7.5 Mental health
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National strategy(ies)
On annual basis, the Government of Republic of North Macedonia adopts a Program for Health Protection of Persons with Mental Disorders in the Republic of North Macedonia for 2023. This program has a general focus, targeting all populations in North Macedonia, and not precisely young people.
In the absence of a strategy for mental health among young people, the Regional Cooperation Council (RCC), in cooperation with National Youth Council of Macedonia, proposed drafting a National Strategy for youth mental health 2024-2026. The main goal of the Strategy stems from the need for development of an intersectoral system to support young people. The close cooperation of the three key ministries, Ministry of Education, Ministry of Health and Ministry of Education, is key to drafting the Strategy, as is the participation of the civil sector and the academic community.
The National Youth Strategy for Mental Health for 2024-2026 was adopted and officially presented in January 2024, at the 221 government session.
Generally, the mission and vision of the National Youth Strategy for Mental Health in North Macedonia aim to address current challenges and issues related to the mental health of young people and to promote a comprehensive, integrated, and evidence-based approach to promoting, preventing, and advancing the mental health and well-being of young people. Three main goals have been identified to achieve the vision:
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Promoting the importance of mental health and well-being among young people.
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Reducing risks associated with the mental health of young people.
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Developing and implementing accessible and high-quality mental health services for young people
The strategy also contains an Action Plan that provides measures and activities, executors, i.e. responsible institutions/organizations, dynamics and terms of realization. In that direction, every responsible institution/organization and competent authority, necessary is to predict and plan the activities and frame them in the annual budget planning through the annual programs.
The Health Strategy of the Republic of North Macedonia 2021-2030 is the overarching strategy for improvement of health status of the population, including mental health, and sets out the vision for improvement of the health and of the health care system, which will be responsive to the needs of the population. Related to Mental health of the population, The Health Strategy of the Republic of North Macedonia 2021-2030 and the Action Plan outline further development to maintain progress in reconfiguring services and to further deepen efforts for more locally based and community-focused service responses, while recognizing the need to develop more specialized service elements, for example, forensic psychiatry, addiction services, child and adolescent psychiatry.
Mental health policy in North Macedonia was developed in 2005 and is based on 11 pillars: developing community mental health services, downsizing large mental health hospitals, developing mental health services in primary health care, capacity building for human resources, involvement of users and their families, advocacy and health promotion, human rights protection, equity in access to services, financing, quality improvement and establishment of monitoring system. [4]
The Law on Mental Health was developed and enacted in 2006, and amended in 2015.
The Law regulates the basic principles of mental health protection and promotion, in addition to the rights and responsibilities of persons with mental health conditions. The Law on Mental Health (Article 34) enacted in 2006 stipulates the importance of mental health in the community and provides legal grounds for establishing a Committee for Mental Health in each unit of local self-government, enabling close monitoring of the implementation and protection of the rights of the persons with mental conditions. However, only a few municipalities have established such committees and their work is not publicized or widely disseminated to the public.
All these documents do not specifically address youth, but mental health of the general population.
However, in the new National Youth Strategy 2023-2027, in thematic area 2, a special Strategic Goal 2 is envisaged, which relates to Improved mental well-being of young people, encompassing:
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Opening new and revitalizing existing Mental Health Centers in all regions of the country, offering electronic consultations to increase service accessibility and reduce waiting times, especially for youth in rural areas, those with disabilities, and those at risk;
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Establishing counseling services for psychological assistance within all higher education institutions, improving access to psychological support for all youth categories within communities;
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Creating a communication network with relevant authorities to identify and report family and peer violence, prevent substance abuse, internet addiction, and early signs of behavioral and mental disorders in youth;
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Amendments to the mental health law focused on prevention, education, and care for the mental health of youth;
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Establishing mechanisms for accessibility to mental health services for individuals with disabilities and their families, directed towards psychological support and increasing their socialization;
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Expanding and updating the range of approved medications for treating medically justified mental conditions in youth;
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Training and enhancing the competence of school psychologists, teachers, and parents for rapid and timely prevention and identification of mental conditions;
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Activities to improve the well-being of working youth, focusing on reducing workplace burnout, better integration into the workforce, and access to workplace mental health services.
Health care for persons with mental health problems is provided at 3 levels of health care, the primary health care physician being the first point of entry that recognizes the problem and refers patients to higher levels of care. Secondary health care is provided through neuropsychiatry specialist-consultative outpatients services in Health Centers, in addition to Institutes for Children and Youth located in the cities of Skopje and Bitola. Inpatient secondary care is provided by neuropsychiatry departments within General Hospitals, while most severe cases are treated at tertiary level in psychiatric hospitals. Additional tertiary care is provided by the University Clinic of Psychiatry.
Monitoring of implementation of Law on Mental Health and Strategic plan are responsibility of National Mental Health Committee and National Coordinator for Mental Health, both appointed by the Minister of Health. Monitoring is done through a set of defined indicators, however, not completely and on a regular basis.
Improving the mental health of young people
Mental health of young people is embedded in existing strategic documents of the Ministry of Health (Health Strategy 2020, Mental health policy, 2005 and Law on Mental Health, 2006), as well as the new National Youth Strategy 2023-2027. However, programs for mental health of youth are scarce, in addition to being neither sufficient, nor comprehensive.
In this regard, huge advancement has been made, with the adoption of the National Youth Strategy for Mental Health 2024-2026, who’s most important goals are:
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To increase awareness of mental health problems among young people and to reduce the stigma surrounding mental health.
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To improve access to mental health services for young people, including through development of community-based services.
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To promote early intervention and prevention of mental health problems, through implementation of evidence-based interventions and programs.
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To ensure that mental health services are of high quality and culturally sensitive and accessible to all young people, regardless of their socio-economic status or geography location.
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To encourage cooperation between different sectors, including health, education and social services, to address the complex social determinants of mental youth health.
The Institute for Mental Health of Children and Youth "Mladost" Skopje operates within the Health Center of Skopje. The Institute, with its main activity - protection and promotion of mental health of children and youth, conducts primary, secondary and tertiary prevention of mental health, i.e. works on preventing the occurrence of mental disorders among children and young people, their early detection and diagnosis, as well as treatment and rehabilitation. Unfortunately, there is no publicly available information or reports of specific measures undertaken by the Office in order to improve the mental health of young people.
Community health services for children and youth are still underdeveloped, there is a lack of professional staff particularly in schools, as well as lack of child and adolescent psychiatrists, child and adolescent psychologists and social workers.
According to the latest information of the State Statistical Office, in the start of School year 2020-2021 there were 128 high schools in North Macedonia. Not all of them have psychologist.
The most important challenge at present is the introduction of mental health programs for youth in schools, as an opportunity to support young people prior to onset or at the early stage of mental health problems. Mental health in schools is of particular importance, facilitating the process of further professional orientation and psychological adaptation of the student to the workplace activities.
In most of the faculties in North Macedonia there is no psychologist at all, but there are rare exceptions.
In 2019, NAVANTI Foundation together with the National Youth Council of Macedonia conducted a study “Cross-Sectoral Youth Assessment in North Macedonia”. One of the findings is that the education, employment and social situation which shape feelings of limited agency and exclusion amongst many young people growing up in North Macedonia have likely contributed to what some consider a mental health crisis in the country. This issue was raised by young people as well as youth experts across the CSYA. University professors described the situation in the country in terms of “collective depression” and blamed it on unfairness in the society.
In the last period the non-governmental organizations are undertaking many different activities related to the mental health of the youth. Some of these organizations are the National Youth Council of Macedonia, Youth Can, Psihesko and S.H.A.R.E.