Transformation of hospital-based mental health care has been widely discussed in post-communist countries. However, there are still doubts about the efficiency of community-based care, particularly because of hospital— and drug-based traditions.

We worked between October 1999 and July 2000 as medical doctors in community shelters in Peje, Kosovo with a Czech Republic non-governmental organisation, ‘People in Need’. We found that the conflict in Kosovo brought an opportunity to review the whole approach of the mental health system.

During the 1990s many Albanian physicians had been fired from jobs at public hospitals. Kosovo Albanians were often forced to seek medical care in private institutions or turn to humanitarian agencies. In May 1999, most of the Serbian minority left Kosovo, including medical staff. International institutions are now working with local doctors to fill the gap in the health care system. Kosovo, with a population of 1.8 million, had only approximately 25 psychiatrists (July 2000). Medication and hospitalisation are the only tools professionals use to deal with psychiatric disorders. The same doctors usually provide neurological and psychiatric care.

Despite this situation, the future mental health services in Kosovo will be oriented towards a community-based approach. World Health Organization adviser Liliana Urbina considers this model not only more humane but also more cost-effective and more affordable for local conditions (L. Urbina, personal communication, 2001). Community-based mental health centres are planned to organise day hospital and out-patient care, individual and group therapeutic activities, manage sheltered accommodation and a psychiatric ward for those with acute psychiatric disorders (one bed per 16 000-18 000 population). The team of 20 professionals will respond to the mental health needs of 250 000-350 000 inhabitants.

Local doctors are now being offered training in places where the concept of community-oriented psychiatry is developing such as Trieste (Italy), Asturias (Spain) and Birmingham (UK). Although local staff, who had to deal with hundreds of international organisations, often suffered from “mission fatigue” (Reference Black and TosicBlack & Tosic, 1999), they seem to be attracted by this concept.