The Mental Health Project in Bosnia and Herzegovina, Phase 2 (March 2014 – February 2018)

The Mental Health Project in Bosnia and Herzegovina is a result of the continuous commitment of the Entity Ministries of Health to carry on with the reform of the mental health sector in Bosnia and Herzegovina. The Project supports the implementation of the strategy of mental health in both Entities (the Federation of Bosnia and Herzegovina-FBiH and the Republika Srpska-RS) and the Brcko District of BiH-BD BiH. The Project has had a role of a facilitator of planned interventions, encouraging responsibility, ownership of the activities and results as well as the visibility of the partners - local institutions and organizations. It has been recognized as a key catalyst for change in the reform of mental health care in the country.

The Mental Health Project in BiH (MHP in BiH), Phase 2, is a continuation of the Mental Health Project Phase 1 (2010 – 2014) and it directly reflects and supports the strategic approach in response to the many challenges that arise in the reform of the mental health as defined in entity strategies for the protection and promotion of mental health.
An overall approach framework aiming at strengthening the community mental health services and transforming them from a crisis-driven system to one that includes a focus on prevention and well-being was established during Phase 1, building on the achievements of the previous mental health reforms in the country.

The vision is that prevention and early intervention community-based services comprise the first step in a continuum of services designed to identify early symptoms and prevent mental illness from becoming severe and disabling. Integration of mental health promotion in the services provided in the community will increase the number of people who enjoy good mental health and well-being.

The design and expected results of the Project are based on the achievements and the challenges identified in Phase 1 as well as on the recognized needs of mental health professionals and service users.
The Project will operate in three different but complementary strategic areas that summarize as:
1.    Enhancing the management capacity of the actors in the community-based mental health system.
2.    Improving access to and quality of the community-based mental health services.
3.    Reducing discrimination against persons with mental health problems.

Improved health and well-being of persons with mental disorders/problems and of those at risk of developing mental disorders/problems will be achieved by an intervention focusing on improving the quality, accessibility and effectiveness of mental health prevention and promotion services and anti-stigma activities. By developing capacities and mechanisms for the evidence-based planning and organization of mental health services and the increased involvement of users of mental health services in these processes, the Project will contribute to the establishment of an effective mental health management system. Application of evidence-based practice and standardized procedures will ensure that the service quality is monitored and consistently improved. Service user associations will be supported in advocating for their rights, demanding accountability from the health authorities and service providers, and in the development and implementation of community-based plans to fight discrimination and social exclusion of persons with mental health problems. Reduced discrimination and stigma will enable persons suffering from mental health disorders and their families to seek and receive more adequate service, achieve recovery and reintegrate into society. In order to ensure that the community mental health centers are able to respond to users’ needs and demands, community-based multidisciplinary teams capacities to provide specialized outpatient services (such as psychotherapy or occupational therapy) will be strengthened. Through the sufficient training and continuous support these teams will consistently apply innovative and modern recovery-oriented methods as well as engage in prevention of mental disorders in the community. This will reach those at risk of mental health problems/disorders and contribute to the prevention of developing mental disorders. Furthermore, reconstructed and/or refurbished mental health facilities have upgraded the working environment of mental health professionals contributing to the improved service provision. Targeted interventions will enhance the patient orientation of the mental health care system, respectful and responsive care provision and the effective treatment of patients. The interventions will contribute to better health outcomes, a higher quality of life for mental health service users and general well-being of people with mental disorders and those at risk of developing mental health problems.  

The mandate and responsibility for the implementation of this, second, Project phase have been entrusted to Association XY. The key success factors are based on the recognizability of the Project and Association XY as key facilitators of change in the mental health care system in Bosnia and Herzegovina, the existence of an organized and integrated team of experts in the field of mental health with the experience of the implementation of Phase 1 and the established cooperation with and among the Project partners. Association XY will have a leading role in organizing Project activities. Through the Project team Association XY will ensure smooth coordination of all aspects of the Project and provide administrative support and facilitation at all levels of the Project implementation.

The overall strategic leadership of the Project has been entrusted to the Steering Committee consisting of representatives of the key Project partners (the Swiss Agency for Development and Cooperation - SDC and representatives of the Swiss Cantons of Bern, Fribourg, Jura and Geneva as donors, and representatives of the institutions in BiH as the main institutional actors) who will steer and support the Project general strategic direction.

In the process of the Project preparation and analysis of the existing expert resources (know-how) in the country that the Project could rely on in the implementation of its activities, insufficiency of certain skills and knowledge of domestic experts was noted. However, the Project has a privilege to have at its disposal support from the Swiss Cantons of Bern, Fribourg, Jura and Geneva and their experts and institutions in the field of mental health and health care management. Cooperation with experts from the Swiss Cantons started during Phase 1 and it has been considered as extremely valuable example of good practices. The Project in this phase also intends to continue the cooperation with the Swiss cantons experts, and will use their expertise to achieve results within all specific Project goals/outcomes.

The Project framework proposed in this document covers the Implementation Phase 2 over the four-year period (March 1, 2014 – February 28, 2018).