alth al hent me for Ovitek Mira Resolucija ANG sept 2020.indd 1 30/09/2020 21:46 Mira resolucija A4 ANG sept 2020.indd 1 30/09/2020 21:45 MIRA for mental health National Mental Health Programme Editors: Jožica Maučec Zakotnik, Vesna Švab, Marija Anderluh, Mojca Zvezdana Dernovšek, Nuša Konec Juričič, †Davor Dominkuš, Marjeta Ferlan Istinič, Nadja Čobal, Agata Zupančič, Matej Vinko, Irena Makivić Publisher: Nacionalni inštitut za javno zdravje, Trubarjeva 2, Ljubljana Place and year of publication: Ljubljana, 2020 Design: Uvid.si d.o.o. Digital edition Website: www.nijz.si Free copy. 1st . Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID=63381507 ISBN 978-961-6945-31-8 (PDF) Credits Mira resolucija A4 ANG sept 2020.indd 3 30/09/2020 21:45 Preface Introduction Mental health in Slovenia National Mental Health Programme Purpose, vision and challenges Principles Priority areas and measures Priority Area 1 Community-based approach to improving mental health Priority Area 2 Mental health promotion and the prevention and destigmatisation of mental illness Priority Area 3 Mental health network Priority Area 4 Alcohol and mental health Priority Area 5 Suicide prevention Priority Area 6 Education, research, monitoring and evaluation National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 4 30/09/2020 21:45 Managing implementation Supporting implementation Financing implementation and management Benefits of implementation Appendices Abbreviations Glossary Organisational structure Sources and references For mental health Mira resolucija A4 ANG sept 2020.indd 5 30/09/2020 21:45 ental health is one of the basic pillars of general health and well-being for every individual and their loved ones. The National Mental Health Programme is an attempt to improve the mental health – and therefore the general health and well-being – of individuals and of society as a whole. It incorporates activities and measures aimed at promoting good mental health and well-being, preventing mental illness, safeguarding human rights, and ensuring that people experiencing mental health problems get the comprehensive care they need. The World Health Organization states that one fifth of adolescents are affected by mental health problems, with figures showing that depression is one of the leading causes of incapacity to work and that roughly half of all mental disorders begin before a person reaches the age of 14. Suicide is the second most common cause of death among young adults aged between 19 and 25. People with serious mental illness die, on average, 10 to 20 years sooner than the general population. Mental illness is responsible for significant economic losses through reduced productivity, with thousands of billions of dollars lost globally every year through depression and anxiety alone. The National Mental Health Programme was passed by parliament on 27 March 2018 with cross-party support. It is the first time in its history that Slovenia has attempted to address this vital area in a comprehensive and integrated manner. The programme lays down the fundamental principles of support and care for the mental health of the individual (and, indirectly, of society as a whole), and sets strategic goals for the ten-year period leading up to 2028. The goals we have set ourselves are ambitious. They require intersectoral cooperation and political support, backed up by measures aimed at protecting vulnerable individuals, children, adolescents, adults and older people, as well as their families, and involving all stakeholders and representatives of local environments in the process. A key component of the National Mental Health Programme is its attempt to expand mental healthcare from treatment alone, to encompass activities and measures aimed at preventing mental illness. It emphasises the importance of promoting mental health as a key aspect of health – one that fosters the well-being and prosperity of the individual, their loved ones, their immediate environment and society as a whole – and incorporates into mental illness treatment the key principles of swift, local access and high-quality integrated care provision based on multidisciplinary approaches. It encourages professionals working in the field to gather their expertise around the individual needing help, as well as their families, and to prioritise the provision of effective, evidence-based health and psychosocial approaches to treatment. It includes programmes that already constitute examples of good practice, opening a path towards the creation of the new practices that will have to be introduced and developed over the next decade. This attempt to understand the importance of maintaining and improving mental health in an integrated and comprehensive manner through a national-level programme makes Slovenia one of the most developed countries in this regard. We would like to deploy active policy-making processes and intersectoral cooperation to create the conditions for holistic early-years development, supportive school environments and healthy work environments, and to ensure that individuals suffering from mental illness get the right care. Paying proper care and attention to the mental health of children and adolescents is an investment in the future, as equal access to timely, high-quality, integrated care is part of the process of ensuring that vulnerable groups in our society enjoy the same human rights and the right to a life of dignity as everyone else. By reducing health inequality, involving support groups and linking local communities together, we aim to promote the values of solidarity, compassion and help and, consequently, to steer individuals’ creativity and productivity towards ensuring that everyone is included in society and is able to enjoy a high quality of life. All of us, in our local and work environments, can begin this process today: of working together to improve the mental health of the whole population. Dejan Židan, Speaker of the National Assembly of the Republic of Slovenia National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 6 30/09/2020 21:45 e can define perfect mental health as having a positive attitude towards ourselves and others, the ability to meet challenges successfully, a positive self-image and high levels of self-respect, a feeling of power and optimism, and the ability to deal with problems. Mental health is the result of a number of different factors, the main ones being those, at the levels of the individual, community, environment and society, that strengthen, protect or indeed threaten our mental health and well-being. Alongside individual factors such as sex, age, heredity, personal characteristics and lifestyle, the risk factors for mental health problems and mental illness include early childhood stress and other factors in the environment around us. The most important of these are poverty, social exclusion, discrimination, isolation, old-age deprivation and unjust inequality, as well as the