In the aftermath of the war in Bosnia Herzegovina, a task group of Swedish experts organised and supported training of community psychiatry and social work as part of the mental health reform. Among the basic principles of the programme were a close cooperation with the Ministry of Health, personal continuity, exchange of knowledge and long term engagement. With the support of the programme, community mental health centres were created and staffed with a team consisting of: a psychiatrist, four nurses, a psychologist and a social worker. They catered, on average, for 65,000 people of all ages and saw 25–30 patients a day. Of these patients, 75% had psychiatric problems. Among the trained personnel, a major attitude shift occurred in favour of community psychiatry. As a result of the training, informal networks between local professionals were established. An evaluation, four years after the project ended, found that the community mental health centres were the major providers of psychiatric services in the region.

Chronology of important historical events in Bosnia and Herzegovina during past two centuries indirectly influenced the incidence and prevalence of different psychoactive substances use and thus the organization of services for the treatment of persons who develop addiction symptoms. The organization of health system in the last war, 1992-1995, suffered enormous damage and the reform process which inevitably followed, included the area of mental health care services and the establishment of network of centers for mental health in the community (CMHC). The centers are functioning within the primary health care almost in whole country, with specialized centers for the prevention and treatment of addicts and the therapeutic communities, which today represents the basic organizational units to help people who have drug related issues. In this paper we will present the possibility of treatment of drug addicts in Bosnia and Herzegovina, from consulting services, psycho-education and early detection of disease, detoxification and substitution programs with Methadone and Suboxone, as well as programs of rehabilitation and resocialization. Although a very complicated political and administrative structure of the country, insufficient financial support, pronounced stigmatization of addicts, insufficient staffing and number of treatment centers are objective obstacles for progress in treatment of addicts, we believe that, with existing resources, these constraints can be converted into new opportunities in terms of improvement of treatment options in the future.

Bosnia and Herzegovina (BH) is located on the western part of the Balkan Peninsula. It has an area of 51 210 km2 and a population of 3 972 000. According to the Dayton Agreement of November 1995, which ended the 1992–95 war, BH comprises two ‘entities’ – the Federation of Bosnia and Herzegovina (FBH) and the Republic of Srpska (RS) – and the District of Brcko. The administrative arrangements for the management and financing of mental health services reflect this. The FBH, with 2 325 018 residents, is a federation of 10 cantons, which have equal rights and responsibilities. The RS has 1 487 785 residents and, in contrast, a centralised administration. Brcko District has just under 80 000 residents.

The war in the former Yugoslavia between 1991 and 1995 destroyed the mainly hospital-based mental health care system in Bosnia and Herzegovina. This report summarizes the situation before and after the war and describes efforts to rebuild and reform mental health services under politically and economically challenging conditions. As a result of these efforts, there are now 39 multidisciplinary community mental health centers that are linked to primary care and that aim to provide prevention, treatment, and rehabilitation of mental disorders. The reform process has been supported by international initiatives and is now continuing in collaboration with other countries in South Eastern Europe.

In this paper we have presented historical overview of development of psychiatric services in Bosnia and Herzegovina. Special attention was given to the recent war destruction (l992-l995), as well as to the reconstruction and reform of mental health services within a frame of newly introduced mental health strategy.

Problems related to abuse of various psychoactive substances started in Bosnia and Herzegovina during the early eighties of the twentieth century. This is proven by the data from Counseling for the prevention and treatment of drug addiction that was working since 1978 until 1992 at the Psychiatric Clinic of the Clinical Center of Sarajevo University. At the end of 1991 this center registered 1000 drug users among which 50 was heroin addicts on the Methadone maintenance treatment. All organized activities on prevention and treatment of drug addiction stop during the spring of 1992. During the war 1992-1995, only few cases of drug addicts was treated due to overdose, abstinence and toxic psychotic states. Catastrophic war devastation had the consequence in social and economic disorganization of the whole society in Bosnia and Herzegovina. Large part of the population was killed or severely wounded. Majority of civilian population were expelled from their homes and spread all over the country and the whole world. Violence toward themselves and others, aggressively, tension, and domestic violence with large number of stress related mental disorders are still characteristics of our society. One of the important features of such a society is incensement of drug abuse, starting with alcohol, tobacco and all sorts of drugs. Extent of this socio-pathological problem are unknown, but indicators such as quantity of confiscated drug, number of legal processes related to drug, number of those who are coming to health institutions due to drug related problems, number of overdoses, and occasional surveys among youth indicated that the problem became more serious than anybody in this society wants to believe. All these indicators are showing that the problem of harmful alcohol, tobacco and drug use in our society have multiple negative consequences, and that in the recent future we cannot expect that these trends will became positive. Obviously, without the support from the community in this area we cannot achieve some good results. Today it is clear that without a strategy and preventive programs for the prevention of alcohol, tobacco and drug use at the state and even regional level there cannot be any success in stopping the epidemy of use and abuse of legal and illicit psychoactive substances.