100 oT pic: The mental health system as a target of transitional justice: Mental Health reform in post-communist Albania The right to health is a fundamental human right and also an understanding of our life in dignity. The 1948 Universal Declaration of Human Rights mentioned health as part of the right to an adequate standard of living. The right to health was recognized as a human right in the 1966 International Covenant on Economic, Social and Cultural Rights.3 The right to health is an inclusive right, which means that everyone should access health care. It contains freedom of person, which includes the right to be free from torture and other cruel, inhuman or degrading treatment or punishment. In Albania, during the communist regime, the right to health was one of the most violated human rights. Communist regime was incapable to provide a qualitative health care for the Albanian population. Furthermore, mental health services were misused as a torture and punishment for the regime enemies. The significant political and socioeconomic changes in Albania and other post-Socialist countries have contributed to the perception and perspective on mental health in these countries. As a mental health system in transition, Albanian healthcare had to overcome Soviet practices and principles of medicine, which were in accordance with Marxist-Leninist to incorporate policies of contemporary international standards such as those of the World Health Organization. Semashko was the health system that the Albanian communist party adapted during its governance, which persisted even after the breaking of diplomatic relations with the former Soviet Union, because of the country’s isolation and limited resources for a system transition. Semashko is a totally socialist health care model, originated in the Soviet Union. It was centralized, integrated, hierarchically organized with the government providing state-funded health care to all citizens.4 The Soviet Pavlovian model of medicine was applied in the field of mental health, which explored the biological, genetic and inherited bases for disease. Similar to Eastern communist countries, Albania rejected the application of Freudian psychotherapy as a bourgeois science. Diagnosis was focused mainly in psychosis, while mental health disorders such as depression, were considered as a product derived by failure of capitalist policies in Western countries. Every system is the target of reforms and several changes in a political system and this is common even in a transitional period, in order to ensure the addressing of citizen’s needs. The need for political reform is a recurring theme in political life in virtually all countries. This by itself is enough to show that people are to a degree rejecting the ways in which politics is currently conceived and practiced.5 Health System reform deals with a fundamental change of processes in policies and institutional arrangements of the health sector, usually guided by the government. Health sector reform deals with equity, efficiency, quality, financing, and sustainability in the provision of health care, and also in defining the priorities, refining the policies and reforming the institutions through which policies are implemented.6 The Mental Health System, as part of Health System reform, has a special context because the broken mental health system contributes to school drop-outs, job losses, homelessness, incarceration, and suicide, according to the Mental Health America.7 3. Office of the United Nations High Commissioner for Human Rights, The Human Rights Fact Sheet, (United Nations Geneva, 2008). 4. Tereza Lukášová, Semashko health financing model – economic and health consequences in Czechia, (Ecoforum, 2018). 5. José Antônio Moroni, Reforming the political system: giving power back to the people, (Social watch poverty eradication and gender justice, 2009). 6. 18th Meeting of Ministers of Health in Nepal, Health sector reform; Issues and Opportunities, (World Health Organization, 2000). 7. Mental Health America, Transforming The Mental Health System, (Official website MHA, 2019).