6^th International Congress of the WIAMH

Tuzla, Bosnia and Herzegovina, August 13 - 15, 1999.

DEVELOPMENT OF PSYCHIATRIC SERVICES IN BOSNIA AND HERZEGOVINA – FROM INSTITUTIONS IN ASYLUM TO SOCIO-PSYCHIATRIC APPROACH

I. CERIĆ, O. SINANOVIĆ, S. LOGA, L. ORUČ

The history of modern psychiatric service in Bosnia and Herzegovina is rather short. The first psychiatric institution was established in 1894 in the former Vakufska Bolnica of Sarajevo, and in 1907 within the Zemaljska Bolnica, a newly constructed psychiatric department with 113 beds was set.

During the time between the two world wars, the number of beds for psychiatric patients had not increased and there were no significant improvements of psychiatric service. The psychiatric department of the General State Hospital Koševo in Sarajevo, remained as the only psychiatric institution in Bosnia and Herzegovina until 1948.

Since that time, the psychiatric service was under intensive development. Therefore, before the war the psychiatric service was organised following the below given principles.

1. Within the outpatient clinics there were psychiatric departments with neuro-psychiatrists and nurses, and psychologists and social workers as consultants. Psychiatric services within the outpatient clinics worked with the narrowest relation with the primary health service and it dealt with the treatment of psychotic and non-psychotic disorders. Prevention activities were not treated to a great deal and the role of the community in improvement of mental health was almost fully ignored.
2. Within the general hospitals on the territory of Bosnia and Herzegovina, there were neuro-psychiatric departments, which treated acute psychotic and other disorders over a certain short period..
3. On the territory of Bosnia and Herzegovina, at the same time existed large psychiatric hospitals (Sokolac, Jagomir, Domanovići) and a psychiatric colony (Jakeš near Modriče). The later was consisted of a classic psychiatric hospital for long-term patients, very developed occupational and working therapy, hetero-family accommodation of patients in the families in surrounding villages (Garevac, Jakeš). Psychiatric hospitals had an average of 300 heavy patients, while Jakeš near Modriča had 800 to 1000 clients.
4. Treatment of alcoholism and drug addiction was carried out throughout Institutes for treatment of Alcoholism and other addictions and the Centre for treatment of Drug Addiction of the Psychiatric clinic in Sarajevo. Primary and tertiary prevention of alcoholism was dealt with within 120 clubs of treated alcoholics.
5. More difficult mentally retarded persons were treated in special institutions of the social welfare system, and those with smaller mental retardation were treated and rehabilitated within their own families and educated in a number of special schools.

According to the data from the Republic Institute for Health Protection Sarajevo, the state of the neuro-psychiatric services in BIH, on 31 December 1991 was as follows – the total number of neuro-psychiatrists was 2337, total number of physicians who were specialising for neuro-psychiatrists was 56, number of medical personnel with high education level was 100, the number of medical personnel with secondary education was 897, number of medical personnel with low education was 36, and the total number of beds was 2822.

The first months of the aggression on Republic Bosnia and Herzegovina lead to various disorders in all fields of life. The especially difficult repercussions of war activities and destruction were seen on psychiatric services – hospitals and patients. Psychiatric hospitals Jagomir and Domanovići were closed. Numerous patients – who had spent ten or more years in such institutions – were left to the streets with no support and control. Some of them disappeared, and some were wounded and killed.

Since the very beginning of the war, the worst situation in Bosnia and Herzegovina was in Sarajevo – not only for the extremely difficult worsening of living conditions, wounding and killing of people, but also due to lack of food, water, electrical supplies and all other necessities for living. Since the very beginning and until the end of the war, the only psychiatric institution that was operational with no breaks, was the Psychiatric Clinic. The largest number of displaced psychiatric patients from the hospital in Jagomir was accommodated in the small space of this Clinic.

Having seen the situation at the very beginning of the war, all psychiatric personnel that was available, was distributed in district units and collective centres all over the city under siege.