BackgroundSevere mental illness (SMI) presents a major burden to societies worldwide. Low- and middle-income countries (LMICs) often do not have sufficient financial resources and qualified staff to provide extensive specialised services for outpatients with SMI. Our research therefore aims to explore and test low-cost interventions that use existing resources in routine patient-clinician meetings, families and communities.MethodsIn Bosnia-Herzegovina, Colombia and Uganda, three psychosocial interventions will be tested, i.e. making patient-clinician meetings therapeutically effective through DIALOG+, family involvement in multi-family group meetings, and support for patients in befriending schemes with volunteers. All interventions will be provided to patients with SMI, delivered over a six-month period and evaluated with assessments at baseline and after six and 12 months. We will conduct nine trials including non-controlled trials, non-randomised controlled trials and randomised controlled trials (RCTs). Core outcome criteria will be used across all studies. However, details of study delivery and additional outcome criteria vary to accommodate local contexts, interests and priorities. The studies will be analysed separately, but with the option to compare and combine findings.DiscussionThe approach provides the opportunity to learn from commonalities and differences in the results and experiences across the three resource-oriented approaches and the three countries. If successfully implemented the studies can lead to more extensive research and are expected to inform health policies and clinical practice of community care for patients with SMI in the three participating countries and other LMICs.Trial registrationAll RCTs were registered prospectively and non-randomised trials retrospectively within the ISRCTN Registry.DIALOG+ in Uganda: ISRCTN25146122 (Date of Registration: 20/11/2018, prospective); DIALOG+ in Colombia: ISRCTN83333181 (Date of Registration: 20/11/2018, prospective); DIALOG+ in Bosnia-Herzegovina: ISRCTN13347129 (Date of Registration: 20/11/2018, prospective); Volunteer Support in Uganda: ISRCTN86689958 (Date of Registration: 04/03/2019, retrospective); Volunteer Support in Colombia: ISRCTN72241383 (Date of Registration: 04/03/2019, retrospective);Volunteer Support in Bosnia-Herzegovina: ISRCTN51290984 (Date of Registration: 20/11/2018, prospective); Family Involvement in Uganda: ISRCTN78948497 (Date of Registration: 04/03/2019, retrospective); Family Involvement in Colombia: ISRCTN11440755 (Date of Registration: 04/03/2019, retrospective); Family Involvement in Bosnia-Herzegovina: ISRCTN13347355 (Date of Registration: 20/11/2018, prospective).

Testimony psychotherapy is a brief individual psychotherapeutic method for working with survivors of state-sponsored violence. First described by a group of Chilean mental health professionals who were working with survivors of political violence during the Pinochet dictatorship it was further described by Agger and Jensen in their work with refugees in Denmark and with Holocaust survivors.  All groups report that testimony functions both in private and in public realm as a means for individual recovery and a means of bearing witness to historical truths.Although testimony approach is not strictly a clinical intervention, many have noted that it offers the survivor clinical benefits. This observation was confirmed in our study  of testimony psychotherapy with survivors from Bosnia and Herzegovina.As part of  research activities of the ‘Project on Genocide, Psychiatry and Witnessing’ of The University of Illinois at Chicago, dr Stevan Weine and I conducted a pilot clinical trial of testimony psychotherapy, at the same time creating oral history archives, and creating awareness in the community of Bosnian refugees of the importance of documenting the survivors’ narratives. In this work we were functioning as witnessing professionals, committed to helping individual survivor's recovery, but also to addressing the social and historical tragedy of genocide.. Because we saw testimony work from an interdisciplinary perspective, we also sought to create testimony documents that would move outside of the psychotherapeutic dyad and make connections with others in the scholarly, human rights, artistic, and survivors' communities.

Objectives: To identify and compare the stressors in the work environment experienced by employees in primary health care and secondary health care, amongphysiciansand nurses. Patients and methods: The survey was conducted to identify types of stressors by assessing health care workers employed in the primary and secondary health care services of the Public Institution, the Health Centre of the Sarajevo Canton, using a questionnaire about stress in the workplace. Results: Among all study participants stressors connected to the organization of work, finance and communication were found to affect their mental health most strongly. The results show a significant difference between primary and secondary health care in experience of stressors related to the organization of work, communication, and stressors related to the emotional and physical risks. Primary health care physicians report a significantly higher experience of stress and impact on mental health compared with other physicians related to emotional difficulties when working in the field of palliative care. Our results also indicate a significant difference between primary and secondary health providers in experiencing stressors related to the organization of work, such as: on-call duty shifts, an inadequate working environment and in the assessment of administrative work overload. Conclusion: The survey identified the most intense stressors for doctors and nurses at primary and secondary levels of health care services. The results of the study indicate that doctors and nurses have a different hierarchy of stressors, as well as subjects at Primary and Secondary Health Care. The results of the study indicate that subjects et Primary Health Care perceive more stressful organizational, emotional and communicational problems.