Politika Mentalnog Zdravlja

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Ministarstvo zdravlja i socijalne zatite Republike Srpske

Ministry of Health and Social Welfare Republic of Srpska

Politika mentalnog zdravlja

Mental Health Policy


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Vlada Republike Srpske Republic of Srpska Government MINISTARSTVO ZDRAVLJA I SOCIJALNE ZATITE MINISTRY OF HEALTH AND SOCIAL WELFARE

www.vladars.net


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Sadraj Contents

Predgovor 7 Foreword

Uvod 9 Introduction

injenice i podaci o Republici Srpskoj 11 Facts and gures on the Republic of Srpska

Vizija, vrijednosti, principi i ciljevi politike 18 Vision, values, principles and goals of the policy

Strateki izazovi i prioriteti (prioritetna polja aktivnosti) 20 Strategic challenges and priorities (Priority activities)

Plan aktivnosti 26 Activity plans


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7Politika mentalnog zdravlja Mental Health Policy

Predgovor

Detaljna procjena irom regije zemalja JugoistoneEvrope koja je preduzeta u okviru inicijative Pakta sta-bilnosti, naglasila je potrebu za reformom postojeegsistema lijeenja i brige za ljude sa mentalnim oboljen-jima. Prisutna je dominantna kultura zapostavljanja iiskljuivanja ljudi sa mentalnim oboljenjima, koja jejasno izraena kreiranjem velikih institucija za mentalnozdravlje koje nisu uspjele da zadovolje potrebe a i kreprava mentalno oboljelih lica.

Dolo se do konsenzusa da sistem brige o mental -nom zdravlju mora zatiti ljudska prava i da ekasno od-govori na raznovrsne potrebe populacije (naroito djece

i adolescenata, starih lica i posebno ugroene populaci-je). Sistem pruanja usluga iz oblasti mentalnog zdravljamora se zasnivati na najboljim dostupnim dokazima imora biti ekasan i prihvatljiv.

Mentalno zdravlje se tie svih ljudi. Razvoj visokokvalitetnih usluga iz oblasti mentalnog zdravlja zahtjevaaktivno uee i saradnju od strane Vlade, svih relavant-nih profesionalnih disciplina, korisnika i organizacija

koje obezbjeuju usluge i udruenja graana.

Foreword

The comprehensive analysis of the South-EastEuropean countries carried out within the Stability pactinitiative has emphasised the necessity to reform thecurrent health care system and care for people suffer-ing from mental illness. A dominant tradition of neglectand exclusion of people with mental illness is presenthere, which can be clearly seen in the creation of largemental health institutions caring, which were not able tomeet the requirements, and they violate the rights of thepeople with mental illnesses.

The consensus has been reached, so that the men-tal health care system has to protect the human rights

and has to more efciently meet the various needs of thepopulation (especially children and adolescents, seniorcitizens and vulnerable population). The service provi-sion system in the eld of mental health has to be basedon the best available evidence and has to be efcient andacceptable.

Mental health concerns all the people. Upgradingthe highly professional mental health services requires

active participation and co-operation of the Govern-


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Vlada mora osigurati da sistemi pruanja usluga izoblasti mentalnog zdravlja budu adekvatno osposobljeninansijski i ljudskim resursima. Od postojeih i novihresursa se trai da prue podrku procesu reforme, anaroito uspostavljanje i dalji razvoj lijeenja i pruanjanjege u zajednici.

Sad je vrijeme za reformu mentalnog zdravlja. In-vestiranje u mentalno zdravlje je neophodno radi soci-

jalnog i ekonomskog razvoja. Rad Pakta Stabilnosti upodruju mentalnog zdravlja se pojavljuje unutar dogov-orenog radnog okvira za kooperativne aktivnosti iromregiona. Nacionalna politika i Zakon o zatiti lica sa men-talnim poremeajima e omoguiti Republici Srpskoj darjeava probleme u ovoj oblasti i dostigne standarde kojisu takoer i indikatori, a i preduslovi za odgovarajui iodriv razvoj.

ment, all relevant professional disciplines, citizens asso-ciations, users and organisations providing services.

The Government has to ensure mental health ser-vice systems to be appropriately equipped with nan-cial means and human resources. The existing and newresources are to provide the assistance to the reform,especially to the foundation and further development oftreatment and providing care in the community.

Now is the right time for the mental health reform.Investments in mental health are crucial for the socialand economic development. The activities of the Sta-bility Pact in the eld of the mental health have beencarried out within the established framework for coop-eration activities throughout the region. The NationalPolicy and the Law on Protection of People with MentalDisorders will enable the Republic of Srpska to solve

the problems in this eld and reach the standards whichare at the same time indicators, and preconditions forappropriate and sustainable development.


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Uvod

Svjetska zdravstvena organizacija procjenjuje da450 miliona ljudi irom svijeta ima mentalne, neurolokeili bihevioralne probleme. Procjenjuje se da takoe jednaod etiri osobe koje trae zdravstvene usluge ima nekiporemeaj koji je mentalne, neuroloke ili bihevioralneprirode. Broj ljudi koji periodino zahtjeva psihijatrijskupomo ili neku drugu vrstu profesionalnog savjetovan-ja ili pomoi je mnogo vii nego to se moe stvarnoprocjeniti. Imajui u vidu da se psiholoki uzroci zabrojne somatske bolesti ne mogu isljuiti i da imamosve vei broj dokaza da je stres uzrok velikog broja so-matskih bolesti, moemo slobodno rei da su problemi

mentalnog zdravlja na vrhu liste zdravstvenih problemaglobalno.

Mentalni problemi su esti u svim zemljama, uz-rokuju velike ljudske patnje, socijalnu izolovanost, in-

validnost i lo kvalitet ivota. Oni takoe poveavajumortalitet i uzrok su izrazito visokih ekonomskih idrutvenih trokova. U veini zemalja, usluge mentalnogzdravlja ne podmiruju potrebe stanovnitva. Rastua

potreba stanovnitva za odgovarajuim uslugama iz

Introduction

According to the estimates of the World HealthOrganisation, there are 450 million people around theworld with mental, neurological or behavioural prob-lems. It is also estimated that one out of four personsasking for the health services, has a disorder of men-tal, neurological or behavioural nature. The number ofpeople asking for psychiatric help or some other sortof professional counselling or help is much larger than

what estimates show. Having in mind that psychologicalcauses of numerous somatic diseases cannot be exclud-ed and that there are more and more evidence showingthat stress causes large number of somatic diseases, we

can freely say that mental health problems come out ontop of the list of health problems at the global level.

Mental problems are frequent in all countries, causesevere human sufferings, social isolation, disabilities andpoor quality of life. They also increase mortality andcause extremely high nancial and social costs. In mostcountries, mental health services do not satisfy needs ofthe population. The increasing needs of the population

for proper mental health services require urgent restruc-


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oblasti mentalnog zdravlja zahtjeva hitnu reorganizacijusadanjih sistema pruanja usluga irom svijeta.

Postojee usluge iz oblasti mentalnog zdravlja uRepublici Srpskoj nisu u stanju da zadovolje potrebe sta-novnitva i postoji potreba za jaanjem i reorganizaci-jom postojeeg sistema. Bosna i Hercegovina, Repub-lika Srpska je meu zemljama koje su najmanje imunena poremeaje u mentalnom zdravlju i njihove poslje-

dice kao to je stigmatizacija, invalidnost, segregacija isvi oblici izolovanosti. Drutvena stigma vezana za po-remeaje mentalnog zdravlja, segregacija i izolovanostosoba sa problemima mentalnog zdravlja iz drutvenihtokova, krenje ljudskih prava su meu osnovnim bari-jerama prema lijeenju i reintegraciji ljudi sa mentalnimproblemima u Republici Srpskoj i Bosni i Hercegovini.

Takoer postoji potreba za senzibiliziranjem ja-

vnosti u vezi vanosti mentalnog zdravlja kao i potrebakontinuiranog poboljanja prevencije, lijeenja i rehabili-tacije u oblasti mentalnog zdravlja.

Ukazana situacija u polju mentalnog zdravlja, os-tavlja dovoljno prostora za reviziju uloge psihijatrije ipsihijatrijskih institucija, a vezano za njihove terapeutskei rehabilitacione funkcije, drutveno djelovanje, orga-nizaciju, nansiranje i meusektorsku saradnju. Ovotakoe, znai naputanje koncepta psihijatrijske bolnicekao arhaine institucije socijalne izolovanosti, stigme ikrenja ljudskih prava i postepeni prijelaz ka pruanjuusluga mentalnog zdravlja u lokalnoj zajednici.

Iz ovih razloga neophodno je razviti politiku izoblasti mentalnog zdravlja, koja e sluiti kao uputstvoza dalji razvoj i jaanje sektora mentalnog zdravlja.

turing of the existing service provision systems aroundthe world.

The existing mental health services in the Republicof Srpska do not satisfy the needs of the population andit is necessary to strengthen and restructure the systemin place. Bosnia and Herzegovina, the Republic of Srp-ska is one of the countries immune to the mental healthdisorders and their consequences, such as stigmatisation,

disabilities, segregation and all forms of isolation. Thesocial stigma related to mental health disorders, segre-gation and isolation of mental patients from social av-enues, violation of human rights are among the basicobstacles for treatment and reintegration of persons suf-fering from mental problems in the Republic of Srpskaand Bosnia and Herzegovina.

It is also necessary to raise public awareness about

importance of mental health as well as to continuouslyimprove mental health prevention, treatment and reha-bilitation.

The situation discovered in the eld of mentalhealth leaves sufcient space for a review of the roleof psychiatric hospitals and psychiatric institutions, in

view of their therapeutic and rehabilitation functions,social impact, organisation, nancing and cooperationamong sectors. Additionally, this implies abandoning theconcept of psychiatric hospital as an archaic institutionof social isolation, stigma and violation of human rightsand gradual transition to provision of mental health ser-

vices within the local community.Therefore, it is necessary to develop a mental health

policy to be used as the guidelines for further develop-ment and strengthening of the mental health sector.


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injenice i podaci oRepublici Srpskoj

Socio demografski opis

Dejtonskim mirovnim sporazumom denisana jeRepublika Srpska kao jedan od dva entiteta Bosne i Her-cegovine.

