The could be said that development of Croatian

The history of Croatian psychiatry, similarly as the history of psychiatry itself, is not long. To understand it better, history of Croatian psychiatry should be studied from historical context, more specifically from the historical context of Croatian nation and Croatia itself. Croatia lost its independence in the 12th century and regained it after the Yugoslavian dissolution in 1991. Therefore, speaking of progress of Croatian psychiatry the fact that foreign authorities and other historical circumstances significantly influenced that progress should be taken into account. For example, it took twenty years for the Viennese court to issue a permit for foundation and construction of “zemaljska ludnica u Zagrebu” (today’s Psychiatric hospital Vrap?e in Zagreb) and another thirty years to build it. First psychiatric ward was founded in city Rijeka when Rijeka still wasn’t part of Croatia. On the other hand, during the Yugoslavian era, a few more psychiatric facilities were founded in Croatia and Slovenia with them being two economically strongest and most developed republics. This meant that many more beds were made available for psychiatric uses than it was necessary. Moreover, many patients from other Yugoslavian republics were sent and taken care of in Croatian psychiatric hospitals. It could be said that development of Croatian psychiatry was somewhat late but generally it followed up with the development of psychiatry worldwide. In some areas, Croatian psychiatry was underdeveloped in comparison with western countries, but it consistently kept track with other developed countries in other aspects. For example, electroconvulsive therapy was used practically right after it was first applied worldwide. Furthermore, first psychopharmacol (chlorpromazine) was put in use in Croatia in 1953., only one year after it was first used in France.Although history of Croatian psychiatry could be observed through more dimensions (development and organization of psychiatric service, introduction and development of new methods and procedures, educational overview of psychiatric staff, development of psychiatric publications, psychiatric reflection on socio-cultural events, etc.) it can be best described through development of psychiatric service.  Care for mentally ill patients prior to upbuilding of Psychiatric Hospital Vrap?eThere is relatively little data on care for psychiatric patients before the first Croatian psychiatric hospital was built in the late 19th century. It seems that before 19th century socially organized care system for mentally ill was not existent. The patients were left to be taken care of by their families or themselves. There are some indications that at the beginning of 19th century in cases of extreme mental illness, these patients would be transferred to hospitals on the territory of Austria or Hungary because at this point Croatia was still a member of Austro-Hungarian Monarchy.According to available data, it seems that the first infirmary (“little station”) for mentally ill was founded in Dubrovnik in 1804. and it had the capacity for only 10 patients. In the first part of 19th century, specifically in 1923., in the city of Rijeka, as part of the almshouse, a first “department” of psychiatry was founded. Also, there is some data suggesting that during the 19th century there was a relatively small psychiatric department within the Hospital “Male Bra?e” in Zagreb.Foundation of Psychiatric Hospital Vrap?e in ZagrebThe real history of Croatian psychiatry begins with foundation and building of Psychiatric hospital Vrap?e which exists and operates even today. The hospital was first called “Institute for lunatics Stenjevac” and then later it was renamed to “Vrap?e”. This was the first time that care system for mentally ill appeared in Croatia. Robert Zlatari? who was government healthcare commissioner at the time was persistently advocating for building the psychiatric hospital and following is the quote from one of his speeches in Croatian government: “There are over 300 mentally ill patients in Croatia and Slavonia and as many in Vojna Krajina, and out of those there are only 100 of them provided with basic care, the rest are just wandering around as burden to their families and left with their suffering. This number is growing from day to day and it is an urgent matter to provide means for treatment of these people. All other educated nations have special departments for treating such people.” Construction of the hospital started in 1877. and it was finished in two years. First patients were relocated on 15th and 16th of November of 1879. from the Hospital “Male Bra?e”. The hospital originally had the capacity for 300 patients but that number was surpassed and the hospital had to go under construction again in order to create more space. Due to the big inflow of patients throughout the first half of 20th century, the hospital was forced to expand and a few additional buildings and departments ad to be built. In 1932. the hospital founded another infirmary in Jankomir in Zagreb which had the capacity for around 130 patients. As part of the treatment, the patients used to be engaged in agricultural work and feeding of pigs, poultry, and cows.Since the very beginning of Psychiatric Hospital Vrap?e, they based their work on premises