Viera Zahorcova

Viera Zahorcova has engineered the field of mental health to integrate disabled citizens into education and the workforce as well as represent their rights in government policy. She has created the first institutions to address mental health and an extensive network of support for the mentally disabled and their families. Through the diverse networks Viera has built, she is ensuring early intervention, incorporation of the disabled into the education system, improved rehabilitation and vocational training, and full employment for disabled citizens.

Over the last two decades, Viera has been at the forefront of the movement to engage disabled citizens in society as equal economic players and ensure their full economic citizenship, proper social treatment, and human rights. She was instrumental in creating the first experimental early intervention center for disabled in Slovakia, which now serves as the country’s model for developing early intervention care for the mentally disabled. In this center, multidisciplinary teams of specialists work with families who have disabled children ranging from prenatal to school age. In 1998, Viera founded the Association for Help to People with Mental Disabilities in Slovak Republic, which evolved into the umbrella organization for forty-seven independently-run organizations that support the disabled. Viera’s vision and entrepreneurship is best illustrated by her perseverance toward full employment opportunities for the disabled. In 1999 Viera founded the first Agency for Supported Employment (APZ), an employment network which has now expanded to over sixty APZs in Slovakia and thirty in other regions of the world.

Quite rapidly the APZs brought together local and regional governments, clients, the disabled and organizations seeking new employees, who all had different agendas, yet APZ helped bring these players together toward a shared goal. One of the creative ways that Viera continues to coordinate, scale, and ensure quality is by associating APZs with the Slovak Union of Supported Employment, which provides counseling and education services to its members. Viera has also developed quality standards in all supported employment agencies, which enables APZs to be considered a social service.

Viera has built diverse networks of governments, citizen organizations (COs), parents, for-profit organizations, and healthcare institutions at a time when these stakeholders did not traditionally overlap, and in a society that discriminates against and isolates disabled individuals. To build this comprehensive mental healthcare system, Viera has had to focus on her ultimate purpose: The full integration of the disabled into society, in particular, relating to their education and employment opportunities, as well as the legislation essential for their fair treatment. Viera’s experience began twenty-five years ago when she began empathizing with the disabled, although it has transformed into a systemic approach to disability that combines intervention, education, and employment support. Viera’s continuum of care has been adopted as national policy in Slovakia and is funded by the state.

The introduction of totalitarian regimes after World War II affected the development of democratic nations across Central and Eastern Europe (CEE). Even though there were differences in the intensity of oppression by country, there are universal characteristics of this time: Limited attention to human rights, government control of individuals, a paternalistic approach to government, oppression of civil society, and irrational optimism. Because of this irrational optimism and the overly idealistic society it assumed, there were assumptions that social problems did not exist and thus little attention was paid to disabled citizens. In particular, the quality of care in mental health institutions was very poor. Rehabilitation principles were limited, resources were scarce, and a regimented treatment model was in place for the treatment of patients. Even though impressive economic and political progress has characterized the CEE region since the end of the communist era, many transitioning countries of post-communist Europe, including the four Visegrad countries (Czech, Slovakia, Hungary, and Poland) still lag behind. In particular, there is a visible mismatch between economic development and the evolution of social policies to support citizens, especially with respect to mental health. For example, mental health institutions considered unacceptable according to international standards are still in operation.

It is estimated that roughly 6 percent of all CEE countries populations are disabled. In addition, 30,000 people remain in psychiatric institutions in the other Visegrad countries. Because many CEE countries still employ the classical institutional model for the treatment of disabled, people with mental illness remain at the periphery of society with limited rights. Although many are incapacitated, many individuals are left in specialized institutions even when their prognosis does not require it. In addition, there are still hospitals that fail to meet basic human rights in their treatment regimens, such as those hospitals that place more than twenty patients in one room or only provide one toilet for fifty or more patients to share. There are even CEE countries with institutions that have more than 500 beds. In some countries there are only 100 beds for 100,000 inhabitants. These examples of poor quality of care result in the deprivation of human rights for many. The mentally disabled in CEE society are still considered dependents.

In addition to the trend across CEE to institutionalize rather than integrate mental health disabilities within society, the policies relating to the rights of disabled citizens do not universally ensure a fair society. In the Slovak Republic, for example, it was not until 2000 that all children, regardless of disability, were required to complete some level of education. Viera responded with organizing a campaign to lobby for changes in the educational law, which ended up in the new school law that supports the acceptance of all children in the education system. After this success, the association was able to enforce the right to integrated education for children with mental disabilities.