Dejtonski mirovni sporazum je dao odgovornostentitima za organizaciju zdravstvene zatite, njeno -nansiranje, nain pruanja usluga kao i za donoenje za-kona iz oblasti zdravstvene zatite.

Republika Srpska zauzima priblino 25. 000kvadratnih metara i ima oko 1,4 miliona stanovnika.

Prema posljednjem popisu stanovnitva iz 1991. go-dine i dodatnom popisu raseljenih lica i izbjeglica iz1996. godine, Republika Srpska ima ukupno 1,391,593stanovnika, 30% su izbjeglice i raseljena lica (Republikizavod za statistiku 2001.). Statistiki indikatori varirajuu posljednjoj dekadi 20-og stoljea, i bez obzira na totrebaju se analizirati sa odreenom rezervom poto jeraunica zasnovana na projekciji popisa stanovnitva iz

1991. godine.

Facts and gures on theRepublic of Srpska

Socio demographic description

The Dayton Peace Agreement constituted the Re-public of Srpska as one of the entities of Bosnia andHerzegovina.

The Dayton Peace Agreement made entities re-sponsible for healthcare organisation, funding, methodof providing services as well as adopting the legislationin the eld of healthcare.

The Republic of Srpska covers approximately25,000 square meters, with the population of about 1.4

million. According to the last census in 1991 and thesubsequent census of displaced persons and refugeesin 1996, the total population of the Republic of Srp-ska was 1,391,593, out of which 30% were refugees anddisplaced persons (the RS Statistics Institute 2001). Thestatistic indicators vary in the last decade of the 20thcentury, and nevertheless should be analysed with pre-caution since the calculation was based on the projection

of the census in 1991.


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Vano je naznaiti da se nekoliko hiljada ljudi vodikao nestalo i da je preko 12. 000 porodica izgubilo sina

ili mua. Oko 14.000 djece nema jednog roditelja, a 550

It is important to emphasise that several thousandsof people are missing and that more than 12,000 fami-

lies lost a son or husband. Around 14,000 children are

Indikatori

Indicators1991.

BiH

1998.

RS

1999.

RS

2001.

RS

Stanovnitvo (mil)

Population (mil)4,3 BiH 1,43 1,45 1,49

Stanovnitvo 65 i stariji

Population 65 and over6,0 BiH 0,21 0,22 0,24

Stopa nataliteta na 1000

stanovnika / Birth rate per

1,000 of the population

14,9 BiH 9,4 10,0 9,2

Stopa mortaliteta na 1000

stanovnika / Death rate per

1,000 of the population

7,2 BiH 8,7 8,5 9,0

Oekivane godine ivota

- ene / Life expectancy- women 74,6 (1989) 74 74 74

Oekivane godine ivota -

mukarci / Life expectancy

- men

69,2 (1989) 71 71 71

Maternalni mortalitet

na 100,000 poroaja /

Maternal mortality rate per

100,000 live births

NA NA 8,11 NA

Smrtnost novoroenadi na

1000 ivo roene djece / In-

fant mortality rate per 1,000

live births

14,5 8,3 8,2 5,3

Izvor: Zavod za statistiku Republike Srpske / Source: RS Statistics Institute

Tabela 1. Demografski indikatori: Republika Srpska, 1991-2001Table 1. Demographic indicators: the Republic of Srpska, 1991-2001


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je ostalo bez oba roditelja. Prema nekim procjenama iistraivanjima (SZO) oko 16% stanovnitva pati odpostraumatskog stresnog poremaaja - PTSP. 35 smrt-nih sluajeva je izazvano psihijatrijskim poremeajima u2002. godini, a broj suicida iste godine je bio 302.

Sistem pruanja usluga iz oblasti mentalnogzdravlja u Republici Srpskoj

Pruanje usluga

Psihijatrijska sluba u BiH prije rata je bila jedna odbolje organizovanih u bivoj Jugoslaviji. Sistem pruanjausluga iz oblasti mentalnog zdravlja bio je zasnovan napsihijatrijskim bolnicama i malim odjelima neuropsi-hijatrije unutar optih bolnica, usluge su se pruale i udomovima zdravlja.

Rat je donio razaranja brojnih tradicionalnih psi-hijatrijskih institucija. Obolijevanje od psihijatrijskih bo-lesti je poraslo uz masivnu psiholoku patnju ukupnogcivilnog stanovnitva.

Usluge iz oblasti mentalnog zdravlja u RepubliciSrpskoj se obezbjeuju u javnim institucijama sekun-danog i tercijarnog nivoa. To su sledee institucije: Psihi-jatrijska klinika u Klinikom centru u Banjoj Luci, jedne

psihijatrijske ustanove za dugorono lijeenje i reha-bilitaciju sa 154 kreveta u Jakeu, psihijatrijska bolnicasa 160 kreveta u Sokolcu (za akutne sluajeve 60, a zaforenziku psihijatriju 100), est optih bolnica sa psi-hijatrijskim odjelima i 12 centara za mentalno zdravljeu zajednici koji su u satavu domova zdravlja. Sistem jeosnaen otvaranjem dvije zatiene kue i jednom ko-operativom. Tri udruenja korisnika su aktivna na teri-

toriji Republike Srpske.

without a parent, while 550 have lost both parents. Ac-cording to some estimates and research of the WHOapproximately 16% of population suffer from posttrau-matic stress disorder PTSD. In 2002, 35 deaths werecaused by psychiatric disorders and the number of sui-cides was 302.

System of mental health service provision in the

Republic of Srpska

Provision of services

Psychiatric service in BiH was among better or-ganised services in the former Yugoslavia. The systemof mental health service providers relied on psychiatrichospitals and small neuropsychiatry wards within gen-eral hospitals, while services were also provided in thehealthcare centres.

War caused devastation of a number of traditionalpsychiatric institutions. The rate of psychiatric illnessesincreased followed by massive psychological distress ofthe overall population.

Mental health services in the Republic of Srpskaare provided in public institutions of secondary and ter-tiary levels. These institutions are as follows: Psychiatric

Clinic of the Clinical Centre Banja Luka, one psychiat-ric institution for long-term treatment and rehabilitationwith 154 beds in Jakes, psychiatric hospital with 160 bedsin Sokolac (60 for acute cases and 100 for forensic psy-chiatry), six general hospitals with psychiatry wards and12 mental health centres within the healthcare centres inthe community. The system is reinforced with two safehouses and one cooperative. There are three users as-

sociations active in the Republic of Srpska.


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Reformskim opredjeljenjem u Politikama i strategi-jama razvoja zdravstvenog sistema u Republici Srpskoj(Narodna Skuptina 1996. i 2002.godina) opredjelili smose za razvoj pruanja usluga iz oblasti mentalnog zdravljakao ambulantne usluge na nivou primarne zdravstvenezatite. Centri mentalnog zdravlja u zajednici uspostav-ljeni su i funkcioniu u 12 domova zdravlja u optinamakoje su denisane Izmjenama i dopunama Odluke o pla-

nu mrea zdravstvenih ustanova i to: Banjaluka, Doboj,Trebinje, Derventa, Sokolac, amac, Vlasenica, KozarskaDubica, Gradika, Srbac, Zvornik, i Prnjavor. U drugih10 optina Novi Grad, Prijedor, Laktai, Tesli, Kotor

Varo, Ugljevik, Istono Sarajevo, Viegrad, Gacko iipovo proces uspostavljanja centara mentalnog zdravljaje u toku. U preostalih 40 optina, zdravstveni radniciu domovima zdravlja upuuju pacijente sa problemima

mentalnog zdravlja na vii nivo, obino u susjednu bol-nicu. U nekim domovima zdravlja rade psihijatri kojiobezbjeuju usluge u vidu ambulantnih aktivnosti.

Dominira medikamentni pristup u lijeenju paci-jenata. esti su neurotski, somatoformni i stresom uz-rokovani poremeaji uz ozbiljne psihijatrijske bolesti.

Reformative determinations of the Health SystemDevelopment Policy and Strategy of the Republic ofSrpska (National Assembly 1996 and 2002) had optedfor development of mental health service provision inthe form of out-patient service at the level of primaryhealthcare. Mental healthcare centres in the communityare up and running in 12 Healthcare Centres in munici-palities as dened in Changes and Amendments of the

Decision on the Plan of Health Institutions Network, asfollows: Banja Luka, Doboj, Trebinje, Derventa, Soko-lac, Samac, Vlasenica, Kozarska Dubica, Gradiska, Srbac,Zvornik and Prnjavor. The process of establishing men-tal healthcare centres is ongoing in another 10 municipal-ities: Novi Grad, Prijedor, Laktasi, Teslic, Kotor Varos,Ugljevik, Istocno Sarajevo, Visegrad, Gacko and Sipovo.Health professionals working in the healthcare centres in

the remaining 40 municipalities address the patients af-fected by mental disturbances to the higher level, usuallyto neighbouring hospitals. In some healthcare centres,there are psychiatrists providing out-patient services.

Patient treatment is dominated by medication ap-proach. Neurotic, somatoform and stress related disor-

Broj kreveta / Number of beds Na 10,000 stanovnika / Per 10,000 of the population

Ukupno psihijatrijskih kreveta / Total psychiatric beds 3,93

Psihijatrijski kreveti u KC Banjaluka

Psychiatric beds in the Clinical Centre Banja Luka0,91

Psihijatrijski kreveti u optim bolnicama / Psychiatric beds in general hospitals 0,68

Psihijatrijski kreveti u drugim institucijama / Psychiatric beds in other institutions 2,33

Broj kreveta na 10,000 stanovnika je predstavljen na donjoj tabeli:Number of beds per 10,000 of the population is shown in the following table:


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i sredstva koja su namjenjena odreenom broju krevetana tercijarnom nivou. Fond nema posebno namjenjenbudet za programe iz oblasti mentalnog zdravlja iliobezbjeenje usluga. to se tie specijalizovanih ustano-

va, postoji godinji budet za Zavod za hospitalizacijuljudi oboljelih od hroninih mentalnih bolesti u Jakeu iza Psihijatrijsku bolnicu u Sokolcu.

