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Provision of Psychiatric Services and Mental Healthcare Reform in Eastern Europe and the Balkans
Collaboration Through Science ‘institutionalisation in the community’ has been used in situations such
Research has a universal language, and is therefore the best way to as the above, and it seems that the term is not unrealistic as it reflects
achieve collaboration after conflict; as Claude Bernard said, “Science a pragmatic situation. This does not mean that de-institutionalisation
increases our power as much as it decreases our pride”. A few efforts should be discouraged and rehabilitation of patients should not
multicentric studies have been carried out in the Balkans, including STOP be promoted; on the contrary, both should be carried out with greater
and CONNECT
19,20
– two important words for the region that represent enthusiasm and with thoughtful and timely creation of substructures
two multicentric studies dealing with PTSD, supported by the EU. NGOs and allocation of funding that will guarantee the viability of
were involved in assessing PTSD in refugees (STOP), and the medical community services. The paradigm of countries within the region that
faculties of eight countries are involved in the study of PTSD in the have already carried out psychiatric reform, such as Greece, is
community (CONNECT): three from member countries (London, Dresden particularly useful.
and Modena) and five from ex-Yugoslav countries (Belgrade, Rijeka,
Skopje, Sarajevo and Zagreb; Prishtina joined the group later). About Psychiatric reform in developing countries should take a middle way,
5,000 subjects were assessed in the randomised study. Preliminary results adjusted to local tradition and needs, and not be an uncritical
after assessment of 640 subjects in Serbia, for instance, are showing that adoption of the prevailing Western trend of modern mental
PTSD is currently present in 18.8% of the population, while 32.3% of healthcare. There should be a balance of care, in keeping with the
people have life-time PTSD seven years after the end of the conflict. Ancient Greek dictum ‘nothing in excess’.
These multicentric projects will hopefully bring significant results, and The growing trend of psychiatric reform is a challenge to the role of
represent an empirical basis for adequate programmes for people mental health professionals. Tackling problems of social stress,
suffering from post-traumatic stress, as well as for a better integrating mental healthcare into the general medical care system
organisation of assistance to traumatised people. In addition to and building up general hospital inpatient psychiatric units are of
collaboration, the establishment of a research network is significant strategic importance.
16,17
Also important are changing attitudes,
and complementary to the mental health programme of the Stability individualising and humanising care and increasing access to evidence-
Pact for SEE. Moreover, the projects will, hopefully, help the and value-based care. Steps towards strengthening social support
process of conflict resolution, reconciliation and transgenerational networks for people with mental illness should be undertaken in a
transmission of trauma, which underlies the spiral of violence that the pentalogue involving the patient, his or her family, professionals, the
people of the region have repeatedly faced in the past. community and society.
7
Reform of Psychiatry – Future Steps Collaboration with the WPA and the WHO is important on the road to
There are paradigms in Western Europe that indicate that psychiatric psychiatric reform. There are many important WPA initiatives, such as
reform carried out uncritically may have unwanted consequences. Two the institutional programme ‘Psychiatry for the Person’.
21
Person-centred
conditions seem to be of utmost importance: psychiatry and medicine, with an emphasis on comprehensive, humane
and individualised care, is of utmost importance in the globalised world
• preparation of alternative facilities in the community before closing for both the identity of our patients and our profession. The Psychiatric
down the hospital; and Association of Eastern Europe and the Balkans, affiliated with the WPA,
• continuous and adequate funding of community facilities. is another important tool of collaboration in the region. The recent,
highly successful First East European Congress, held last year in
If these conditions are not observed, the effect can be catastrophic Thessaloniki, Greece, has highlighted the advantages of collaboration
and patients may find themselves in a more difficult situation than the of the psychiatric associations of the region for the advancement of
one they were in when they were hospitalised in big asylums. The term psychiatry in the area. ■
1. Becker I, Vázquez-Barquero JL, The European perspective of 9. Murthy RS, The city of Bangalore, India. In: Goldberg D, 16. Poloshij B, Saposhnikova, Psychiatric reform in Russia, Acta
psychiatric reform, Acta Psychiatr Scand Suppl, 2001;410: Thornicroft G (eds), Mental Health Care in our Future Cities, Psychiatr Scand Suppl, 2001;410:56–62.
8–14. Psychology Press, 1998;57–76. 17. Saraceno B, Mental health in EMRO: The future is now, East
2. Muijen M, Challenges for psychiatry: delivering the Mental 10. Lecic Tosevski D, Pejuskovic B, Mental health care in Mediterr Health J, 2001;7(3):332–5.
Health Declaration for Europe, World Psychiatry, 2006;5: Belgrade – challenges and solutions, Eur Psychiatry, 18. Mental Health Project for South Eastern Europe, Enhancing
113–17. 2005;20(Suppl. 2):266–9. social cohesion through strengthening mental health services
3. Lecic Tosevski D, Prevention and mental health promotion: A 11. Lecic Tosevski D, Pejovic Milovancevic M, Popovic Deusic S, in South Eastern Europe, 2003. Available at:
need for international collaboration, Psychiatriki, 2005;16(1): Reform of mental health care in Serbia: Ten steps plus one, www.seemhp.ba/index.php
7–8. World Psychiatry, 2007;6:51–5. 19. Priebe S, Gavrilovic J, Schuetzwohl M, et al., Rationale and
4. Lecic-Tosevski D, Christodoulou GN, Herrman H, et al., WPA 12. Lecic Tosevski D, Pejovic Milovancevic M, Pejuskovic B, et al., method of the STOP study – Study on the treatment
Consensus Statement on Psychiatric Prevention, Dynamische Burnout syndrome of general practitioners in postwar period, behaviour and outcomes of treatment in people with
Psychiatrie, 2003;36(5–6):307–15. Epidemiologia e Psychiatria Sociale, 2006;15(4):307–10. posttraumatic stress following conflicts in ex-Yugoslavia,
5. World Health Organization, World Health Report 2001. Mental 13. Lecic-Tosevski D, Gavrilovic J, Knezevic G, Personality factors Psych Today, 2002;34:133–60.
Health: New Understanding, New Hope, Geneva: World Health and posttraumatic stress: associations in civilians one year 20. Priebe S, Jankovic J, Gavrilovic J, et al., A study of long-term
Organization, 2002. after air attacks, J Person Disord, 2003;17:537–49. clinical and social outcomes after war experiences in ex-
6. World Health Organization, Mental Health: Facing Challenges 14. Lecic Tosevski D, Draganic-Gajic S, The Serbian experience. Yugoslavia – Methods of the “CONNECT” project, Psych
and Building Solutions, Geneva: World Health Organization, In: Lopez-Ibor JJ, Christodoulou GN, Maj M, et al. (eds), Today, 2004;36:101–23.
2005. Disasters and Mental Health, Chichester: John Wiley & Sons, 21. Mezzich J, Institutional consolidation and global impact:
7. Sartorius N, Fighting for Mental Health, Oxford: Oxford 2004;247–55. towards psychiatry for the person, World Psychiatry,
University Press, 2005. 15. World Health Organization, Preventing Suicide Series, Geneva: 2006;5:65–70.
8. World Health Organization, Mental Health Atlas 2005, Mental and Behavioural Disorders Department of Mental
Geneva: World Health Organization, 2005. Health World Health Organization, 2000.
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