To achieve her vision of a more inclusive approach to disability, Viera has taken an integrated approach that combines all the key stakeholders in the field. She works with the parents of disabled children to ensure they feel supported, the disabled community, organizations who hire regularly, local and national governments, and the social care centers who refer patients to institutions. Viera and her team have built a coalition to earn a special non-governmental commission status, which permits working directly with the Ministry of Social Affairs, Labor and Family. In addition, Viera has convinced government officials to address problems in the state-run facilities; she has built her strategy off of successful placement of some of these patients into the open labor market.

Inspired by her travels abroad in 1988, Viera opened the first experimental early intervention center in Slovakia, which now serves as the model for developing early intervention care for the mentally disabled across Slovakia. Viera approached eight Ministers of Health before she was able to find one to approve the Department of Early Diagnostic and Intervention as the model to spread at the state level. Viera and her colleagues assisted with the creation of thirty-two centers for early intervention. The most famous of these centers are still functioning in regions such as Kežmarok, Spišská Nová Ves, Košice (Eastern Slovakia), Banská Bystrica, Nitra (Central Slovakia), Nové Zámky, Trnava, and Komárno (Southern and Western Slovakia).

By the early 1990s Viera began to publically address the employment of those with mental disabilities in the open labor market. Through her association’s network, Viera set up the first sheltered workshops (Prima and Aktiva in Eastern Slovakia) in cooperation with employment offices. These workshops are partially financed by the state (30 percent), participant fees (25 percent) and other funding sources (45 percent). However, Café Radnicka, which Viera established in the center of Bratislava, was most critical for promoting employment of people with mental disabilities across the country. This initiative helped to connect politicians, officers, citizens, employers, and other people in the movement to promote the employment of people with mental disabilities. During the nine years following its establishment, it led to the replication of similar venues in several other Slovak towns (e.g. Trnava and Trenčín).

By 1998, the Velvet Revolution brought changes in the structures of the clinic as well as the healthcare system as a whole in CEE. It also allowed parents to discuss the challenges faced by their children more openly. Viera began holding parents’ meetings, which evolved into the Parents’ Club, and she has since created the Association for Help to People with Mental Disabilities in Slovak Republic (ZPMP in SR). This organizational growth took place once Viera decided to quit her job in the clinic to dedicate her time fully to developing the healthcare system for children with disabilities and their families. Under her leadership, the association has catalyzed the movement of parents of children with disabilities and became an umbrella organization to forty-seven independent organizations supporting people with disabilities. Viera’s association helps to ensure that the membership organizations and their clientele (parents, specialists, and supporters) communicate and collaborate. The association is also a tool to change the attitudes of people on the local level through engaging them in community and integration activities. This umbrella association also offers educational programs for members, so they are able to establish new, modern, and good-quality services for people with mental disabilities (daycare centers, sheltered housing, and sheltered workshops). The association’s social network has become powerful enough to challenge employers and change the life conditions of people with mental disabilities to enable their employment.

In 1999 Viera established the first APZ as a non-profit organization and became its director. The agency created a network of social partners in employment areas within the Bratislava region to learn how to communicate and work for the benefit of clients. Because the model was highly successful, Viera and her colleagues approached the Ministry of Labor, Social Affairs, and Family to implement this model of work in other regions of Slovakia. In cooperation with the Ministry another three new APZs were created. In the first year of operating APZs with state funding, the agency had 123 clients, and committed to finding employment for at least 30 percent in the area of Bratislava, although it managed to provide employment to 55 percent. In 2005, the growing network of APZs succeeded to enforce the changes in the Law on Employment Services to introduce APZ as one of the instrumental tools in the employment field. Since 2004, there have been fifty-seven agencies established in Slovakia and in 2004 Viera established the Slovak Union of Supported Employment associating APZs throughout the country to ensure members’ quality and scale. This union provides counseling, education, and other services to its members.

While twenty-two agencies have been created with the support of APZ led directly under Viera, there have been over thirty other APZs in other regions serving different groups of disadvantaged people (i.e. employment of Roma people, ex-prisoners, long-term unemployed, and others). Between 2006 and 2009 Viera launched and created Quality Standards for Supported Employment. Based on the application of these quality standards into the work of APZs, Viera was able to ensure public funding for APZs. Agencies are registered as providers of specialized social counseling at the regional level and can get authorization from the Ministry of Labor, Social Affairs, and Family for this social service and the costs of the service subsidized by their respective regional governments.

