Limited mental health services

People with concerns and mental illness in Kosovo have two choices - to be treated in overburdened public institutions with limited capacities, or in private ones without supervision and with expensive sessions. Experts and heads of institutions that manage this sector have more than once raised the alarm about the lack of spaces and professional staff, about the impossibility of providing services in remote areas, as well as about the isolation of patients and the lack of conditions for their socialization. .

The treatment of serious cases is the responsibility of the psychiatry wards in the NKUK and regional hospitals and mental health centers.

Services in these institutions are offered even for the mildest cases, such as those with anxiety and depression concerns, but according to the director of the Center for Mental Health in Pristina, neuropsychiatrist Sami Rexhepi, they are limited due to the lack of capacities.

"This center offers services for one third of Kosovo, either in terms of territory, but also in terms of the number of inhabitants. Unfortunately, it does not fulfill the conditions for the role and function it has in terms of spaces. However, a number of workers are also missing. Until a few years ago, we didn't even have vehicles for field work, but we won a grant and we won three cars", said Rexhepi.

The university professor of psychology, Natyra Agani, has brought her experience as a clinical psychologist. She has shown that most of the cases that seek help are young people with emotional problems.

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"Most often and most commonly, people seek mental health services for anxiety disorders first, for mood disorders, and for specific behavioral difficulties they may have, for example, worrying thoughts or obsessive thoughts that then manifest with behavior repeated which are hindering for the environment where they operate", stated Agani.

All public mental health services are provided within the Kosovo University Clinical Hospital Service (SHSKUK). The data from the HCWs, but also from the Departments of Psychiatry, show that most of the beneficiaries of these services are patients who suffer from disorders of the diagnostic group of schizophrenia and delusional diseases.

For affective concerns, which Professor Agani said are more frequent cases, services are requested and offered in the private sector.

"The practical part of receiving mental health services, which I am most familiar with, is in the private sector. These are psychological clinics, often also psychiatric clinics that also offer psychological services, from a multidisciplinary team, such as psychiatrists and specialists in clinical psychology and psychotherapy, perhaps even only clinical psychologists who directly provide mental health services. either through therapy or through various services", she said.

From the data provided by KOHA, it appears that a psychological session in these private institutions costs from 20 to 35 euros. Usually the sessions are held every two weeks, but in the most severe cases even more often and even accompanied by psychiatric sessions that cost around 50 euros.

While services in public institutions are mainly focused on people with more serious mental conditions and chronic diseases, the Mental Health Centers (MHCs), found in each regional center, are conceived as a place where people with mental health concerns and make the transition from institutionalized and closed treatment in Psychiatry wards to rehabilitation and reintegration into society.

"If we had more space, more personnel, we would, in addition to working as the Center for Mental Health, Rehabilitation, Resocialization of chronically mentally ill people was originally designed, also deal with the rest who are not sick, who often they only need professional support to overcome a crisis, with mild disorders that prevent the worsening or deepening of the disease, which would be a great help", said director Rexhepi.

Agani psychology has shown the reason why young people are the ones who seek professional psychological help the most. According to her, this has to do with their awareness of the importance of mental health.

"I work with a target group of young people between the ages of 18 and 45, this is also the group of individuals who most often seek mental health services, perhaps they are also more aware of mental health services with children, it is the parents who take a more proactive role, although not always in time", said Agani.

The older ages, according to Agan, are marginalized and they are referred to mental health professionals, mainly by doctors specializing in other areas of treatment.

"However, these ages, let's say older (45 years and older), are really very marginalized from receiving mental health services, and more often it can happen in cases where another general practitioner, such as a doctor family member, a cardiovascular specialist, an internist may also refer to psychologists in this case as a need for a conversation for emotional release. But I have the impression that the trend in general and at the global level, this age of 18+, that the most and most often seek mental health services from professionals", stated Professor Agani.

Neuropsychiatrist Rexhepi raised the alarm about the lack of services for people of retirement age who also suffer from mental illness.

"Therefore, there is a lack of institutions that would take care of people who have mental health problems and are over 65 years old, nursing homes do not accept people with mental health problems. But we don't have an institution that would deal with this category of the population, over 65 and with mental health problems", said Rexhepi.

The World Health Organization has come up with some recommendations for mental health services. Among other things, it has been requested that they be deinstitutionalized and focus on the community, where the individual is not isolated.

The Center for Mental Health in Pristina follows a similar example. It serves as a daily stay for clients, where they are also offered a tour, psycho-educational and even recreational activities.

This center, according to director Rexhepi, is open from morning to four in the afternoon. Customers enter and leave this institution freely.

