Obzornik zdravstvene nege, 55(4), pp. 228–236.
https://doi.org/10.14528/snr.2021.55.4.3151
Primary health care plays an increasingly important 
role. Countries which lack quality primary health 
care will not be able to ensure a universally accessible 
and financially efficient health system. The World 
Health Organization has already laid the groundwork 
for the development of primary health care with the 
adoption of the Declaration of Alma-Ata, which 
is now considered the "gold standard" for societal 
commitment to the development of this field (World 
Health Organization & United Nations Children's 
Fund, 2018). However, the development of primary 
health care must also be accompanied by the concurrent 
development of the nursing profession, as primary 
health care is expanded through newly developed 
programmes in which nurses assume advanced roles 
(Soares Ferreira, Devinar Périco, & Gonçalves Dias, 
2018). New programmes are also emerging in the field 
of mental health care, primarily in the development of 
community-based mental health services (Boschma, 
2012). 
In Slovenian language, the term "skupnostna 
psihiatrična obravnava" has come to refer to 
community(-based) mental health care (Jerič, 2015). 
In the field of nursing, community nursing in mental 
health care and psychiatry began to emerge in the 
United States, the United Kingdom and Italy as 
early as 1954. At that time, nurses were sent from 
psychiatric hospitals to monitor patients diagnosed 
with schizophrenia in their home environment. The 
main duties of these nurses were to monitor and guide 
patients with mental disorders; and their nursing 
activities were thus limited to monitoring patients' 
health and administering medication. Originally, the 
role of psychiatric nurses was based primarily on the 
traditional treatment of people with mental disorders in 
psychiatric hospitals. The community-based approach 
to treating people with mental disorders therefore also 
presented a challenge to the development of mental 
health care and psychiatry. In the advancement of 
community-based mental health care and psychiatry 
in the 1960s and 1970s, nurses played the central 
role in the development of novel community-based 
rehabilitation procedures and mental health services 
(Gournay, 2000; Boschma, 2012). 
Gradually, community mental health care became 
established in the system of mental health services 
around the world, including poorer countries. The 
Republic of Slovenia has signed several conventions, 
such as the Declaration Mental Health Action Plan for 
Europe, adopted at the WHO European Ministerial 
Conference on Mental Health in 2005, thus committing 
itself to comprehensive treatment of people with 
mental disorders at the local level and prevention of 
such disorders, which can only be ensured through 
regionalisation of services. According to Švab (2012), 
the term community mental health care refers to the 
treatment of persons with mental disorders and thus 
includes all forms of assistance an adult needs to live 
safely and independently in their own environment 
and their own community when experiencing 
problems with independence due to disabilities 
or special needs. Community mental health care 
relies on a network of interconnected services (e.g., 
selected psychiatrists, selected general practitioners 
and other health services, social work centres, work 
environments for people with mental disorders, 
informal networks of relatives and loved ones) whose 
role is to care for and support the individual on behalf 
of and for the benefit of the community (Švab, 2012). 
In this respect, community health care differs from 
community nursing. It is a synergy of services and 
collaborations within informal networks of important 
people and environments with the aim of helping the 
person with a mental disorder establish the highest 
possible level of functioning and enabling them to 
enjoy the highest possible quality of life. 
Editorial / Uvodnik 
The development of mental health care at the primary level: Community mental 
health care as an opportunity for nursing development 
Razvoj skrbi na področju duševnega zdravja na primarni ravni zdravstvenega varstva: 
skupnostna psihiatrična obravnava kot  priložnost za razvoj zdravstvene nege 
Jacinta Doberšek Mlakar
1, *
1
 Community Health Centre Sevnica, Trg svobode 14, 8290 Sevnica, Slovenia
* Corresponding author / Korespondenčni avtor: jacinta.mlakar@gmail.com
Received / Prejeto: 21. 11. 2021
Accepted / Sprejeto: 3. 12. 2021

Doberšek Mlakar, J. (2021) / Obzornik zdravstvene nege, 55(4), pp. 228–236. 229
In Slovenia, the programme of community mental 
health care has been developed since 2006. The 
programme was established on the basis of teams in 
psychiatric hospitals. It provides support to people 
with mental health disorders to function in their home 
environment (Jerič, 2015).
At the primary level of health care, four regional 
community mental health centres started operating 
in Slovenia in 2013: the community mental health 
centres of Posavje, Koroška, Prekmurje, and Dolenjska 
with Bela Krajina. Operating under the auspices 
of health centres, these community mental health 
centres provide outpatient specialised mental health 
services delivered by a multidisciplinary team of 
health professionals. One such multidisciplinary team, 
consisting of two registered nurses, a psychiatrist, an 
occupational therapist and a psychologist, provides 
mental health services to 70,000–90,000 individuals. 
It mainly includes people with severe and recurrent 
mental health disorders (Doberšek Mlakar, 2017). The 
most important reason for treating people with mental 
health problems in their home environment is that this 
is an effective approach to treatment and support, as it 
involves a cohesive network of different services and 
patients' relatives, which leads to better cooperation 
in treatment. Professional assistance is also provided 
to those who have been offered help very late in the 
worsening of the illness and to those who have not yet 
received adequate support (Švab, 2012). 
Švab (2012) adds that a registered nurse, as a 
member of the multidisciplinary team, performs 
a very autonomous role in assessing, planning, 
implementing, monitoring and evaluating the patient's 
levels of ability and independence in their basic life 
activities, supports patients with mental disorders and 
their family members, and coordinates the network of 
different services and people in the local community. 
This means that nurses deal with professional content 
for which they have not been properly trained.
Despite the growing awareness of society about the 
occurrence of mental disorders and the increasing 
coexistence with people with mental disorders, 
their stigmatisation is still extremely widespread 
(Resolution on the National Mental Health Programme 
2018−2028, 2018). For this reason, treating people 
with mental disorders within their local communities 
has many benefits (Konec Juričič, 2016). Firstly, this 
approach ensures easier access to appropriate help 
and thus faster identification of the needs of people 
with mental disorders and their families. Community 
health care for people with mental health problems 
enables a comprehensive, coordinated, continuous, 
responsive and individualised treatment based on 
comprehensive assessment of the patient's needs, 
an active role of the patient and their relatives, and 
an equal relationship between the patient, their 
relatives and the members of the medical team. This 
leads to patient's greater independence and faster 
resocialisation as a result of the engagement of experts 
based on the teamwork of all professional services in 
the field of mental health, as well as the involvement 
and attention of local communities and civil society. 