Osnovna ulaganja vezana za razvoj (izgradnja ili

preureenje) centara za mentalno zdravlje se pokrivajuiz donacija.

Procenat raspodjele zdravstvenog budeta za oblastmentalnog zdravlja nije odreen. Informacije o direkt-nom out of pocket nansiranju usluga za usluge izoblasti mentalnog zdravlja nisu poznate.

Obuka kadrova

Usluge iz oblasti mentalnog zdravlja u RepubliciSrpskoj uglavnom pruaju neuropsihijatri, psihijatri, psi-holozi i drugi lanovi multidisciplinarnih timova. Veinapsihijatara i drugih specijalista za mentalno zdravlje radiu bolnicama u veim centrima i nisu jednako raspodjelje-ni irom Republike Srpske. U poreenju sa drugim

Evropskim zemljama broj psihijatara i psihologakoji radi nije dovoljan da podmiri potrebe iz oblasti men-talnog zdravlja za stanovnitvo Republike Srpske.

Nakon zavretka Medicinskog fakulteta, ljekari kojiele da rade u polju mentalnog zdravlja biraju psihijatrijukao specijalizaciju. Obuka traje 4 godine i obezbjeenaje na univerzitetskim bolnicama u Republici Srpskoj i uinostranstvu. Potrebe za psihijatrima ili klinikim psi-holozima su denisane na lokalnom nivou i zdravstveneinstitucije odreuju broj i tip specijalista iz oblasti men-talnog zdravlja koji im je potreban. Master plan na na-

tertiary level. The Fund does not include a special bud-get for mental health programs or provision of services.Speaking of specialized institutions, there is an annualbudget for the Fund for hospitalization of patients suf-fering from chronic mental diseases in Jakes and for thePsychiatric Hospital in Sokolac.

Capital investments for development (constructionor refurbishing) of the mental health centres are covered

from donations.It is not dened which percentage of funds within

the health budget should be allocated for mental health.The information on direct out of pocket nancing ofservices in the eld of mental health are not known.

Personnel training

Mental health services in the Republic of Srpska are

generally provided by neuropsychiatrists, psychiatrists,psychologists and other members of multidisciplinaryteams. Majority of psychiatrists and other mental healthspecialists work in hospitals in bigger towns and are notequally represented throughout the Republic of Srpska.Compared to other European countries, the number ofpsychiatrists and psychologist is not sufcient to satisfythe needs of the population of the Republic of Srpskain the eld of mental health.

After graduating from a Medical Faculty, medicaldoctors who wish to specialise in the eld of mental hea-lth choose psychiatry for specialisation. The training lastsfor four years and is provided at the university hospitalsin the Republic of Srpska and abroad. The needs for psy-chiatrists or clinical psychologists are specied at the locallevel and health institutions dene the number and typeof mental health specialists they require. The country-


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cionalnom nivou koji bi trebao da denie potrebe i ra-spored obuke za specijaliste iz oblasti mentalnog zdravlja,a prema potrebama stanovnitva, jo nije razvijen.

Kontinuirana medicinska edukacijaKontinuirana edukacija za zdravstvene radnike u

oblasti mentalnog zdravlja u Republici Srpskoj je organi-zovana kroz aktivnosti Komore doktora i profesional-nih udruenja psihijatara i psihologa. Takoe je vanospomenuti da su programi dodatne obuke sa temama izporodine terapije i grupne psihoanalize, spoznajne tera-pije i bihevioralne terapije inicirane i implementirane odstrane profesionalaca iz oblasti mentalnog zdravlja. Obukaza profesionalno osoblje iz oblasti mentalnog zdravlja seobezbjeuje i kroz zajedniki evropski projekat koji orga-nizira Tempus Far i kroz postdiplomske studije Mentalnozdravlje u zajednici i Djeija i adolescentna psihijatrija.

Upravljanje

Administrativna struktura Republike Srpske je cen-tralizovana, poto se sve vane odluke o zdravstvenoj po-litici i raspodjeli sredstava donose na centralnom nivou.Ministarstvo zdravlja i socijalne zatite je odgovorno zaobezbjeenje funkcije upravljanja za zdravstvene uslugeu mentalnom zdravlju. Nema regulatorne jedinice u Mi-

nistarstvu vezano za pitanja mentalnog zdravlja. Odgo-vornost za oblast mentalnog zdravlja se djeli izmeurazliitih sektora unutar Ministarstva. Nacionalni koordi-nator za mentalno zdravlje u prvom redu zaduen zaodravanje kontakta sa Svjetskom Zdravstvenom Or-ganizacijom je de fakto odgovoran za organizaciju ikoordinaciju aktivnosti iz oblasti mentalnog zdravlja nacentralnom nivou. Pozicija nacionalnog koordinatoranije profesionalna pozicija unutar Ministarstva.

wide master plan that should dene the needs and sched-ule of training for mental health specialists, based on theneeds of the population, has not yet been developed.

Permanent medical educationThe permanent education in the Republic of Srp-

ska for health professions in the eld of mental healthis organized through activities of the Doctors Chamberand professional associations of psychiatrists and psy-chologists. It is also worth mentioning that additionaltraining programs with subjects in family therapy andgroup psychoanalysis, cognitive therapy and behaviouraltherapy were initiated and implemented by mental healthprofessionals. The training for mental health profession-als is also provided under the joint European projectorganized by Tempus Phare and postgraduate studiesMental Health in the Community and Child and Ad-

olescent Psychiatry.Management

The RS administrative structure is centralised, sinceall crucial decisions on health policy and distributionof funds are made at the central level. The Ministry ofHealth and Social Welfare is responsible for managementof health services in the eld of mental health. There is

no regulatory unit within the Ministry dealing with men-

tal health issues. Responsibility over the eld of mentalhealth is divided among various sectors within the Min-istry. The national coordinator for mental health, whois primarily in charge of maintaining contacts with the

World Health Organization, is de facto responsible fororganisation and coordination of mental health activitiesat the central level. The position of a national coordina-tor is not a professional position in the Ministry.


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Vizija, vrijednosti, principi i ciljevipolitike

Vizija

Ustav Republike Srpske priznaje zdravlje kao os-novno pravo graana. Mentalno zdravlje je integralni dioukupnog blagostanja pojedinca i drutva i mora se uni-

verzalno posmatrati kao takvo.Ministarstvo zdravlja i socijalne zatite vidi Re-

publiku Srpsku kao drutvo osloboeno stigme i dis-kriminacije, gdje se ljudi sa problemima mentalnogzdravlja lijee u zajednici i potpuno su integrisani udrutvo.

Vrijednosti i principi

Mentalno zdravlje je osnov za razvoj i ispunjenjepunog potencijala svake osobe.

Promocija vanosti mentalnog zdravlja kao iprevencija mentalnih, emocionalnih i socijalnihproblema je odgovornost svake osobe i ustanoveu zajednici.

Potrebno je obezbjediti dovoljna sredstva zapreventivne intervencije, obrazovanje, lijeenje i

pruanje usluga iz oblasti mentalnog zdravlja uzajednici.

Osobe sa mentalnim oboljenjima se mogu opor-aviti i ivjeti zdrav i produktivan ivot.

Lijeenje iz oblasti mentalnog zdravlja treba bitiuniverzalno dostupno.

Usluge iz oblasti mentalnog zdravlja moraju seuskladiti sa potrebama korisnika

Vision, values, principles and goals ofthe policy

Vision

The RS Constitution recognised health as the fun-damental right of citizens. Mental health is integral partof the overall welfare of an individual and the society

and universally must be observed as such.The Ministry of Health and Social Welfare observes

the Republic of Srpska as a society free from stigma anddiscrimination, where people affected by mental healthproblems are treated in the community and are fully in-tegrated into the society.

Values and principles

Mental health is the base for development andachievement of each persons potential.

Promotion of signicance of mental health aswell as prevention of mental, emotional and socialproblems is the responsibility of each person andinstitution in the community.

It is necessary to provide sufcient funds forpreventive interventions, education, treatment and

provision or services in the community in the eldof mental health.

Persons suffering from mental illnesses can becured to live a healthy and productive life.

Treatment in the eld of mental health should begenerally accessible.

Services in the eld of mental health must beharmonised with the needs of users.


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Stanovnitvo treba da ima pristup kvalitetetnomuslugama iz oblasti mentalnog zdravlja, koje sepruaju u zajednici i dio su jedinstvenog zdravst-

venog sistema.

Ciljevi

Opti ciljevi:

Poboljanje psiho-socijalnog statusa stanovnitva i

uspostavljanje zdravstvenog sistema koji e obez-bjediti potpune i ekasne usluge u mentalnomzdravlju svim osobama koje pate od poremeajamentalnog zdravlja.

Smanjenje svih faktora koji doprinose razvojuporemeaja mentalnog zdravlja kao to su: ne-zaposlenost, migracije, socijalne tenzije, alkohol,droga i drugi faktori rizika.

Denisanje programa za unaprijeenje izatitu mentalnog zdravlja za ugroene grupestanovnitva (djeca, adolescenti, stara lica, vulnera-bilne grupe).

Dalji razvoj mree centara za mentalno zdravlje uzajednici

Dalji razvoj ljudskih resursa u oblasti mentalnogzdravlja

Jaanje promotivnih aktivnosti na edukaciji ja-vnosti

Specini ciljevi

Revizija planova i programa edukacije zdravst-venih radnika i implementacija dodatne obuke izoblasti mentalnog zdravlja za zdravstvene radnikekoji rade u primarnoj zdravstvenoj zatiti

The population should have access to qualityservices in the eld of mental health, provided

within the community and are part of the uniquehealth system.

Goals

General goals:

Improve psycho-social status of the population

and establish health system that will enablecomplete and efcient mental health servicesto all persons suffering from mental healthdisorders.

Alleviate all factors that contribute to the increaseof mental health disorders such as: unemploy-ment, migration, social tensions, substance abuseand other risk factors.

Dene the program for mental health improve-ment and care for vulnerable groups of thesociety (children, adolescents, elderly, vulnerablegroups).

Further development of the network of mentalhealth centres in the community.

Further development of human resources in theeld of mental health.

Increase promotional activities in raising publicawareness.