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"Our goal is to make them functional. With their functionalization, the goal is that relapses, which are very normal, because it is a chronic disease, should be as rare as possible, as short as possible, so that the person feels the quality of life, feels himself as someone who is useful, to feel themselves as members of this society, not as a part of the people with a ghetto", he said.

In addition to the daily stay, professionals of this center also make field visits to the families of their clients.

"When we go on home visits, our goal is also to evaluate the relationships between family members. What are the cohesive forces, what is the best way to motivate the family members to deal more with the person, so that he does not feel neglected, burdened or redundant", Rexhepi continued.

The director of the Center for Information and Social Improvement (QIPS), Bind Skeja, said that community services are ideal for people with mental problems. He opposes keeping patients inside various institutions that provide mental health services.

"There have been cases that have been identified that have stayed for months, some even for years, because they did not know where to send them, that is, someone came to receive services and the person was qualified by the psychiatrist to be able to return to the community, but because there was no policy to help him return, he had no employment, housing, he was left with no financial means. This also contributes to taking action, because in those cases the family can go and sell the property without your consent, these cases are very evident. We have the case of Shtime that for years, they are spending most of their lives in psychiatry, within the walls of the center in Shtime, which WHO has recommended to be closed. So, every day we send people there or every day that passes and they continue to be kept there against their will, we are not even trying to find community solutions for them and we are violating their basic life rights", stated Skeja.

Professionals in this field demand reform of the mental health service delivery system, regulation and supervision of services offered in private, as well as the avoidance of practices that they consider wrong.

"If we don't have policies to house people seeking help for mental health, who are homeless or policies to employ them. Not to be employed to be exploited by some business, but to be employed in some cooperative for example, then we will always return to zero and we will have nowhere to send these people, we only have to fill the Psychiatry Clinic , but also the Center for Mental Health, since it is happening. We have visited the HCWs and psychiatric clinics and we have seen that the people who seek these services are the people who are receiving social assistance, this only proves to us that these services are failing in terms of rehabilitation", added Skeja.

Neuropsychiatrist Rexhepi also criticizes the way mental health centers are organized. He said that there is a risk that these services will be re-institutionalized in the future.

"We are part of SHSKUK, the idea was or a fight for which I am ready to enter is that this service is unique at the level of Kosovo. When it is unique, then all centers have the same way of working, we create the same development documents. Now the idea of ​​being part of regional hospitals has come up, it would somehow destroy the spirit of mental health in the community. Community mental health is very different from mental health in hospital services. They deal with the acute case, treat it and release it, while ours is to continue to accompany them, take care of them", said Rexhepi.

While Bind Skeja points out the lack of extension of these services even in the most peripheral areas of Kosovo.

"They are not well organized, because the idea of ​​community services is to work in the community. It is impossible to work in the community when you are in Ferizaj, and since the regional map also has Hani e Elezit, it takes two hours to go there, two hours to return, which means that the effectiveness is totally lost because there is no you are in the field", stated the director of QIPS.

For psychologist Natyra Agani, the problem is the lack of institutional mechanisms that regulate, supervise and evaluate the work of psychologists.

"A greater provision of the community of clinical psychology specialists and a greater effort to create the chamber of clinical psychologists is needed. Otherwise, there is a real possibility that the most adequate and quality services will not be provided to the people who need them. Until the establishment of the chamber of psychologists, I think that we are more in a professional improvisation and not necessarily a provision of specific expertise for people in need", said Agani.
 

Sociologist Erisa Hajziri has mentioned the cultural transition that Kosovar society is experiencing. She said that the religious families that used to be more common have provided more socialization and support for her family.

"This most of the time falls on the lack of socialization, in sociology we say that every person or every social being goes through several stages of socialization, which are very important to give meaning to social life, in the absence of socialization and spaces for socialization and to give meaning to the individual being most of the time individuals are closed or isolated, if not physically isolated, because we each have institutional duties. Children go to school, parents to work or housework, but it does not matter that we are not isolated or that we do not communicate with each other. The good or the bad of the post-modern transformation also brings this social coldness to each other and I think that this has affected both young people and a lot of other people and it should be given a lot of importance and talked about so as not to be stigmatized. as an ordinary problem, but it is a problem that has lived, has to live and will always live within societies", said sociologist Eriesa Hajziri.

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KOHA has asked the Ministry of Health if institutional actions have been taken to solve the problems raised by the experts, but has not received an answer.

In addition to psychiatry wards in regional hospitals and mental health centers, there are also institutions where the mentally ill are kept for many years, such as the centers in Shtime, Fushë-Kosovo and Drenas.