Mental Health in North MacedoniaThe World Health Organization (WHO) has recently worked to help citizens improve their mental health in North Macedonia. In North Macedonia, the insurance fully covers mental health services and psychotropic medicines. According to the Mental Health Atlas, there were 179 psychiatrists in the country as of 2020.

There were also 20 hospital-attached mental health outpatient facilities as opposed to zero “community-based/non-hospital” mental health facilities. And other mental health facilities totaled 32.

The Mental Health Atlas also reported four mental hospitals and eight psychiatric units in general hospitals. In addition, there were 376 mental health nurses in North Macedonia, with the country spending 7.3% of its total health expenditure on mental health.

The Pressures of Poverty

In 2022, the WHO stated that nearly 40% of the nation’s residents were “at risk of poverty or severe material deprivation in 2019.” COVID-19 added to preexisting barriers to health equity, causing many to experience mental health challenges.

Rising costs of basic necessities pose another threat to impoverished citizens of North Macedonia. According to UNICEF, a 25% increase in household energy/heating costs and a 29% increase in food costs could disproportionately affect poorer households with multiple children.

A 2022 UNICEF mental health workshop for social protection frontline workers provided evidence of the negative effect of poverty on mental health in North Macedonia. Workers interested in learning how to cope with stress and build resilience shared their experiences with stress caused by daily dealings with complex cases of poverty and related adversities.

Economic Effects of Global Crises

COVID-19 took a toll on mental health in North Macedonia. In 2022, WHO also added that the pandemic diminished social and financial protection systems, leading to substantial mental health challenges. Furthermore, a 2023 UNICEF report highlighted a link between the pandemic and symptoms of anxiety and depression among the country’s residents.

The report examined 11 nations, including North Macedonia, and showed a statistically significant relationship between personal exposure to the virus and anxiety/depression symptoms in adults. Around 42% of adolescent respondents also reported moderate to severe symptoms of anxiety in response to the pandemic.

The recent conflict between Russia and Ukraine has also affected nations, including North Macedonia. According to UNICEF’s 2022 Country Office Annual Report, North Macedonia’s economy, which was recovering from the blow it suffered during the pandemic, faced another setback due to the war. Unfortunately, these economic events also pose risks to mental health in North Macedonia.

Economic Threats to Mental Health

Ongoing trends suggest that economic instability threatens mental health in North Macedonia. In a 2015 review, Ben Fell and Miles Hewstone argued that poverty increases the risk of mental illnesses such as anxiety, depression, schizophrenia and drug addiction.

Instances of poverty’s harmful effect on mental health exist abroad. A 2020 article by Lee Knifton and Greig Inglis revealed that in 2018, 23% of men and 26% of women in the most impoverished areas of Scotland reported symptoms of possible psychiatric disorders, as opposed to 12% of men and 16% of women in its most well-off areas. With a heightened risk of poverty comes a threat to mental well-being.

Systemic Barriers to Quality Care

Recent reforms have focused largely on North Macedonia’s mental health system. A May 2022 WHO news release reported that from 2000 to 2008, WHO and the Ministry of Health initiated reforms that moved North Macedonia’s mental health care out of hospitals and into community mental health centers.

This migration of mental health care reflects a need to remove patients from the negative conditions of hospital-based mental health units. A 2010 BalkanInsight article revealed that conditions at the Demir Hisar psychiatric hospital in North Macedonia were dehumanizing and that hospitals like Demir Hisar were underfunded and understaffed.

WHO Takes Action

Between 2008 and 2017, the WHO’s efforts to improve the mental health situation in North Macedonia faced challenges that were due to a reduction in government support for community-based mental health services.

In 2018, the Republic of North Macedonia adopted the new National Strategy for the Promotion of Mental Health. Goals include decentralizing mental health services, decreasing the number of psychiatric hospitals and strengthening staff at community mental health centers, according to a May 2022 WHO news release.

