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Drug that holds back return of ovarian cancer gets UK licence

A pill treatment that holds back ovarian cancer and has the potential to prolong life has been launched in the UK.

Trial results have shown that niraparib, taken once daily, can buy months of time before the disease returns after chemotherapy.

In women with an inherited BRCA gene mutation, the time to relapse was increased from 5.5 months to 21 months compared with chemotherapy alone. Niraparib was also shown to help women without a BRCA mutation to a lesser degree, doubling the length of time before recurrence.

The drug is now licensed for use in the UK but is yet to be assessed for free availability on the NHS.

Prof Jonathan Ledermann, from the University College London Cancer Institute, said: “Niraparib is the first treatment of its class licensed to delay the progression of ovarian cancer following platinum-based chemotherapy, regardless of BRCA status.

“This represents a critical milestone in the management of ovarian cancer. Access to effective and tolerable medicines is sorely needed and the hope is that niraparib will be available in the NHS as quickly as possible.”

Ovarian cancer has been called a “silent killer” because it is often spotted late and at a deadly stage. Each year around 7,400 women in the UK are diagnosed with ovarian cancer and 4,128 die from it. Roughly 85% of patients will experience recurrence after treatment.

Decisions about what drugs are offered to NHS patients in England and Wales follow the recommendations of the National Institute for Health and Care Excellence, which balances clinical and cost effectiveness. The Scottish Medicines Consortium provides similar guidelines in Scotland.

Katherine Taylor, chief executive of the charity Ovarian Cancer Action, said: “The outlook for women diagnosed with ovarian cancer can be bleak. Current treatment lags behind other and better-known cancers and survival rates are low.

“Today’s news is an encouraging step in the right direction but we now need to ensure all UK women diagnosed with recurrent platinum-sensitive ovarian cancer can benefit.

“We call upon the National Institute for Health and Care Excellence and the Scottish Medicines Consortium to approve this drug to provide more treatment options for those diagnosed with ovarian cancer. For many women this could be life-changing.”

Drug that holds back return of ovarian cancer gets UK licence

A pill treatment that holds back ovarian cancer and has the potential to prolong life has been launched in the UK.

Trial results have shown that niraparib, taken once daily, can buy months of time before the disease returns after chemotherapy.

In women with an inherited BRCA gene mutation, the time to relapse was increased from 5.5 months to 21 months compared with chemotherapy alone. Niraparib was also shown to help women without a BRCA mutation to a lesser degree, doubling the length of time before recurrence.

The drug is now licensed for use in the UK but is yet to be assessed for free availability on the NHS.

Prof Jonathan Ledermann, from the University College London Cancer Institute, said: “Niraparib is the first treatment of its class licensed to delay the progression of ovarian cancer following platinum-based chemotherapy, regardless of BRCA status.

“This represents a critical milestone in the management of ovarian cancer. Access to effective and tolerable medicines is sorely needed and the hope is that niraparib will be available in the NHS as quickly as possible.”

Ovarian cancer has been called a “silent killer” because it is often spotted late and at a deadly stage. Each year around 7,400 women in the UK are diagnosed with ovarian cancer and 4,128 die from it. Roughly 85% of patients will experience recurrence after treatment.

Decisions about what drugs are offered to NHS patients in England and Wales follow the recommendations of the National Institute for Health and Care Excellence, which balances clinical and cost effectiveness. The Scottish Medicines Consortium provides similar guidelines in Scotland.

Katherine Taylor, chief executive of the charity Ovarian Cancer Action, said: “The outlook for women diagnosed with ovarian cancer can be bleak. Current treatment lags behind other and better-known cancers and survival rates are low.

“Today’s news is an encouraging step in the right direction but we now need to ensure all UK women diagnosed with recurrent platinum-sensitive ovarian cancer can benefit.

“We call upon the National Institute for Health and Care Excellence and the Scottish Medicines Consortium to approve this drug to provide more treatment options for those diagnosed with ovarian cancer. For many women this could be life-changing.”