It is important that a person with a mental disorder is 
treated in their living environment, in their home, and 
does not have to fear the 'stigma' of institutionalisation 
represented by a psychiatric hospital. 
Collaboration between services in the local 
environment is based on the specific needs of the 
patient and aims to address all dimensions of the 
patient's health in a comprehensive and continuous 
manner. This leads to a higher level of stability and 
quality of life for people with mental health problems, 
while continuous monitoring also enables the 
provision of timely help. Another crucial aspect in this 
context is also good collaboration with psychiatric 
treatment at secondary and tertiary levels of health 
care (Švab, 2012), as modern treatment of mental 
disorders represents a balance between interrelated 
hospital and community services (Thornicroft & 
Tansella, 2013). Along similar lines, since 1998, 
several Slovenian authors have argued (Škerbinek, 
1998; Sedlar, 2002; Švab, 2012; Kramar Zupan, 2013) 
that the needs of people with mental disorders mostly 
originate from the field of basic life activities, i.e. the 
field of nursing, and that these needs are related to 
the physical and psychosocial functioning and quality 
of life in the individual's immediate home setting 
and wider community environment. Therefore, the 
nursing profession plays the most important role in 
community mental health care. Thornicroft, Deb, & 
Henderson (2016) state that the greatest challenge in 
mental health care is the general disregard for the fact 
that the vast majority of people with mental disorders 
do not receive treatment. This means that there is a 
need to provide most of the relevant services in non-
specialist settings, i.e., community-based primary 
health care services, as these forms of services allow 
for much greater and easier access.
The experience of the community mental health 
team at the primary level shows that the key 
measures of community mental health treatment 
and rehabilitation include regular visits, which help 
establish a trusting relationship, support, defusing 
sessions and motivation for decision-making. These 
measures establish, strengthen and maintain trust 
in the relationship between the members of the 
community mental health team and the person with 
mental health problems. Trust is often the basic and 
only instrument used in the therapeutic relationship, 
especially in cases where the patient refuses medication 
therapy and comprehensive professional treatment 
(Doberšek Mlakar, 2017). The therapeutic relationship 
based on trust between the person with a mental 
disorder and the nurse is the essence or foundation 
of all mental health and psychiatric care. Although a 
good therapeutic relationship contributes significantly 

Doberšek Mlakar, J. (2021) / Obzornik zdravstvene nege, 55(4), pp. 228–236. 230
to the patient's successful coping with everyday 
problems, nurses often do not pay sufficient attention 
to this aspect of their professional role (Pazargadi, 
Fereidooni Moghadam, Fallahi Khoshknab, Alijani 
Renani, & Molazem, 2015). This seems to be especially 
characteristic of nurses entering this professional field.
According to modern guidelines for psychiatric 
treatment, people with severe and recurrent mental 
disorders with frequent relapses who are hospitalised 
against their will, who participate poorly in treatment, 
and who may also have been diagnosed with addiction 
or frequent abuse of psychoactive substances, must be 
placed in intensive care units of psychiatric hospitals 
and monitored continuously. Continuous treatment 
in the community provides this group of individuals 
with better quality of treatment, timely emergency 
response, and a higher quality of life, while also having 
a positive impact on the number of readmissions and 
shortening of hospital stays (Kauric, Jez, & Mazgon 
2012).
The Resolution on the National Mental Health 
Programme 2018−2028 (2018) was adopted by the 
National Assembly of the Republic of Slovenia in 
March 2018. With this resolution, Slovenia was 
given the opportunity to comprehensively regulate 
the entire field of mental health from prevention to 
treatment and rehabilitation. An important part of 
the resolution is the establishment of a network of 
mental health centres in local settings, as they provide 
better access to mental health assistance. Since 2019, 
in Slovenia we have established mental health centres 
for adults (MHCA) and mental health centres for 
children and adolescents (MHCCA), based on the 
model and experience of community mental health 
care. Each MHCA consists of two multidisciplinary 
teams: an outpatient team and a mobile community 
team. An MHCA multidisciplinary team consists 
of the following professionals: registered nurses, 
psychiatrists, psychologists, clinical psychologists 
and an occupational therapist. An MHCCA consists 
of registered nurses, a child psychiatrist, clinical 
psychologists, psychologists, a special education 
teacher, an occupational therapist, a speech therapist 
and a clinical speech therapist.
New forms of mental health care also offer new 
employment opportunities for registered nurses. While 
an outpatient MHCA team employs one registered 
nurse, the community team includes five registered 
nurses. A MHCCA employs two registered nurses, in 
addition to other experts (Zakotnik, 2019). Currently, 
Slovenia is experiencing a historical and systemic shift 
in the  care of people with mental disorders from the 
institutional model represented by the hospital to 
that of the home setting (Resolution on the National 
Mental Health Programme 2018−2028, 2018). This 
new form of treatment in the home setting is also 
something that nurses have to adapt to by acquiring 
new knowledge and professional skills to implement 
different and more autonomous approaches. In the 
international context, the professional profile of the 
community mental health nurse has been established 
in this field (Ryan, 2017). 
In Slovenia, the professional community has not 
yet reached an agreement on the establishment of this 
professional profile following the example of other 
countries where the work of a nurse with people with 
mental disorders in the community is the standard. 
Of course, it is not only the title that is important, 
but also the fact that nurses in this field need more 
knowledge to develop new competencies that are 
expected of them. These are more independent and 
advanced competencies than those of a nurse with 
a general training in nursing. In Slovenia, a nurse in 
this field needs to be trained as a clinical specialist 
in the field of mental health (Bregar et al., 2013). A 
review of the literature (Kalan, 2017) shows that 
nurses working in the community are authorised to 
prescribe medication, conduct clinical research, write 
treatment protocols, conduct psychotherapy, and 
formulate mental health policies, which fall under the 
competencies of advanced nursing.
In practice, the intertwining of the nurse's 
professional individuality with the multidisciplinary 
team and the simultaneous development of the 
required competencies represent both a challenge and 
an opportunity for the development of mental health 
and psychiatric nursing in Slovenia. At the primary 
level of health care, the community mental health nurse 
working in a residential setting is thoroughly focused 
on the holistic psychophysical state of the patient and 
their family, and is able to triage and manage daily 
task that may change on a daily basis. Key attributes 
for this professional role include the nurse's personal 
maturity and ability to manage their own emotional 
responses in stressful situations - for example, 
when the patient's health deteriorates in their home 
environment or during initial visits. The nurse must 
therefore be flexible and open to the peculiarities of 
different cultural and social environments. The nurse's 
responsibilities include motivating the patient to 
follow medication regimens, preparing medications, 
administering depot medications, and assessing the 
patient's reactions and side effects. Moreover, the 
nurse works closely with other members of the health 
care team and also provides health education through 
which people with mental health problems gain 
skills in self-observation and management of their 
condition.
