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.

Antipsychotic drugs produce a wide spectrum of physiological actions. Some of these effects differ among the various classes of antipsychotics. This medications have indications in the treatment of acute psychotic disorders. The main goal of this investigation was to determine the incidence and prevalence of the neuroleptic therapy acute side effects. The reason for this epidemiological investigation performing was the lack of knowledge of the exact neuroleptic therapy side effects incidence. Qualitative study on this problem has not been performed yet. Antipsychotic therapy side effects prevalence rate according to the literature data is ranging from 24% to 74%. Different prevalence rate is a consequence of different antipsychotic drug usage, different drug administration method and different side effects identification. On account of all these facts, we put the hypothesis on the correlation between the antipsychotic therapy and occurred side effects. Our experiment included all patients hospitalised from December 31st 1999 to January 31st 2000 in Intensive Care Unit of Biological Psychiatry Department of Psychiatric Clinic in Sarajevo. All patients were divided in three groups according to the applied therapy. All of them met ICD-10 criteria for schizophrenia (F20-29). During our study the following examinations were performed: psychiatric interview, BRPS, scale of side effects, psychophysiological tests, general clinical impression, scale of appetite, carbon hydrate needs scale. Psychiatric and statistical evaluations were done as well. The evaluation of our examination is showing successful results in all groups of patients. The improvement of psychopathological symptoms was insignificant. Reported side effects were minimal with low incidence rate and relatively high prevalence rate. Statistical tests were calculated from the obtained data after what the null hypothesis was rejected. Consequently, an alternative hypothesis was confirmed and it indicated that the acute side effects incidence and prevalence were within the range of expectation. Intensity of the recorded side effects was moderate to mild. On the basis of the obtained data, it has been concluded that applied antipsychotic agents did not induce more psychophysiological function impairments in the treated patients. Psychophysiological functions remained in physiological range limits and their changes were not significant. Neuroleptic therapy side effects were minimal, meaning no toxic signs or therapy discontinuations were recorded.

It is well known that drug abuse is common in early adolescence with almost the same epidemiological characteristics in economical developed and undeveloped countries. Aim of this study is to compare drug abuse among adolescents in the urban and rural areas. Research covers 600 adolescents equal gender and age distribution. Distribution of participants regarding to the rural and urban type of areas, was equal, as well. It was used Q 2000 questionnaires, which was comprehensive tool for all aspects of adolescents life. Results shows that drug abuse is much more common in urban areas (alcohol 62.4%; and cannabis 70.0%; in rural areas alcohol 37.6%; and cannabis 30.0%). Regarding to age, drug abuse is the most common among adolescents aged 15-17. Alcohol is much more related to boys, but regarding to cannabis there is almost no differences.

Psychiatric services in Bosnia-Herzegovina before the war disaster was fairly developed and one of the best organized services amongst the republics of the former Yugoslavia. The psychiatric care system was based on psychiatric hospitals and small neuropsychiatric wards within general hospitals, accompanied by psychiatric services in health centers. The onset of war in B&H brought devastation and destruction in all domains of life, including the demolition and closing of numerous traditional psychiatric institutions, together with massive psychological suffering of the whole civilian population. Already during the war, and even more so after the war, the reconstruction and reorganization of the mental health services was undertaken. The basis of mental health care for the future is designed as a system where majority of services is located in the community, as close as possible to the habitat of the patients. The key aspect of the system of the comprehensive health care is primary health care and the main role is assigned to family practitioners and mental health professionals working in the community. Large psychiatric institutions were either closed or devastated, or have their capacities extensively reduced. There will be no reconstructions or reopening of the old psychiatric facilities, nor the new ones will be built. The most integrated part of the psychiatric system are the Community based mental health centers. Each of these centers will serve a particular geographic area. The centers will be responsible for prevention and treatment of psychiatric disorders, as well as for the mental health well being. Chronic mental health patients without families and are not able to independently live in the community will be accommodated in designated homes and other forms of protected accommodation within their communities. The principal change in mental health policy in B&H was a decision to transfer psychiatric services from traditional facilities into community, much closer to the patients. Basic elements of the mental health policy in B&H are: Decentralization and sectorization of mental health services; Intersectorial activity; Comprehensiveness of services; Equality in access and utilization of psychiatric service resources; Nationwide accessibility of mental health services; Continuity of services and care, together with the active participation of the community. This overview discusses the primary health care as the basic component of the comprehensive mental health care in greater detail, including tasks for family medicine teams and each individual member. 1. Comprehensive psychiatric care is implemented by primary health care physicians, specialized Centers for community-based mental health care, psychiatric wards of general hospitals and clinical centers in charge of brief, "acute" inpatient care; 2. Primary mental health care is implemented by family practitioners (primary care physicians) and their teams; 3. Specialized psychiatric care in community is performed professional teams specialized mental health issues' within Mental health centers in corresponding sectors; 4. A great deal of relevance is given to development of confidence and utilization of links between primary health care teams and specialized teams in Mental health centers and psychiatric in patient institutions; 5. Psychiatric wards within general cantonal hospitals, departments of psychiatric clinics in Sarajevo, Tuzla, and Mostar, and Cantonal Psychiatric hospital in Sarajevo (Jagomir) shall admit acute patients as well as chronic (with each new relapse). Treatment in these facilities is brief an patients are discharged to return to their homes, with further treatment referral to their family practitioner or designated Mental health center; 6. Chronic mental patients with severe residual impairment in social, psychological, and somatic functioning, shall live in the community with their families or independently. Those chronic patients without families and economic and other resources to live independently shall be placed in supervised Homes in the communities where they live. The above delineated strategy of mental health care program in B&H has several fundamental and specific objectives, among which the most important are: Reduction of incidence and prevalence of some mental disorders, particularly war stress-related disorders and suicide; Reduction of level of functional disability caused by mental disorders through improvement of treatment and care of individuals with mental health problems; Improvement of psychosocial well being of people with mental health problems, through implementation of comprehensive and accessible service for community mental health care; and Respect of basic human rights of individuals with mental health disabilities. The program has been updated since 1996, after the two-year pilot program. The main goals for current two- and five-year period are: Implement the mental health care reform program by launching all 38 Mental health centers in the Federation of BiH by 2002; Complete the 10-day education and re-education of at least 50% of all professionals employed in mental health services in FB&H by 2002; and Achieve that 80 percent of all mental health problems are treated by family medicine teams (primary care practitioners) and specialized mental health services (Community mental health care centers) by 2005.

The last few decades have seen a sharp increase in research into the psychological, psychiatric and social consequences of war. However the bulk of this research relates to male veterans and refugees. There is a serious dearth of literature on female civilians, particularly where the research is being performed in the country of trauma origin. This study aims to explore the psychosocial effects of war on women. One hundred and fifty female civilians participated in this study, conducted in the city of Sarajevo and surrounding refugee settlements in Bosnia. The subjects were divided into three groups: domestic women residing in Sarajevo during and after the war, displaced: women forced to leave their homes, and staying in refugee settlements, returness: women who have returned to Sarajevo from exile. Each woman was interviewed extensively by local psychiatrists. This interview contained the Harvard Trauma Scale for the screening of PTSD and Social Functioning, and the Hopkins Checklist for Anxiety and Depression. Both these tests have been revised, translated and validated for the Bosnian population. The Rosenberg Self-Esteem Scale and the Lazarus Coping scale examine psychological aspects of self-esteem and coping. A questionnaire containing demographic information was devised for the purposes of this study.