Drug that holds back return of ovarian cancer gets UK licence

A pill treatment that holds back ovarian cancer and has the potential to prolong life has been launched in the UK.

Trial results have shown that niraparib, taken once daily, can buy months of time before the disease returns after chemotherapy.

In women with an inherited BRCA gene mutation, the time to relapse was increased from 5.5 months to 21 months compared with chemotherapy alone. Niraparib was also shown to help women without a BRCA mutation to a lesser degree, doubling the length of time before recurrence.

The drug is now licensed for use in the UK but is yet to be assessed for free availability on the NHS.

Prof Jonathan Ledermann, from the University College London Cancer Institute, said: “Niraparib is the first treatment of its class licensed to delay the progression of ovarian cancer following platinum-based chemotherapy, regardless of BRCA status.

“This represents a critical milestone in the management of ovarian cancer. Access to effective and tolerable medicines is sorely needed and the hope is that niraparib will be available in the NHS as quickly as possible.”

Ovarian cancer has been called a “silent killer” because it is often spotted late and at a deadly stage. Each year around 7,400 women in the UK are diagnosed with ovarian cancer and 4,128 die from it. Roughly 85% of patients will experience recurrence after treatment.

Decisions about what drugs are offered to NHS patients in England and Wales follow the recommendations of the National Institute for Health and Care Excellence, which balances clinical and cost effectiveness. The Scottish Medicines Consortium provides similar guidelines in Scotland.

Katherine Taylor, chief executive of the charity Ovarian Cancer Action, said: “The outlook for women diagnosed with ovarian cancer can be bleak. Current treatment lags behind other and better-known cancers and survival rates are low.

“Today’s news is an encouraging step in the right direction but we now need to ensure all UK women diagnosed with recurrent platinum-sensitive ovarian cancer can benefit.

“We call upon the National Institute for Health and Care Excellence and the Scottish Medicines Consortium to approve this drug to provide more treatment options for those diagnosed with ovarian cancer. For many women this could be life-changing.”

Drug that holds back return of ovarian cancer gets UK licence

A pill treatment that holds back ovarian cancer and has the potential to prolong life has been launched in the UK.

Trial results have shown that niraparib, taken once daily, can buy months of time before the disease returns after chemotherapy.

In women with an inherited BRCA gene mutation, the time to relapse was increased from 5.5 months to 21 months compared with chemotherapy alone. Niraparib was also shown to help women without a BRCA mutation to a lesser degree, doubling the length of time before recurrence.

The drug is now licensed for use in the UK but is yet to be assessed for free availability on the NHS.

Prof Jonathan Ledermann, from the University College London Cancer Institute, said: “Niraparib is the first treatment of its class licensed to delay the progression of ovarian cancer following platinum-based chemotherapy, regardless of BRCA status.

“This represents a critical milestone in the management of ovarian cancer. Access to effective and tolerable medicines is sorely needed and the hope is that niraparib will be available in the NHS as quickly as possible.”

Ovarian cancer has been called a “silent killer” because it is often spotted late and at a deadly stage. Each year around 7,400 women in the UK are diagnosed with ovarian cancer and 4,128 die from it. Roughly 85% of patients will experience recurrence after treatment.

Decisions about what drugs are offered to NHS patients in England and Wales follow the recommendations of the National Institute for Health and Care Excellence, which balances clinical and cost effectiveness. The Scottish Medicines Consortium provides similar guidelines in Scotland.

Katherine Taylor, chief executive of the charity Ovarian Cancer Action, said: “The outlook for women diagnosed with ovarian cancer can be bleak. Current treatment lags behind other and better-known cancers and survival rates are low.

“Today’s news is an encouraging step in the right direction but we now need to ensure all UK women diagnosed with recurrent platinum-sensitive ovarian cancer can benefit.

“We call upon the National Institute for Health and Care Excellence and the Scottish Medicines Consortium to approve this drug to provide more treatment options for those diagnosed with ovarian cancer. For many women this could be life-changing.”