The entire process of community mental health 
treatment begins with triage, assessment of the 
patient's condition, and identification of their specific 
needs. After the patient's gives their consent, the initial 
and subsequent visits are conducted and a treatment 
plan is developed with short- and long-term goals for 
improving the patient's functioning and quality of life 
in their home setting and broader community. This plan 

Doberšek Mlakar, J. (2021) / Obzornik zdravstvene nege, 55(4), pp. 228–236. 231
also includes cooperation and networking between the 
various agencies and the patient's relatives, physicians, 
selected psychiatrists, the employment office, schools, 
hospitals, NGOs, individuals and family members, and 
gradual involvement of the patient in various forms of 
home and other activities. As the person's functioning 
improves, the frequency of visits, treatment and 
support sessions gradually decreases. Conversely, as 
the person's psychophysical condition deteriorates, 
treatment sessions become more frequent again. 
Implementation of the treatment plan is adjusted 
both on a regular basis and bi-annually. The treatment 
plan is designed to be accessible, understandable and 
within the capacity and capabilities of the person 
with a mental disorder. The short-term plan, which 
is very important, can be a simple agreement about 
improving personal hygiene or using free time. We 
continuously educate our patients about these aspects 
and help them implement what they learn. In addition 
to health education knowledge, the nurse also needs 
additional knowledge on how to conduct motivational 
interviews and how to implement psychotherapeutic 
and counselling interventions.
Each patient is supervised by their case coordinator, 
who is also a team member and coordinates the 
patient's treatment, maintains regular contact with 
the patient, negotiates agreements, and keeps all 
documentation. The role of the case coordinator in 
this process is usually assumed by the registered nurse.
With the introduction of MHCA and MHCCA, 
mental health and psychiatric nurses were confronted 
with the challenge associated with the demands of this 
new professional environment and the need for new 
formal competencies. Due to the rapid development 
of mental health centres between 2019 and 2021, we 
estimate that there will be a great need for additional 
education, empowerment and provision of specialist 
competencies in community mental health nursing. 
W e anticipate that the first specialist training in mental 
health nursing will take place in early 2022, providing 
a deeper understanding of this area of work. We also 
expect postgraduate specialisation programmes to be 
introduced shortly thereafter. There is a clear need in 
professional practice for in-depth knowledge related to 
working with people with psychosis, eating disorders, 
depression, anxiety, obsessive compulsive disorder, 
addictions, post-traumatic stress disorder, as well as 
for knowledge related to mental health promotion, 
forensics, management and psychopharmacology. 
But most importantly, there is a lack of knowledge 
in motivational approaches, counselling and 
psychotherapy, which is the standard for every mental 
health nurse abroad.
The beginnings of the Posavje Community Mental 
Health Team were quite a challenge. The community-
based approach contains peculiarities which can only 
be perceived during practical work. The geographically 
diverse area of the Posavje region has its own cultural 
and local characteristics. We are dealing with a high 
tolerance of alcohol consumption, which often leads 
to addiction and problems in family dynamics and 
relationships. Entering one's home environment 
and personal space outside the controlled clinical 
environment has been shown to be challenging. A 
person with a mental disorder is often in a state of 
relapse, showing signs of deviant behaviour and 
lacking critical judgement. It is often necessary to first 
go through the basic trust-building phase and only 
then, sometimes after several weeks, take further steps 
in treatment. Over the span of several years, we have 
gained experience, observed and evaluated our own 
approaches, and identified the best practices. As the 
concern for one's own safety remains an important 
factor , most home visits are carried out by a professional 
team of two people. The lives of people with severe 
mental disorders (and their relatives) living outside 
the institutional environment are characterised by 
very specific features. They often live in disadvantaged 
conditions and their lives are thus uncertain in terms 
of psychophysical health maintenance. The integration 
of patients into the wider social world outside their 
place of residence can be hampered by geographical 
diversity, lack of resources, psychopathology, a poor 
network of NGOs and other rehabilitation services.
It is particularly difficult to take action against the 
patient's will, as we would damage the therapeutic 
relationship and lose the patient's trust, thus also 
losing the chance of favourable opportunities for 
further work by the community mental health team. 
The patient's relatives often do not see the severity of 
the condition, and may express feelings of helplessness 
and anxiety. According to Doberšek Mlakar (2017), 
the greatest advantage and "professional privilege" of 
the work of registered nurses is in that they frequently 
and continuously visit patients at home, in their 
residential community. For a person with mental 
health problems, their relatives, and for staff in other 
professional fields, the nurse is most usually the most 
important professional liaison (White & Hall, 2006). 
The established therapeutic relationship is based 
on a dynamic assessment of the patient's condition 
and needs. The nurse is therefore well familiar with 
the patient's role and abilities in the context of their 
functioning and life needs in their environment.
This approach enables the citizens of Slovenia 
to receive treatment at home. This significant 
breakthrough in the treatment of people with mental 
health problems has not been followed by the nursing 
profession. We need to make up for the missed 
opportunities by working with the National Institute 
of Public Health as the umbrella organisation for 
mental health centres. People with mental disorders 
must receive the optimal and highest quality care. In 
the international context, the standards for training 
have already been established. Now the possibility 
of clinical specialisation in the field of mental health 

Doberšek Mlakar, J. (2021) / Obzornik zdravstvene nege, 55(4), pp. 228–236. 232
must also be defined, as does the prospect of autonomy 
and formally recognised competencies of a specialist 
nurse.
Slovenian translation / Prevod v slovenščino
Primarno zdravstveno varstvo ima vse pomembnejšo 
vlogo. Brez kakovostnega primarnega zdravstvenega 
varstva države ne bodo mogle dosegati sistema 
zdravstvenega varstva, ki bo vsesplošno dostopen in 
finančno učinkovit. Svetovna zdravstvena organizacija 
je temelje razvoja primarnega zdravstvenega varstva 
postavila že z deklaracijo Alma-Ata, ki pomeni 
»zlati standard« za družbeno zavezanost k razvoju 
tega področja (World Health Organization & 
United Nations Children's Fund, 2018). Z razvojem 
primarnega zdravstvenega varstva se mora razvijati 
tudi stroka zdravstvene nege, saj se primarno 
zdravstveno varstvo širi tudi z novimi programi, v 
katerih zaposleni v zdravstveni negi dobivajo nove 
napredne vloge (Soares Ferreira, Devinar Périco, & 
Gonçalves Dias, 2018). Novi programi nastajajo tudi 
na področju duševnega zdravja, predvsem z razvojem 
psihiatrične obravnave v skupnosti (Boschma, 2012). 
