Innovation summary

During the 1990s, the health system suffered from neglect and a lack of funding due to substantial violence and upheaval. The situation worsened after the political turmoil in 1999, with facilities struggling to provide even the most basic health services. Aside from this, mental health services were primarily hospital focused and biologically orientated. Neuropsychiatric wards provided inpatient care – primarily pharmacological treatment – and primary health care was virtually non-existent for mental health disorders.1 The Mental Health Reform of the early 2000s aimed to develop a new strategy for mental health focusing on shifting the little existing care to community based services.

The Mental Health Reform of Kosovo consisted of:

  • Initial activities by WHO: establishment of a mental health unit and rapid situation assessment
  • Establishment of the Mental Health Task Force
  • Approval of a Mental Health Strategic Plan
  • Reform of Kosovo’s asylum

Impact summary

  • 22,069 people served in all mental health facilities in 2012
  • 40% decrease in number of hospitalizations
  • Increase in number of visits to community mental health centers and home visits by multidisciplinary teams

The crisis of 1999 created an opening for mental health reform. In the midst of this upheaval, mental health stakeholders became receptive to considering new approaches and, at the same time, external human and financial resources were made available; these needed to be used quickly.

-World Health Organization (2013)1

Innovation details

Basic assessment 

The World Health Organization established a mental health unit as part of the UN Kosovo team and conducted a rapid assessment to understand the country’s mental health needs.

Mental Health Task Force

The Mental Health Task Force was created by Kosovar neuropsychiatrists and consisted of psychiatrists from different regions as well as representatives of WHO’s mental health unit. The Mental Health Task Force focused on developing a mental health reform strategy, which incorporated new approaches in the field, local problems, hidden resources, and various options for reorganizing services.

Mental Health Strategic Plan

The Mental Health Strategic Plan was drafted to cover the mental health policy and the implementation plan. Mental health became one of the five priority health areas within the health policy of the relevant authority (UN Interim Administration Mission in Kosovo – UNMIK – Health Department) soon after the Strategic Plan was developed.

Reform of Asylum

The Shtime Special Institution, Kosovo’s asylum, was transformed into the Center for Integration and Rehabilitation. It is for long term patients and is a part of community based mental health services, managed by the Ministry of Health.

Linking primary health care to mental health services

Community based mental health services remain separate from primary health care in Kosovo. However, training was provided to all primary health care teams on:

  • New vision of mental health
  • Need for community based services
  • Existence and contents of the Mental Health Strategic Plan
  • How to work effectively with mental health teams
  • Basic psychopathology and treatment

Key drivers

Education and advocacy 

The Mental Health Task Force and WHO engaged in education and advocacy to counter the previous misconceptions that mental health interventions must be short term, unrealistic, and/or unnecessary.  They also advocated for a comprehensive, community based approach, which was documented in detail in the Mental Health Strategic Plan.

Expert consultation

The Mental Health Strategic Plan was drafted after numerous regularly held meetings, consultations from international experts and site visits outside the country. The high level of detail and extensive expert contributions that went into drafting the Plan, ensured sustainability.

Training and capacity building

Training and capacity building (formal training, day to day interactions with international experts, and collaborations with centers) for core local professionals contributed to sustainability.

Challenges

Resistance

The reform received resistance from people:

  • Advocating for asylums, post-traumatic stress disorders and protecting and promoting psychosocial well-being
  • Establishing a market for psychoactive pharmaceuticals
  • Importing new, unproven psychotherapies
  • Creating visibility for their organisations without considering impact
  • Challenging those who thought that the Kosovar community was prepared to sustain a community based mental health system

Financing

Fragmented budget due to:

  • Limited financial resources
  • Funds for services allocated directly to the regions
  • Funds for inpatient wards dependent on hospital direction

Coordination

Duplication and inadequate coordination for mental health services due to:

  • Lack of communication and coordination of care, as funds and administrative care for outpatient and inpatient wards funds are from different separate entities

Continuation

Future plans include ensuring sustainability and quality control of services.

Partners

UN Kosovo team

  • Kosovo Psychiatric Association
  • Mental Health Task Force (Kosvo)
  • World Health Organization (Switzerland)
  • Donors and other agencies

Funders

Evaluation methods

Innovation was evaluated through reports submitted from the mental health institutions to Kosovo’s Ministry of Health.

Cost of implementation

Total budget for program: $1,653,995 USD (2013)

Impact details

The development of a range of mental health services to provide a continuum of care for people with mental health needs in six designated regions and seven catchment areas. Facilities in each region now consist of one each of the following:

  • Community-based mental health center, staffed by a multidisciplinary team
  • Inpatient ward in a general hospital providing acute care
  • Residential facility offering a limited number of beds to those with severe mental disorders

Kosovo’s asylum has been transformed into the Center for Integration and Rehabilitation for long term patients. It has 50 inpatient beds and offers secondary-level services to all seven regions.

Two child and adolescent health units are operational, under the administration of regional mental health directors. In addition, residential facility for 26 young people opened under social welfare administration.

In 2012, the Mental Health Reform contributed to the following:

  • Increase in psychiatric visits by 22,000
  • Increase in home visits conducted by multidisciplinary teams by 7,161
  • Increase in referrals to psychiatric wards in regional hospitals by 109

References

1. World Health Organization (2013) Building Back Better: Sustainable Mental Health Care After Emergencies. Geneva: WHO Press.

Research
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