Drug that holds back return of ovarian cancer gets UK licence

A pill treatment that holds back ovarian cancer and has the potential to prolong life has been launched in the UK.

Trial results have shown that niraparib, taken once daily, can buy months of time before the disease returns after chemotherapy.

In women with an inherited BRCA gene mutation, the time to relapse was increased from 5.5 months to 21 months compared with chemotherapy alone. Niraparib was also shown to help women without a BRCA mutation to a lesser degree, doubling the length of time before recurrence.

The drug is now licensed for use in the UK but is yet to be assessed for free availability on the NHS.

Prof Jonathan Ledermann, from the University College London Cancer Institute, said: “Niraparib is the first treatment of its class licensed to delay the progression of ovarian cancer following platinum-based chemotherapy, regardless of BRCA status.

“This represents a critical milestone in the management of ovarian cancer. Access to effective and tolerable medicines is sorely needed and the hope is that niraparib will be available in the NHS as quickly as possible.”

Ovarian cancer has been called a “silent killer” because it is often spotted late and at a deadly stage. Each year around 7,400 women in the UK are diagnosed with ovarian cancer and 4,128 die from it. Roughly 85% of patients will experience recurrence after treatment.

Decisions about what drugs are offered to NHS patients in England and Wales follow the recommendations of the National Institute for Health and Care Excellence, which balances clinical and cost effectiveness. The Scottish Medicines Consortium provides similar guidelines in Scotland.

Katherine Taylor, chief executive of the charity Ovarian Cancer Action, said: “The outlook for women diagnosed with ovarian cancer can be bleak. Current treatment lags behind other and better-known cancers and survival rates are low.

“Today’s news is an encouraging step in the right direction but we now need to ensure all UK women diagnosed with recurrent platinum-sensitive ovarian cancer can benefit.

“We call upon the National Institute for Health and Care Excellence and the Scottish Medicines Consortium to approve this drug to provide more treatment options for those diagnosed with ovarian cancer. For many women this could be life-changing.”

Drug that holds back return of ovarian cancer gets UK licence

A pill treatment that holds back ovarian cancer and has the potential to prolong life has been launched in the UK.

Trial results have shown that niraparib, taken once daily, can buy months of time before the disease returns after chemotherapy.

In women with an inherited BRCA gene mutation, the time to relapse was increased from 5.5 months to 21 months compared with chemotherapy alone. Niraparib was also shown to help women without a BRCA mutation to a lesser degree, doubling the length of time before recurrence.

The drug is now licensed for use in the UK but is yet to be assessed for free availability on the NHS.

Prof Jonathan Ledermann, from the University College London Cancer Institute, said: “Niraparib is the first treatment of its class licensed to delay the progression of ovarian cancer following platinum-based chemotherapy, regardless of BRCA status.

“This represents a critical milestone in the management of ovarian cancer. Access to effective and tolerable medicines is sorely needed and the hope is that niraparib will be available in the NHS as quickly as possible.”

Ovarian cancer has been called a “silent killer” because it is often spotted late and at a deadly stage. Each year around 7,400 women in the UK are diagnosed with ovarian cancer and 4,128 die from it. Roughly 85% of patients will experience recurrence after treatment.

Decisions about what drugs are offered to NHS patients in England and Wales follow the recommendations of the National Institute for Health and Care Excellence, which balances clinical and cost effectiveness. The Scottish Medicines Consortium provides similar guidelines in Scotland.

Katherine Taylor, chief executive of the charity Ovarian Cancer Action, said: “The outlook for women diagnosed with ovarian cancer can be bleak. Current treatment lags behind other and better-known cancers and survival rates are low.

“Today’s news is an encouraging step in the right direction but we now need to ensure all UK women diagnosed with recurrent platinum-sensitive ovarian cancer can benefit.

“We call upon the National Institute for Health and Care Excellence and the Scottish Medicines Consortium to approve this drug to provide more treatment options for those diagnosed with ovarian cancer. For many women this could be life-changing.”

