7.5 Mental health
There is no national strategy on mental health in BiH.
Although being one of the most vulnerable societies in the region, BiH has made significant progress in 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 centres which provide services to 3.8 million residents. The centres employ multidisciplinary teams comprising psychiatrists, psychologists, social workers and medical nurses; some centres, 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 centres, a multidisciplinary 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.
The COVID-19 pandemic has touched every aspect of people’s lives, including mental health. At the same time, it was also obvious that this is still a forbidden subject, and we have seen reluctance and hesitancy to acknowledge and discuss it openly among family members, peers and service providers. There is an urgent need of promoting mental health and wellbeing, and severity of the global burden of mental health problems for children, adolescents, parents and caregivers.
All children and adolescents are at risk of poor mental health outcomes. WHO’s Global Health Estimate shows that up to one in five adolescents will experience a mental disorder each year, self-harm is the third leading cause of death for adolescents and depression is among the leading causes of disability. However, these risks are particularly acute for the most vulnerable children and families, for example those with disabilities, those facing violence, neglect, and abuse in the home, or who live in humanitarian emergencies and low resource settings.
It is encouraging that mental health and psychosocial support services are now seen as an increasingly urgent part of the COVID-19 response globally and in BiH.
When the COVID-19 pandemic broke out in BiH in March 2020, non-essential health and social welfare services were limited and/or interrupted and physical access to centres for mental health and centres for social welfare was interrupted by lockdown measures. Children, adolescents, parents and caregivers, including those who experienced prior mental health issues and those who experienced mental health issues due to the COVID-19 pandemic due to many reasons struggled in accessing mental health and psychosocial support services.
Upon the request of the FBiH Ministry of Health and the RS Ministry of Health and Social Welfare, UNICEF has intensified support to ensure access to mental health and psychosocial support, with a particular focus on children, adolescents, parents and caregivers as well as support aimed at prevention of burnout for teachers and professionals in centres for mental health and centres for social welfare.
With the support of the international community, in particular USAID and the Swiss and Swedish Governments, UNICEF delivered IT equipment such as tablets, smartphones and personal protective equipment to centres for mental health, centres for social welfare and key child protection service providers to ensure and even restore mental health and critical child and family welfare services. In partnership with the Associations of Psychologists in FBiH and RS and the BiH Association for Integrative Child and Adolescent Psychotherapy, relevant professionals were trained and certified for virtual crisis interventions, particularly through phone. This intervention was complimented through establishment of community-based support groups across the country.
More than 45,000 children, adolescents, parents and caregivers across the country have benefitted from this support, including 5,000 children and parents from direct mental health and psychosocial support services.
However, much more remains to be done to ensure greater access to tailored, holistic and community-based mental health and psychosocial support, especially for the most vulnerable children, adolescents, parents and caregivers in BiH, during and after COVID-19.