7.5 Mental health
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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. In January 2021, the Government of Republic of North Macedonia adopted the Program for 2021 (Програма за здравствена заштита на лица со душевни растројства во Република Северна Македонија за 2021 година).  The program has a general focus, targeting all populations in North Macedonia, and not precisely young people, as previous years.
The National Mental Health Strategy 2018-2025 (Национална стратегија за унапредување на менталното здравје во Република Македонија септември 2018 - 2025 година со акциски план (септември 2018 – 2025)) was adopted and officially presented by the Minister of Health in September 2018. 
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. The strategy is based on the Constitution of the Republic of North Macedonia which guarantees the right of every citizen to health care, the World Health Organization’s “Health for all in the 21st century” strategy for the European region, the Millennium Declaration of the United Nations, the public health policy of the EU, as well as on finished policies and strategies in various fields of health and health care (HIV/AIDS, tuberculosis, mental health, alcohol, tobacco, drugs, food safety and nutrition, pharmaceuticals etc.). 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. 
The Law on Mental Health (Закон за ментално здравје) developed and enacted in 2006 and amended in 2015 (Закон за изменување и дополнување на Законот за ментално здравје) 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.
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 Minister of Health. Monitoring is done through a set of defined indicators, however, not completely and on regular basis.
 Program for Health Protection of Persons with Mental Disorders in the Republic of North Macedonia, https://www.slvesnik.com.mk/Issues/91de98bf9b494c3da0e4b3ae4b7d4169.pdf (Accessed: February 15 2020)
 National Strategy for Mental Health 2018-2025, http://zdravstvo.gov.mk/wp-content/uploads/2020/05/strategija-za-MZ-2018-2025-170718-pf-1.pdf (Accessed: February 15, 2022)
 The Health Strategy of the Republic of North Macedonia 2021-2030, Ministry of health http://zdravstvo.gov.mk/wp-content/uploads/2021/12/19.11.-SZ-posledna-Konechna-Natsrt-Strategija-MKD.pdf (Accessed: February 15, 2021)
 WHO- AIMS report on mental health system in the former Yugoslav Republic of Macedonia (World Health Organization 2009), p.11 http://www.who.int/mental_health/macedonia_who_aims_report.pdf (Accessed: December 15 2020)
 Edict for announcing the Law on Mental Health, (2006) http://zdravstvo.gov.mk/wp-content/uploads/2015/10/1-ZAKON-ZA-MENTALNO-ZDRAVJE-71.06.pdf (Accessed: December 15 2020)
 Edict for announcing of the law and amending the Law on Mental Health, (2015) http://zdravstvo.gov.mk/wp-content/uploads/2015/10/2-ZAKON-ZA-MENTALNO-ZDRAVJE-150.15.pdf (Accessed: December 15 2020)
Mental health of young people is embedded in existing strategic documents of Ministry of Health (Health Strategy 2020, Mental health policy, 2005 and Law on Mental Health, 2006). However, programs for mental health of youth are scarce, in addition to being neither sufficient, nor comprehensive.
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.
According to a report by the Center for Public Health (Извештај на Центарот за јавно здравје), half of all mental illnesses begin at the age of 14, but most cases are not detected or treated. In terms of the burden of adolescent disease, depression is the third leading cause. Suicide is the second leading cause of death among young people aged 15-29 years. 
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. Thus, recently (2018) University "St. Kliment Ohridski"- Bitola (Универзитет Св.Климент Охридски Битола) founded the first psychological counseling center for students.  The main objective of the counseling center is to promote mental health among students by developing healthy lifestyles, fostering resentment, and assisting in resolving current and developmental problems. Students have the opportunity for individual or group psychological counseling, psycho-educational workshops as well as workshops for the development of life skills. Currently there are 2 centers within the University, one in Faculty of Security- Skopje, and second one in the Kredo center in Bitola.
Due to the COVID-19 and its potential reflection on the mental health, professors from the same University provided free call center for all students who would like to discuss with psychologist regarding the situation with pandemic. At the end of 2020, they also organized free webinar on topic “Mental health of students during COVID - 19”. This webinar was supported by the National Platform of the Chamber of Psychologists.
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. 
Светски ден на менталното здравје 2018, (2018) http://www.cph.mk/ftp/Informativni%20i%20edukativni/2018/Svetski%20den%20na%20mentalnoto%20zdravje%202018.pdf (Accessed: December 15 2020)
 Secondary schools in the Republic of North Macedonia at the beginning of the school year 2020/2021, http://makstat.stat.gov.mk/PXWeb/pxweb/mk/MakStat/MakStat__ObrazovanieNauka__SrednoObrazovanie__PocetokUcebna/275_sreducil_reg_poc_t5_ml.px/table/tableViewLayout2/?rxid=f2ab74b7-411c-4388-8c13-fdd5ae7ff461 (Accessed: February 15, 2022)
 University “St. Kliment Ohridski” Bitola, https://uklo.edu.mk/tabs/view/68eb3695171b671a80774c5f59c53efa (Accessed: December 15 2020)
 НМСМ со повик за млади за поддршка при грижата за менталното здравје, Радио МОФ (2021), https://www.radiomof.mk/nmsm-so-povik-za-mladi-za-poddrshka-pri-grizhata-za-mentalnoto-zdravje/ (Accessed: January 22 2020)
 Менталното здравје сѐ уште претставува табу тема, сметаат младинските организации, YEF, (2019) https://www.radiomof.mk/mentalnoto-zdravje-se-ushte-pretstavuva-tabu-tema-smetaat-mladinskite-organizacii/ (Accessed: December 15 2020)