The Mental Health Context in Bosnia and Herzegovina

Although being one of the most vulnerable societies in the region, Bosnia and Herzegovina (BiH) has made significant progress in the area of mental health care reform, which was launched in 1996 focusing on community-based mental health. BiH is the only country in the South-East Europe (SEE) region that has set up a network of 74 community-based mental health centers which provide services to 3.8 million residents. The centers employ multi-disciplinary teams comprising psychiatrists, psychologists, social workers and medical nurses; some centers, however, also employ occupational therapists, defectologists, speech therapists - somatotherapists, child psychiatrist. The essential change of the context of service provision in mental health implies a decrease in the rate of psychiatric bed occupancy, opening a network of mental health centers, a multi-disciplinary approach and teamwork, development of other community-based services and improvement of inter-sectoral cooperation. These processes aim to build an effective, efficient and quality mental health service focused on the user needs and accessible to as many people as possible in the context of the integrated system of service delivery. The mental health care system needs to protect human rights, ensure gender equality and efficiently respond to diverse needs of the population, especially of the most vulnerable groups.

Mental health services in the Federation of Bosnia and Herzegovina are provided in a network of 45 community-based mental health centers (CMHCs), where each center has 10 beds available on psychiatric wards in general hospitals for acute cases. Secondary and tertiary health care services are provided by the teaching clinical centers in Sarajevo, Tuzla and Mostar and 9 psychiatric wards in general hospitals (694 beds) in other major cities. According to the special report of the Institution of the Ombudsmen BiH for 2009, some psychiatric patients were placed in social welfare institutions together with persons with special needs (over 1000 users) in Fojnica, Pazaric and Doboj East.

Some centers organize alternative rehabilitation services in cooperation with social welfare centers (SWC), the Healthy Ageing Centre in Sarajevo and over 40 mental health user associations in different thematic areas, of which 4 are associations of persons with severe mental conditions.

In the Republika Srpska, mental health services at the primary-level health care (PHC) are provided by 28 CMHCs within the community health centers (Dom zdravlja-DZ). The centers employ one or more multi-disciplinary teams depending on the size of the catchment area and population, including available human resources. At the secondary and tertiary mental health care level, mental health services are provided by the Psychiatric Clinic of Banja Luka, the Clinical Centre and Psychiatric Clinic in Sokolac, the Chronic Psychiatry Hospital in Modrica and 6 psychiatric wards in general hospitals. The total number of beds in the RS include: 269 beds for acute treatment and 154 beds for chronic patients in the Chronic Psychiatry Hospital in Modrica. The RS has two safe houses, approximately 30 user associations and 4 alcoholic anonymous clubs, 17 daily centers, mobile teams for crisis interventions in cases of domestic violence in certain local communities, which completes the system of community based mental health services in the RS.

In addition, a special forensic psychiatric hospital has been opened, which should soon start providing treatment to forensic patients from across BiH, in accordance with modern international standards, in particular having regard to the protection of human rights and provision of quality treatment and rehabilitation to this group of patients.

Mental health services in Brcko District of Bosnia and Herzegovina (Brcko District) are provided by the CMHC and psychiatric ward of the General Hospital. Brcko District has one mental health service user association.

The positive effects of the reform are visible in most of the areas with CMHCs in terms of improved accessibility of services, quality of treatment, shorter length and frequency of hospitalization, increased staffing levels in mental health care. The activities of the mental health centers have contributed to a better intra-sectoral cooperation within the health care system (family medicine, hospital services) and inter-sectoral cooperation at the local level with CSWs, schools, non-governmental organizations (NGOs); however, this area of action requires further improvement.

The Mental Health Project in BiH (2010-2014), in its phase I, achieved major and significant results in the implementation of the many activities defined in the Entity strategies for mental health development, raised awareness of the importance of mental health for the overall health of the population, became the key facilitator of reform changes in the area of mental health and ensured harmonized development of mental health across BiH. The successful implementation of the Project activities and attainment of the Project goals was supported by the close cooperation and joint work of the Project team and all relevant partners (health institutions - CMHCs, psychiatric hospitals and wards in general hospitals, PHIs, agencies for accreditation and enhancement of health care quality, user associations and NGOs, educational institutions, SWC, and others) under the leadership of Entity MoHs. The planned Project activities were implemented thanks to the excellent and committed work of the Project team and the Project administration provided by Association XY.

On numerous occasions, the line Entity Ministries have stated that this Project is the best example of good practices applied in the implementation of Project goals and partnerships among all stakeholders, and that it can serve as a model for other projects in BiH and the region.