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Media as Psycho-social Support for Young People

Organization

Humanitarian Organisation Duga

Contact details

Vasic Marina, Project co-ordinator
Izetbegovic Anka, Director
HO Duga
Kalemova 34
71000 Sarajevo
Bosnia and Herzegovina
Tel: +387 33 670 249
Email: info_duga@yahoo.com

Project partners

Primary and secondary schools
Centre for Social Welfare
Community mental health centres
Health centres
Ministry of Social Welfare
Ministry of Health

Location

Sarajevo, Bosnia and Herzegovina

Background

The Project has its origins in three key factors:

• Médecins du Monde and mental health professionals from Bosnia set up a psychological reception and support centre for adolescents in Sarajevo;

• the need to provide psychological support to children and adolescents of Sarajevo, traumatised by war;

• a government-inspired project to restructure mental health services with a community-based approach.

In pre-war Bosnia the healthcare system was focused on hospitals and clinics to the detriment of primary healthcare structures. Psychiatric services were well established and organized according to the following principles:

• Psychiatrists worked very closely to the primary healthcare worker, using primarily drug-based therapy and gave little importance to psychotherapy. Psychiatric care for children and adolescents was provided in the Hospital Clinic for child psychiatry. Little attention was given to preventative care or the role of the community;

• the psychiatric service in Kosovo Hospital had multidisciplinary patient therapy teams involving both mental health specialists and non-medical specialists such as social workers. Their main activity was to take care of patients' social problems and ensure their links to the external world on discharge;

• the treatment of alcoholism and drug addiction was attached to the hospital day-care service, which was trying to develop a methadone programme;

• children and adolescents with special needs were treated in specialized institutions within a system of special social protection.

It became evident, especially during the war, that a new community-based approach was needed. During the war, children and adolescents came under severe stress. They were constantly confronted by their parents' anxiety for their safety; their movements were restricted; they missed school and were cut off from their friends. The educational system was seriously disrupted. Classes were interrupted or continued in incredible conditions - in dungeons, without books, and even without qualified teachers. As a result countless children suffered psychological distress. Some psychological problems are already evident, but most will be expressed at some time in the future. Diagnosis, therapy and prevention work in the post-war period has to adopt a psycho-socio-cultural model of approach to tackle the issues at question. Mental health services started to shift from the medical model to the social model of provision.

Aims and objectives

Main aim

To enable young people to find their own way and contribution to society through their strengths and capabilities

Objectives

• Offering mental health protection to children and adolescents in accordance with new healthcare system policy.

• Meeting the needs of children and adolescents for social and psychological support, and welcoming them to a readily accessible Centre.

• Extending that support to their families.

• Creating awareness in the community of the psycho-social problems and introducing preventive action in which the community can actively participate.

• Supporting the most vulnerable children and adolescents by offering the specific treatment methods or personalized support and mentoring.

• Offering training opportunities for health, education and social work to professionals working in the psycho-social aspects of adolescence.

• Establishing and maintaining links with institutions and partners able to contribute to the support of the target population.

• Establishing partnerships with local and international agencies involved with the target population.

Participants

The multi-disciplinary team of professionals working on the project consists of two psychiatrists, a social worker, two psycho-pedagogues, a special pedagogue, a psychologist, a speech therapist and collaborators - a photographer, art designer and journalist.

Target population

Children and adolescents from four to 24 years of age, as well as parents.

Wider beneficiaries

Teaching staff and the local community in general.

Involvement of target population

Clients are involved in various activities at all stages of this project. They are also involved in evaluation, through questionnaires completed at the beginning and end of each individual treatment and group activity.

Summary of project

The project of 'Psycho-social support to children and adolescents' started in 1994. A Médecins du Monde mental health co-ordinator was sent to Bosnia to explore the situation. There were several organizations interested in children, but no projects for young people aged 12-18, despite the fact that adolescents are most vulnerable to psychological disturbances, especially in time of war.

The Bosnia Pilot Committee was set up in September 1994 and in April 1995 Centre Duga was officially opened. Duga was registered as a local non- governmental organization (NGO) in April 1999.