Drug that holds back return of ovarian cancer gets UK licence

A pill treatment that holds back ovarian cancer and has the potential to prolong life has been launched in the UK.

Trial results have shown that niraparib, taken once daily, can buy months of time before the disease returns after chemotherapy.

In women with an inherited BRCA gene mutation, the time to relapse was increased from 5.5 months to 21 months compared with chemotherapy alone. Niraparib was also shown to help women without a BRCA mutation to a lesser degree, doubling the length of time before recurrence.

The drug is now licensed for use in the UK but is yet to be assessed for free availability on the NHS.

Prof Jonathan Ledermann, from the University College London Cancer Institute, said: “Niraparib is the first treatment of its class licensed to delay the progression of ovarian cancer following platinum-based chemotherapy, regardless of BRCA status.

“This represents a critical milestone in the management of ovarian cancer. Access to effective and tolerable medicines is sorely needed and the hope is that niraparib will be available in the NHS as quickly as possible.”

Ovarian cancer has been called a “silent killer” because it is often spotted late and at a deadly stage. Each year around 7,400 women in the UK are diagnosed with ovarian cancer and 4,128 die from it. Roughly 85% of patients will experience recurrence after treatment.

Decisions about what drugs are offered to NHS patients in England and Wales follow the recommendations of the National Institute for Health and Care Excellence, which balances clinical and cost effectiveness. The Scottish Medicines Consortium provides similar guidelines in Scotland.

Katherine Taylor, chief executive of the charity Ovarian Cancer Action, said: “The outlook for women diagnosed with ovarian cancer can be bleak. Current treatment lags behind other and better-known cancers and survival rates are low.

“Today’s news is an encouraging step in the right direction but we now need to ensure all UK women diagnosed with recurrent platinum-sensitive ovarian cancer can benefit.

“We call upon the National Institute for Health and Care Excellence and the Scottish Medicines Consortium to approve this drug to provide more treatment options for those diagnosed with ovarian cancer. For many women this could be life-changing.”

Malaria is back on the rise as lack of funds stalls push to wipe out disease

Progress in driving down infections and deaths from malaria has stalled and even reversed in some countries, according to the World Health Organization.

The WHO director general, Tedros Adhanom Ghebreyesus, warned of a “troubling shift” in the downward trajectory of malaria, one of the biggest killers in poorer countries, and until recently, one of the greatest public health success stories.

There is a real chance malaria could be eliminated, this year’s world malaria report suggests, but only if funding increases.

Inadequate investment in controlling the disease in high-burden countries, which have been reducing funding for at-risk populations, represents the “greatest threat” to gains the world has made, said the report.

Since 2014, investments in malaria control have, on average, declined in many high-burden countries. The WHO estimates that a minimum of $ 6.5bn will be needed annually by 2020. Last year, just $ 2.7bn was invested.

Sub-Saharan Africa still accounts for 90% of malaria cases and deaths worldwide, but inefficient implementation of interventions, conflict and other crises – as well as climate change – have shifted attention away from the disease.

Following an unprecedented fall in global malaria cases since 2010, conservative estimates suggest cases have increased by 5m between 2015 and 2016. The global toll of malaria deaths reached 445,000 in 2016, a similar number to that reported in 2015.

Fifteen countries account for 80% all malaria cases globally. Nigeria accounts for the highest proportion of cases, at 27%, followed by the Democratic Republic of the Congo, at 10%.

In a foreword for the report, Tedros, the former Ethiopia health minister, said the malaria response was “at a crossroads”. He urged countries and the global health community to boost funding to save lives.

“The choice before us is clear,” he said. “If we continue with a business-as-usual approach – employing the same level of resources and the same interventions – we will face near-certain increases in malaria cases and deaths.

“As I have said before, countries must be in the driver’s seat; they alone are ultimately responsible for the health of their citizens. Universal health coverage is indeed a political choice – one that takes courage, compassion and long-term vision.”