Specic goals:

Review health professions education syllabi andcurricula and implementation of additional mentalhealth training for health professional working inthe primary health care


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Razvoj klinikih vodia iz oblasti mentalnogzdravlja

Kontinuirana edukacije zdravstvenih radnika uoblasti mentalnog zdravlja

Osnivanje dodatnih 10 centara za mentalno zdrav-lje u zajednici, (planiranih mreom zdravstvenihustanova u Republici Srpskoj)

Usvajanje Politike/ Strategije razvoja mentalnogzdravlja

Revizija i auriranje liste esencijalnih lijekovaza Republiku Srpsku i pozitivne liste lijekovaFonda zdravstvenog osiguranja Republike Srpske.

Razvoj i implementacija kampanja za educiranje isenzibiliziranje javnosti prema mentalno oboljelim

Strateki izazovi i prioriteti (prioritetnapolja aktivnosti)

Identikacija problema

Na osnovu strunog miljenja i pregleda situacijena terenu, napravljena je analiza sistema pruanja usluga

iz oblasti mentalnog zdravlja. Analiza je obezbjedila os-

nove za identikaciju prioritetnih polja aktivnosti:1. Lijeenje na primarnom nivou2. Dostupnost lijekova3. Obezbjeenje usluga iz oblasti mentalnog zdravlja

u zajednici4. Edukacija javnosti5. Angaovanje zajednice, porodica i korisnika6. Razvoj politika i donoenje zakona

Create clinical guidelines in the eld of mentalhealth

Permanent education of health professionals inthe eld of mental health

Establish additional 10 mental health centres inthe community (foreseen by the network of healthinstitutions in the Republic of Srpska)

Adopt the Mental Health Policy/StrategyReview and update the list of essential medicationsfor the Republic of Srpska and the lists of posi-tive medications of the RS Health Insurance Fund

Develop and implement the campaign for educa-tion and public awareness about the people withmental health problems.

Strategic Challenges and Priorities(priority areas of action)

Problem Identication

On the basis of expert opinion and screening thesituation in the eld, a system analysis was made of

provision of services in the eld of mental health. Theanalysis has provided the ground for identication ofpriority areas of action:1. Treatment on the primary level2. Availability of medications3. Provision of services in the eld of mental health

in the community4. Education of the public5. Engagement of the community, families and users


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7. Razvoj ljudskih resursa8. Uspostavljanje veza sa drugim sektorima9. Praenje statusa mentalnog zdravlja u zajednici10. Razvoj informacionog sistema11. Unaprijeenje istraivakih kapaciteta meu

zdravstvenim radnicima

Prioritetne intervencije

Pruanje usluga

1. Obezbjediti lijeenje u primarnoj zdravstvenojzatitiLijeenje mentalnih poremeaja u primarnoj zdrav-

stvenoj zatiti omoguava veini ljudi da bre i jednos-tavnije doe do zdravstvenih usluga. Kako bi obezbjediliodgovarajue lijeenje na nivou primarne zdravstvene

zatite, neophodno je da zdravstveni radnici koji rade uprimarnom nivou imaju osnovna znanja iz oblasti men-talnog zdravlja. Mentalnom zdravlju e biti dato poseb-no mjesto u programu obuke za porodinu medicinu, saciljem poboljanja ekasnosti upravljanja i ljeenja men-talnih poremeaja u primarnoj zdravstvenoj zatiti.

2. Omoguiti dostupnost psihotropnih lijekova

Nove generacije psihotropnih lijekova treba da seobezbjede i da budu konstantno dostupni na svim nivo-ima zdravstvene zatite. Preko njih se obezbjeuje prvapomo, naroito u situacijama kada psihosocijalne inter-

vencije nisu dostupne, kao i pomo visoko kvalikova-nog osoblja.

Osnovni psihotropni lijekovi su dostupni i nalazese na esencijalnoj listi lijekova koje odreuje Vlada Re-

publike Srpske i na tzv. pozitivnoj listi Fonda zdravst-

6. Development of policies and adoption of laws7. Development of human resources8. Establishment of linkages with other sectors9. Monitoring the status of mental health in the

community10. Development of information system11. Improvement of research capacities among men-

tal health professional

Priority interventions

Provision of Services

1. To provide treatment in primary health careTreatment of mental disorders in primary health

care enables most of the people to faster and easierreach medical services. In order to provide appropriate

treatment on the level of primary health care, it is nec-essary that medical workers who work on the primarylevel have basic knowledge in the eld of mental health.Mental health will be given a special place in the programof training in family medicine, with an aim to improveefciency of management and treatment of mental dis-orders in primary health care.

2. To provide availability of psychotropic medicationsNew generations of psychotropic medicationsshould be provided and be constantly available on alllevels of health care. First aid is provided through them,particularly in the situations when psychosocial interven-tions are not available, as well as the assistance of highlyqualied staff.

The basic psychotropic medications are available

and are listed in the essential drug list determined by


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venog osiguranja Republike Srpske. Ove liste treba da seauriraju i da im se dodaju lijekovi nove generacije kaoto su: atipini antipsihotici i nove generacije antidepre-siva. Lijekovi za lijeenje depresije, psihoza i epilepsije dabudu dostupni na nivou primarne zdravstvene zatite.

3. Pruanje usluga u zajedniciLijeenje na nivou zajednice ima bolje efekte nego

institucionalno lijeenje u smislu rezultata i kvaliteta i-vota pojedinaca koji pate od hroninih i drugih oblikamentalnih bolesti. Prebacivanje oboljelih iz bolnica ilispecijalizovanih ustanova za mentalno oboljele u zajed-nicu je ekonomski isplativo i u skladu sa potovanjem ljud-skih prava i postizanja viih standarda ivota. Usluge izoblasti mentalnog zdravlja trebaju se prema tome pruatiu zajednici, uz koritenje svih raspoloivih sredstava.

Dalje uspostavljanje centara za zatitu mentalnogzdravlja u zajednici je prioritetna aktivnost RepublikeSrpske.

Dobro planirana senzibilizacija i obrazovne kam-panje mogu smanjiti stigmu i diskriminaciju, poveatikoritenje usluga iz oblasti mentalnog zdravlja i pribliitizdravstvenu zatitu zikog i mentalnog zdravlja.

Finansiranje sistema pruanja usluga iz oblasti

mentalnog zdravljaFinansiranje je klju za uspjenu implement-

aciju reforme u oblasti mentalnog zdravlja. Cilj je raz-viti sistem nansiranja tako da se obezbjedi odrivostpruanja usluga iz oblasti mentalnog zdravlja. Svakakou doglednoj budunosti treba razdvojiti budet za pro-grame mentalnog zdravlja od opteg budeta iji je da-nas sastavni dio. U svakom sluaju, nansiranje usluga

the Government of the Republic of Srpska and also inthe so-called positive list of the RS Health InsuranceFund. Both lists should be updated with medicationsof the new generation such as: atypical antipsychoticsand new generation of antidepressants. Medications fortreating depression, psychosis and epilepsy should beavailable on the level of primary health care.

3. Provision of services in the communityTreatment in the community has better effects thaninstitutionalised treatment in terms of results and qualityof living of individuals suffering form chronic or otherforms of mental diseases. Transferring of the patientsfrom hospitals or specialised institutions for mental pa-tients to the community is economically cost-effectiveand in accordance with the respect of human rights and

reaching higher standards of living. Services in the eldof mental health should accordingly be provided in thecommunity, using all available sources.

Further establishment of mental health centres inthe community is priority activity of the Republic ofSrpska.

Well planned awareness and educational campaignsmay reduce the stigma and discrimination, increase theusage of services in the eld of mental health and make

the physical and mental health care available.

Financing of the mental health service system

Financing is essential for the successful implemen-tation of the reform in the eld of mental health. Thegoal is to develop a system of nancing in order to en-able sustainability of the provision of services in the eldof mental health. In the foreseeable future, the budget


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mentalnog zdravlja treba da bude poseban dio od uku-pnog sistema nansiranja zdravstvenog sistema. Imajuina umu optereenje koje poremeaji mentalnog zdravljanameu drutvu, neophodno je dati prioritet mentalnomzdravlju i stvaranju uslova koje bi smanjili rizike za raz-

voj poremeaja mentalnog zdravlja. Prema tome, neo-phodno je razviti mehanizam za dugorono rijeavanjenansiranja obezbjeenje usluga iz oblasti mentalnog

zdravlja. U procesu pronalaenja odgovarajueg me-hanizma nansiranja, neophodno je denisati odgovor-nosti lokalne zajednice i centralnih institucija. Takoe jeneophodno denisati sredstva koja su trenutno dostup-na i potrebna za nansiranje drugaijeg sistema pruanjausluga iz oblasti mentalnog zdravlja. Jasna razlika se trebanapraviti izmeu nansiranja usluga iz oblasti mentalnogzdravlja koje se pruaju u primarnoj zdravstvenoj zatiti

i u centrima za mentalno zdravlje u zajednici. Timoviporodine medicine su odgovorni za pruanje zdravst-vene zatite za denisanu (registrovanu) populaciju iplaeni su per kapita iz dijela budeta namjenjenom zanasiranje primarne zdravstvene zatite. Usluge koje sepruaju u centrima za mentalno zdravlje bi trebalo dabudu plaane dijelom iz dijela budeta namijenjenog zanansiranje primarne zdravstvene zatite a dijelom izbudeta porodinog ljekara.

Obuka kadrova

Investiranje u ljudske resurse je jedan od pre-duslova za obezbjeivanje usluga iz oblasti mentalnogzdravlja koje su prije svega bezbjedne po pacijente a izbog obezbjeenja adekvatnog kvaliteta usluga u oblastimentalnog zdravlja. Na primarnom nivou obuka moebiti organizovana kroz denisanje programa dodatne

for programs of mental health should be separate fromthe budget it is incorporated in at present. In any case,nancing of the mental health services should be a sepa-rate part of the overall system of the health care systemnancing. Having in mind the burden that mental disor-ders have on the society, it is necessary to give priority tomental health and creation of conditions for decreasingthe risks for mental disorders. Accordingly, it is neces-

sary to develop a mechanism for long-term solution ofnancing the provision of services in the eld of mentalhealth. In the process of nding the best nancing mech-anism, it is necessary to dene the responsibility of thelocal community and central institutions. It is also neces-sary to dene the funds currently available and neededfor nancing of a different system of the provision ofservices in the eld of mental health. A clear distinction

must be made between the nancing of the services inthe eld of mental health provided in primary health careand in mental health centres in the community. Familymedicine teams are in charge of the provision of healthcare for the dened (registered) population and are paidper capita from the part of the budget planned for -nancing of the primary health care. Services provided inthe mental health centres should be paid partially fromthe part of the budget planned for nancing the primary

health care and partially from the family doctor budget.