V Sloveniji se je za psihiatrično obravnavo v skupnosti 
uveljavil termin skupnostna psihiatrična obravnava 
(Jerič, 2015). Na področju zdravstvene nege govorimo 
o skupnostni zdravstveni negi na področju duševnega 
zdravja in psihiatrije, katere začetke opisujejo v 
Ameriki, Angliji in Italiji že od leta 1954 dalje. 
Takrat so poslali medicinske sestre iz psihiatričnih 
bolnišnic za spremljanje pacientov z diagnosticirano 
shizofrenijo v njihovo domače okolje. Glavna naloga 
teh sester je bila spremljanje in vodenje pacientov z 
duševno motnjo zgolj z izpostavljenimi dejavnostmi 
zdravstvene nege opazovanja zdravstvenega stanja 
pacientov in aplikacije zdravil. Vloge psihiatričnih 
medicinskih sester so v začetku izhajale predvsem 
iz tradicionalne obravnave oseb z duševno motnjo 
v psihiatričnih bolnišnicah. Zato je bil skupnostni 
pristop do oseb z duševno motnjo tudi izziv za razvoj 
zdravstvene nege na področju duševnega zdravja in 
psihiatrije. Medicinske sestre so imele v nadaljnjem 
razvoju področja duševnega zdravja in psihiatrije 
v skupnosti v šestdesetih in sedemdesetih letih 
prejšnjega stoletja osrednjo vlogo pri oblikovanju 
novih rehabilitacijskih praks in storitev za duševno 
zdravje v skupnosti (Gournay, 2000; Boschma, 2012).  
Skupnostna psihiatrična obravnava je polagoma 
dobila svoje mesto v sistemu psihiatričnih služb 
povsod po svetu, tudi v bistveno revnejših državah od 
naše. Republika Slovenija je v preteklosti podpisala 
več konvencij, kot sta Deklaracija in akcijski načrt 
za področje duševnega zdravja v Evropi, sprejeta 
na Evropski ministrski konferenci SZO v Helsinkih 
leta 2005 (WHO European Ministerial Conference 
on Mental Health, 2005), s katerima se je zavezala 
k celostni obravnavi oseb z duševnimi motnjami 
na lokalnem nivoju ter k preventivi, ki jo je mogoče 
zagotoviti le z regionalizacijo služb. Skupnostna 
psihiatrična obravnava je po Švabovi (2012) obravnava 
oseb z duševno motnjo, ki se nanaša na vse oblike 
pomoči, ki jih odrasla oseba potrebuje, da bi lahko 
varno in neodvisno živela v lastnem okolju, lastni 
lokalni skupnosti, kadar ima zaradi oviranosti, bolezni 
ali posebnih potreb določene težave pri neodvisnem 
funkcioniranju. Skupnostna skrb temelji na mreži 
medsebojno povezanih služb (npr. izbrani psihiatri, 
izbrani osebni zdravniki in druge zdravstvene službe, 
centri za socialno delo, delovna okolja osebe z duševno 
motnjo, neformalna mreža svojcev, bližnjih), katerih 
poslanstvo je, da se v imenu in v korist skupnosti 
posvečajo posamezniku in mu pomagajo (Švab, 
2012). V tem se skupnostna obravnava razlikuje 
od patronažne obravnave. Gre za sinergijo služb in 
sodelovanje neformalnih mrež pomembnih oseb 
in okolij s ciljem, da se vzpostavi najvišje možno 
funkcioniranje osebe z duševno motnjo in najvišja 
mogoča kakovost življenja. 
V Sloveniji se od leta 2006 razvija program 
skupnostne psihiatrične obravnave (SPO), ki osebam 
s težavami v duševnem zdravju nudi podporo pri 
funkcioniranju v domačem okolju (Jerič, 2015) in 
se je oblikoval iz timov, zaposlenih v psihiatričnih 
bolnišnicah.
Na primarni ravni zdravstvenega varstva so v letu 
2013 v slovenskem prostoru pričeli delovati štirje 
regijski centri skupnostne psihiatrične obravnave 
(SPO): Posavje, Koroška, Prekmurje in Dolenjska z 
Belo krajino. Gre za zunajbolnišnično specialistično 
psihiatrično obravnavo, ki jo izvaja multidisciplinarni 
tim zdravstvenih strokovnjakov. Nosilci dejavnosti so 
zdravstveni domovi. Multidisciplinarni tim sestavljajo: 
dve diplomirani medicinski sestri, psihiater, delovni 
terapevt in psiholog. V SPO je multidisciplinarni 
mobilni tim izvajal psihiatrične storitve za 70.000–
90.000 prebivalcev. V obravnavo so bili vključeni 
predvsem posamezniki s hudimi in ponavljajočimi 
se duševnimi motnjami (Doberšek Mlakar, 2017). 
Najpomembnejši razlog za obravnavo oseb s težavami 
v duševnem zdravju v domačem okolju je, da gre za 
učinkovit pristop, ki v zdravljenje in podporo vključuje 
povezano mrežo različnih služb in domačih ljudi, 
kar vpliva predvsem na izboljšanje sodelovanja pri 
zdravljenju. To pomeni višjo kakovost življenja oseb s 
težavami v duševnem zdravju in njihovih pomembnih 
drugih. Strokovna pomoč je bila ponujena tudi 
tistim posameznikom, ki so do potrebne pomoči ob 
poslabšanju bolezni prišli zelo pozno ali pa ustrezne 
pomoči sploh še niso prejeli (Švab, 2012). 
Švabova (2012) dodaja, da diplomirana medicinska 
sestra kot del multidisciplinarnega tima opravlja zelo 
samostojno vlogo ocenjevanja, načrtovanja, izvajanja, 
spremljanja in ovrednotenja kapacitet in samostojnosti 
v vseh osnovnih življenjskih dejavnostih, nudi podporo 

Doberšek Mlakar, J. (2021) / Obzornik zdravstvene nege, 55(4), pp. 228–236. 233
osebi s težavami v duševnem zdravju in družinskim 
članom ter povezuje mrežo različnih služb in domačih 
ljudi, kar pomeni, da se ukvarja s strokovno vsebino, 
za katero ni nikoli pridobila ustreznih kompetenc.