fast pace of life and the heavy expectations that we place on ourselves. The important safety factors that can guard against mental illness include economic and social security, a supportive social network, a safe family environment, good physical health, and the ability to employ social skills and effective strategies to good effect when confronting problems. Regularly published health statistics and other research in Slovenia indicate that there is an increased awareness of mental health issues and of certain forms of mental illness. Mental illness places a heavy burden on the individual, their loved ones and the wider community. Poor mental health is responsible for a loss of between 3 and 4% of GDP, mainly as a result of lost productivity (some 65% of the costs connected with mental illness lie outside the health sphere, in things like absence from work and incapacity to work) and early retirement. In addition to the burden of the disease itself, people suffering from mental illness (and their loved ones) are discriminated against in different areas of their lives, with the stigma attached to mental illness significantly reducing their access to care and assistance. Good mental health is the basis of good general health and therefore of social, family and economic stability, social prosperity and quality of life. The mental health of society is based on the good mental health of children and adolescents. Half of all mental illness begins before the age of 14, with this figure rising to three quarters before the age of 24. As the Resolution on the National Mental Health Programme 2018–2028 (hereinafter referred to as the National Mental Health Programme, the National Programme or the NPDZ) points out, ensuring a safe and nurturing environment that prevents mental health problems in childhood is an investment in the future. Effective measures and approaches to improve and protect mental health are key to social progress and economic growth: only an individual with good mental health is able to develop their abilities, manage stress in their everyday lives, work efficiently and profitably, and contribute to society. For mental health Mira resolucija A4 ANG sept 2020.indd 7 30/09/2020 21:45 Mental health in Slovenia National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 8 30/09/2020 21:45 The results of studies carried out in Slovenia show that in 2016 approximately one quarter of the Slovenian adult population experienced stress on a daily basis and had problems managing it (Figure 1), that more than 7% had been diagnosed with depression, and that around 7% of adults used seda- tives and sleeping pills and 5% used anti-depressants. Between 2008 and 2015, in addition to a rise in the use of medication to treat mental illness and behavioural dis- orders, there was an increase in the number of visits to primary and secondary healthcare institutions (Figure 2). Figure 3 shows the most common mental illnesses at different stages of life. Proportion of people experiencing stress and having problems managing it Daily work-related stress/ tension Stress management Poor workplace Daily work-related stress/ relationships tension Stress management Poor workplace relationships 2012 2016 Figure 1 Study of health-related behaviour 2012 and 2016. Proportion of people experiencing stress because of poor workplace relationships, having problems dealing with stress and experiencing work-related stress/anxiety on a daily basis. For mental health Mira resolucija A4 ANG sept 2020.indd 9 30/09/2020 21:45 Number of first visits by children and adolescents (on account of mental and behavioural illnesses) Secondary level Primary level +25 % Figure 2 Increase in the number of first visits by children and adolescents to primary and secondary healthcare services on account of mental health problems 2008–2015 (NIJZ, 2018) Mental health problems are common among children and adolescents as well, with survey figures indicating that between 20 and 40% show some signs of mental illness or mental health problems. Mental illness among children and adolescents (Figure 3) places a heavy social and financial burden on society, with several assessments suggesting that an individual with behavioural issues in early childhood has cost society ten times more than their peers by the time they reach the age of 27 Most common mental illnesses at different stages of life Young Older Adolescents Adults Elderly children children (15–19) (up to 65) (over 65) (up to 5) (6–14) Response to Anxiety-related Emotional (Unspecified) Developmental severe stress disorders disorders dementia disorders and adaptive disorders Depressive episodes Conduct Depressive Other anxiety- disorders episodes related Stress-related Emotional disorders and adaptive disorders disorders Anxiety-related Hyperkinetic Depressive disorders disorders episodes Alcohol-related problems Stress-related ADHD Developmental Eating and adaptive disorders (minor) disorders Schizophrenia disorders Figure 3 Most common mental illnesses at different stages of life (NIJZ health statistics 2008–2015 and Merikangas et al., 2009) National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 10 30/09/2020 21:45 Slovenia is a country of very high alcohol consumption, which is one of the major mental health risk factors (Figure 4). Since 2008 an average of 881 people have died every year of a disease directly attributable to alcohol, with mental and behavioural disorders caused by alcohol consumption being the second most common cause of alcohol-related mortality. In 2015 alcohol consumption per capita in Slovenia (persons aged 15 and over) was: 44.5 litres of wine 114.6 litres of beer 2.2 litres of spirits Drinking habits of the Slovenian population (aged 25–74) For every ten inhabitants of Slovenia, two are teetotal, seven indulge in less-risky alcohol consumption, and one drinks excessively. Excessive alcohol consumption: 150,000 inhabitants of Slovenia drink High-risk alcohol excessively, consumption: 47 % of the population engage in high-risk alcohol consumption at least once a year Men are three times more likely to drink of women excessively than women. of men Figure 4 Alcohol consumption per capita (NIJZ, 2015) For mental health Mira resolucija A4 ANG sept 2020.indd 11 30/09/2020 21:45 Every year between 400 and 450 people commit suicide in Slovenia, with the average suicide rate standing at 25 per 100,000 people between 1996 and 2016. This is above the European average, which was 11 per 100,000 people in 2014. Approximately four times as many men commit suicide as women, with older people at greater risk. One very concerning statistic is that suicide is the second most common cause of death for young people aged between 15 and 19, behind road accidents. There are also marked regional differences, with the eastern areas of the country having a suicide rate higher than the national average (Figure 5). Suicide mortality rate by municipality, 2013–2017 Figure 5 Suicide