of professional, scientific and humane approach to the patients. This was the institution where the worldwide knowledge of psychiatry was finally reaching Croatia. First Croatian psychiatrists who were educated and trained here later on organized psychiatric service over the rest of Croatia. Today the hospital has the capacity of 850 beds.Foundation of other psychiatric hospitalsIn 1905, another psychiatric hospital was founded in Pakrac with over 100 beds. It was originally a part of the Hospital Vrap?e but later in the 1970s, it became a part of the general hospital in Pakrac. In September of 1991. numerous patients (around 250) were evacuated to other psychiatric hospitals in Croatia due to dangers and destructions of Croatian War of Independence. After the war ended the patients were never relocated back and the hospital was never renovated. In 1934., 60 kilometers east from Zagreb, in abandoned castle of Popova?a, dr. Ivan Barbot founded a psychiatric hospital that was later named after him. By the end of 20th century, the hospital had over 900 beds but today it has 650.In Zemunik Donji near Zadar in 1938. by adapting  an agricultural building, they opened a psychiatric ward with the capacity of 80 beds as an additional building to the main psychiatry ward in Šibenik. The department was affiliated to the general hospital in Zadar and then later it started operating as an independent psychiatric hospital with 250 beds. The hospital was closed in 1991. because of war operations and patients had to be relocated to other hospitals. In 1955. a few hospitals were founded in the abandoned barracks on islands of Rab and Ugljan. These hospitals still exist and operate today but because of the islands’ insularity, development of hospitals is compromised and there is a question if hospitals should still run in first place. In each of these hospitals, there are 450 beds today.Furthermore, psychiatric hospital Vrap?e’s annex hospital Jankomir becomes an independent hospital in 1958. (today it is renamed to Psychiatric hospital “Sveti Ivan”) with the capacity of 500 beds.In 1966. a social and health institution for mentally ill patients was founded in Lopa? near city of Rijeka and today it is developing the potential to become an independent psychiatric hospital. Moreover, in 1983., a psychiatric ward in Šibenik («Zemaljka ludnica u Šibeniku») was founded as a psychiatric hospital with 84 beds but later on it was affiliated to the general hospital in Šibenik.Foundation of Neuropsychiatric departments in general hospitalsMost of the neuropsychiatric departments were founded in Croatian general hospitals in the 60s and 70s. This was preceded by general development of psychiatry in the world and Croatia but specifically by the discovery of psychopharmaceuticals. Firstly everything was operating within neuropsychiatric departments until they were divided into neurological and psychiatric departments. Now there are 17 independent psychiatric departments in Croatia. Aside from the ones in Šibenik and Pula, the rest of them were created by separation from neuropsychiatric departments. Department in Šibenik has 18 and the one in Pula 35 psychiatric beds. Psychiatric department in Našice is part of the department of internal medicine, and the one in Gospi? is still under construction but will also probably be part of the department of internal medicine. There is a similar situation in Ogulin where the psychiatric department was formed in 1975. The independence of psychiatric departments went in this order (the number in brackets is the number of beds): 1980. Zadar (20), 1981. Koprivnica (27), 1982. Varaždin (42), 1985. Dubrovnik (27), 1990. Vinkovci (35) and Karlovac (30), 1992. Požega (18), 1993. ?akovec (29), 1996. Bjelovar (29), Nova Gradiška (15), Clinical Hospital Dubrava Zagreb (30), 1997. Virovitica (20), 1999. Vukovar (22) and 2001. Slavonski Brod (35). In 1972. there was a big psychiatric department in Petrinja but in September of 1991. all the patients had to be evacuated due to war damage. The hospital was never renovated.Foundation and development of psychiatric clinicsAccording to Croatian law, a clinic is a health institution where along with disease diagnostics and patient treatment, it also offers education and opportunity for scientific research. Along with adequate space, a number of highly qualified staff in the clinic must have scientific and teaching vocations. Clinics are generally connected to some of the higher educational institutions such as medical or dental faculties. A clinic has to have a professional library and its employees need to regularly publish scientific papers. For all these reasons, foundation and development of psychiatric clinics had huge significance for the progress of psychiatry in Croatia. Students of medicine and psychiatry residents received education there and spread that knowledge to other parts of the country.The first neuropsychiatric clinic was founded in Zagreb in 1923. as part of the medical university that was built a few years earlier in 1917. It worked as a clinic from the very beginning, whereas other clinics only got the status when neuropsychiatric clinics would become faculties of biomedicine and when they would satisfy professional and scientific criteria. In 1971., the neuropsychiatric clinic was divided into the neurology clinic and psychiatric