Stigmatizacija oseb z duševno motnjo je kljub vedno 
večjemu ozaveščanju družbe o pojavnosti duševnih 
motenj in vse večjem sobivanju z osebami z duševno 
motnjo še vedno zelo velika (Resolucija o nacionalnem 
programu duševnega zdravja 2018–2028, 2018). 
Obravnava oseb z duševnimi motnjami v lokalnih 
skupnostih ima zato mnogo prednosti (Konec Juričič, 
2016). Najprej omenimo večjo dostopnost do ustrezne 
pomoči in s tem hitrejše prepoznavanje potreb 
ljudi z duševnimi motnjami in njihovih bližnjih. 
Skupnostna obravnava oseb s težavami v duševnem 
zdravju ponuja celovito, usklajeno, nepretrgano, hitro 
odzivno in posamezniku prilagojeno obravnavo, 
ki temelji na celoviti oceni potreb, dejavni vlogi 
pacientov in njihovih svojcev ter enakopravnem 
odnosu med pacientom, svojci in člani tima. To vodi 
v večjo samostojnost in hitrejšo resocializacijo, kar 
pomeni profesionalno delo strokovnjakov, ki temelji 
na timskem sodelovanju vseh služb oziroma vseh 
strok s področja duševnega zdravja, vključevanje in 
upoštevanje lokalnih skupnosti in civilne družbe. 
Pri tem je bistveno, da je oseba z duševno motnjo 
obravnavana v svojem okolju, na svojem domu in 
se ji ni treba bati »stigme« institucionalizacije, ki jo 
predstavlja psihiatrična bolnišnica. 
Gre za vzpostavitev sodelovanja med službami 
v lokalni okolici glede na potrebe pacienta z 
namenom celostne in kontinuirane obravnave vseh 
dimenzij njegovega zdravja. Tako se vzpostavljajo 
višja stabilnost in kakovost življenja oseb s težavami 
v duševnem zdravju ter zaradi kontinuiranega 
spremljanja pravočasna pomoč. Pomembno je tudi 
dobro sodelovanje s psihiatrično obravnavo na 
sekundarnem in terciarnem nivoju zdravstvenega 
varstva (Švab, 2012), saj naj bi sodobna obravnava 
duševnih motenj predstavljala ravnotežje med 
seboj povezanih bolnišničnih in skupnostnih služb 
(Thornicroft & Tansella, 2013). Podobno že od leta 
1998 več slovenskih avtorjev trdi (Škerbinek,1998; 
Sedlar, 2002; Švab, 2012; Kramar Zupan, 2013), da 
se potrebe oseb z duševno motnjo izražajo večinoma 
na področju osnovnih življenjskih dejavnosti, torej 
na področju zdravstvene nege, in se po vsebini 
nanašajo na fizično ter psihosocialno funkcioniranje 
in kakovost življenja v ožjem domačem in širšem 
okolju posameznika. Ravno stroka zdravstvene nege 
ima torej lahko v skupnostni psihiatrični obravnavi 
največji pomen. Thornicroft, Deb, & Henderson (2016) 
navajajo, da največji izziv pri oskrbi duševnega zdravja 
predstavlja visoka stopnja neupoštevanja dejstva, da 
se velika večina oseb z duševnimi motnjami po vsem 
svetu ne zdravi. To pomeni, da je nujno zagotavljanje 
večine storitev v nespecializiranih okoljih oziroma v 
primarnih storitvah zdravstvenega varstva v skupnosti, 
saj je dostopnost do teh oblik storitev mnogo lažja in 
večja.
Izkušnje tima skupnostne psihiatrične obravnave 
na primarni ravni kažejo, da so redni obiski in s 
tem vzpostavljanje zaupnega odnosa, podpora, 
razbremenilni pogovori in motivacija za sprejemanje 
rešitev ključni ukrepi skupnostnih psihiatričnih 
obravnav in rehabilitacije. Našteto vzpostavlja, krepi 
in vzdržuje zaupanje v odnosu članov skupnostnega 
psihiatričnega tima do osebe s težavami v duševnem 
zdravju. Zaupanje je pogosto temeljno in edino 
orodje terapevtskega odnosa, zlasti v primerih, 
ko oseba s težavami v duševnem zdravju odklanja 
medikamentozno terapijo, zdravljenje in celostno 
strokovno obravnavo (Doberšek Mlakar, 2017). 
Prav terapevtski odnos, ki temelji na zaupanju med 
osebo z duševno motnjo in medicinsko sestro, je 
bistvo oziroma temelj celotne zdravstvene nege na 
področju duševnega zdravja in psihiatrije. Kljub 
temu da dober terapevtski odnos bistveno pripomore 
k uspešnemu soočanju osebe z duševno motnjo z 
vsakodnevnimi težavami, medicinske sestre tega 
vidika svoje profesionalne vloge pogosto ne upoštevajo 
dovolj (Pazargadi, Fereidooni Moghadam, Fallahi 
Khoshknab, Alijani Renani, & Molazem, 2015). 
Slednje je še posebej značilno za medicinske sestre, ki 
na novo vstopajo na to področje.
Sodobne smernice psihiatričnega zdravljenja zahtevajo 
poleg intenzivnega zdravljenja v psihiatričnih 
bolnišnicah tudi nepretrgano spremljanje skupine 
oseb s hudimi in ponavljajočimi se duševnimi 
motnjami, ki se jim bolezen pogosto ponavlja, ki jih 
hospitalizirajo proti njihovi volji, slabo sodelujejo pri 
zdravljenju in imajo dvojne diagnoze z odvisnostjo 
ali pogostimi zlorabami psihoaktivnih substanc. 
Nepretrgana obravnava te skupine oseb v skupnosti 
zagotavlja boljšo kakovost obravnave, pravočasne 
nujne posege, izboljša kakovost življenja, vpliva na 
število ponovnih sprejemov in lahko skrajša obdobja 
hospitalizacije (Kauric, Jez, & Mazgon 2012).
