Support to persons with mental health problems in Macedonia is provided almost explicitly by public institutions. Private service providers and relevant NGOs have minimal relevant activities, since this sector still remains almost closed. Currently, there are 19 mental health outpatient facilities in the country (World Health Organization, 2015), as well as six mental health day treatment facilities (three provide treatment for children and adolescents only). There are also 4 mental hospitals and 12 psychiatric units in general hospitals, including specialized units for children and adolescents (1% of beds in mental hospitals reserved for children and adolescents only). Of all outpatient mental health facilities available in the country, about 14% are specialized for children and adolescents. Only 6% of all users treated in mental health outpatient facilities were children or adolescents. Programmes for addressing mental health problems are neither sufficient, nor comprehensive. Community mental health services for children and youth are still underdeveloped. There is also a lack of professional staff in the country specialised in mental health problems for children (psychiatrists, psychologists and social workers for children and adolescents), although nowadays there is separate medical specialization in Child and Adolescent Psychiatry with a total duration of 60 months.
Persons with mental health problems and disabilities in general routinely face exclusion from the labour market, public services and social life. In the Republic of Macedonia, the stigma for disabilities, which in other countries would pose little obstacle to leading a “normal” life, remains severe. Besides the stigma, a number of issues that are very important for the protection and rehabilitation of persons with disabilities are not appropriately resolved in the existing laws and by-laws in the areas of social protection, education and health. Other burdens are related to the lack of appropriate infrastructure, as well the insufficient strategic, organizational, and human capacities for improving the situation of persons with disabilities.
The existing physical barriers to access housing buildings, streets, public transport, public facilities etc. remain among the most burnings issues for the persons with disabilities, alongside with the lack of programmes for their inclusion in the labour market and improvement of the overall social inclusion. At the same time, prejudice and stereotypes in the general public regarding persons with disabilities have not been properly tackled, having as a consequence discrimination against persons with disabilities on a daily basis as all levels (community, labour, educational, even family).
Based on the above, the main challenges related with the support of persons with disabilities include:
- Insufficient information about the number and the characteristics of persons with disabilities in the country, which would facilitate the design of effective policies and strategies promoting their social inclusion
- Low engagement and motivation of persons with disabilities for actively contributing to identifying and serving their own needs
- Support structures haven’t still been decentralised, with central institutions providing low-level services
- Lack of deinstitutionalised approach and mentality, which would help persons with disabilities be integrated in their local communities
- Lack of diversified mental health services, following an integrated approach
- Lack of specialised professionals able to provide integrated rehabilitation services, enabling people with disabilities to live in the community rather than in institutions
- Engaging municipalities and institutions at local level to design community based services for persons with disabilities
- Low level of sensitisation of the general public regarding the rights of persons with disabilities
KMOP has worked for more than 10 years for the benefit of persons with disabilities (mainly mental disorders), utilising community-based services mainly for the benefit of persons with mental disorders. In fact, KMOP has been operating for several years three Care Homes and a Day Care Centre that provide competent, integrated and non-stigmatising mental health services. At the same time, KMOP has implemented various programmes aiming at building the skills and competences for persons with disabilities and promoting them to the labour market. Therefore, KMOP’s solid background in supporting persons with disabilities can be extremely useful also for the current challenges in the Republic of Macedonia.
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