humbly present, they are subjected to the medical model and are not aimed at the integration of the patients in the community (in the family, social and work environment). Patients stay in psychiatric hospitals for several years after the termination of the medical indication for treatment because they do not have where to go. This is mostly due to the lack of other residential structures, lack of acceptance shown by the family or having no family and not having means for existence. A large number of patient were living for more years in the environment of a psychiatric hospital, without communication with the outside world, without conditions to satisfy their basic needs to be informed, to maintain relation with the environment, contact with other areas of interest, or affirmation of their wishes and needs.
Later, at the Second Macedonian Psychiatry Congress, held in 2000, professor Kirovski in his introductory words in the collection of works “Modern directions for reforms in psychiatry” emphasizes the need of “… redefinition of the theoretical and scientific psychiatric thought and its relation towards the social and humanities achievements with which the diagnostic, therapeutic and rehabilitation programs will be redefined with new objectives and different social engagement. This will lead to further destruction of the isolation, protection, paternal psychiatric hospitals and will ask for creation of outpatient services: counselling centres, cabinets, day and night hospitals, clubs, etc., i.e. one Service for protection of mental health and psychiatric service for diagnostic and treatment that will be close to the natural and social environment of every human being and will apply methodology of an efficient professional work with psychodynamic and social dynamic orientation conditioned by complete integration of the psychiatry in the community.
This decade is marked by the preparations for the reforms in the psychiatry that formally start in 2001 by inauguration of the Mental Health Centre “Prolet”.
It is marked by the on-going reforms in the current organizational structure of the Hospital with the tendency of deinstitutionalization of treatment and social reintegration of patients. The result in this decade is the reduction of hospital beds.
In this period the capacity for treatment of patient with opiates addiction expands with the opening of the new ward in the Daily Hospital within the Addiction Centre in Kisela Voda.
The last decade of the existence of the Hospital may be marked as the period of activities directed towards improvement of the infrastructure.
The project of the Ministry of Health and the World Bank on complete renovation of 4 hospital wards was initiated in this year. The Ward for acute states and the Ward for Psychotherapy were renovated.
In 2016 the stage of renovation of the Hospital’s facilities with assets obtained from the budget of the Hospital starts. The Psychiatry Emergency Ward and the central hospital kitchen were fully renovated and put into function.
The construction works for the replacement of the construction woodwork of another two hospital wards were completed.
Furthermore, reconstruction and complete replacement of the 60-year old external water supply installation was performed which increased the safety of the potable water and the huge communal costs incurred due to leakage and permeability of the old water pipes were significantly reduced.
In the following years numerous construction and reconstruction activities took place with assets from the Hospital’s budget: reparation of the heating installation and electrical installation of the facility- Boiler room, reconstruction of the facilities of the old forensic department and complete reconstruction of the facility that accommodates two hospitalization wards (the Extended Treatments Ward “A” and “B”). Reconstruction of the walking tracks in the park of the Hospital and horticultural arrangements were performed, as well as reconstruction of the street lights in the hospital’s yard. Video surveillance equipment for the facilities and yard of the hospital was procured.
During this period, the procurement and renewal of the IT equipment is continuously performed as well as the procurement of web applications and software in accordance with the needs for keeping records in the medical and administrative process.
All activities in the recent period in the Hospital contribute to having improved treatment conditions and stay which leads to increased quality of the healthcare related services.