Resolucijo o nacionalnem programu duševnega 
zdravja 2018–2028 (2018) je državni zbor Republike 
Slovenije sprejel marca 2018. S tem smo v Sloveniji 
dobili možnost, da celostno poskrbimo za področje 
duševnega zdravja od preventive do zdravljenja 
in rehabilitacije. Pomemben del resolucije je 
ustanavljanje mreže centrov za duševno zdravje v 
lokalnih okoljih, saj omogočajo boljšo dostopnost 
do pomoči na področju duševnega zdravja. Od leta 
2019 v Sloveniji iz modela in izkušenj skupnostne 
psihiatrične obravnave razvijamo centre za duševno 
zdravje odraslih (CDZO) in centre za duševno 
zdravje otrok in mladostnikov (CDZOM). Posamezni 
center za duševno zdravje odraslih sestavljata dva 
multidisciplinarna tima: ambulantni in skupnostni 
tim, ki je mobilen. Multidisciplinarni tim CDZO je 
sestavljen iz naslednjih strokovnjakov: diplomiranih 
medicinskih sester, psihiatrov, psihologov, kliničnih 

Doberšek Mlakar, J. (2021) / Obzornik zdravstvene nege, 55(4), pp. 228–236. 234
psihologov in delovnega terapevta. CDZOM sestavljajo 
diplomirani medicinski sestri, pedopsihiater, klinični 
psihologi, psihologi, specialni pedagog, delovni 
terapevt, logoped in klinični logoped.
Nove oblike organizacije pomoči na področju 
duševnega zdravja predstavljajo tudi nove možnosti 
zaposlitve diplomiranih medicinskih sester. V 
ambulantnem timu CDZO je zaposlena ena, v 
skupnostnem pa pet diplomiranih medicinskih sester. 
V centru za duševno zdravje otrok in mladostnikov sta 
poleg ostalih strokovnjakov zaposleni dve diplomirani 
medicinski sestri (Zakotnik, 2019). Danes smo v 
Sloveniji torej priča zgodovinskemu in sistemskemu 
organiziranemu premiku skrbi za osebe z duševno 
motnjo iz institucije, ki jo predstavlja bolnišnica, v 
njihovo domače okolje (Resolucija o nacionalnem 
programu duševnega zdravja 2018–2028, 2018). Z 
novo obliko obravnave v domačem okolju se pri 
nas soočajo tudi medicinske sestre, ki si morajo za 
drugačne in samostojnejše pristope pridobiti nova 
znanja in veščine dela. V tujini se je na tem področju 
uveljavilo delovno mesto community mental health 
nurse (Ryan, 2017). 
V Sloveniji stroka še ni dosegla dokončnega 
dogovora glede imenovanja navedenega delovnega 
mesta po zgledu tujine, kjer delo medicinske sestre 
z osebami z duševno motnjo v skupnosti predstavlja 
standard. Pri tem seveda ni pomemben le naziv, 
treba se je zavedati, da medicinske sestre na tem 
področju potrebujejo več znanja, da bodo prevzele 
nove kompetence, kot se od njih pričakuje. Gre za 
samostojnejše in razširjene kompetence, kot jih ima 
medicinska sestra s splošno izobrazbo iz zdravstvene 
nege. Zato je v slovenskem prostoru medicinsko 
sestro na tem področju treba izobraziti kot klinično 
specialistko s področja duševnega zdravja (Bregar et 
al., 2013). Pregled literature (Kalan, 2017) namreč 
kaže, da so medicinske sestre v skupnosti pooblaščene 
za predpisovanje zdravil, izvajanje kliničnih raziskav, 
pisanje protokolov, izvajanje psihoterapije, oblikovanje 
politike na področju duševnega zdravja, kar spada 
med kompetence napredne zdravstvene nege.
Prepletanje profesionalne individualnosti medicinske 
sestre z multidisciplinarnim timom in istočasno sledenje 
kompetencam sta se v praksi izkazala kot nov izziv 
in priložnost za razvoj zdravstvene nege na področju 
duševnega zdravja in psihiatrije v Sloveniji. Skupnostna 
psihiatrična medicinska sestra je na primarnem nivoju 
zdravstvenega varstva v skupnosti, kjer ljudje živijo, 
podrobno orientirana na celostno psihofizično stanje 
posameznika in družine ter sposobna triažirati in 
upravljati številne dnevno spremenjene prednostne 
naloge. Za njeno profesionalno vlogo sta pomembni 
osebna zrelost in sposobnost obvladovanja lastnih 
čustvenih odzivov v stresnih situacijah – na primer pri 
poslabšanem zdravstvenem stanju pacientov v domačem 
okolju ali ob prvih obiskih. Biti mora prilagodljiva in 
odprta za posebnosti različnih kulturnih in socialnih 
okolij. Njene pomembne naloge so: motivacija za 
jemanje medikamentozne terapije, priprava zdravil, 
aplikacija depo terapije, ocena odzivov in neželenih 
učinkov. Zdravstveno vzgojo izvaja z namenom, da 
si osebe s težavami v duševnem zdravju pridobijo 
spretnosti obvladovanja bolezni in samoopazovanja, ter 
tesno sodeluje z drugimi člani zdravstvenega tima.
Celoten proces skupnostne psihiatrične obravnave 
se prične s triažo, oceno stanja in ugotavljanjem potreb 
osebe s težavami v duševnem zdravju. Ob privolitvi 
pacienta sledijo prvi in nadaljnji obiski ter sestava 
načrta obravnave s kratkoročnimi in dolgoročnimi 
cilji za izboljšanje funkcioniranja in kakovosti 
življenja v ožji domači in širši skupnosti, sodelovanje 
in povezovanje ustanov in ljudi, ki so pomembni 
za bolno osebo (centri za socialno delo, izbrani 
zdravniki, izbrani psihiatri, zavod za zaposlovanje, 
šole, bolnišnice, nevladne organizacije, posamezniki v 
družini in kraju), postopno vključevanje pacientov v 
različne oblike domačih in drugih dejavnosti. Obiski, 
obravnave in podpora se postopno zmanjšujejo ob 
boljšem funkcioniranju. Osebe se pogosteje obravnava 
ob poslabšanju psihofizičnega stanja. Izvajanje načrta 
se vrednoti sproti in obdobno na šest mesecev. 
Načrt obravnave je sestavljen tako, da je dosegljiv 
in razumljiv ter v okviru kapacitet in zmogljivosti 
osebe z duševno motnjo. Tako je zelo pomemben 
kratkoročni načrt lahko le preprost dogovor v zvezi z 
izboljšanjem osebne higiene ali izrabe prostega časa, 
o čemer pacienta dlje časa učimo in ga podpiramo pri 
uresničevanju. Poleg zdravstvenovzgojnega znanja je 
potrebno dodatno znanje o izvajanju motivacijskega 
intervjuja, psihoterapevtskih in svetovalnih ukrepih.
Za posameznega pacienta je odgovoren koordinator 
primera, ki je član tima in skrbi za organizacijo 
obravnave, stalne kontakte s pacientom, izvedbo 
dogovorov, dokumentacijo. V tem procesu je 
diplomirana medicinska sestra največkrat koordinator 
primera.