The data showed a “precipitous drop” in spraying the inside walls of houses with insecticide since 2010 in all regions, while access to public health system was an ongoing problem. Although the threat of drug resistance remains “serious”, the immediate threat was low.

Eleven of the 21 countries identified by the WHO as having the potential to reach zero indigenous cases in 2020 reported increases in malaria since 2015. Five of them, Botswana, Ecuador, Saudi Arabia, South Africa and Swaziland have reported increases of more than 100 cases in 2016 compared with the previous year.

Dr Abdisalan Noor, of the WHO’s surveillance global malaria programme, described the findings as a “wake-up call” to action. “Globally, we can safely say that after an unprecedented period of success, we are no longer making progress, which is supported by the data in this year’s report.”

If the trend continued, the WHO said, it would miss its target of a 40% reduction in case incidence and mortality by 2020.

There were some gains, it said. Globally, the number of countries that were malaria endemic in 2000 and reported fewer than 10,000 cases increased from 37 in 2010 to 44 in 2016.

For the second consecutive year, the WHO European region continued to be malaria free, and coverage rates of access to insecticide treated bednets increased across most regions in 2016 when compared with 2010.

Kyrgyzstan and Sri Lanka were certified malaria-free by the WHO in 2016, and Algeria, which remained malaria free in 2016, is now eligible. Argentina and Paraguay have begin the certification process, while Uruguay is set to request certification of elimination by the end of 2017, the report said.

In warring countries, or those with other major crises, such as Yemen, Nigeria, South Sudan, Venezuela, interruption of services have all resulted in an increasing malaria burden.

New data from national surveillance systems suggests the WHO has been underestimating the global malaria burden and it would review estimation methods in 2018.

‘We give people their humanity back’: inside Croatia’s pioneering mental health centre

High walls still surround the oldest asylum in the Balkans, an 18th-century building pocked with the artillery scars of last century’s civil war, but the gates are no longer locked. Handles have been replaced on internal doors and bars removed from windows.

“The jail,” said Darko Kovaoic, a 53-year-old poet with schizophrenia who lives here, “has broken open.”

The institution in Osijek, eastern Croatia, is run by Ladislav Lamza, a former social worker who is taking on the government, the health minister, and his own staff to transform the lives of his “beneficiaries” – the patients of what was until recently an old-style asylum.

It was in May 2015 that Lamza ripped down the sign outside – replacing “Home for the Insane” with “Centre for People Like Us” and began moving people out.

“We express many things in that small sentence,” said Lamza. “Because what we have done for the past two centuries is the opposite. We’ve said: ‘You are not like us, you are ugly and mad and I’m not like you.’ This is where we exclude, stigmatise and restrain people for the rest of their lives.

“We have people in need and we provide inappropriate help and the result is catastrophic. I never knew anyone who was rehabilitated. We make equality between criminals and people with disabilities.”

Lamza’s transformation of the centre caused shock and upset: one member of staff pointed out that these were people who should have been “exterminated”.

In four years, 172 out of 200 people have been successfully moved into shared flats dotted around the small city, with carers from the centre visiting them as needed.

As his institution emptied, Lamza ditched the metal bed frames and stained mattresses. Although the paint still peels and the furniture is scratched and sagged, he has turned the bleak, soulless wards into rooms for day classes, a library and a bright cafe where former patients demonstrate how to make pancakes and brew tea for other ex-patients who come by daily to grow cabbages in the gardens or to chat with staff. Staff are no longer janitors, nurses, cooks or cleaners, but all re now “care assistants”. The transformation, says Butkovic Jadranka – formerly a hairdresser here, now running sewing classes and shopping and theatre trips – is amazing.

Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says.


Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says. Photograph: Photo: Robin Hammond/NOOR

“When we first heard of the director’s plans, I was fearful, everyone was fearful, we thought perhaps he had gone a little crazy. But now everything is completely different. Before it was like they were objects, slightly out of focus objects. Just numbers. Like on a conveyer belt. I never asked anyone’s name. Now they are my friends. People are not dangerous lunatics, they have become citizens, they have become neighbours.”