Personnel Training

Investing in human resources is one of the prereq-uisites for provision of services in the eld of mentalhealth that are, above all, safe for patients. It is also impor-tant for the provision of adequate quality of services inthe eld of mental health. On the primary level, training


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obuke za profesionalce iz podruja mentalnog zdravljai sa ukljuenjem tema mentalnog zdravlja u programza specijalizaciju porodine medicine. Od vitalnog jeznaaja razvoj klinikih vodia za lijeenje poremeajamentalnog zdravlja.

Posebnu panju treba obratiti na obrazovanjemedicinskih sestara za rad u oblasti mentalnog zdrav-lja sa fokusom na rad u zajednici. Uloga psihijatrijskih

sestara treba da bude od posebne vanosti u multidis-ciplinarnom pristupu lijeenju pacijenta. Psihijatrijskesestre predstavljaju osnovni profesionalni prol u ovompolju i odrivost, kao i kvalitet zatite mentalnog zdravljau zajednici zavisi i od nivoa kvaliteta njihovog rada.

Republika Srpska treba unaprijediti i poboljatiobuku profesionalaca koji rade u oblasti mentalnogzdravlja sa ciljem da stvori strunjake koji e obezbjeditispecijalizovanu zatitu kao i pruiti podrku u aktivnos-tima primarne zdravstvene zatite. Primarna zdravstvenazatita je najekasniji okvir za pruanje osnovnog nivoazdravstvene zatite. Specijalisti su neophodni za pruanjeireg opsega usluga iz oblasti mentalnog zdravlja. Speci-jalizovani timovi za pruanje usluga iz oblasti mentalnogzdravlja trebalo bi da ukljue i medicinsko i ne-medicin-sko osoblje. Specijalizovane timove ine: neuropsihijatri,psihijatri, kliniki psiholozi, psihijatrijske sestre, socijalni

radnici, radnookupacioni terapeuti koji mogu raditi za-jedno u cilju obezbjeenja ukupne zatite i integracijepacijenta u zajednicu. Jedan od prioriteta je denisanjeplana za dalji razvoj ljudskih resursa koji rade u oblastimentalnog zdravlja. Plan bi trebalo da bude osnova zaorganizovano i sistematsko obrazovanje profesionalacakoji rade i koji e raditi u oblasti mentalnog zdravlja.

may be organised by dening the programs of additionaltraining for professionals in the eld of mental healthand inclusion of topics of mental health in the familymedicine specialist program. Creation of clinical guidesfor treatment of mental disorders is of vital importance.

Special attention should be paid to the educationof nurses to work in the eld of mental health with thefocus on work in the community. The role of psychiat-

ric nurses should be of special importance in multidis-ciplinary approach to the treatment of patients. Psychi-atric nurse is the basic professional prole in this eld.Sustainability and quality of mental health care in thecommunity depend on the quality of their work.

The Republic of Srpska should advance and im-prove the training of professionals who work in the eldof mental health with the aim to create experts who

will provide specialised care and support to the activi-ties of primary health care. Primary health care is themost efcient framework for provision of the basiclevel of health care. Specialists are needed for the provi-sion of a wide spectre of services in the eld of mentalhealth. Specialised teams for provision of services in theeld of mental health should include both medical andnon-medical staff. Specialised teams include neuropsy-chiatrists, psychiatrists, clinical psychologists, psychiat-

ric nurses, social workers, occupational therapists thatmay work together for the purpose of providing totalcare and integration of patients in the community. Oneof the priorities is to dene a plan for further develop -ment of human resources working in the eld of mentalhealth. The plan should be the basis for organised andsystematic education of professionals who work or willbe working in the eld of mental health.


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UpravljanjeDa bi uspostavili i odrali ekasnu koordinaciju re-

forme i procesa upravljanja aktivnostima u oblasti men-talnog zdravlja u Republici Srpskoj, neophodno je daljejaanje postojeih kapaciteta u Ministarstvu. Nekolikoopcija je mogue, kao uspostavljanje Komiteta za men-talno zdravlje pri Ministarstvu ili osnivanje specijalnihodjeljenja za mentalno zdravlje unutar Ministarstva.

Ministarstvo, izmeu ostalog, treba da:

obezbjeuju uputstva za dalji razvoj sektora men-talnog zdravlja

prate i evaluiraju mentalno zdravlje stanovnitva

planiraju lokacije izgradnje i kapaciteta objekatamentalnog zdravlja

razvijaju politike i zakonsku regulativunadgledaju kvalitet pruenih usluga.

Treba da se naglasi da se dio odgovornosti za pru-anje usluga na nivou zajednice treba da se prenesu nalokalne zajednice i da se one ukljue to je mogue viene samo u kreiranje

usluga nego i u nansiranje istih.

Takoer, trebalo bi istraiti metode meuentitetskesaradnje kao i sredstva i naine za pruanje podrke isaradnju sa Distriktom Brko.

ManagementIn order to establish and maintain an efcient co-

ordination of reform and process of management ofactivities in the eld of mental health in the Republicof Srpska, it is necessary to further strengthen the pres-ent capacities in the Ministry. Several options are avail-able, such as the founding of the Committee for MentalHealth with the Ministry, or founding of a special de-

partment for mental health within the Ministry.

The Ministry should, among other things:

Provide instructions for further development ofthe mental health sector

Monitor and evaluate the mental health of thepopulation

Plan the locations of construction and capacitiesof mental health facilities

Develop policies and legal provisions

Monitor the quality of services provided.

It has to be emphasised that one part of responsi -bilities for provision of services on the community levelshould be transferred to the local communities, which

should then get involved as much as possible not onlyinto the process of creation of services but also of theirnancing.

Methods of inter-entity cooperation should be ex-amined, as well as of the sources and manners of pro-

viding support and cooperation with the Brcko District.


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Plan aktivnosti

Polja aktivnosti

Lijeenje u primarnoj zdravstvenoj zatiti

Dostupnost lijekova

Obezbjeenje usluga iz oblasti mentalnog zdravlja

u zajedniciEdukacija javnosti

Razvoj politika i donoenje zakona

Razvoj ljudskih resursa

Uspostavljanje veza sa drugim sektorima

Razvoj informacionog sistema

Unaprijeenje istraivakih kapaciteta meu

zdravstvenim radnicima

Strategije za implementaciju

Ukazana situacija u polju mentalnog zdravlja zahtje-va ponovno denisanje uloge psihijatrije i psihijatrijskihustanova imajui u vidu njihove terapeutske i rehabili-tacione funkcije, drutvenu ulogu, organizaciju, nain

nansiranja i saradnju sa drugim sektorima. Strategijaza implementaciju politike u oblasti mentalnog zdravljaima za osnov naputanje osnivanja velikih psihijatrijskihbolnica i razvoj koncepta obezbjeenja usluga iz oblastimentalnog zdravlja u zajednici. Druga strategija je daljaedukacija zdravstvenih radnika koji rade u primarnojzdravstvenoj zatiti. Ovo e se postii unaprijeenjemplanova i programa dodiplomske i postdiplomske nas-tave kao i organizacijom i provoenjem programa do-

Action plan

Fields of activities

Treatment in primary health care

Availability of medications

Provision of services in the eld of mental health

in the communityEducation of the public

Development of policies and adoption of laws

Development of human resources

Establishment of linkages with other sectors

Development of information system

Improvement of research capacities among medi-

cal workers

Implementation Strategies

The explained situation in the eld of mental healthrequires redenition of the role of psychiatry and psy-chiatric institutions bearing in mind their therapeutic andrehabilitation functions, social role, organisation, manner

of funding and cooperation with other sectors. Strategyfor implementation of policies in the eld of mentalhealth is based on abandoning the establishment of bigpsychiatric hospitals and development of the concept ofproviding mental health services in the community. An-other strategy is further education of medical workers

who work in primary health care. This can be achievedby improvement of curricula of undergraduate and post-graduate studies as well as organisation and implementa-


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datne obuke za zdravstvene radnike koji ve rade u pri-marnoj zdravstvenoj zatiti.

to se tie bolnikog lijeenja na sekundarnomi tercijarnom nivou, tu e se obezbjeivati lijeenje zaakutna stanja bolesti. Lijeenje u bolnikim odjeljenjimae biti kratko i pacijenti e nastaviti lijeenje kod ljekaraporodine medicine ili u centrim za mentalno zdravlje. Zapacijente koji se oporavljaju od akutnih psihotikih epi-

zoda koje rezultiraju psihosocijalnim slomom, lijeenjee se nastaviti u kuama na pola puta. Ove kue e bitismjetene u blizini bolnica i vodie ih i nadzirati posebnoobuene medicinske sestre.

Pacijenti oboljeli od hroninih mentalnih bolesti,kao osobe koje imaju velike poremeaje drutvenih,psiholokih ili somatskih dimenzija koji su nastali kaorezultat mentalne bolesti e po pravilu ivjeti samostalnoili sa porodicama u zajednici. Hronini mentalni bole-snici koji nemaju porodicu ili ekonomske ili druge usloveza samostalan ivot biti e smjeteni u posebne kue sanadzorom u gradu u kome ive tj. u zajednici iz kojedolaze. Ovi programi podrke e biti organizovani kaoljeilita namjenjena hroninim bolesnicima sa ozbiljnimi trajnim disfunkcijama.

Uspostavljanje grupnih domova za trajni smjetajlica koja pate od hroninih psihijatrijskih oboljenja je jo

jedan vid strategije za obezbjeenje dugotrajnog lijeenja.Pacijenti e ivjeti u ovim domovima nezavisno, iako enjihova autonomija biti ograniena.