rate by municipality (NIJZ, 2011–2015) National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 12 30/09/2020 21:45 Slovenia 20 Rate per 100,000 inhabitants number too small for a reliable estimate no data 11 or fewer 12–17 18–23 24–29 30 or more For mental health Mira resolucija A4 ANG sept 2020.indd 13 30/09/2020 21:45 National Mental Health Programme National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 14 30/09/2020 21:45  the Programme for Children  the Resolution on the National Programme for Young The National Mental Health Programme 2018– 2028 is the first strategic document to be published in Slovenia that comprehensively People (2013–2020) addresses the issue of mental health. The programme  the Resolution on the National Social Care Programme brings together existing structures, and adds urgently (2013–2020) required new ones, and organises them in an integrated,  the Strategy for Managing Dementia in Slovenia up interdisciplinary and intersectoral way aimed at improv- to 2020 ing mental health promotion, prevention, treatment and  the Integrated Early Treatment of Preschool Children rehabilitation. It is based on the inclusion, integration and with Special Needs Act cooperation of all services and stakeholders involved in  the draft Long-Term Care Act mental healthcare for individuals and groups within local  the Family Code communities and at all levels of provision.  the Report of the WHO Mission on Mental Health in It is possible to respond to the significant public Slovenia (2015) health problem presented by mental illness through sys-  the National Programme on Illicit Drugs (2013–2020) temic measures to strengthen emotional and social de- velopment in childhood and by deploying an established In 2015 the World Health Organization proposed the and interconnected network of institutions, services following strategic improvements in response to the and activities that respond to the needs of individuals, findings of the mission to Slovenia: communities and the population as a whole. Only an ap-  transferring the focus of mental health institutions proach such as this is able to ensure that mental health and services to the local level and making them more is strengthened and maintained, and that mental accessible health problems are prevented, detected and treated  setting up emergency children’s services responsible on time and sufficiently early enough. These activities for assessment and psychological first aid will be successful only if, at the same time, we ensure  reducing the duration of hospitalisation and the num- that people are able to exercise their rights to social ber of readmissions to hospital through the commu-inclusion, employment, economic security, a safe living nity-based monitoring of people suffering from se-environment, rehabilitation and destigmatisation. vere mental illness For high-quality, timely, universal and accessible  expanding the number and capacities of community- treatment of people suffering from mental illness, we based teams on the basis of needs assessments need an intersectoral network of services and institu-  providing further training to professional staff at the tions, and the involvement of planners, providers, and primary healthcare level and in social care service users and their families. This network will include  planning, educating, training and employing profes- municipalities, institutions at all levels of health and so- sionals in line with national needs cial care, employment services, services at all levels of  increasing the number of clinical psychologists schooling and education, informal and user-run organi-  providing trained professionals from recognised sations, organisations and associations operating in the schools of psychotherapy with psychotherapy work in field of mental health, and other local community-based healthcare and social care services organisations and associations. The process of prevent-  assessing the needs of residents of social care insti- ing mental illness from arising, and of treating people tutions and the options for their deinstitutionalisation already suffering from mental health problems at all  reducing institutional capacities over the long term stages of life, must be brought closer to the level of the  updating legislation and regulations on care for fo- community – that is, to the places where people live. rensic patients who present a danger to the com- The National Mental Health Programme 2018–2028 munity has been aligned with various existing documents that  setting up a secure unit for children and adolescents emphasise the importance of maintaining and improving  developing more sector-based psychosocial teams mental health and preventing mental illness from arising for children and adolescents in the first place. These documents are:  supporting the gradual introduction of regional inter-  the Resolution on the National Healthcare Plan (2016– disciplinary centres to support children with learning 2025) difficulties  the Slovenian Development Strategy (2030)  the Strategy for a Long-Lived Society For mental health Mira resolucija A4 ANG sept 2020.indd 15 30/09/2020 21:45 Purpose, vision and challenges National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 16 30/09/2020 21:45 Purpose, vision and challenges The aim of the National Mental Health Programme is to strengthen and maintain good mental health for all in- habitants of Slovenia and to prevent mental health prob- lems and illness from arising, from childhood to old age. By improving the skills of specialist services in all areas To provide all inhabitants of Slovenia with the right to relating to the maintenance of good mental health, we enjoy the best possible mental and physical well-be- wish to establish an environment that supports good ing, the best possible conditions for developing and mental health. The aim is to bring mental health insti- realising their potential in their professional, social, tutions and services closer to their users. By reducing private and family lives, and equal access to high- the stigma and discrimination attached to people with -quality resources of care. mental illness, we aim to encourage people to seek help earlier and thereby reduce instances of institutionalisa- tion for reasons of mental illness. The three key challenges of the National Programme are described in detail below. For mental health Mira resolucija A4 ANG sept 2020.indd 17 30/09/2020 21:45 TO REDUCE MENTAL HEALTH PROBLEMS AND The burdens created by mental health problems ILLNESS, AND THE BURDEN CREATED BY and illness are considerable (Figure 6), with the highest POOR MENTAL HEALTH proportion of costs coming from loss of productivity, i.e. absence from work and early retirement resulting from mental illness. Mental illness accounts for 35% of the costs of all types of illness in Europe. In 2014 the costs of mental illness in Europe were estimated at EUR 240 billion a year, while brain