clinic. At the same time, department of psychotherapy that belonged to the neuropsychiatric clinic became the center for mental health and consequently got the status as the psychological clinic in 1988.In 1993. the Medical University founded another clinic (clinic for general and forensic psychiatry and clinical psychophysiology) as part of psychiatric hospital Vrap?e, at the same time when they introduced the possibility to do postgraduate program in psychiatry (from 1980. it becomes a center for postgraduate studies in Forensic psychiatry).Neuropsychiatric department of today’s Clinical hospital Sestre Milosrdnice in Zagreb got a status of the neuropsychiatric clinic within Faculty of Dentistry in Zagreb in 1971. In 1995. it became an independent psychiatric clinic. The clinic mostly focused on the social psychiatry and studying and treatment of alcoholism and other addictions.The Medical University in Rijeka was founded in mid years of the 20th century but opening of Rijeka’s psychiatric clinic was slowed down due to staffing difficulties. The clinic was formed in 1973. but due to inadequate conditions closed down temporarily and then reopened by the end of the 1990s. The psychiatric department in the hospital of Split became independent by separation from the neuropsychiatric department in 1980. Later on, it became a psychiatric clinic by the foundation of Medical University in Split in 1986.The neuropsychiatric department in Osijek was formed in 1940. It only became independent in 1987., and then a year later, in 1988., it became a psychiatric clinic as part of the Medical University in Osijek. The amount of psychiatric beds in particular clinics goes from 50 (Hospital of Sestre Milosrdnice) to over 100 (Vrap?e). Except for the stationary part, each of the clinics has developed excellent polyclinical service and the day-hospital. In the Psychological medicine department in the Hospital “Rebro” in Zagreb there are around 20 beds but present plans are to reduce the amount and make them intended specifically for adolescents and children.Some characteristics of psychiatric service in Croatia throughout its developmentWhen talking about the way the patients were treated and approached it’s important to know it greatly depended on the level of development of psychiatric service which underwent big change throughout the history of Croatian psychiatry. Historical development of psychiatric service in Croatia is similar to the one worldwide – it has undergone four stages. There first was the era of clinical psychiatric service which included care of psychiatric patients in asylum-type institutions. This was happening around the time when first psychiatric hospitals were being built in the 19th century. The second era is characterized by a cascade type of psychiatric aid – the patients are taken care of based on severity and duration of the illness. This era begins with the opening of (neuro)psychiatric departments in general and clinical hospitals in the second part of 20th century. The third era is characterized by socially oriented psychiatry which is still present. The fourth era would be described as a communal type of psychiatry but at the moment this is still the stage Croatian psychiatry is aiming to reach.There is another important characteristic of developing psychiatric service in Croatia: the way the institutions were established and founded was quite disorganized. It very often was not the result of carefully planned and deliberate health politics. The reason behind foundation of a certain psychiatric hospitals was more due to “strong” individual or group of local politicians with agenda of employing the local residents. Therefore, all the psychiatric hospitals, except for Vrap?e, were founded because some sort of free space needed to be put in use – old castles, military bases or barracks. The hospitals of “Ugljen” and “Rab” were constructed on an isolated island for instance, “Popova?a” in an old castle, “Jankomir” built not even a kilometer from the biggest psychiatric hospital Vrap?e.This approach to the analysis of the history of psychiatry in Croatia can only partially cover other aspects of psychiatric development in Croatia. As science and profession, psychiatry undergone great change through foundation of medical universities in Croatia (1917. in Zagreb, 1957. in Rijeka, 1978. in Split and Osijek) and  foundation of psychiatric clinics. By implementation of law and regulations about specialties and subspecialties in 1994., there were 6 subspecialties established within basic branches of psychiatry including social, biological and forensic psychiatry and psychotherapy, child and youth psychiatry and alcoholism and other addictions. Specialty and subspecialty education in psychiatry, education through postgraduate studies, as well as the intensive collaboration of Croatian psychiatrist with the number of psychiatric institutions worldwide has made the quality of Croatian psychiatric service and ranking of institutions close to the ones worldwide. Today, Croatian psychiatry is looking for ways to improve. The Ministry of Health has formed a few committees who are yet to make new organizations of psychiatric service, education programs and plans that would highlight professional and scientific research in psychiatry.


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