Tretman u zajednici prema svim pokazateljimaima bolji efekat na ishod oboljenja i kvalitet ivota ljudisa hroninim mentalnim poremeajima u poreenju sanajboljim institucionalnim tretmanom. Lijeenje duev-nih bolesnika sa hroninim defektima i hendikepima u

tion of further training programs for medical workersalready working in primary health care.

With regard to hospital treatment on the secondaryand tertiary levels, treatment will be provided for acutediseases. Treatment in hospital facilities will be short andpatients will continue their treatment with family medi-cine physicians or in mental health centres. For patients

who recover from acute psychotic episodes resulting

in psychosocial breakdown, treatment will continue inhalf-way homes. These homes will be located in thevicinity of hospitals and will be led or monitored by spe-cially trained nurses.

Patients suffering from chronic mental illnes, suchas the persons who have disorders of social, psychologi-cal or somatic nature, generated by a mental disease will,as a rule, live independently or with families in commu-nity. Chronic mental patients who do not have a familyor economic or other conditions for living independent-ly will be accommodated in special homes with surveil-lance in towns where they live, i.e. in the communitiesthey come from. These support programs will be organ-ised as treatment centres intended for chronic patients

with serious or permanent disorders.Establishment of group homes for permanent ac-

commodation of continued care clients is another form

of strategy for provision of long-term treatment.Treatment in the community, according to all in-

dicators, has a better impact on the psychosocial out-come and quality of living of the people with chronicmental illnes in comparison with the best institutionaltreatment. Treatment of mental patients with chronicdisorders and handicaps in the community is cheaperand signicantly enables the respect of human rights of


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zajednici je jeftinije i u znatnoj mjeri omoguava poto-vanje ljudskih prava ove grupe marginaliziranih i diskri-minisanih lanova zajednice.

Postojanje odgovarajuih slubi u zajednici omogu-ava pravovremenu strunu i odgovarajuu intervencijukoja nam pomae u prevenciji nastupanja stigme kojuduevni poremeaj imanentno posjeduje.

Dalje treba obuhvatiti otvaranje novih i unapreenje

postojeih malih bolnikih psihijatrijskih odjeljenja u ok-viru optih bolnica kao denitivnu alternativu velikimpsihijatrijskim azilarnim bolnicama.

Treba organizovati i provoditi kunu njegu ljudikoji boluju od mentalnih poremeaja ili njihovih dugo-trajnih posljedica. Posebnu brigu treba dalje posvetitipomoi u kriznim stanjima, jer u naem drutvu vladajubeznae, sa stresom povezani mentalni poremeaji,depresija, alkoholizam i zloupotreba psihoaktivnih sup-stanci, porast pokuanih i izvrenih suicida, nasilje i dru-gi raznovrsni oblici rizinog ponaanja, koji imaju velikiuticaj na oboljevanje i prerano nastupanje smrti kod ljudiu naem drutvu. Organizovanje zdravstvenih i slubi zamentalno zdravlje u zajednici omoguava da se na nivoulokalnih zajednica obezbjede zatiene i grupne kue zaljude sa mentalnim oteenjima.

Aktivnosti1. Lijeenje na primarnom nivou zdravstvene zatite

Ministarstvo zdravlja i socijalne zatite e iniciratiprocjenu postojeih planova i programa edukacije naMedicinskim fakultetima u Republici Srpskoj kao i pla-nova i programa za specijalistiki trening. Na osnovu re-zultata analize uvee se poboljanja u cilju jaanja znan-ja i vjetina ljekara iz oblasti mentalnog zdravlja. Takoe,

this group of marginalised and discriminated membersof the community.

Availability of appropriate services in the commu-nity provides timely expert and appropriate interventionthat helps us prevent the stigma that mental disordersimmanently possess.

Opening of new and improvement of the presentsmall hospital psychiatric wards within general hospitals

as a denite alternative to big psychiatric asylum hospi-tals should also be included.Home visits and health care should be organised

and conducted for the people who suffer from mentaldisorders or their long-term effects. A special role shouldbe further given to the assistance in crisis conditions, be-cause our society is ruled by despair, mental disordersconnected with stress, depression, alcoholism and abuseof psychoactive substances, increase of attempted andcommitted suicides, violence and other various forms ofrisk behaviour, which have a deep impact on develop-ment of diseases and early death of the people in oursociety. Organisation of medical and mental health ser-

vices in the community will enable the provision of pro-tected and group homes for the people suffering frommental disorders in the local communities.

Activities1. Primary Health Care Treatment

The Ministry of Health and Social Welfare will ini-tiate the assessment of the present curricula of studiesin Medical Faculties in the Republic of Srpska as well asthe curricula for specialist training. On the basis of theanalysis results, improvements will be introduced for thepurpose of improving the knowledge and skills of doc-


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organizovae se program dodatne obuke iz oblastimentalnog zdravlja sa fokusom na pruanje usluga uzajednici i mjesto i ulogu centara za mentalno zdravlje.Cilj ovih aktivnosti je izgradnja kapaciteta zdravstvenihradnika radi obezbjeenja sveobuhvatne zdravstvenezatite, naroito to se tie mentalnog zdravlja. Takoeje neophodno razviti niz klinikih vodia iz oblasti men-talnog zdravlja kao i denisati referalni sistem u oblasti

mentalnog zdravlja, indikacije za upuivanje na vii nivo,opsege i opise rada centara i timova porodine medicineu oblasti mentalnog zdravlja.

2. Dostupnost lijekovaMinistarstvo zdravlja i socijalne zatite e imeno-

vati komisije ili radne grupe koje e napraviti analizupostojeih lista esencijalnih lijekova i pozitivnih listalijekova.

Osnovni psihotropni lijekovi trebaju da buduobezbjeeni i stalno dostupni na svim nivoima zdravst-

vene zatite. Ovi lijekovi moraju da budu na tzv. pozi-tivnoj listi.

Cilj ovih analiza je dopunjavanje postojeih listesa novim generacijama psihotropnih lijekova za koje jedokazano da su i ekasniji i isplativiji u lijeenju psihi-jatrijskih oboljenja, kao to su atipini neuroleptici i anti-

depresivi nove generacije.

3. Obezbjeenje zatite u zajedniciU Republici Srpskoj je neophodno nastaviti sa

osnivanjem centara za mentalno zdravlje u zajednici.Ministarstvo zdravlja i socijalne zatite e u saradnji salokalnim zajednicama nastaviti da iznalazi naine i sred-stva za rekonstrukciju postojeih zdravstvenih ustanova

tors in the eld of mental health. Also, a program ofadditional training will be organised with the focus onprovision of services in the community as well as on theplace and role of mental health centres. The objective ofthese activities is to build capacities of health workers inorder to provide comprehensive health care, particularlyin the eld of mental health. It is also necessary to devel-op a series of clinical guides in mental health as well as

to dene a reference system in the eld of mental health,indications for directing to a higher level, scope and jobdescription of centres and teams of family medicine inmental health.

2. Availability of MedicationsThe Ministry of Health and Social Welfare will ap-

point committees or working groups that will performthe analysis of the available lists of essential medicationsand positive drug lists. Basic psychotropic medicationsshould be provided and always available on all levels ofhealth care. These medications must be included in theso-called positive list. The objective of these analyses isto update the present list with new generations of psy-chotropic medications that have proven to be more ef-cient and cost-effective in treatment of psychiatric dis-eases, such as atypical neuroleptics and antidepressants

of the new generation.

3. Provision of Health Care in the CommunityIt is necessary to continue founding mental health

centres in the communities in the Republic of Srpska.The Ministry of Health and Social Welfare will in co-operation with local communities continue to seek waysand funds for reconstruction of the present medical


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i ziku transformaciju dijela prostora u Centre za men-talno zdravlje. Neophodno je dalje razvijanje zacrtanepolitike mentalnog zdravlja, stalno inoviranje planova iprograma, i prilagoavanje i unapreivanje prema potre-bama zajednice, porodice, a naroito samih korisnika.

4. Edukacija javnostiMinistarstvo zdravlja i socijalne zatite e pokre-

nuti inicijativu kod Ministarstva civilnih poslova Odjelza zdravstvo, da predloi meunarodnim organizacijamai drugim donatorima da nansiraju razvoj i implement-aciju javnih obrazovnih kampanja iz oblasti mentalnogzdravlja. Cilj ove aktivnosti je kreiranje usluga mental-nog zdravlja i senzibiliziranje javnosti u vezi mentalnihporemeaja kao i smanjenje negativnih posljedica men-talnih poremeaja kao to su stigma i socijalna izolova-nost. Zajednica, porodice i korisnici trebaju biti ukljueniu razvoj i donoenje politika, programa i usluga. Ovotreba da vodi ka uslugama koje e biti ekasnije jer sukreirane prema potrebama korisnika.

Treba nastaviti zapoetu kampanju obrazovanja gra-ana, irenje svijesti o znaaju mentalnog zdravlja kaoneodvojivog dijela opteg zdravlja. Osnovni cilj irokihedukativnih aktivnosti je proirenje znanja zajednice oprirodi i rasprostranjenosti mentalnih poremeaja, mo-

gunostima ekasnog lijeenja, procesa oporavka i ljuds-kim pravima oboljelih lanova zajednice.Kroz elektronske, tampane medije i na druge nai-

ne treba iriti istinite informacije o istinitosti i korisnostipsihijatrijskog lijeenja koje je na dananjem stepenu raz-

voja nauke podjednako, a u nekim aspektima bolje i ko-risnije nego kod nekih somatskih bolesti.

Treba uporno nastaviti ovo obrazovanje kako bi sepostepeno promijenile reakcije opte populacije, brojnih

institutions and physical transformation of one part ofthose spaces into mental health centres. It is necessaryto further develop the charted policy of mental health,constantly update the curricula, and adjust and improveaccording to the needs of the community, families andespecially the users themselves.

4. Education of the Public

The Ministry of Health and Social Welfare willinitiate with the Ministry of Civil Affairs, Departmentof Health, a proposal to international organisations andother donors do nance the development and imple-mentation of public education campaigns in the eld ofmental health. The goal of this activity is to create men-tal health services and raise awareness of the public withregard to mental disorders and reduction of negative ef-fects of mental disorders such as stigma and social isola-tion. The users, their families ands communities shouldbe involved in development and adoption of policies,programs and services. This should lead to the servicesthat will be more efcient because they are created ac-cording to the users needs.

