106 oT pic: The mental health system as a target of transitional justice: Mental Health reform in post-communist Albania The process of analysis takes into consideration the Helsinki Declaration on Mental Health21 and the Mental Health Action Plan approved by ministers of health of member states in the European Region of the World Health Organization. This approach is based on the reflection and recognition of mental health policy and services as important and fundamental for ensuring dignity, equality and social inclusion for all citizens. On the other hand, it is crucial to overcome the differences in mental health policy between countries, especially between East and West, in the context of a communist or non-communist past. THE MENTAL HEALTH SYSTEM AS A PART OF THE REPRESSIVE STATE: A TRANSITIONAL JUSTICE RESPONSE TO PUNITIVE PSYCHIATRY The concept of transitional justice stems from the international human rights movement, referring both to judicial and non-judicial processes to address human rights violations committed by dictatorial or repressive regimes in the course of democratic transition and to the addressing of war crimes and massive human rights abuses committed in violent conflicts.22 Mental health needs can be seen as a part of transitional justice in situations transitioning from conflict of authoritarianism. Supporting the mental health and psychosocial needs of survivors contributes to the individual’s ability to come to terms with the past, individual and societal stability, healthier families and communities, the ability to participate in civic life and positive civil society growth. Applied comprehensively, transitional justice supports stable institutions, guarantees non-reoccurrence of violence, fosters democratic institutions, and provides truth, justice, and accountability for the victims.23 HISTORY OF MENTAL HEALTH SERVICES IN ALBANIA At the beginning of the 20th century in Albania psychological or psychiatric problems were considered related to religion and paranormal factors, which according to the beliefs caused suffering to the people. Until the beginning of the 21st century, it was believed that contact with Genies, or jinni, a spiritual creature mentioned in Ancient Arabian culture and Islamic theology, made people psychologically sick. Cure for psychiatric cases was through the practice of magic rituals, and sick people visited monasteries, where sick people gathered from all parts of Albania, with the hope of remedy from such disease.24 The first attempt at opening a psychiatric hospital to treat the mentally ill was made by physician Sezai Çomo, who was driven by patriotic feeling and humanitarian vision. The first psychiatric hospital in Albania was opened in Vlora, in 1921, but its capacities were insufficient; there were only 20 beds, which could not address the health needs of the country. Although this hospital had more an isolation functions rather than a curative approach. In 1929, two new buildings were added and the capacity of the psychiatric hospital of Vlora was increased to 80 beds, enabling for the first time hospitalization of patients, including women. Years later, ergo therapy (the use of physical activity and exercise in the treatment of disease) was practiced as part of treatment. 21. WHO European Ministerial Conference on Mental Health, Mental Health Declaration for Europe Facing the Challenges, Building Solutions, (EUR/04/5047810/6, 2005). 22. Neil J. Kritz, Transitional Justice: How Emerging Democracies Reckon with Former Regimes, Volume 1, (US Institute of Peace Press, 1995). 23. The Center for Victims of Torture, A Survivor-Centered Approach to Transitional Justice, (CVT Blog, 2017). 24. Nestor Polimeri, History of Albanian Psychiatry, (Medical books, 2000).