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Mental health services for war-affected children

Report of a survey in Kosovo

Child Advocacy International and Centre for Family Research, Cambridge University, UK

Alban Rrustemi

Department of Computer Science, Computer Laboratory, Cambridge University

Mimoza Shahini, MD and Aferdita Uka, MD

Department of Neuropsychiatry, University Clinical Centre, Prishtina, Kosovo

Correspondence: Lynne Jones, Centre for Family Research, Free School Lane, Cambridge CB2 3RF, UK

Declaration of interest None. Funding details in Acknowledgements.

Background In war-affected societies it is assumed that the major mental health problem facing the population will be stress reactions.

Aims To describe the creation of a child and adolescent mental health service (CAMHS) in Kosovo after the military conflict ended in 1999, and to establishthe range of problems and diagnoses that presented.

Method Data were collected on 559 patients over 2 years, including their referring problems and diagnoses.

Results Stress-related disorders constituted only a fifth of the case-load in year 1. A substantial number of patients were symptom-free but attended because they had been exposed to a traumatic event, and believed it might make them ill. Non-organic enuresis and learning disability were the most common diagnoses in year 2. Many patients had a complex mix of social and psychological difficulties that did not fit conventional diagnostic categories.

Conclusions Mental health services that only address traumatic stress may fail to meet the needs of war-affected children. A comprehensive, culturally appropriate CAMHS is needed to address a wide range of problems including learning disability. It should be developed through local actors, and build on existing local infrastructure. Services can also have an educational role in ‘depathologising’ normative responses.

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