A community-based mental healthcare system

Project completed
With SDC aid, the quality of care is improving in the community mental health centres of Bosnia and Herzegovina. © SDC

In Bosnia and Herzegovina, much of the population is still suffering the consequences of the war which ravaged the Balkans in the 1990s. Since 2010, Switzerland has been helping the country to modernise its mental healthcare system to give patients access to high quality services in their communities.

Country/region Topic Period Budget
Bosnia and Herzegovina
Health
Mental health & well-being
Primary health care
Health systems strengthening
01.03.2014 - 28.02.2018
CHF 5'665'000

In Bosnia and Herzegovina, the number of cases of depression, anxiety and disorders related to stress or domestic violence is rising steadily. Of particular concern is alcohol and substance abuse among young adults suffering from transgenerational trauma, which affects the children of those exposed to conflict. These mental disorders are exacerbated by high unemployment and widespread impoverishment.  Mental health problems that affect elderly people, in particular dementia have also risen owing to the ageing population and increased life expectancy.

To meet these challenges, the country embarked on a large-scale reform of its mental health system in 1996. The reform aims to progressively integrate mental health services into basic healthcare infrastructures. The SDC has been supporting the reform in partnership with the cantonal governments of Jura, Fribourg, Bern and Geneva since 2010.

Mental healthcare for all

The project aims to improve the health and well-being of people living with psychological disorders or at risk of mental illness. The project takes a global approach, combining several objectives. These include guaranteeing patients’ access to mental healthcare in their communities, fighting the stigma attached to mental health problems and encouraging better integration of people with a mental illness in communities. So far 74 mental health centres have been established to serve communities nationwide.

The project works with the system already in place and aims to facilitate the reform process while strengthening the capacity of the individuals and organisations involved in the changes. In addition to this, the Swiss cantons are providing valuable technical assistance.

© FDFA

A multidisciplinary approach

The mental health centres set up through the project are fully integrated in primary healthcare services; the high quality services they provide are covered in full by patients’ health insurance. The centres offer new therapeutic options within a reasonable waiting time, made possible by the establishment of multidisciplinary teams of qualified staff comprising a psychiatrist, psychologist, nurse and social worker. This approach has given patients access to more personalised therapies better suited to their specific needs.

The mental health centre teams also run public health and prevention campaigns. Furthermore, a partnership between the public health institutions of the two countries has organised nationwide campaigns to tackle depression and anxiety. Investing in prevention has been proven to be effective and early diagnosis is known to reduce the costs of treating serious psychological disorders and to increase the efficacy of therapies. Together, these activities have reduced hospitalisation by 30% since the start of the project.