disorders (psychiatric and neuro- logical) alone were estimated to have cost the Slovenian economy EUR 2.4 billion (7% of GDP) in 2010. Poor mental health affects one in two people at least once in their lives. COSTS associated with mental illness medical care treatment costs loss of productivity early retirement absence from work premature mortality Figure 6 Indirect and direct costs associated with mental illness Poor social conditions, poverty, unemployment and (i.e. knowledge, beliefs and opinions regarding mental ill- drug use are closely linked with the suicide rate. On av- ness), we can aid recognition, treatment and prevention, erage, people with mental health problems die 15 to 20 strengthen awareness, and help people to seek help at years sooner than the general population, chiefly as a the right time. result of a lack of care provision. One of the key chal- Studies in Slovenia show that men, single people, lenges is therefore to strengthen the mental and physi- younger people, people with lower levels of education cal health of the whole population, and to reduce mental and those living in regions with a higher suicide rate are health problems and illness in order to reduce the bur- less inclined to seek help if they experience mental health den caused by poor mental health. problems. Stigmatisation of and discrimination against people TO INCREASE MENTAL HEALTH LITERACY suffering mental illness are also evident in the fact that AND AWARENESS, AND REMOVE THE STIGMA people delay seeking help, which worsens the outcome FROM MENTAL ILLNESS of treatment and rehabilitation and results in feelings of The feedback loop of mental illness, physical disease helplessness. Stigma appears at all levels of society and and exclusion can only be broken by means of integrat- in all systems. It leads people to dismiss, play down or ed social measures. By increasing mental health literacy deny the seriousness of the issue, and to a shortfall in National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 18 30/09/2020 21:45 resources for adequate, high-quality, accessible mental By establishing a network of mental health institu-health programmes. tions and services (Figure 7), we can create settings By tackling discrimination, we increase social power that enable and foster care for one’s own mental health, and help people with mental health problems to recover. support social care programmes and informal forms Awareness-raising and anti-discrimination programmes of community-based assistance, and integrate mental are also aimed at the families of people suffering from health institutions into primary care (community medical mental health problems and dementia, as they also need centres, social work centres, social care programmes), well-timed, high-quality, specialist support. while striving to reduce the number of admissions (and involuntary admissions in particular) to psychiatric hos- TO IMPROVE THE ORGANISATION OF MENTAL pitals and social care institutions (deinstitutionalisation) HEALTH INSTITUTIONS AND SERVICES and gradually rerouting funds from institutional to com- Via a network of healthcare, social care, school and munity-based forms of provision. education institutions, services and programmes organ- Access to mental health services, and the quality of ised in an intersectoral and interdisciplinary way, and those services, must be improved; this will enable us to backed up by specialist services, we will be able to pro- prevent the development of mental health problems in vide high-quality, timely and universally accessible im-the early stages of a person’s life and in adulthood, re- provements to mental health, along with the prevention duce the duration of mental illness, prevent the develop- and treatment of mental illness in all age groups, in the ment of comorbidities and reduced capacity, and ease local environment. the burden on families. Health education/ health promotion centres Adult mental Social work Primary healthcare Community- health centre centres based treatment coordinators Mental health centre for children and Emergency adolescents Anti-stigma service Mental health advocates Individuals Psychiatric and families hospitals, in the subpatient teams community Community- based social care programmes Protocols of Family- cooperation Institutional support NIJZ care programmes Local Counselling Professional communities, services at User-run services at associations education associations residential and institutions counselling centres Figure 7 Integrated mental health network at regional level For mental health Mira resolucija A4 ANG sept 2020.indd 19 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 20 30/09/2020 21:45 T he National Mental Health Programme contains the eight strategic objectives that we wish to meet over the ten years of the programme. Mental health is not only an issue for the health sector but for other sectors and policies as well. It represents a form of ‘national capital’ that must be improved by pooling the efforts of the entire community and all sectors, including service users, their associations and their families. Mental health is also formed within families, schools and the workplace, and is also the consequence of how we treat ourselves and how others treat us. The principle of inserting health into all policies emphasises the effect public policies have on determinants of health, tends to reduce inequality, highlights the benefits of promoting health across a range of different areas, and encourages policy-makers to think about the effects their policies have on health. One fundamental measure for improving mental health at the level of the population as a whole is therefore the implementation of support policies and measures for mental health across all sectors. We will introduce and strengthen evidence-based programmes of destigmatisation, mental health promotion and mental illness prevention. These programmes will be aimed at a range of population groups and be organised in all environments in which we spend significant parts of our everyday lives. Stigma, and the social exclusion it creates, places a heavy burden on sufferers of mental illness and their families, while the stigmatisation of people with mental illness is the most severe obstacle preventing individuals from seeking help. This is evident in all areas of life, has systemic effects (on planning, policy, funding), and irrevocably damages the self-respect and life opportunities of the individuals exposed to it. Stigmatisation reduces access to and the quality of care and assistance. Discrimination against people with mental illness also manifests itself in social exclusion and greater exposure to poverty, patronising attitudes and other daily humiliations. Preventive mental health work focuses on reducing the incidence and prevalence of mental illness and mental health problems. Activities to prevent mental illness focus on minimising the risk factors and strengthening