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Signposting of young people at risk is envisaged in all strategic documents listed in previous sections (Health strategy 2020 and Law on Mental health, 2006). However, in practice the institutional treatment is prevailing in the mental health system.
Prospects are seen in the Health strategy 2020 that envisage paying special attention to the health education for school children, expected to contribute to better health for young people (target 4). This is especially important for the adoption of healthy lifestyles, such as proper nutrition, sufficient physical exercise, prevention of addiction to tobacco, alcohol and psychoactive substances (target 12), and prevention of sexually transmitted diseases including HIV/AIDS and mental health problems.
Primary health care services are at the moment not well prepared to cope with patients with mental health problems. There isn’t any sufficiently developed network of services for counselling and treatment of children and adolescents with such problems either.
The Program for Systematic Medical examination of Students and Students in the Republic of Macedonia for 2020 (Програма за систематски прегледи на учениците и студентите во Република Северна Македонија 2021 година) states that the Classic Method for Screening the Health of School Children and Youth is systematic examinations that are organized in the public health institutions by the services of preventive health care and preventive dental care for school children.
One of the most common causes (among others) of morbidity and mortality among youth is the mental health disorder (depression, anorexia, bulimia), and therefore early detection should be a priority in caring for school children and youth. Thus, the content of the systematic medical examination includes the collection of data for the early detection of signs of depression and other mental health disorders.
The main stakeholders for designating young people at risk are Ministry of Health and Ministry of Education and Science, and established bodies within the institutions, such as National Mental Health Committee and National coordinator for mental health and health institutions dealing with youth mental health problems.
Ministry of Health is the principle entity responsible for monitoring of implementation of Law on Mental Health, Strategy 2020 and Mental Health Strategy, through oversight of activities implementation. Ministry of Education and Science oversights activities that are performed in primary and secondary school and implementation of designed programs.
There are no bodies established at local level, although such structures are defined in Health Strategy 2020 and should be main focus in the future, to allow for proper addressing of youth mental health issues through prevention and health promotion programs.
Specific programs for sensitization of stakeholders are not in place, except work of some civil society organizations working on substance abuse (Healthy Options Project Skopje), sexual and reproductive health (Health, Education and Research Association – HERA), in collaboration with the institutions.
The Ministry of Health regularly carries out annual programs targeting different categories of citizens suffering from certain diseases, however general health policies are undertaken for all young people equally, with respect for the right to non-discrimination on any ground.
According to the Law on Public Health (Article 34), Funds for financing public health are provided by:
1) the Budget of the Republic of Macedonia;
2) the budgets of the units for local self-government;
3) own sources of income;
4) donations and
5) other sources of income determined by other law.
The Budget of the Republic of North Macedonia for the Ministry of Health for 2021 is 6.779.816 MKD (Буџет на Република Северна Македонија 2021). For comparison, the budget for the same Ministry in 2020 was 7.112.872 MKD.
Financing of health in general, including mental health services has seen contrasting trends. In addition to Ministry of Health as policy and decision maker, the main funding comes from Health Insurance Fund (HIF), an entity responsible for purchasing health services, including mental health. Ambulatory services are reimbursed using global budgets and a capped fee-for-service payment system. Primary care providers are paid based on a mix of capitation and achievement of preventive health targets.
However, there is no data on specific activities dedicated to mental health of youth.
Funding for CSO activities is donor based, making programs largely dependent on external funding and therefore lack of sustainability of established activities and their continuity and upgrade.