The aim and objectives are achieved through:

• individual consultations/psychotherapy, without the use of medication;

• psychological tests carried out by the clinical psychologist;

• treatment of developmental disorders by a special pedagogue;

• treatment of speech problems by the speech therapist;

• group activities.

The group setting is important and an indispensable element in the life and development of adolescents. Group activities have a dual purpose. Firstly, they are for children/adolescents who require socialization in a safe environment where they can explore their doubts and problems and thereby receive group support and understanding. Groups provide an opportunity to explore and heal while exposed to a variety of people with different ethnic and social backgrounds and with a palette of beliefs, values, attitudes and priorities. Secondly, group activities provide an invaluable chance for early detection of disturbances and appropriate intervention. Prevention work is particularly important in case of adolescents who are more likely than other groups to engage in high-risk behaviours and their consequences. It also provides an opportunity for social affirmation, development of skills and abilities, and constructive use of spare time.

The main concern for the youth population at present is boosting their morale and self-esteem in order to prepare them for future challenges in a society where the employment rate is very low and where young people hardly see any future perspective. Younger children who are returning with their families are faced with a new culture and language barriers, and adolescents who are returning to their homes of origin have to be integrated into a new environment such as schools and social networks.

Parents often need counselling and advice on how to cope with changes that their children are facing in the period of adolescence, as well as advice on how to cope with children with special needs.

Duga offers support to adolescents with special needs by equipping them with knowledge necessary for normal functioning within the community and ways of challenging prejudice and stereotyping.

10 group activities are divided into four sections:

Creative-socialization: Photo group, Journalist Group, Radio Group, Art Workshop, and Creative-socialization Group;

Support groups with elements of confrontation: Cinema Forum, Support Group, and School of Parenting;

Educational therapy: Group of Adolescents with Special Needs;

Prevention work: Bibliotherapy.

The Journalist Group produces an Alternative Youth Magazine Trash which is published every three months and is in close cooperation with the Photo Group for the purposes of illustrations and photos. Members of the Radio Group have live sessions every two weeks at the Student eFM Radio station.

Bibliotherapy has been introduced recently and is the first activity to take place in primary schools. It has been adopted according to the books and programme developed by Dr. Gervais from Quebec University in Canada. It is meant for children aged 8 to 12 who do not necessarily have any significant psychological disturbances. It is primarily prevention work aimed at developing strategies for coping with stress and anxiety imposed by different life circumstances, from divorce to relationships with disabled people. It has shown to be very effective and well accepted, and we are now exploring the possibility of expanding the programme.

Partners

Médecins du Monde

Funders

Médecins du Monde - France
CORDAID - Holland

Cost

Strengths of project

The young people find a neutral, discreet environment in Duga, compared with traditional institutions such as school or the clinic. They therefore feel more confident about coming forward to express their problems and less stigmatized by outmoded attitudes which still label people who need psychological support as 'insane'. The result is a much better relationship, which in turn increases the quality of the aid provided, and the potential for individuals to benefit. This combination of factors is an integral part of the community-based approach to psychiatry and the promotion of psychology outside the framework of the hospital.

Challenges

Developing a community-based approach to mental health and the reform of mental health service provision.

Evaluation

Internal evaluation is conducted every three months through questionnaires completed by clients, parents and therapists.

An external evaluation focusing on the organizational structure was conducted in 2000. In January 2002 a qualitative external evaluation report was completed.

Lessons learned

Through this project we discovered that adolescents are the most vulnerable section of the population. We learned that timely recognition of their problems is very important if we are to help them properly. The approach to each of their problems must be very serious and sympathetic.

Sustainability

Young people come willingly to Duga, because they know they will find professional and sympathetic help in a pleasant atmosphere, without being stigmatized.

Good ideas

• Offering a community-based approach to mental health.

• Providing psychiatric and psychological support to children and adolescents through individual consultations.

• Enabling beneficiaries of group activities to feel positive about themselves, as well as detection of any underlying psychological disorders.

• Providing career guidance to children and adolescents.

• Providing psycho-social support to the families of beneficiaries through consultations.

• Raising community awareness of mental health problems by organizing meetings and round-table discussions.

• Establishing links with institutions and partners providing psycho-social support to children and adolescents.

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