those protective factors that safeguard the individual against mental illness. Mental health promotion focuses on improving quality of life and strengthening the power of the individual – and not only on reducing mental health problems and illnesses. In addition to reducing the prevalence of mental illness, one important goal of mental health promotion is to move towards a situation where individuals and communities enjoy high levels of mental well-being and a high quality of life; this can be achieved by creating environments that enable every individual to enjoy good mental well-being and by bolstering their own internal psychological resources. For mental health Mira resolucija A4 ANG sept 2020.indd 21 30/09/2020 21:45 Suicide is a preventable phenomenon. Slovenia is a country with a higher suicide risk than many others, and one in which suicide is a major public health concern from late childhood on. Other forms of suicidal behaviour, such as attempted suicide, self-harming and suicidal thoughts, also constitute a public health problem. The fall in suicide mortality in Slovenia in recent years should spur us on to continue to work to prevent people from taking their own lives; and while any measure that improves people’s mental health is important, there are also several other measures that have been proven to work effectively, such as raising people’s awareness and mental health literacy, identifying suicide risks early on, providing at-risk individuals with easy access to help, restricting access to the means of suicide, and reducing alcohol consumption. Risky and harmful alcohol consumption is one of the main preventable risk factors for chronic diseases, injuries, accidents, violent behaviour, murder and suicide and is, across the globe, one of the main risk factors for morbidity, incapacity, disability and mortality. Slovenia is above the EU average and the average for the European region of the WHO for health consequences resulting from causes directly attributable to alcohol. The National Mental Health Programme will address harmful alcohol use by organising awareness-raising activities, developing a critical approach to alcohol consumption, and by integrating and proving training to those specialist services best able to identify problems related to alcohol consumption at an early stage. An accessible network of services for dealing with alcohol dependence must be set up. Under the National Mental Health Programme, the principle of a community-based approach means that we will bring healthcare, social and other services closer to people in their natural environments, and ensure that people’s needs are addressed by means of tried-and-tested forms of provision in all settings. By strengthening and expanding existing local initiatives and assistance networks, we are also aiming to remove the stigma from mental illness, placing people experiencing mental health problems to the fore and learning from their experiences. By formulating the National Mental Health Programme, we have committed ourselves to a respectful, needs-adjusted, timely and high-quality approach and to a gradual reduction in long-term institutionalisation in ‘ali-en’ environments. We will prevent institutionalisation, which leads to apathy, hopelessness and wit-hdrawal, by means of early, well-timed treatment, uninterrupted monitoring and the strengthening of networks of assistance in the local environment. The community-based approach requires partners in local environments to overcome obstacles and develop competences, skills and methods of implementation in a coordinated and collective manner. It will encourage and mobilise local structures and partners to establish the conditions for improved health by working in a coordinated manner in the name of a collective mission. We are setting up a network of mental health centres at the primary healthcare level that will, with the help of new, well-qualified staff, improve access to and the quality of services. We have undertaken to ensure direct and immediate access to services without payment or surcharges, in accordance with health insurance rules. We have been successful in involving specialist staff from various professions in mental health provision on an equal basis and in line with their competencies, and ensured a high level of commitment to the work on the part of these specialists. Our work is overseen by service users and their families, whom we consult on a continuous basis. National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 22 30/09/2020 21:45 Mental health issues must be adequately inserted into all levels of education and training in order to raise awareness of and remove the stigma from mental illness. It is important to educate and raise the general public’s awareness of mental health. The relevant knowledge and skills must also be provided to all specialists and professional staff who encounter people experiencing mental health problems. The state is committed, in parallel with the process of strengthening healthcare resources, to strengthening the social assistance network, laying the groundwork for improved opportunities for supported, settled living for vulnerable groups, and putting in place a network of centres and services that will provide people with paid work that supports their efforts to live a life of dignity. It has ensured that the country will, at the end of the ten-year period of the programme, have a network fit for the needs of groups of adapted rehabilitation and recovery centres and programmes that strengthen study and work capacities and reduce exclusion. Only by working in an interconnected way can we begin to tackle the numerous factors that affect mental health. In order to provide an adequate basis for good mental health, intersectoral policies and programmes must be formulated and be based on the needs of the population. Integrated policies and programmes must be implemented at the local level by employing vertical forms of cooperation; this will enable us to reduce unjust inequalities and ensure that the resources at our disposal are allocated in line with the specific needs of the relevant population groups. As we have to lay adequate foundations if we are to ensure good mental health and reduce unjust inequalities, providing for an appropriate number of staff from all mental health-related professions and helping them to improve their skills is an important strategic objective of the National Mental Health Programme. For mental health Mira resolucija A4 ANG sept 2020.indd 23 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 24 30/09/2020 21:45 he principles applying to the work of providers and stakeholders are described below. Planning and implementation are based on and prioritise comprehensive, systemic, evaluated measures for the population as a whole and for specific population groups in line with their needs. The planning and implementation of the National Mental Health Programme is based