Stojan Bajraktarov, director of the Psychiatric Clinic in Skopje, North Macedonia, explained that education, communication and cooperation are key in delivering quality mental health care at a primary care level.

Taking Inspiration from Crisis

The pandemic, while tragic, has also provided an opportunity to improve access to quality care for mental health in North Macedonia. The pandemic inspired many to push health equity higher up the political agenda, said Anne Johansen, WHO’s special representative to North Macedonia. Overall, this can have lasting positive impacts on the country and its residents.

– Noel Teter
Photo: Pixabay

Human Trafficking in North MacedoniaNorth Macedonia is a small Balkan country and according to the Freedom House Index, it is considered a partially free country. This means that when combining political rights and civil liberties, the score is not high enough to be considered a free country. Intimidation into voting for certain parties, corruption and lack of government transparency are the main political issues. Also, the score for civil liberties is low when it comes to issues such as a fair judicial system, corruption, forced labor and child marriage. These last issues suggest that human trafficking in North Macedonia remains a serious problem. Despite this, the country has made some improvements recently that are worth knowing about.

Human Trafficking and Poverty

The economic conditions in the country and its weak judicial structure facilitate the work of criminal organizations. Foreign and local women are mainly the victims of forced labor in nightclubs. The victims are also sent to and exploited in other European countries. This also suggests that North Macedonia serves as an easy destination to coordinate international human trafficking. In addition, child labor and forced marriage are mainly caused by human trafficking.

According to a report published by the U.S. Department of Labor, more than 18% of children between the ages of 5 and 14 are working rather than receiving an education. These children are normally forced into begging or other types of street work. Adolescent girls are also victims of sexual exploitation.

Furthermore, the Roma ethnic community is especially vulnerable to human trafficking in North Macedonia. Roma children face discrimination in the education system, as most schools do not provide classes in Romani. This condition makes the Roma community the one with the lowest education rates in the country. Therefore, it incentivizes both perpetual poverty and an increase in child marriage. Roma girls are, thus, especially vulnerable victims of trafficking for the purpose of forced marriage.

How is the Situation Improving?

The most recent improvements to combat human trafficking in North Macedonia are focused on:

Due to the National Strategy 2021-2025, the government has implemented some positive measures in order to increase the victim’s protection. In 2021, 48 victims were identified, compared to seven the previous year. Of these, 40 were victims of forced labor. The Ministry of Labor and Social Policy (MLSP) created groups formed by NGO volunteers, social workers and officers in order to improve protection efforts. For example, during the last six months of 2021, these groups managed to detect more than 200 vulnerable people. Furthermore, the government also increased the funds dedicated to protection. More than $22,000 was earmarked to increase the safety of victims, as well as the quality and capacity of shelters. It also dedicated more than $8,000 to the activities performed by the MLSP groups.

Decreasing the educational gap between Roma and non-Roma children is among the top priorities in order to reduce the vulnerability of this specific group. In recent years, North Macedonia has made some improvements. The Directorate for Development and Promotion of Education in the Languages of Minorities is responsible for improving the quality of education for minority groups such as the Roma ethnic group. By 2019, the Directorate included two Roma employees in order to better address the necessities of this community. Moreover, in November 2022, the Ministry informed that 40 Roma employees will work as mediators in schools with the highest numbers of Roma students in order to improve their educational experience and decrease the dropout rates.

In order to increase the prevention of future cases, the National Commission (NC) and the MLSP incorporated the feedback given by victims in order to implement effective action plans. Thanks to these recommendations and the assistance granted by international groups, the NC managed to conduct four different investigative projects focused on the prevention of trafficking. The government also focused on increasing awareness among vulnerable people, especially young students in order to avoid the risk of human trafficking in North Macedonia. It also implemented a system focused on labor inspections to ensure that companies are not involved in human trafficking and criminal acts.

– Carla Tomas Laserna
Photo: Flickr