It is 10 years since Croatia signed the UN’s Convention on the Rights of Persons with Disabilities but Osijek is the only one of Croatia’s 24 mental health institutions, which house a total of 6,700 people, implementing its spirit. “We signed this with our fingers crossed behind our backs. The government still wants people locked up, locked away. People with disabilities, whether mental health or physical, have rights. There are four reasons why inclusion is better than exclusion,” said Lamza. “It’s better for a person, it’s better for the community, it’s legal, it’s cheaper.” He says the cost per person per month in an institution is $ 1,260 (£950). “In the community, even with the maximum 24-hour support, it is $ 1,020.

“The first day I let people go I didn’t sleep: will she hurt someone, will he cope? But there have been no problems. People have thanked us for giving them the best neighbours they have ever had!”

After 12 years in institutions, Branka Reljan, 55, has spent three years living in the community, in a shared flat with her partner Drazenko Tevlli. She speaks fluent German and English but has suffered mental health breakdowns since university and has let go of old ambitions. Now the couple take great delight in visiting cafes and shops. “We met in the institution but love is not allowed so we lived a secret for 11 years. I say I was in prison before. Now I love to make apple pies and buy spices and oils for cooking. It is wonderful for us to have our own keys, to buy fresh juice and to take a bus. We are satisfied with our neighbours. We are happy.”

Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town.


Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town. Photograph: Photo: Robin Hammond/NOOR

If other asylums in Croatia had any desire to follow Lamza’s care in the community model it would be more difficult. Most were built far from towns.

Rada Matos is the director of Ljeskovica home for mentally ill adults, deep in the Pozega forest, an hour’s drive from Osijek. Lamza describes it as “a warehouse for lost souls”. Matos says she does her best for the 284 people here but points out that Croatia is a poor country and mental health is both under-resourced and stigmatised. “We have no psychologists and no psychiatrists, no professional is interested in coming out here to work, yet perversely we are the main employer in the area for unskilled workers. It’s too far for relatives to visit and there is no community for people to live in even if I had the resources to try. There is a tiny village of uneducated people to whom this is the madhouse.”

There is a long waiting list to come here but few leave. “Maybe two a year,” she said. “We try to explain mental health is an illness, we invite in families, school groups. But what I’d really need to do is move this building somewhere else, somewhere where there is a community.”

Around the grounds and in the corridors, people stand or wander in shabby clothes too big or too small. Miryama Nikoli, 38, is new to Ljeskovica but has been institutionalised for 18 years. Eyes glazed by medication that hasn’t been changed in all that time, she talks to everyone about her daughter, taken away as a baby. “I was sick because of my nerves but now I suffer because of my baby,” she says. “I drink the medicine but I want to see her again.” Matos pulls out her file; her background is heart-breaking and abusive. One line mentions the child, who will now be 18. The file contains four A4 pages.

In Osijek the belief is that lives are better on the outside. Care assistant Vlatka Griner said the hardest task in moving people into the community was to make them use chairs: “At the asylum, they squat in the corridors, smoking. Squat, smoke, move a bit and squat again. What else did they have to do? In only slippers, just slippers because they never went out. When they are in the apartments the hard thing is to get people to sit in chairs. It can take a good two months.

“Then they go to the shops, buy their own food, buy their own clothes, run their own lives. Brush their hair. They’re unrecognisable.”


‘Love was not allowed in the institution. Now we are outside we have our own keys and take a bus. We are happy’

It is not a solution for everyone. Back in Osijek, Zdenko Kovac, 64, is a convicted murderer and, although he claims the scars on his head are from an axe wielded by his wife and he is not deemed dangerous enough for a secure hospital, he has failed to cope outside and is back in the institution where he wants to stay “until I die”.

