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Strengthening research capacities and evaluation of mental health services in Bosnia and Herzegovina

Final Report Summary - EVIDENCE (Strengthening research capacities and evaluation of mental health services in Bosnia and Herzegovina)

The main goal of the project was to strengthen the research capacities and evaluation of mental health services in Bosnia and Herzegovina. As an initial result a research unit at the Psychiatry Department of KCUS was established, developed and strengthened by Evidence. The project continues to inform further developments in the research unit activities and role in mental health services research in B&H.

Evaluation of MNH services was carried out in Sarajevo University Psychiatry Department and in CMHCs Brcko and Gorazde and mentorship links continued with QMUL partner. The networking was complex but flexible and efficient in building group and individual links in doing research for the purpose of evaluation of services. There is debate about the role of health care and social interventions for chronic mental health problems and relatively little empirical evidence is produced in relation to this debate in B&H. Evidence and cost-benefit analysis are important for health and welfare policy development. Evidence was designed and carried out to change this and offer a model for development of the mental health services research in B&H.

MNH Services Research Network under the EVIDENCE project carried out four studies.
1. Connect primary data analysis - Posttraumatic stress disorder characteristics and treatment modalities in Bosnia and Herzegovina
2. RCT - Efficacy of psycho education in treatment of patients with unipolar depression: multi-centric randomised trial
3. Qualitative study - Effectiveness of mental health interventions for patients with depression in mental health services in Sarajevo, Brcko and Gorazde - patients' experience
4. Routine data gathering framework (RDG)

A course of psychoeducation (PE) for depression was delivered by the researchers who have been trained in this method and who did not take part in any other components of this study. An add-on study with qualitative interviewing and research was conducted as part of this research. The trained researcher involved in this part of the study wasn't involved in any other component of this research.

Participants' from all sub-groups included experiences of successes and failures to experience PE as personally relevant or apply the learned principles in their life. In their narratives participants associated positive outcomes high relevance of the PE rationale and relevance of the self-help skills. Participants self-reported perceived positive impact of psycho-education on feelings, thoughts, behaviour and self-image. Understanding of concepts improved use of skills by participants in psycho-education.

Furthermore, participants accounted for readiness for change as associated with positive outcomes and helpful experience of PE while low levels of readiness for change of minority of participants was associated with low personal relevance of PE and self-help skills that resulted in passive compliance with PE and low levels of positive outcomes.

Credibility of the program was experienced to be associated with different components of the PE: the content, the group and the therapist. Participants view respectful therapeutic relationship as centrally important and group cohesion as associated with higher experienced credibility of PE.

It is highly important to understand readiness for change within behavioural intervention framework. Psychosocial interventions should include interventions for perceived stigma, also in community settings. Simple, meaningful, clear and unambiguous information on concepts in PE should be provided to participants. Alternative treatment plans for the non-responder group should be designed.

The project and especially the produced research increased the attention given by the professionals to the importance of mental health services research and generally of mental health in context of social and economic disruption. Awareness of the available effective services for mental health problems was raised. Looking at the aspects of mental health service use is of special importance since there is still a danger of stigma for people seeking mental health services in B&H. The project aimed at decreasing the risk of stigma by providing information on mental health services justification and efficacy related to populations at risk and learning about their availability and effectiveness. Focus on sensitive ethical issues when engaging service users who may be vulnerable to a range of issues will help raise awareness among the researchers, students and practitioners from Department of Psychiatry and CMHCs.

Dissemination was continued through writing new projects designs, preparing presentations and submission of published papers. In the future, different media like TV, radio, newspapers can be used for dissemination through a public campaign based on project experience and results making sure that it reaches the intended audiences including the general public (including service users and potential service users).