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Kosovans should not be sent home before mental health needs are assessed

BMJ 2004; 328 doi: (Published 01 April 2004) Cite this as: BMJ 2004;328:790
  1. Susan Mayor
  1. London

    The Home Office should assess the mental health needs of people who fled to England from the conflict in Kosovo before deciding whether to repatriate them because services are inadequate to treat them appropriately if they return home, a report has warned.

    The report, Mental Health Services in Kosovo, was compiled because increasing numbers of people who left Kosovo during the campaign of “ethnic cleansing” in the late 1990s have been told by the Home Office to return. The Medical Foundation for the Care of Victims of Torture, a charity that works with survivors of torture and organised violence, was concerned to ensure that people were not going back to a place unable to provide appropriate mental health care.

    During 2003, researchers funded by the charity carried out an empirical study assessing the mental health facilities and services in Kosovo for people with mental illness and survivors of torture and organised violence. They gathered information from documentary sources, including relevant policies, and by questioning people working in the delivery of health services in Kosovo about processes, treatments, and resources in mental health services.

    The researchers found that a small number of health professionals were making “remarkable efforts” to tackle the psychological and physical consequences of the 1999 war. A mental health strategic plan had been developed and was being implemented, with the opening of six psychiatric wards (providing a total of 154 places for severely chronically ill and/or acutely ill patients) and seven community mental health centres.

    However, psychiatric treatment was mainly based on drug treatment, which was limited both in range and supply, and wards did not provide outpatient treatment or follow up care. The community centres were not attended by people with post-traumatic stress disorder or by children or women who had been physically or sexually abused. Some services were notavailable to Serbs, and people living in areas where they formed a minority were reluctant to use local services.

    Dr Helen Bolderson, former reader in social policy at Brunel University, London, and one of the authors of the report, said: “Overall, services were considered far from adequate to meet the needs of the people already present in Kosovo.” She added: “It is unlikelythat services would be able to meet the needs of Kosovan survivors of organised violence requiring treatment, if they were repatriated.”

    The medical foundation pointed out that failure to assess properly the mental health needs of Kosovans being repatriated ignored a guideline from the United National Interim Administration Mission in Kosovo that “no-one with an illness or injury that is untreatable in Kosovo should be forcibly returned until such time as the need fortreatment has ended.” Dr Bolderson considered that the Home Office had previously had insufficient information about health services “on the ground” in Kosovo to assess whether the health needs of people being repatriated could be met. She hoped that the report wouldprovide a more accurate assessment of this issue.

    Mental Health Services in Kosovo is available from the Medical Foundation for the Care of Victims of Torture, 111 Isledon Road, London N7 7JW (tel 020 7697 7777), price £5.

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