110 oT pic: The mental health system as a target of transitional justice: Mental Health reform in post-communist Albania For the leadership of the Albanian communist state, the condition of mentally ill people was a concern. Constant accountability from the responsible institutions was expressed in the form of correspondence, reports, and guidelines. In 1974 the General Prosecutor Dhori Panariti shared a report about the situation of 62 mentally ill patients under compulsory treatment in Elbasan’s psychiatric hospital and other patients (an unspecified number) in Vlora psychiatric hospital. They had committed serious crimes such as “crimes against the state, crimes against the life and health of Albanian citizens and theft of socialist wealth”. 16 hospitalized people had committed political crimes. This category of patients was dangerous, according to the report, because they can manipulate doctors concerning their improvement and escape from the hospital. Furthermore, they created groups inside the hospital and because of their physical capacity became a threat to medical staff and other patients.” This report suggested special surveillance and treatment for these patients to keep them under control in both Elbasan and Vlora hospitals, which held this category of patient. The interviewee who had experienced isolation in Elbasan psychiatry for five months during 1989, confirmed the different treatment they received, especially from the medical staff. According to the interviewee, his nutrition was worse than other patients, medical staff beat him often and injected unknown substances that made him unconscious most of the time. Nevertheless, in 1974 representatives from the Ministry of Health proposed the foundation of the Institute of Forensic Psychiatry, dedicated to implement court decisions about compulsory treatment. Previously, the mental examination was made in the psychiatric hospital of Tirana, at clinics in the neuro-psychiatric hospital of Elbasan and the psychiatric hospital of Vlora. When mental irresponsibility of people who had committed crimes was proved, they continued their treatment in those institutions. Representatives from the Ministry of Health expressed their concern about the lack of submission of forensic reports when these patients were hospitalized. Thus, patients were treated in psychiatric hospitals without the necessary information. In many cases, diagnosis when patients were released was contradictory to the initial one, decided by the commission of experts. They had evidence also of long-term hospitalization in these cases, which caused disability in patients. The major justification for the foundation of an Institute of Forensic Psychiatry was its aim to decrease the levels of crimes committed by psychopaths (the term used in the Ministry of Health proposal). Medical conditions in the institute would be more isolated than in psychiatric hospitals. Their isolation and treatment would limit their contact and would prevent social threats to the community and their movement would be restricted. The interviewee claimed that the communist state felt threatened, because of the popularity of political enemies, who were mainly intellectuals. If they were released or had the opportunity to move in the community, they would influence public opinion concerning the repression of the communist party. According to the proposal, individuals would prefer institutions of reeducation rather than new conditions of compulsory treatment. This factor would affect a potential reduction of their illegal actions in the future. The institute was assumed to be a special unit for the isolation of the most dangerous cases until their death. Medical staff, through the institute, would play the decisive role in the process of examination and evaluation. The medical staff was projected to contain 60% qualified doctors, of whom 70% would be males. Each of the candidates would be selected carefully in accordance to the criteria of regime. In the interviews, the function of the Institute of Forensic Psychiatry was unclear, because both categories of former-medical staff and formerpatients were sent to traditional psychiatric hospitals, notably the Elbasan psychiatric hospital. 10.1 Engagement of security agencies in Mental Health After a continuous failure from the Ministry of Health in the management of these cases, Hazbiu delegated the issue to the Ministry of Intern Affairs and the institutions under it, to control this