Living as a longterm psychiatric service user in Serbia: the importance of community-based mental health support

Abstract

The reform of the mental health care system in Serbia started 15 years ago when significant advances were made at the level of national strategies and policies, advocating for the gradual transition from solely in-patient treatment to the development of community-based services, as well as improving the quality of life of people with psychosocial difficulties. However, the treatment of people with mental health problems is still based almost exclusively on the medical model and the provision of pharmacotherapy, often within closed psychiatric institutions, and with a very limited number of community support options available, especially outside Belgrade. The COVID-19 pandemic has brought additional restrictions in terms of the availability and quality of mental health services. Therefore, people with mental health difficulties, especially those from psychotic spectrum disorders, remain an extremely underprivileged and socially invisible group in the Serbian context, facing low quality of life because of poverty, social exclusion, stigmatization, and lack of care and support. This talk will rely on a qualitative study of the everyday experiences and quality of life of people diagnosed with a psychotic disorder, who have been users of psychiatric services for years (even decades), and are also users of some community-based mental health support programs. We will focus on both the challenges and difficulties they face and their strengths and resources, with the aim of highlighting the ways in which mental health community support can contribute to them leading a meaningful and fulfilled life (by providing structure, occupation, and the opportunity for creativity), maintaining some continuous social relationships, and experiencing a sense of agency and control as opposed to passivity and apathy. Finally, we will also address some unmet needs of this population in the local context, especially concerning self-organized associations of users of psychiatric services that work without systemic support.