on ensuring cost-effectiveness, guaranteeing equality of access to institutions and services regardless of the socio-economic, demographic, health-related, cultural and other characteristics of individuals or population groups, and ensuring that provision is All strategic documents must consider accessible and uninterrupted. their impact on mental health. People with mental health problems in all stages The planning and implementation of the National of life will be provided with community-based Mental Health Programme will aim to reduce treatment and rehabilitation. preventable and unjust differences in mental health provision for different population groups. Users and their families will be involved in the planning, implementation and supervision of mental health institutions and services. Implementation of the National Mental Health Programme is based on the notion of strengthening cooperation between all line ministries, professions and civil society in the planning, implementation and monitoring of mental health policies, legislation, services and programmes. For mental health Mira resolucija A4 ANG sept 2020.indd 25 30/09/2020 21:45 Priority areas and measures National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 26 30/09/2020 21:45 the objectives of providing prevention services, early diagnosis and integrated treatment for children and The activities set out by the National Mental Health Programme are divided into six priority areas, with each containing the specific objec- adolescents and their families in local settings, and ac- tives and measures that will make achievement of the cess to interdisciplinary services at the secondary and priority possible. The priority areas of mental health pro- tertiary healthcare levels. The sub-area covering the motion, the prevention and destigmatisation of mental mental health network for adults, including older people, illness, the mental health network, and education, re-contains the objectives of providing prevention services, search, monitoring and evaluation are further broken early diagnosis and accessible, high-quality interdisci-down into sub-areas. plinary treatment at the primary healthcare level, with The area of mental health promotion and the pre-an emphasis on community-based care; accessible and vention and destigmatisation of mental illness is there- high-quality acute treatment at the secondary level; the fore broken down into four separate sub-areas: mental rehabilitation of people with recurring mental health health promotion and the prevention of mental illness for problems; long-term care for people with mental health various target groups; mental health promotion and the disorders and mental developmental disorders; adequate prevention of mental illness for children, adolescents and integrated care for people with mental health problems their families in various settings; mental health promo- accompanied by dangerous behaviour; and sub-areas tion and the prevention of mental illness for adults at the addressing the specific mental health needs of older workplace; and mental health promotion and the preven- people, and psychological and psychotherapy activities. tion of mental illness for older people. The area covering education, research, monitoring The area covering the mental health network is simi- and evaluation is divided into sub-areas that deal sepa- larly divided into sub-areas based on population groups rately with education, research, and the monitoring and and specific areas. The sub-area covering the mental evaluation of the National Mental Health Programme. health network for children and adolescents contains For mental health Mira resolucija A4 ANG sept 2020.indd 27 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 28 30/09/2020 21:45 Community-based approach to improving mental health COMMUNITY-BASED APPROACH TO grammes, municipalities, etc.) with the aim of improving IMPROVING MENTAL HEALTH AND (mental) health in the community. COMMUNITY-BASED PROVISION FOR PEOPLE Measure 5: Preparation of an assessment of the WITH MENTAL HEALTH PROBLEMS situation and needs in specific environments, the iden-SPECIFIC OBJECTIVE 1: COORDINATED tification of vulnerable groups, and the production and INTERSECTORAL COOPERATION AND THE monitoring of an action plan for implementation of the INVOLVEMENT OF CIVIL SOCIETY IN MENTAL HEALTH measures contained in the Resolution. 1. PROVISION AT NATIONAL, REGIONAL AND LOCAL LEVELS SPECIFIC OBJECTIVE 2: DEINSTITUTIONALISATION Line ministries: Ministry of Health, Ministry of Labour, AND THE COMMUNITY-BASED PROVISION OF Family, Social Affairs and Equal Opportunities, Ministry of HIGH-QUALITY AND ACCESSIBLE SERVICES AND Education, Science and Sport, Ministry of Economic Devel- PROGRAMMES TO PEOPLE WITH MENTAL HEALTH opment and Technology, Ministry of Public Administration PROBLEMS Measure 1: Coordinated intersectoral cooperation in Line ministries: Ministry of Health, Ministry of Labour, the planning and provision of institutions, programmes and Family, Social Affairs and Equal Opportunities, Ministry of services at national, regional and local levels in order to Education, Science and Sport, Ministry of Finance, Min-improve mental health and the provision of mental health istry of Economic Development and Technology, Ministry services to people suffering from mental illness. of Public Administration, Ministry of the Environment and Measure 2: Involvement of specialists working on Spatial Planning social care programmes and user-run organisations in Measure 1: Organisation and implementation of the planning, provision and management of institutions, community-based intersectoral and interdisciplinary in- programmes and services at national, regional and local stitutions and services with the aim of satisfying, to the levels in order to improve mental health and the provi- greatest possible extent, the needs of people experienc- sion of mental health services to people suffering from ing mental health problems, and the destigmatisation of mental illness. mental illness. Measure 3: Reduction of stigma and discrimination Measure 2: Reduction in the administrative obstacles using tried-and-tested programmes. that hinder access to community-based services for peo- Measure 4: Establishment of regional mental health ple with mental health problems, older people and other councils and local (interdisciplinary and intersectoral) vulnerable population groups. groups for community-based (mental) health, to in- Measure 3: Establishment of the foundations for the clude the fields of health, education, social security and planned relocation of mental health patients from institu- the family, societies and associations, social care pro-tions to community-based care. For mental health Mira resolucija A4 ANG sept 2020.indd 29 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 30 30/09/2020 21:45 Mental health promotion and the prevention and destigmatisation of mental illness MENTAL HEALTH PROMOTION AND THE the strengthening of the network of housing groups PREVENTION AND DESTIGMATISATION OF and other forms of supported living MENTAL ILLNESS FOR DIFFERENT TARGET Provision of a safe and accessible envi- GROUPS ronment that enables individuals to be involved in social SPECIFIC OBJECTIVE 1: CREATION OF ENVIRONMENTS (cultural, sports and other) activities to strengthen their SUPPORTIVE OF GOOD MENTAL HEALTH AND mental health and fosters connections between different THE INTRODUCTION OF PROGRAMMES TO generations. 