The initiated campaign on education of citizens,raising awareness on importance of mental health as anintegral part of the health in general should be contin -

ued. The basic goal of broad educational activities is tospread the knowledge of the community about the na-ture and extent of mental disorders, possibilities of ef-cient treatment, recovery process and human rights ofthe diseased members of the community.

True information should be disseminated throughelectronic and print media, as well as in other ways,about the validity and usefulness of psychiatric treat-ment which is in the present level of scientic develop-


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zdravstvenih strunjaka, novinara, politiara i zakono-davaca kako prema mentalnom zdravlju tako i premamentalnim poremeajima, odnosno ljudima koji bolujuod nekog psihikog oboljenja.

Dobro zamiljenje i provedene edukativne kam-panje mogu sprijeiti ili smanjiti stigmatizaciju, poboljatikoritenje slubi za mentalno zdravlje u zajednici u znat-noj mjeri, izjednaiti i unaprijediti shvatanja kako o tjele-

snom tako i mentalnom zdravlju.

5. Razvoj politika i donoenje zakonaDonoenje strategije o razvoju sektora mentalnog

zdravlja, programa i zakona su neophodni koraci za re-alizaciju predvienih aktivnosti i za njihovu odrivost.Razvoj istih treba da se zasniva na savremenim saznan-jima iz ove oblasti uzimajui u obzir ljudska prava. Re-forma sektora mentalnog zdravlja treba da bude dio re-forme cjelokupnog zdravstvenog sistema.

U Republici Srpskoj Zakon o zatiti osoba sa men-talnim oboljenjima je usvojen.

Ministarstvo zdravlja i socijalne zatite e istraiti idruge opcije u vezi razvoja i usvajanja stratekih doku-menta i zakona iz oblasti mentalnog zdravlja.

Svakako u doglednoj budunosti treba razdvojitibudet za programe mentalnog zdravlja od opeg budeta

iji je danas sastavni dio, jer se uvoenjem sistema psi -hijtrije u zajednici u znatnoj mjeri smanjuju nansijskasredstva koja e se za njegovo izdravanje koristiti.

6. Razvoj ljudskih resursaDenisanje plana za razvoj ljudskih resursa u oblasti

mentalnog zdravlja e biti prva aktivnost Ministarstvozdravlja i socijalne zatite u vezi sa ciljem sistematskog i or-

ment equal, and in some aspects better and more usefulthan to some other somatic diseases. It is necessary topersistently continue this education in order to graduallychange the reactions of the general public, numerousmedical experts, journalists, politicians and law makers,both towards mental health and mental disorders, i.e. thepeople who suffer from psychotic diseases.

Well thought out and implemented educational

campaigns may prevent or reduce stigmatisation, improvethe utilisation of mental health services in the commu-nity to a signicant extent, and equalise and improve un-derstanding of both physical and mental heath.

5. Development of Policies and Adoption of LawsAdopting a strategy on development of the mental

health sector, programs and laws are necessary steps inrealisation of foreseen activities and their sustainability.

Their development should be based on modern knowl-edge in this eld, taking into account the human rights.Reform of the mental health sector should be a partof the reform of the entire health system. The law onhealth care of persons suffering from mental diseaseshas been adopted in the Republic of Srpska. The Min-istry of Health and Social Welfare is going to examineother options with regard to development and adoption

of strategic documents and laws in the eld of mentalhealth.

In the foreseeable future, the budget for programsof mental health should be separate from the budget itis incorporated in at present, because introduction ofpsychiatric system in the community will signicantlydecrease nancial sources needed for its maintenance.


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ganizovanog obrazovanja zdravstvenih radnika koji rade ilie raditi u oblasti mentalnog zdravlja. U tom smislu traitie se tehnika pomo za razvoj ovog plana kao i donatoreza nansiranje ove aktivnosti. Jedna od strategijaza im-plementaciju plana ljudskih resursa moe biti i denisanjecentara koji mogu provoditi trening zdravstvenih profe-sionalaca i organizovanje kurseve za trening trenera, a samtrening ukljuiti profesionalce iz drugih sektora. Takoe

je neophodno unaprijediti uticaj struke profesionalaca izoblasti mentalnog zdravlja na donosioce odluka, to senajekasnije moe raditi kroz aktivnosti udruenja profe-sionalaca iz oblasti mentalnog zdravlja (Udruenje psihi-jatara i psihologa Republike Srpske).

Dalje osnaivanje i poboljanje obuke osoblja kojirade u oblasti mentalnog zdravlja je neophodno da bise pacijentima omoguilo da dobiju kvalitetniju i viso-ko specijalizovanu zatitu i lijeenje. Ti isti profesionacitreba da pruaju podrku zdravstvenim radnicima kojirade u primarnoj zdravstvenoj zatiti. Timovi specijalistaza mentalno zdravlje bi idealno trebali da ukljue medi-cinsko i ne-medicinsko osoblje, kao psihijatre, klinikepsihologe, psihijatrijske sestre, socijalne radnike i radneterapeute koji zajedno rade u cilju obezbjeivanja ukup-nog lijeenja i integracije pacijenata u zajednici.

7. Uspostavljanje veza sa drugim sektorimaOstali sektori pored zdravstva, kao: obrazovan-

je, rad, socijalna zatita, zakonodavni i pravni sektor inevladine organizacije treba da budu ukljueni u procespoboljanja mentalnog zdravlja u zajednicama. Nevladineorganizacije treba da budu aktivnije sa bolje denisanimulogama, a kroz njih se treba dati vea podrka lokalniminicijativama.

6. Development of Human ResourcesDenition of a plan for development of human

resources in the eld of mental health will be the rst ac-tivity of the Ministry of Health and Social Welfare withregard to the goal of systematic and organised educationof workers who work or who will be working in the eldof mental health. In these terms, technical assistance fordevelopment of this plan will be sought, as well as the

donors to nance these activities. One of the strategiesfor implementation of the plan of human resources mayalso be the establishment of centres that can providetraining for health professionals and organise coursesfor training of trainers. The training itself should includeprofessionals from other sectors. It is also necessary toimprove the impact of the branch of professionals inthe eld of mental health on decision-makers, which canmost efciently be done through the activities of profes-sional associations in the eld of mental health (Associa-tion of Psychiatrists and Psychologist of the Republicof Srpska).

Further empowerment and improvement of train-ing for the personnel working in the eld of mentalhealth is necessary to provide patients with more qual-ity and highly specialised health care and treatment. Thesame professionals should provide support to medical

workers working in primary health care. Specialist teamsfor mental health should ideally include medical andnon-medial personnel, as well as psychiatrists, clinicalpsychologists, psychiatric nurses, social workers and vo-cational therapists who work together for the purposeof providing overall treatment and integration of pa-tients in the community.


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Prvi korak ka formalnom uspostavljanju veza sadrugim sektorima e biti osnivanje KoordinacionogKomiteta za mentalno zdravlje i bolesti zavisnosti nanivou Vlade Republike Srpske. Ovaj Komitet bie sas-tavljen od predstavnika Ministarstava zdravlja i socijalnezatite, Ministarstava obrazovanja, Ministarstava za loka-lu samoupravu, Ministarstava unutranjih poslova i Mini-starstava rada. Koordinacioni komiteti e biti zadueni za

implementaciju politike mentalnog zdravlja i implemen-

taciju aktivnosti iz akcionog plana. Slijedea odgovor-nost ovih komiteta je razvoj i implementacija programaza unaprijeenje mentalnog zdravlja ugroenih grupastanovnitva. Posebnu panju treba posvetiti ukljuenjui uvezivanju nevladinog sektora, davanje uloge tim orga-nizacijama u smislu lobiranja, volonterskog rada i formi-ranja fondova pomoi i slinim aktivnostima iz oblastimentalnog zdravlja.

8. Razvoj informacionog sistemaKada je u pitanju razvoj informacionog sistema iz

oblasti mentalnog zdravlja neophodno je doi do spora-zuma o vrsti podataka koji bi se prikupljali i analiziraliu cilju dobijanja pouzdanih informacije za donosioceodluka za daljnji razvoj strategija u oblasti mentalnogzdravlja. Neophodan je razvoj i deniranje osnovnog

seta indikatora koje je lako prikupiti, lako analizirati iu vremenskom okviru pratiti trendove na osnovu ko-jih e se postavljati prioriteti svake godine, procjenjivatipotrebe i efektivnosti tretmana mentalnog zdravlja i raz-

vijati strategije u oblasti zatite mentalnog zdravlja. Setindikatora je dogovoran i treba biti dostupan redovitoza ocjene zdravstvenog stanja. Razvijanje indikatora jeujedno i snana podrka buduim istraivanjima razliitih

7. Establishment of Linkages with Other SectorsOther sectors besides health care, such as educa-

tion, labour, social welfare, legislative and legal sectorand nongovernmental organisations should be involvedin the process of improving mental health in commu-nities. Nongovernmental organisations should be moreactive and have better dened roles, and greater supportshould be given to local initiatives through them.

The rst step towards formal establishment of link-

ages with other sectors will be the founding of the Co-ordination Committee for mental health and addictiondiseases on the level of the Government of the Republicof Srpska. This Committee will be composed of the rep-resentatives of the Ministry of Health and Social Welfare,Ministry of Education, Ministry of Local Self-Gover-nance, Ministry of Interior and Ministry of Labour. Thecoordination committees will be in charge of the imple-mentation of the mental health policy and implementa-tion of the action plan activities. The next duty of thesecommittees will be to develop and implement the pro-grams for improvement of mental health of the vulner-able population groups. Special attention should be de-

voted to inclusion and linking with the nongovernmentalsector, giving the role to those organisations in terms oflobbying, volunteer work and forming assistance funds

and similar activities in the eld of mental health.