“He is someone I worry about,” admits Lamza, “he wants to stay and ideally he will.” For others, it was never the right place. Luka Bobanovic, 36, caught a fever aged seven that left him brain-damaged. His mother handed him over to state care and he has been bounced around from institution to institution. “When he came to us he was very disturbed,” said Lamza. “Eight times Luka went through a door or window, either him chasing staff or them chasing him. The doctor told staff to tie him to his bed. I found him like that, tied to his bed, crying for his mamma. The staff shrugged and told me ‘we are scared of him’.”

Now he lives in a small bungalow with three other beneficiaries and round-the-clock care.“Our work doesn’t end when people live outside the institution,” said Lamza. “We are supporting them to live like every citizen of this town, to fall in love, dance, eat pancakes. I want to give people back a reason to live. That is what we have been taking from them, their humanity.

“I’m ashamed of how people lived before, but I’m happy,” Lamza said, “because they’re happy.”

‘We give people their humanity back’: inside Croatia’s pioneering mental health centre

High walls still surround the oldest asylum in the Balkans, an 18th-century building pocked with the artillery scars of last century’s civil war, but the gates are no longer locked. Handles have been replaced on internal doors and bars removed from windows.

“The jail,” said Darko Kovaoic, a 53-year-old poet with schizophrenia who lives here, “has broken open.”

The institution in Osijek, eastern Croatia, is run by Ladislav Lamza, a former social worker who is taking on the government, the health minister, and his own staff to transform the lives of his “beneficiaries” – the patients of what was until recently an old-style asylum.

It was in May 2015 that Lamza ripped down the sign outside – replacing “Home for the Insane” with “Centre for People Like Us” and began moving people out.

“We express many things in that small sentence,” said Lamza. “Because what we have done for the past two centuries is the opposite. We’ve said: ‘You are not like us, you are ugly and mad and I’m not like you.’ This is where we exclude, stigmatise and restrain people for the rest of their lives.

“We have people in need and we provide inappropriate help and the result is catastrophic. I never knew anyone who was rehabilitated. We make equality between criminals and people with disabilities.”

Lamza’s transformation of the centre caused shock and upset: one member of staff pointed out that these were people who should have been “exterminated”.

In four years, 172 out of 200 people have been successfully moved into shared flats dotted around the small city, with carers from the centre visiting them as needed.

As his institution emptied, Lamza ditched the metal bed frames and stained mattresses. Although the paint still peels and the furniture is scratched and sagged, he has turned the bleak, soulless wards into rooms for day classes, a library and a bright cafe where former patients demonstrate how to make pancakes and brew tea for other ex-patients who come by daily to grow cabbages in the gardens or to chat with staff. Staff are no longer janitors, nurses, cooks or cleaners, but all re now “care assistants”. The transformation, says Butkovic Jadranka – formerly a hairdresser here, now running sewing classes and shopping and theatre trips – is amazing.

Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says.


Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says. Photograph: Photo: Robin Hammond/NOOR

“When we first heard of the director’s plans, I was fearful, everyone was fearful, we thought perhaps he had gone a little crazy. But now everything is completely different. Before it was like they were objects, slightly out of focus objects. Just numbers. Like on a conveyer belt. I never asked anyone’s name. Now they are my friends. People are not dangerous lunatics, they have become citizens, they have become neighbours.”

It is 10 years since Croatia signed the UN’s Convention on the Rights of Persons with Disabilities but Osijek is the only one of Croatia’s 24 mental health institutions, which house a total of 6,700 people, implementing its spirit. “We signed this with our fingers crossed behind our backs. The government still wants people locked up, locked away. People with disabilities, whether mental health or physical, have rights. There are four reasons why inclusion is better than exclusion,” said Lamza. “It’s better for a person, it’s better for the community, it’s legal, it’s cheaper.” He says the cost per person per month in an institution is $ 1,260 (£950). “In the community, even with the maximum 24-hour support, it is $ 1,020.