2. PROMOTE MENTAL HEALTH AND PREVENT MENTAL Implementation of activities and pro- ILLNESS THROUGH THE VARIOUS PERIODS OF AN grammes oriented towards healthy lifestyles (exercise, INDIVIDUAL’S DEVELOPMENT healthy eating, healthy habits, socialising, maintaining Line ministries: Ministry of Health, Ministry of Labour, capacities and independence, etc.). Family, Social Affairs and Equal Opportunities, Ministry of Implementation of activities and pro- Education, Science and Sport, Ministry of the Environ-grammes aimed at strengthening individuals’ mental ment and Spatial Planning, Ministry of Public Administra- robustness and resistance (emotional and social skills, tion, Ministry of the Interior, Ministry of Finance, Ministry resistance to stress, positive self-image, problem resolu-of Economic Development and Technology tion, communication, empathy, etc.). Raising of the awareness of decision- Introduction of programmes and servic- makers in all sectors of the importance of promoting es to promote mental health and prevent mental illness mental health and preventing mental illness. for vulnerable groups and population groups with an in- Coverage of an individual’s basic needs creased risk of falling ill. and the establishment of a support environment that Use of the latest ICT and of innovative ap- works to protect individuals, improve their mental health proaches to mental health promotion and the prevention and that of the community or various target groups, and of mental illness. reduce inequality. This includes: the provision of social security to vulnerable popula- SPECIFIC OBJECTIVE 2: INCREASE IN MENTAL tion groups through: HEALTH LITERACY AND MENTAL HEALTH AWARENESS • the provision of an appropriate level of social and AMONG VARIOUS STAKEHOLDER COMMUNITIES, THE family benefits EDUCATION AND TRAINING OF PROFESSIONAL STAFF, • inclusion in the compulsory social insurance system AND DESTIGMATISATION • access to high-quality social and family care services Line ministries: Ministry of Health, Ministry of Labour, the implementation of active employment policy Family, Social Affairs and Equal Opportunities, Ministry of measures for various vulnerable groups Education, Science and Sport For mental health Mira resolucija A4 ANG sept 2020.indd 31 30/09/2020 21:45 MENTAL HEALTH PROMOTION AND THE Development and implementation of PREVENTION AND DESTIGMATISATION programmes that increase mental health literacy within OF MENTAL ILLNESS FOR CHILDREN, various target groups and settings (family, workplace, ADOLESCENTS AND THEIR FAMILIES IN school systems, etc.): VARIOUS SETTINGS different forms of information-provision on mental health, mental illness and mental health problems SPECIFIC OBJECTIVE 1: MENTAL HEALTH PROMOTION and on the options available, including resources for AND THE PREVENTION OF MENTAL HEALTH help and care PROBLEMS AMONG CHILDREN AND ADOLESCENTS IN continuous contact with the media in order to en- EDUCATION INSTITUTIONS AND LOCAL SETTINGS courage them to report responsibly on mental health Line ministries: Ministry of Education, Science and issues. Sport, Ministry of Health, Ministry of Labour, Family, Social Continuous implementation of evidence-Affairs and Equal Opportunities, Ministry of the Interior based destigmatisation campaigns (campaigns aimed at Preparation of protocols of cooperation professionals, young people and the general public, etc.). between promotion and prevention providers and pro- grammes. SPECIFIC OBJECTIVE 3: PROVISION OF EVENLY Systemic introduction of the concept SPREAD AND EASILY ACCESSIBLE FREE-OF-CHARGE of mental health improvement in nursery schools and INFORMATION, COUNSELLING AND ONE-TO-ONE schools, and the cross-curricular discussion of health-ASSISTANCE SERVICES AIMED AT PEOPLE IN NEED IN related topics. THE LOCAL ENVIRONMENT Systemic introduction of tested and Line ministries: Ministry of Health, Ministry of Labour, evaluated programmes to promote mental health and Family, Social Affairs and Equal Opportunities prevent mental health problems among children and Development and implementation of different tried- adolescents. and-tested forms of assistance to people in need (e.g. Systemic introduction of tried-and-test- problems at the workplace, at school, in the family, with ed early-intervention programmes that include parent- partners, during childhood). The aim is to ensure that ing programmes, early-intervention programmes for contact is established immediately with people in need, children and adolescents, and programmes for teach- and with their families, and that they are given support to ers. resolve their problems and, where necessary, referred to Pilot testing and the gradual systemic appropriate forms of specialist help. These forms of sup- introduction of tried-and-tested programmes to reduce port may be organised in local settings or by governmen- peer-to-peer violence (which increases children’s sus- tal and non-governmental organisations. This will enable ceptibility to these problems) aimed at addressing iden- us to prevent mental health problems from developing tified cases of peer-to-peer physical and online violence, into mental or physical illness. and programmes that work successfully to establish a Counselling services for adults that pro- safe and nurturing school environment. vide timely, high-quality help in situations that present a Provision of training and the strengthen- risk of the development of mental illness. ing of cooperation between school counselling services Counselling services for children, adoles- and mental health centres for children and adolescents, cents and parents. with mental health issues being incorporated into the Expansion of existing and the develop-concept of work of school counselling services and so- ment of new peer-support activities. cial work centres in relation to children and adolescents Self-help groups for people with similar with learning and mental health difficulties. Preparation problems and for their families. of protocols for more effective collaboration. Telephone and online counselling for chil- Development and implementation of pro- dren, adolescents and adults. grammes for vulnerable groups of young people (e.g. Introduction of tried-and-tested psycho- children who have abandoned their schooling, minorities, logical first-aid programmes (dissemination of knowl- migrants). edge of the causes, symptoms and signs of mental Development and