At a two-day workshop led by the WHO Country Office in North Macedonia and supported by USAID, mental health professionals from across North Macedonia discussed ways of strengthening the community mental health system in the country. Participants focused on establishing work protocols for community-based mental health care centres and developing an action plan to ensure their better integration at primary care level.
“The prevalence of mental illness is already high and expected to increase dramatically due to the COVID-19 pandemic and its socioeconomic consequences,” said Dr Anne Johansen, WHO’s Special Representative to North Macedonia. “Particularly in the wake of the pandemic, the need to improve public mental health services is more evident than ever. We aim to put mental health and well-being at the heart of the national health system as a key to recovery from the COVID-19 emergency.”
A fundamental element of any individual’s health and well-being is the enjoyment of good mental health, yet mental well-being is far from assured. Though significant progress has been made in North Macedonia, the COVD-19 pandemic has strained the health systems in unprecedented ways, including by disrupting essential health services for mental health.
Paving the way for quality mental health care
North Macedonia’s community mental health system is mainly composed of mental health centres, established largely as a result of the reforms initiated and implemented by WHO and the Ministry of Health in the years 2000–2008. In 2008–2017 the reform process was interrupted following a reduction in the support for community mental health services and strengthening of the hospital-oriented mental health system, until the adoption of the new National Strategy for the Promotion of Mental Health in the Republic of North Macedonia (2018–2025). Adopted by the Government of North Macedonia in 2017, the Strategy identifies the following priority areas:
- decentralizing mental health care
- reducing the number of psychiatric hospitals
- building the capacity of medical staff at community mental health centres
- creating a sustainable financial system for the mental health of the community
- establishing a standardized monitoring and evaluation system.
Resuming the reform process
“In order to further develop the community mental health system, it is necessary to ensure continuous education of staff at mental health centres and consolidate their work throughout the country,” says Dr Stojan Bajraktarov, Director of the Psychiatry Clinic in Skopje and WHO mental health focal point.
“At the same time, continuous education of primary health care professionals is needed to improve knowledge about mental illness, educate people with mental illness and their families, and destigmatize mental illness. Although there is a good referral system between primary, secondary and tertiary health care, a lack of constant communication and cooperation can seriously undermine the effectiveness of mental health care delivered at primary health care level,” adds Dr Bajraktarov.
WHO will continue to support health authorities in resuming the reform process and developing comprehensive, integrated, and responsive mental health and social care services delivered through community platforms. This workshop was an initial foray into the process of turning that plan into action.