“The first day I let people go I didn’t sleep: will she hurt someone, will he cope? But there have been no problems. People have thanked us for giving them the best neighbours they have ever had!”

After 12 years in institutions, Branka Reljan, 55, has spent three years living in the community, in a shared flat with her partner Drazenko Tevlli. She speaks fluent German and English but has suffered mental health breakdowns since university and has let go of old ambitions. Now the couple take great delight in visiting cafes and shops. “We met in the institution but love is not allowed so we lived a secret for 11 years. I say I was in prison before. Now I love to make apple pies and buy spices and oils for cooking. It is wonderful for us to have our own keys, to buy fresh juice and to take a bus. We are satisfied with our neighbours. We are happy.”

Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town.


Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town. Photograph: Photo: Robin Hammond/NOOR

If other asylums in Croatia had any desire to follow Lamza’s care in the community model it would be more difficult. Most were built far from towns.

Rada Matos is the director of Ljeskovica home for mentally ill adults, deep in the Pozega forest, an hour’s drive from Osijek. Lamza describes it as “a warehouse for lost souls”. Matos says she does her best for the 284 people here but points out that Croatia is a poor country and mental health is both under-resourced and stigmatised. “We have no psychologists and no psychiatrists, no professional is interested in coming out here to work, yet perversely we are the main employer in the area for unskilled workers. It’s too far for relatives to visit and there is no community for people to live in even if I had the resources to try. There is a tiny village of uneducated people to whom this is the madhouse.”

There is a long waiting list to come here but few leave. “Maybe two a year,” she said. “We try to explain mental health is an illness, we invite in families, school groups. But what I’d really need to do is move this building somewhere else, somewhere where there is a community.”

Around the grounds and in the corridors, people stand or wander in shabby clothes too big or too small. Miryama Nikoli, 38, is new to Ljeskovica but has been institutionalised for 18 years. Eyes glazed by medication that hasn’t been changed in all that time, she talks to everyone about her daughter, taken away as a baby. “I was sick because of my nerves but now I suffer because of my baby,” she says. “I drink the medicine but I want to see her again.” Matos pulls out her file; her background is heart-breaking and abusive. One line mentions the child, who will now be 18. The file contains four A4 pages.

In Osijek the belief is that lives are better on the outside. Care assistant Vlatka Griner said the hardest task in moving people into the community was to make them use chairs: “At the asylum, they squat in the corridors, smoking. Squat, smoke, move a bit and squat again. What else did they have to do? In only slippers, just slippers because they never went out. When they are in the apartments the hard thing is to get people to sit in chairs. It can take a good two months.

“Then they go to the shops, buy their own food, buy their own clothes, run their own lives. Brush their hair. They’re unrecognisable.”


‘Love was not allowed in the institution. Now we are outside we have our own keys and take a bus. We are happy’

It is not a solution for everyone. Back in Osijek, Zdenko Kovac, 64, is a convicted murderer and, although he claims the scars on his head are from an axe wielded by his wife and he is not deemed dangerous enough for a secure hospital, he has failed to cope outside and is back in the institution where he wants to stay “until I die”.

“He is someone I worry about,” admits Lamza, “he wants to stay and ideally he will.” For others, it was never the right place. Luka Bobanovic, 36, caught a fever aged seven that left him brain-damaged. His mother handed him over to state care and he has been bounced around from institution to institution. “When he came to us he was very disturbed,” said Lamza. “Eight times Luka went through a door or window, either him chasing staff or them chasing him. The doctor told staff to tie him to his bed. I found him like that, tied to his bed, crying for his mamma. The staff shrugged and told me ‘we are scared of him’.”

Now he lives in a small bungalow with three other beneficiaries and round-the-clock care.“Our work doesn’t end when people live outside the institution,” said Lamza. “We are supporting them to live like every citizen of this town, to fall in love, dance, eat pancakes. I want to give people back a reason to live. That is what we have been taking from them, their humanity.

“I’m ashamed of how people lived before, but I’m happy,” Lamza said, “because they’re happy.”