Z vzpostavitvijo CDZO in CDZOM smo se 
medicinske sestre na področju duševnega zdravja in 
psihiatrije soočile z izzivom potreb novega strokovnega 
okolja in doseženih formalnih kompetenc. Zaradi 
hitrega razvoja centrov za duševno zdravje med 
letoma 2019 in 2021 ocenjujemo veliko potrebo 
po dodatnem izobraževanju, opolnomočenju in 
omogočanju specialnih znanj na področju skupnostne 
psihiatrične zdravstvene nege. Pričakujemo, da se 
bo v začetku leta 2022 odvilo prvo izobraževanje iz 
specialnih znanj za področje psihiatrične zdravstvene 
nege, ki bo omogočilo globlje razumevanje našega 
dela. Pričakujemo tudi čimprejšnje izvajanje 
specializacije. Praksa kaže potrebe po poglobljenem 
znanju o delu s psihozami, motnjami hranjenja, 
depresijo, anksioznostjo, obsesivno kompulzivno 
motnjo, odvisnostmi, posttravmatsko stresno motnjo, 
promocijo duševnega zdravja, forenziko, geriatrijo, 
managementom in psihofarmakologijo. Predvsem 

Doberšek Mlakar, J. (2021) / Obzornik zdravstvene nege, 55(4), pp. 228–236. 235
nam primanjkuje znanja s področja motivacijskih 
pristopov, svetovalnega dela in tudi psihoterapevtskih 
znanj, ki za vsako psihiatrično medicinsko sestro v 
tujini predstavljajo standard.
Začetki tima SPO Posavje so predstavljali izziv. 
Področje skupnostnega pristopa vsebuje posebnosti, ki 
jih zaznaš šele pri praktičnem delu. Geografsko pestro 
razvejano področje Posavja ima svoje kulturološke in 
lokalne značilnosti. Srečujemo se z visoko toleranco 
do pitja alkohola, iz tega izhajajočo odvisnostjo in 
težavami v družinski dinamiki odnosov. Izkazalo se 
je, da vstopanje v domače okolje in osebni prostor, 
ki ni nadzorovano klinično okolje, ni preprosto. 
Oseba z duševno motnjo je pogosto v poslabšanju, 
z odklonilnim vedenjem in nekritična. Najprej je 
treba skozi fazo vzpostavljanja osnovnega zaupanja, 
šele nato, včasih po več tednih, sledijo nadaljnji 
koraki obravnave. S sodelavci smo pridobivali 
izkušnje, opazovali in vrednotili lastne pristope ter 
v večletnem procesu prepoznali uporabne pristope 
dela. Pomemben dejavnik še vedno predstavlja tudi 
skrb za lastno varnost, zato večino obiskov na domu 
izvedemo v strokovnem paru. Obstajajo pomembne 
posebnosti življenja oseb (in njihovih pomembnih 
drugih) s hudo duševno motnjo izven institucije. 
Razmere, v katerih živijo, so pogosto blizu socialnega 
dna in rizične za ohranjanje psihofizičnega zdravja. 
Vključevanje v širši socialni svet izven naslova bivanja 
ovirajo geografska raznolikost, pomanjkanje sredstev, 
psihopatologija, slaba mreža nevladnih organizacij in 
drugih rehabilitacijskih služb.
Na terenu je posebej težko ukrepati proti volji 
pacienta, saj s tem izgubljamo terapevtski odnos 
in zaupanje ter s tem ugodne možnosti za nadaljnje 
delo tima skupnostne psihiatrične obravnave. Tudi 
svojci pogosto niso kritični do resnosti stanja, izražajo 
občutke nemoči in zaskrbljenosti. Temeljna prednost 
in »strokovni privilegij« dela diplomirane medicinske 
sestre je (Doberšek Mlakar, 2017), da osebo pogosto 
in kontinuirano vidi na njenem domu, v skupnosti, 
kjer živi. Za osebo s težavami v duševnem zdravju, 
njene bližnje in sodelavce drugih strok je medicinska 
sestra najpogosteje ključna strokovna vez (White & 
Hall, 2006). Razvije se terapevtski odnos, ki temelji 
na dinamični oceni stanja in potreb. Tako medicinska 
sestra dobro in lažje razume vlogo in zmožnosti 
pacienta v kontekstu funkcioniranja in izražanja 
življenjskih potreb v njenem / njegovem okolju.
Državljanom Slovenije je tako omogočeno 
zdravljenje v domačem okolju. Takšnemu razvojnemu 
preboju obravnave oseb s težavami v duševnem 
zdravju stroka zdravstvene nege ni sledila. Zamujeno 
je treba nadoknaditi v sodelovanju z Nacionalnim 
inštitutom za javno zdravje kot krovno institucijo 
centrov za duševno zdravje. Oseba s težavami mora 
dobiti največ in najboljše. Standard izobrazbe v tujini 
že obstaja, zato naj bo opisano tudi možnost za razvoj 
klinične specializacije na področju duševnega zdravja, 
priložnost za avtonomijo in formalne prepoznane 
kompetence medicinskih sester na tem področju.
Conflict of interest / Nasprotje interesov
Avtorica izjavlja, da ni nasprotja interestov. / The 
author confirm that there are no known conflict of 
interest. 
Literature
Boschma, G. (2012). Community mental health nursing in 
Alberta, Canada: An oral history. Nursing History Review, 
20(1), 103–135.
https://doi.org/10.1891/1062-8061.20.103 
PMid:22360000
Bregar, B., Živič, Z., Jambrošič, I., Lapanja, A., Roljić, 
S., Stopar Stritar, A., Stevanović, N., & Peterka Novak, J. 
(2013). Specializacije v zdravstveni negi: primer psihiatrične 
zdravstvene nege. In B. Skela Savič & S. Hvalič Touzery (Eds), 
Zahtevnejše oblike dela v zdravstveni negi: Mednarodni pristopi 
in stanje v Sloveniji: 6. posvet z mednarodno udeležbo Moja 
kariera – Quo vadis, Ljubljana, 27. marec 2013 (pp. 63–77). 
Jesenice: Visoka šola za zdravstveno nego Jesenice.
Doberšek Mlakar J. (2017). Vloga zdravstvene nege v timu 
skupnostne psihiatrične obravnave na primarni ravni. In S. 