8. Development of Information SystemWith regard to the development of an information

system in the eld of mental health, it is necessary toreach an agreement on the type of data that will be col-lected and analysed for the purpose of obtaining con-dent information for decision makers who will further


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aspekata mentalnog zdravlja u cilju razumjevanja uzroka,toka i ishoda mentalnih poremeaja.Aktuelno u Republici Srpskoj registriruje se niz zna-

ajnih riziko faktora koji izazivaju poremeaje mentalnogzdravlja stanovnitva. Stoga je potrebno razviti redovanmonitoring mentalnog zdravlja stanovnitva putem pop-ulacionih anketa, u periodu od svake dvije godine. Kaoinstrumenti se koriste internacionalno preporueni up-

itnici.Nephodno je jaanje postojeeg sistema izvjetava-nja prema Institutu za zatitu zdravlja, a u tom smislutrebalo bi razmotriti je razvoj i instalaciju odgovarajuegsoftvera koji bi omoguio lake uvezivanje sa Institutom.Kapaciteti unutar Instituta bi trebali biti analizirani iunaprijeeni da bi se obezbjedili uslovi za razvoj regista-ra koji e omoguiti monitoring i evaluaciju ekasnosti iprogresa implementacije programa iz oblasti mentalnogzdravlja. Potrebno je denisati indikatore za praenje ievaluaciju stanja mentalnog zdravlja u zajednici.

Mentalno zdravlje u lokalnim zajednicama treba dase nadgleda kroz razvoj i koritenje indikatora mental-nog zdravlja kroz sisteme zdravstvenog informisanja iizvjetavanja. Ovakav monitoring pomae odreivanjutrendova i detekciji promjena u oblasti mentalnog zdrav-lja koji mogu biti uslovljeni vanjskim dogaajima npr.

katastrofama.Razvoj informacionog sistema u oblasti mentalnog

zdravlja bi trebalo biti kordinisano sa razvojem integral-nog informacionog sistema u zdravstvu. Takvi sistembi trebao da prikuplja i analizira podatke o broju i vrstiusluga koje se pruaju u oblasti mentalnog zdravlja i daproizvodi pouzdane informacije za donosioce odlukaza daljnji razvoj strategija u oblasti mentalnog zdravlja.

develop the strategies in the eld of mental health. Itis necessary to develop and dene a basic set of indica-tors that are easily gathered, easily analysed, and moni-tor trends in a time period, based on which priorities

will be set each year, needs and effects of mental healthtreatment estimated, and strategies developed in theeld of mental health care. The set of indicators will bemade upon agreement and should be available regularly

through estimations of health condition. Developmentof indicators is at the same time a strong support to thefuture research of various aspects of mental health forthe purpose of understanding the cause, course and out-come of mental disorders. At the moment, a series ofimportant risk factors are being registered in the Republicof Srpska that cause disorders of the populations men-tal health. This is why it is necessary to develop regularmonitoring of the populations mental health throughpolls every second year. Internationally recommendedquestionnaires are used as instruments.

It is necessary to strengthen the present system ofreporting towards the Institute of Health Care, and inthat sense the development and installation of the soft-

ware that will enable easier linking with the Instituteshould be considered. Capacities of the Institute shouldbe analysed and improved in order to ensure conditions

for establishment of registries that will provide monitor-ing and evaluation of efciency and progress of imple-mentation of programs in the eld of mental health.It is necessary to dene indicators for monitoring andevaluation of the mental health condition in the com-munity.

Mental health in local communities should be mon-itored through the development and usage of mental


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Registar sa brojem i tipom poremeaja mentalnog zdrav-lja bi trebali biti uspostavljeni unutar Instituta za zatituzdravlja. Razvoj registara e omoguiti monitoring i eval-uaciju ekasnosti i progresa implementacije programa izoblasti mentalnog zdravlja.

9. Unaprijeenje istraivakih kapaciteta meu zd-ravstvenim radnicima

Vie prouavanja bilokih i psihosocijalnih aspe-

kata u oblasti mentalnog zdravlja jeneophodno ukoliko elimo da bolje razumijemo uz-

roke poremeaja mentalnog zdravlja. Istraivanja se tre-baju vriti na irokoj osnovi, to e nam pomoi u razvi-janju ekasnijih intervencija. Unaprijeenje istraivakihkapaciteta meu zdravstvenim

radnicima koji rade u oblasti mentalnog zdravlja jeneophodno izvoditi na sistematski i organizovan nainkroz akademske ustanove i profesionalna udruenja.

Istraivake kapacitete meu zdravstvenim radnici-ma koji rade u oblasti mentalnog zdravlja je neophodnounaprijeivati kroz razvoj postdiplomskih programa namedicinskim fakultetima i kroz motivaciju zadravste-

vnih radnika da rade istraivanja iz oblasti mentalnogzdravlja. U tom smislu je neophodno obezbjediti usloveza za predstavljanje rezultata istraivanja na domaim i

meunarodnim kongresima i konferencijama.

Odgovorne vlasti

U Republici Srpskoj za implementaciju aktivnostibie odgovorno Ministarstvo zdravlja i socijalne zatiteRepublike Srpske.

health indicators through the systems of medical infor-mation and reporting. Such monitoring helps determinetrends and detect changes in the eld of mental healththat may be caused by external events, e.g. catastrophes.

Development of the information system in theeld of mental health should be coordinated with thedevelopment of integral information system in healthcare. Such a system should collect and analyse data about

the number and type of services provided in the eldof mental health and produce condent information fordecision makers in further development of strategiesin the eld of mental health. A registry containing thenumber and type of mental disorders should be estab-lished within the Institute of Health Care. Developmentof the registry will enable monitoring and evaluation ofefciency and progress of the implementation of pro-grams in the eld of mental health.

9. Improvement of Research Capacities amongHealth WorkersMore research of biological and psychosocial as-

pects of mental health is necessary if we want to bet-ter understand the causes of mental disorders. Researchshould be conducted widely, which will enable us todevelop more efcient interventions. It is necessary to

improve the research capacities among medical workersworking in the eld of mental health in a systematic andorganised manner through academic institutions andprofessional associations.

It is necessary to improve the research capacitiesamong medical workers working in the eld of mentalhealth through the advancement of postgraduate stud-ies in medical faculties and by motivation of medical


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Partneri

Da bi implementirali politiku iz oblasti mentalnogzdravlja, Ministarstvo zdravlja i socijalne zatite treba dauspostavi vrsto partnerstvo sa svim javnim i privatnimorganizacijama koje mogu pomoi u razvoju ovog sek-tora zdravstva. Takodje je neophodno je jasno denisatilinije odgovornosti pri implementaciji akcionih planova

na osnovu politike. Fokus ovih aktivnosti e biti na mo-

bilizaciji lokalnih zdravstvenih odjeljenja, nevladinihorganizacija i meunarodnih organizacija. Od najvee

vanosti je jaanje saradnje sa vodeim meunarodnimorganizacijama koje djeluju u oblasti zdravstva kao i sa

vladama zemalja, koje su ve ukljuene u nansiranjeprojekata u zdravstvu.

Vremenski okvir

Na osnovu denisanih prioriteta aktivnosti iz ovepolitike e biti implementirane u periodu od 12 do 36mjeseci.

Trokovi

Da bi se dobio detaljan budet za implementacijupredvinih aktivnosti neophodno je napraviti procjenupotreba za graevinskim radovima u cilju ureenja pro-storija gdje se trenutno i gdje e se ubudue pruatiusluge iz oblasti mentalnog zdravlja. Potrebno je izvritirestrukturiranje postojeih ili izgradnju novih prostora uRepublici Srpskoj. Za Republiku Srpsku e biti potrebna

vea sredstva za navedeni proces jer je potrebna izgrad-nja deset novih centara. Za sve ovo je potrebna detaljna

workers to do research in mental health. This is why itis necessary to ensure conditions for presentation of re-search results in domestic and international congressesand conferences.

Competent Authorities

The Ministry of Health and Social Welfare will be

in charge of the implementation of activities in the Re-

public of Srpska.

Partners

In order to implement the policy of mental health,the Ministry of Health and Social Welfare should estab-lish strong partnership with all public and private organi-

sations that may help in development of the health caresector. It is also necessary to clearly dene the lines ofresponsibility in implementation of action plans basedon the policy. The focus of these activities will be onthe mobilisation of local medical departments, nongov-ernmental organisations and international organisations.It is of highest importance to strengthen the coopera-tion with leading international organisations engaged inthe eld of health care as well as with governments of

the countries already involved in funding the projects inhealth care.

Timeframe

Activities of this policy will be implemented in theperiod form 12 to 36 months, based on the dened pri-orities.


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analiza, naroito vezano za infrastrukturu.to se tietrokova za edukaciju osoblja ona e biti planirana naosnovu broja zaposlenih u mentalnom zdravlju u Repu-blici Srpskoj.

Kategorije konsultantskih usluga i treninga biedenisane na osnovu procjene za potrebom konsul-tantskih dana u periodu od tri godine za denisanje kuri-kuluma za edukaciju za sve kategorije kadrova i nivoe

edukacije iz oblasti mentalnog zdravlja, kao i za pripremukampanja za edukaciju javnosti.Taniji iznos potrebnih novanih sredstava e se

praviti za svaku pojedinu aktivnost, tj.operativno za sva-ki cilj iz akcionog plana.

Izvori iz kojih e se obezbjediti potrebna sredstva:donacije donatorskih drava i institucija, sredstva lokal-nih zajednica, srededstva zdravstvenih ustanova,i drugiizvori nansiranja.

Expenditures

In order to obtain a detailed budget for implemen-tation of foreseen activities, it is necessary to make anestimation of the needs for construction works for thepurpose of arranging the space where currently, and inthe future, mental health services will be provided. It isnecessary to reconstruct the present or build new spaces

in the Republic of Srpska. More funds will be needed forthe Republic of Srpska for the stated process because itis necessary to build ten new centres. All this requires adetailed analysis, particularly the matters related to infra-structure. With regard to the expenditures for personneleducation, they will be planned according to the numberof employees in the mental health care in the Republicof Srpska.

Categories of consultant services and training willbe dened on the basis of estimations of the require-ments for consultancy days in the period of three yearsfor the purpose of dening the curricula for educationof all categories of staff and levels of education in theeld of mental health, as well as for the preparation ofcampaign for public education.

A detailed amou

Documents

Politika Mentalnog Zdravlja