Bosnia: Integrating Mental Health into Primary Health Care

1. Bosnia: Integrating Mental Health into Primary Health Care World Bank – Harvard Program on Refugee Trauma • Problems of Mental Health Care Access: • Community MH Clinics underutilized • Primary care physicians (PCPs) report feeling • unqualified to manage MH disorders; 65% of • PCPs unable to make DSM-IV diagnoses • 54% of PCPs never referred patients to MH clinics • 30% who referred never received clinic feedback • Program Objectives: • Assess PCP mental health knowledge • and skills • Provide mental health training and • technical assistance PCPs • Create network of PCPs skilled in mental • health and trauma-related disorders • Develop, with cantonal MOH, mental • health services integrated at all levels • Integrate results into Bosnia and • Herzegovina (BiH) health reform • Prepare “lessons learned” for • dissemination throughout BiH • Program Strengths: • Making the overall health care system • more rational and logical in terms of links • between levels and for referrals • Familiarizing the PHC non-psychiatric • staff with mental health and the need for its • protection • Demonstrating the importance of a bottom- • up approach to projects, and the value of • situation and needs assessments • Encouraging health staff to participate in • the process as stakeholders • Encouraging stakeholders to see the project • as a Bosnian one, with a national character • of its own • 2001 Living Standards • Survey: Mental Health • 23% report depressive • symptoms • 6% report recurring • trauma symptoms • 15% report limitations in • physical functioning • Women 2x as likely to • have depression, PTSD • or functional limitations • Results: • PCP knowledge and skills regarding MH increased markedly • Patient attendance at Mental Health Clinics increased