Majcen Dvoršak et al. (Eds), 11. kongres zdravstvene in babiške 
nege Slovenije, Brdo pri Kranju, 27. in 29. november 2017 
(pp. 76–85). Ljubljana: Zbornica zdravstvene in babiške nege 
Slovenije - Zveza strokovnih društev medicinskih sester, babic in 
zdravstvenih tehnikov Slove nije, Nacionalni center za strokovni, 
karierni in osebnostni razvoj medicinskih sester in babic. 
Gournay, K. (2000). Role of the community psychiatric nurse 
in the management of schizophrenia. Advances in Psychiatric 
Treatment, 6(4), 243–251.
https://doi.org/10.1192/apt.6.4.243 
Jerič, A. (2015). Zadovoljstvo z obravnavo pri bolnikih s 
hudo duševno motnjo: primerjava standardne in skupnostne 
psihiatrične obravnave (magistrsko delo). Univerza na 
Primorskem, Fakulteta za vede o zdravju, Izola.
Juričič, N. (2016). Drugi viri pomoči in podpore. In N. Konec 
Juričič et al. (Eds.), Prepoznavanje in obravnava depresije in 
samomorilnosti pri pacientih v ambulanti družinskega zdravnika 
(pp. 87–92). Ljubljana: Nacionalni inštitut za javno zdravje.
Kalan, A. (2017). Kompetence, aktivnosti in področja dela 
medicinskih sester v psihiatriji (diplomsko delo). Fakulteta za 
zdravstvo Angele Boškin, Jesenice.
Kauric, A., Jez, A. S., & Mazgon, K. S. (2012). Evalvacija 
programa skupnostnega psihiatričnega zdravljenja v 
Psihiatrični bolnišnici Idrija. Socialno delo, 51(1/3), 177.

Doberšek Mlakar, J. (2021) / Obzornik zdravstvene nege, 55(4), pp. 228–236. 236
Kramar Zupan, M. (2013). Skupnostna psihiatrična obravnava kot 
multidisciplinarni timi v osnovnem zdravstvu. In Interdisciplinarno 
povezovanje za pretok znanja med teorijo in prakso: zbornik 
prispevkov mednarodne znanstvene konference (p. 179). Novo 
mesto: Fakulteta za zdravstvene vede Novo Mesto.
Kert, S. (2021). Zagotavljanje enakosti v primarni zdravstveni oskrbi 
v povezavi z organizacijo dela in sistemom financiranja v Sloveniji 
in primerjava z državami centralne in vzhodne Evrope (doktorska 
disertacija). Univerza v Mariboru, Medicinska fakulteta.
Pazargadi, M., Fereidooni Moghadam, M., Fallahi Khoshknab, 
M., Alijani Renani, H., & Molazem, Z. (2015). The therapeutic 
relationship in the shadow: Nurses' experiences of barriers to 
the nurse–patient relationship in the psychiatric ward. Issues in 
Mental Health Nursing, 36(7), 551–557.
https://doi.org/10.3109/01612840.2015.1014585 
PMid:26309175
Resolucija o nacionalnem programu duševnega zdravja 
2018–2028 /ReNPDZ18-28/ (2018). Uradni list RS, št. 24/18 
(13.04.2018). Retrieved from http://www.pisrs.si/Pis.web/
pregledPredpisa?id=RESO120
Ryan, D. (2017). Mental health nursing in community care. 
In M. Chambers (Ed.), Psychiatric and mental health nursing: 
The craft of caring (3rd ed., pp. 428–426). Abingdon; New Y ork: 
Routledge, Taylor & Francis Group.
https://doi.org/10.1201/9781315381879-55 
PMid:27759075
Soares Ferreira, S. F., Devinar Périco, L. A., & Gonçalves Dias, 
V . R. F . (2018). The complexity of the work of nurses in Primary 
Health Care. Revista Brasileira de Enfermagem, 71(Suppl. 1), 
704–709.
https://doi.org/10.1590/0034-7167-2017-0471 
PMid:29562031
Sedlar, T . (2002). Dolgoročne strategije razvoja zdravstvene nege 
na področju duševnega zdravja. Obzornik zdravstvene nege, 
36(3), 143–151. Retrieved November 15, 2021 from https://
obzornik.zbornica-zveza.si/index.php/ObzorZdravNeg/
article/view/2403 
Škerbinek, L. (1998). Pasti psihiatrične zdravstvene nege. 
Obzornik zdravstvene nege, 32(5/6), 181–183. Retrieved 
November 15, 2021 from https://obzornik.zbornica-zveza.si/
index.php/ObzorZdravNeg/article/view/2223?articlesBySimila
rityPage=3 
Švab, V. (2012). Skupnostna psihiatrija. Retrieved 15, 2021 
from https://www.varuh-rs.si/fileadmin/user_upload/word/
STROKOVNI_CLANKI_-_razni/Skupnostna_psihiatrija_-_
Vesna_Svab.pdf 
Thornicroft, G., & Tansella, M. (2013). The balanced care 
model: The case for both hospital-and community-based mental 
healthcare. The British Journal of Psychiatry, 202(4), 246–248.
https://doi.org/10.1192/bjp.bp.112.111377 
PMid:23549938
Thornicroft, G., Deb, T., & Henderson, C. (2016). Community 
mental health care worldwide: Current status and further 
developments. World Psychiatry, 15(3), 276–286.
https://doi.org/10.1002/wps.20349 
PMid:27717265; PMCid:PMC5032514
Zakotnik, J. M. (2019). Resolucija o nacionalnem programu 
duševnega zdravja 2018–2028. In L. Šprah (Ed.), Z več znanja 
o motnjah razpoloženja do izhodov iz labirintov: izkušnje in 
razmisleki (pp. 35–40). Ljubljana: Založba ZRC SAZU.
White, P., & Hall, M. (2006). Mapping the literature of case 
management nursing. Journal of Medicine Library Association, 
94(2), 99–106.
World Health Organization (WHO), & United Nations 
Children's Fund (UNICEF). (2018). A vision for primary health 
care in the 21st century: Towards universal health coverage and 
the Sustainable Development Goals. Retrieved November 14, 
2021 from https://apps.who.int/iris/handle/10665/328065 
WHO European Ministerial Conference on Mental Health. 
(2005). Mental health: Facing the challenges, building solutions: 
Report from the WHO European Ministerial Conference. 
Copenhagen: World Health Organization Regional Office for 
Europe.
Cite as / Citirajte kot: 
Doberšek Mlakar, J., 2021. The development of mental health care at the primary level: Community mental health care as an 
opportunity for nursing development. Obzornik zdravstvene nege, 55(4), 228–236. https://doi.org/10.14528/snr.2021.55.4.3151