Building Back Better: Sustainable Mental Health Care after Emergencies

This WHO report shares detailed accounts from 10 diverse emergency-affected areas, each of which built better-quality and more sustainable mental health systems despite challenging circumstances. Cases originate from countries small to large; low to middle-income; across Africa, Asia, Europe, and the Middle East; and affected by large-scale natural disasters, prolonged conflict, and large-scale influxes of refugees. While their contexts varied considerably, all were able to convert short-term interest in population mental health into sustainable, long-term improvements.
This WHO report goes beyond aspirational recommendations by providing detailed descriptions of how mental health reform was accomplished in these situations. Importantly, case contributors report not only their major achievements, but also their most difficult challenges and how they were overcome. Key overlapping practices emerging from these experiences are also summarized.

This report provides the proof of concept that it is possible to build back better, no matter how weak the existing mental health system or how challenging the emergency situation. I call upon all readers to take steps to ensure that those faced with future emergencies do not miss the important opportunity for mental health reform and development.

– Dr Margaret Chan, former Director-General WHO

Executive summary available in Arabic, Chinese, English, French, Russian and Spanish here.

A novel bio-psycho-social approach for rehabilitation of traumatized victims of torture and war in the post-conflict context: a pilot randomized controlled trial in Kosovo.

Background: Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for treating war-related trauma, but it remains unclear whether this approach is applicable to civilians living in resource-poor countries affected by war. In 2012–14, Danish Institute against Torture (DIGNITY) conducted a randomized controlled trial (RCT), in partnership with Kosova Rehabilitation Centre for Torture Victims (KRCT), to examine the effects of ultidisciplinary intervention among victims of torture and war in Kosovo.(BioMedCentral open access)

The Asylum-seeking Child in Europe

Children constitute an important part of asylum seekers whether they arrive With their families or alone. In 2003, there were more than 17 million refugees (43 per cent of refugees), asylum seekers and others who are of concern to the UNHCR. Of these millions of people, it is estimated that children under the age of five make up 11 per cent and 32 per cent are children aged six to seventeen. Many of these children have experienced war, violence, acts of cruelty and similar traumas. Others have been exposed indirectly through their parents traumatizing experiences. Such experiences are today increasingly recognized as being a similar burden to a child as if they are assaulted themselves. The adults often have very big problems and the children run the risk of having their problems concealed. Registration data and statistics are generally not produced in a way that makes the exposed situation of children visible. The childrens reasons for asylum in their own right are rarely investigated.

Survivors of war in northern Kosovo (III): The role of anger and hatred in pain and PTSD and their interactive effects on career outcome, quality of sleep and suicide ideation

This study, based on a household survey of 125 victims of torture and massive violence in Kosovo, aimed to expand current understanding of the diagnostic overlap of pain and PTSD and explore their independent and interactive effect on career change, sleep disorder and suicide ideation. The role of anger and hatred as contributing factors to the persistence of pain and PTSD were also examined .

Survivors of the war in the Northern Kosovo: violence exposure, risk factors and public health effects of an ethnic conflict.

The aim of this population-based study was to assess the long-lasting effects of ethnic conflict on health and well-being (with a focus on injury and persistent pain) at family and community level. The possible risk factors for victimisation during the conflict and factors contributing to healing, have also been investigated.

Survivors of war in the Northern Kosovo (II): baseline clinical and functional assessment and lasting effects on the health of a vulnerable population

This study documents torture and injury experience and investigates emotional well-being of victims of massive violence identified during a household survey in Mitrovicë district in Kosovo. The victims reported a high prevalence of severe pain and emotional disturbance. They showed high BMI and a reduced level of physical fitness.

Conflict, Disaster, Homicide – Mental health reform in post-conflict areas: a policy analysis based on experiences in Bosnia Herzegovina and Kosovo.

This policy analysis provides insight into the ongoing process of mental health reform and the difficulty of sustaining such reform in post-conflict areas. It is based on experiences in Bosnia Herzegovina and Kosovo in the former Yugoslavia.

Therapeutising Refugees, Pathologising Populations: International Psycho-Social Programmes in Kosovo. New Issues in Refugee Research

The first half of the paper discusses material that questions the international projection of refugees as traumatised. The second half of the paper explores psycho-social intervention as a new mode of external therapeutic governance.5 The paper suggests that the influence of a Western therapeutic ethos on international policy does not necessarily represent a humanist turn. Psycho-social intervention does not just simply entail cultural imperialism, that is, the imposition of a Western therapeutic model on other societies, which have their own coping strategies.

Internally Displaced Persons from the Prizren Area of Kosovo: Living Conditions, Mental Health and Repatriation Issues

Throughout and immediately after the formal end of the Kosovo conflict and cessation of NATO bombardment of FR Yugoslavia in 1999, a great number of Serbs and other non-Albanians from Prizren and other regions of Kosovo were forced to flee for refuge to other parts of the country. On the report of respective estimates of certain international organizations (UNHCR, ICRC) about 200, 000 persons were forcibly displaced into the parts of Serbia outside Kosovo (50 pages, .doc, for historical reference).

A General Review of the Psychological Support and Services Provided to Victims of Trafficking

This study is the outcome of an empirical analysis performed by the psychologist Diana Tudorache based on the psychological counseling provided to the victims of trafficking assisted by the IOM Kosovo Counter-Trafficking return and Re-integration Program from September 2001 to March 2003.

Kosova Rehabilitation Centre for Torture Victims (KRCT)

In October 1999, a team of doctors who worked in ARCT and ACHR, Albania, supported by the International Rehabilitation Council for Torture Victims (IRCT) set up a rehabilitation centre. The Kosova Rehabilitation Centre for Torture Victims (KRCT) is an independent, non-governmental and non-profit organisation placed in Prishtina.

War and mental health: a brief overview

About 40 violent conflicts are currently active and nearly 1% of the people in the world are refugees or displaced persons. Over 80% of all refugees are in developing countries, although 4 million have claimed asylum in western Europe in the past decade.