In addition to her focus on the parents and the APZs as means to build employment opportunities for the mentally disabled, Viera also works with the personnel employed by mental health institutions. She supports them in launching projects that lead to the employment of clients at the facilities. The ones who are not able to work will transition to home-based care institutions that ensure basic human rights and dignified treatment. Viera will implement this approach within the next two years and will provide education about supported employment combined with support to social workers, assistants, case managers, and job coaches in the process of tailoring jobs to specific individuals. While addressing the personnel of the facilities, Viera is also addressing potential employers to support them in job creation for people with mental disabilities. In partnership with labor offices she has managed to convince several local and international companies based in Slovakia to continuously employ people with mental disabilities. Among the employers are McDonald’s, national libraries, factories, receptionists at healthcare facilities, schools, and social organizations. To build awareness among employers about the value that people with mental disabilities bring to companies, Viera has developed a number of interactive tools such as short movies, where employers as well as employees with mental disabilities give their testimonies on why it is important and valuable to work with people with mental disabilities. Viera is actively engaging individual business owners, but also leading business organizations regarding this challenge.

Viera’s extensive experience with key players in the field has taught her that those with disabilities learn best in an environment that is not only supported by organized institutions, but also society at-large. Public awareness and changes in attitudes toward people with mental disabilities is instrumental in social integration. Viera, along with the network of APZs and other organizations supporting people with mental disabilities and their families, are continuously engaged in publicity and promotional activities for the integration of the disabled while also showcasing their potential. There are a number of annual events and activities organized both at the national as well as community level that involve participation of the disabled, their families and regular citizens. These series of events present products and services offered by people with mental disabilities, which engages local communities in joint activities with the mentally disabled. Café Radnicka and other similar initiatives have broken barriers in communication, service, and also provided space for mutual cooperation and communication between the mentally disabled and the general public. This model is influencing public opinion and can positively change attitudes throughout society. Viera has also mobilized media, politicians, and other well-known public figures in a number of social campaigns and initiatives.

Viera’s organization is one of three members of a coalition that will be working on implementation of the process of deinstitutionalization in the next five to ten years. To achieve this, Viera will enforce international documents (UN Convention on the Rights of Persons with Disabilities) and arguments supporting the need for humanization. The process will be implemented by the APZs in Slovakia. Over the next year, Viera will also focus on the wide implementation of quality standards into the work of APZ. Viera strongly believes in the supported employment method as a chance for disabled persons, thus she plans to strengthen it in other regions in Slovakia. Viera expects that it will take another ten to fifteen years to solve the challenge of deinstitutionalization completely and holistically, while also developing an alternative system for social care and services. It will be more cost effective and socially beneficial if economic and human resources allocate resources to support the disabled in their day-to-day lives rather than provide nursing services in costly facilities.

Viera is recognized as the reformer of the social care system within the region, in particular for people with mental disabilities. She is considered an international expert for transitioning countries, where she is often invited to share experiences of her work. Viera hopes that the work she does in university settings, in addition to international conferences where professionals and COs participate, will also help disseminate best practices from her region. Viera is dedicated to working toward accelerating the changes that will improve the quality of life of all people—regardless of their disability.

Viera was born in Bratislava in 1958. As a graduate in psychology in 1981 she had been employed as the first and only psychologist in a pediatric clinic. Viera built the entire practice from scratch, since none of the medical doctors (pediatricians and internists) considered psychology as needed in the practice at the time.

One of the most transformative experiences for Viera, however, was a trip to Denmark in 1980, during the second year of her psychology studies. During this trip, she worked with an international youth camp, where upwards of 50 percent of participants faced some kind of significant disability. Viera was shocked that people with such complex disabilities were active participants in the camp. There was a very disabled person lying in bed, and all the participants were transporting her with the bed, looking after her, and ensuring she could participate in the camp activities. There was a poorly-functioning autistic camper, another with Down Syndrome, and several more. The experience of witnessing and engaging with them as if they were healthy and “functioning” people was a major turning point for Viera: She still recalls the faces and names of the campers.

In the early 1990s Viera had a chance to work with a well-known professor of psychiatry and neurology named Matulay, who worked in her clinic though he was already an elderly man. Combined with Viera’s memories of her mother and grandmother who both empathized with vulnerable people, Professor Matulay inspired Viera’s interest in people with mental disabilities. In communist times, Viera had a chance to travel to various countries in Europe and become acquainted with methods and approaches in diagnostics and therapies of children and youth with developmental problems, including those suffering from risks, delays, and/or unsteadiness in development. Her observations led her to focus on a systemic solution to this problem: Early intervention, integrated education, and support for finding employment. This comprehensive model was non-existent in Slovakia, or any other communist country for that matter.

Given that Viera was already working in a state hospital, she took on this challenge to improve the treatment and care of the mentally disabled as her full mission. Over many decades, Viera has changed the way the disabled are diagnosed, cared for, rehabilitated, and supported. In fact, for most of her life, Viera has ensured people with mental disabilities become integrated and fully functioning members of society. Her diverse experiences working with state institutions, building the movement with parents, and ensuring a supportive society for the mentally disabled have been instrumental in making such significant changes to Slovakia and other countries across the region, such as Czech Republic and Hungary.