PSYCHIATRISTS FORUM ON EASTERN EUROPE AND THE BALKANS III

Mental health care in Balkans and SEE – challenges and solutions Dusica Lecic Tosevski Institute of Mental Health Belgrade Content  Conflict in the Balkan  Challenges effecting mental health care  Mental health services  Facing challenges and building solutions  Stability Pact for SEE  Multicentric studies 2 Recent history in the region  Destruction and     revival Wars, civil unrest Loss of life Torture victims Large- scale population movements 3 Conflict in the Balkans  Traumatic experiences  Combat  Detention and torture  Forced migration  Two million people uprooted  100.000 in European member states 4 Challenges effecting mental health care  United Nations sanctions  Bombardment  Political upheaval  Social transition  The culture of poverty 5 Social transition and political upheaval  High unemployment rate (29% - 42%)  Gross national product – 756 - 2295 $  National debt high (9.000.000.000 $ in Serbia)  Health care - 5.1% or less  Health system deteriorated  Mental health reform - a difficult task 6 Mental disorders on rise  Morbidity and mortality - 13%   Stress disorders  Depression and suicide rate  Substance abuse – 100%   Psychosomatic disorders  Delinquency and violence  Burnout syndrome 7 Mental health services  Insufficient primary care (39.5%)  Lack of community centres and homes  Tertiary level predominant (“open” access)  Lack of psychotropic medication  Service users uninvolved 8 Mental health system – problems  Low motivation of staff  Insufficient budget  Prevailing stigma  Sensationalistic media coverage 9 Facing challenges and building solutions 10 Stability Pact for SEE  Albania, Bosnia, Bulgaria, Croatia, FYROM    Serbia and Montenegro, Moldova Comprehensive long-term conflict prevention strategy Mental health project: Enhancing social cohesion through strengthening community mental health services – 2002 Donor countries (Greece, Italy, Belgium) 11 Mental health reform - a new challenge  Component one: Harmonization of mental health policies and legislation related to it  Component two: Common SEE model for CMHC – pilot centres  Component three: Training courses for general practitioners to work in CMHC 12 Psychosocial programs  Refugees and torture victims  Traumatized children and families  Education of GPs  Cooperation with NGOs  Antistigma campaigns 13 WPA institutional program BEE  Strengthening support and collaboration  Participation at the international scene (AEP, WPA)  Collaboration with WHO  Joint projects and research 14 STOP & CONNECT Multicentric studies  STOP – PTSD in refugees (EC, 2002-2005)  CONNECT - PTSD in the community (EC – 2004 – 2007 - medical faculties of 8 centers: London, Dresden, Modena, Zagreb, Rijeka, Sarajevo, Skopje, Belgrade)  Better organisation of assistance to traumatized people  Reconciliation 15