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      Developing Forensic Mental Healthcare in Kosovo

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          In many economically struggling societies, forensic psychiatry is still in its initial developmental stages and thus forensic patients pose an ongoing challenge for the healthcare and juridical systems. In this article, we present the various issues and problems that arose when establishing the first forensic psychiatric institute in Kosovo – a country whose population has constantly been reported as suffering from a high psychiatric morbidity due to long-lasting traumatic experiences during the war of 1999. The implementation of a new forensic psychiatric institute in the developing mental healthcare system of Kosovo, still characterized by considerable shortages, required substantial effort on various levels. On the policy and financial level, it was made possible by a clear intent and coordinated commitment of all responsible national stakeholders and authorities, such as the Ministries of Health and Justice, and by the financial contribution of the European Commission. Most decisive in terms of the success of the project was capacity building in human resources, i.e., the recruitment and training of motivated staff. Training included essential clinical and theoretical issues as well as clearly defined standard operation procedures, guidelines, and checklists to aid daily routine work and the management of challenging situations.

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          Survivors of the war in the Northern Kosovo: violence exposure, risk factors and public health effects of an ethnic conflict

          Background The aim of this population-based study was to assess the long-lasting effects of ethnic conflict on health and well-being (with a focus on injury and persistent pain) at family and community level. We have also investigated possible risk factors for victimisation during the conflict and factors contributing to healing. Methods We conducted a district-level cross-sectional cluster survey of 1,115 households with a population of 6,845. Interviews were carried out in Mitrovicë district in Northern Kosovo from September to October 2008, using standardised questionnaire to collect lifetime violence exposure, lifestyle factors and health information on individual and household. Results Ethnic Albanians made up 95% of the sample population. Crude mortality and under-five mortality rate was not high in 2008. Over 90% of families had been exposed to at least two categories of violence and human rights violations, and 493 individuals from 341 families reported torture experiences. During the two weeks before the survey, 20% of individuals had suffered physical or mental pain. There were differences in pain complaints according to gender and age, and whether people had been injured within 12 months, had lifetime exposure to violence-related injury, or had been tortured. Patterns of social and political participation in a family could affect the proportion of family members complaining of pain. The proportion of family members with pain complaints was related to a decline in the household income (coef = 9.31, 95% CI = 6.16-12.46, P < 0.001) and the fact of borrowing money (coef = 6.11, 95% CI = 2.91-9.30, P < 0.001) because of an injured person in the household. Families that were affiliated with the Kosovo Liberation Army, or had participated in a protest before or during the war, were likely to be targeted by Serbian paramilitary and law enforcement agencies. Conclusions Mitrovicë district is currently characterised by a low level of violence, but the effects of ethnic conflict on health and well-being have not gone. The level of lifetime exposure to violence, the proportion of family members reporting pain and lifetime violence-related injury, and family's financial burden were found to be inter-correlated. The sample confined to one ethnic group in one district limits the generalizability of the findings.
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            Forensic psychiatry in some Balkan countries.

            In Balkan countries, as in all Europe, forensic psychiatry as a subspecialty between psychiatry and legal medicine, an interface between mental health and the law, is focused on assessment and treatment of people with mental disorder who show antisocial or violent behavior. Thus, the authors thought that to show the actual situation of forensic psychiatry in their countries would be more interesting than only to review some articles published in these last 2 years in this part of the world. The article also includes some review about forensic psychiatry in prison in Bulgaria, Serbia and Russia and about a recent book published in Bulgaria. After a brief history of forensic psychiatry in some Balkan countries, the authors describe the services, the high and medium secure units found in forensic hospitals or in general psychiatry hospitals, which are still limited, where mentally disordered offenders are treated. Because of our society's values, individual freedom and civil liberties, questions about the right to treatment (or the right to refuse treatment), involuntary hospitalization, and other legal and ethical issues have no easy answers. Ethical questions remain in dispute, like patient's needs vs. social needs and human rights, legality vs. morality.The quality standards must be improved, especially those concerning elementary care needs and quality of life of forensic psychiatry patients (accommodation, food, sheltered housing, sheltered work places and community involvement). Ways will be found to protect human rights and avoid any abuse of psychiatry.
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              Psychopathology and well-being in civilian survivors of war seeking treatment: a follow-up study.

              The goal of the current study was to examine types of exposure to traumatic events and affective and anxiety disorders of 81 civilian war survivors seeking treatment for war-related stress almost one decade following the war in the area of former conflict. Furthermore, the study investigated changes in symptoms of mental health and in well-being amongst these individuals during a treatment period of 6 months. The results indicated that civilian war survivors seeking treatment reported multiple war-related traumatic events and high levels of psychiatric morbidity. Individuals assessed at follow-up (n = 67) reported no change in post-traumatic stress symptoms or psychological well-being, but improvement in symptoms of depression, overall psychiatric distress and quality of life. The only significant difference between participants classified as achieving clinically significant improvement as compared with those who did not achieve such change was in less symptom severity of depression, post-traumatic stress, general distress and higher psychological well-being at the time of first assessment. Neither the assessment of initial diagnoses nor war or post-war trauma types emerged as significantly different amongst the two groups.

                Author and article information

                URI :
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                04 February 2014
                07 April 2014
                : 2
                1Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University , Mannheim, Germany
                2Whiteray & Delving Ltd. , Helsinki, Finland
                3Vanha Vaasa Hospital , Vaasa, Finland
                4Ministry of Health of Republic of Kosovo , Pristina, Kosovo
                Author notes

                Edited by: Tilman Steinert, Centres of Psychiatry Suedwuerttemberg, Germany

                Reviewed by: Tilman Steinert, Centres of Psychiatry Suedwuerttemberg, Germany; Martin Zinkler, Kliniken Landkreis Heidenheim gGmbH, Germany

                *Correspondence: Hans Joachim Salize, Mental Health Services Research Group, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, D-68159 Mannheim, Germany e-mail: hans-joachim.salize@

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Public Health.

                Copyright © 2014 Salize, Lavikainen, Seppänen and Gjocaj.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Figures: 1, Tables: 2, Equations: 0, References: 16, Pages: 6, Words: 4372
                Public Health
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