introduction of new health problems and mental illness, and the bolstering of approaches and communication channels for mental the general public’s ability to take action). health promotion among children and adolescents (ICT, e-mental health). National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 32 30/09/2020 21:45 MENTAL HEALTH PROMOTION AND THE Preparation of recommendations and PREVENTION AND DESTIGMATISATION OF measures for the education and protection of children’s 2. MENTAL ILLNESS FOR ADULTS AT THE and adolescents’ mental health in the digital media age WORKPLACE with the aim of preventing non-substance addiction (computer games, gambling, social media). SPECIFIC OBJECTIVE 1: STRENGTHENING AND Development of programmes to prevent IMPROVEMENT OF EMPLOYEES’ MENTAL HEALTH non-substance addiction. Line ministries: Ministry of Health, Ministry of Labour, Creation of safe and nurturing learning Family, Social Affairs and Equal Opportunities environments. Improvements to the implementation Provision of inpatient school pro- and supervision of the implementation of health promo- grammes to aid inclusion in a normal school environ- tion programmes (appointment of a coordinator/group ment during and after treatment until full inclusion in charged with promoting health within a company). that environment is possible, and subsequent consulta- Preparation and implementation of inter- tion and contact with the school. sectoral documents on workplace mental health. Development and introduction of learning SPECIFIC OBJECTIVE 2: ESTABLISHMENT OF A modules and tried-and-tested workplace health promo- NETWORK OF COUNSELLING SERVICES FOR tion programmes, with an emphasis on mental health CHILDREN, ADOLESCENTS AND PARENTS and well-being, for employers and in-company health Line ministries: Ministry of Education, Science and promotion coordinators/groups. Sport, Ministry of Health, Ministry of Labour, Family, Social Preparation of a learning module for employers (man-Affairs and Equal Opportunities agement, workplace health promoters/coordinators) Design of an operating concept for coun- that recognises the importance of organising work selling centres and a proposal for their insertion into the and management operations to benefit of employees’ system. mental health (e.g. management training in the fields Preparation of staff standards and stand- of communication and corporate culture, manage- ards for programmes of provision for at-risk children and ment styles and time management, the introduction adolescents. of staggered arrival at work, flexible working hours For mental health Mira resolucija A4 ANG sept 2020.indd 33 30/09/2020 21:45 for employees with mental health problems, promo-ployed over the long term because of mental health and tion of employee creativity, etc.). other issues), the systemic introduction of measures to Preparation of a learning module for employers assess their capacity for work and need for support via (management, human resources) on the importance occupational medicine specialists and other qualified as- of systematically monitoring absence from work sessors, the promotion of employment on the basis of through illness in order to identify as quickly as pos- an assessment of capacities/skills and other effective sible any protracted or recurring absences, plan pro-measures for inclusion in the workplace (mentoring, in- motional measures, and provide support to employ- duction programmes, etc.), and the expansion of the net- ees upon their return to work after such absences. work of social enterprises and cooperatives for people Preparation of healthy lifestyle guidelines suffering from mental illness. and the promotion of healthy choices at work (healthy Preparation and implementation of pro- eating, increased physical activity, spaces for socialising grammes to promote mental health and prevent mental during breaks, etc.). illness for risk groups (unemployed, difficult-to-employ, Preparation and implementation of rec- unemployable and institutionalised people) adapted to ommendations for promoting and strengthening positive their needs and capacities within their environments, psychosocial factors (supervision of own work, autono- with an emphasis on strengthening their power and ad- my, positive relations with colleagues, social and emo-vocacy. tional support from colleagues and superiors, employee MENTAL HEALTH PROMOTION AND THE career development). PREVENTION AND DESTIGMATISATION OF Establishment of national and regional MENTAL ILLNESS AMONG OLDER PEOPLE coordination for promoting and strengthening (mental) health at the workplace in support of employers and em- SPECIFIC OBJECTIVE 1: STRENGTHENING OF ployees. PROTECTIVE FACTORS FOR HEALTHY AGEING Establishment of links between health Line ministries: Ministry of Health, Ministry of Labour, promotion centres and employers in the local environ-Family, Social Affairs and Equal Opportunities ment in the implementation of prevention and promotion Education and awareness-raising on programmes in the field of mental health. healthy lifestyles and the maintenance of physical Involvement of social partners in the health, with the aim of exerting a positive influence on planning and implementation of workplace mental health mental health, and the organisation of activities and pro- promotion programmes. grammes that include older people. Strengthening of informal and formal SPECIFIC OBJECTIVE 2: SUPPORT TO EMPLOYEES, entities and networks within the community that have THE UNEMPLOYED AND SOCIALLY EXCLUDED ADULTS a positive impact on quality of life within the community SUFFERING FROM MENTAL HEALTH PROBLEMS and prevent isolation (NGO programmes, social activities, Line ministries: Ministry of Health, Ministry of Labour, intergenerational centres, universities of the third age). Family, Social Affairs and Equal Opportunities, Ministry of Strengthening of access to programmes Economic Development and Technology to prevent or manage memory-related problems. Psychological first-aid guidelines for workplaces (preparation of guidelines and training in the provision of psychological first aid at the workplace). Preparation of guidelines and the provision of support by employers to employees in their reintroduc- tion to work after a protracted absence due to mental or other illness (flexible work and working hours, etc.). Promotion of the employment and in- creased access to work of people with fewer options as a result of chronic mental and other illnesses (reliefs/ subsidies for companies, adaptation of workplaces and processes, flexible working hours, etc.). Promotion of the employment of the long-term unemployed (identification of people unem- National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 34 30/09/2020 21:45 2. For mental health Mira resolucija A4 ANG sept 2020.indd 35 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 36 30/09/2020 21:45 Mental health network MENTAL HEALTH NETWORK FOR CHILDREN appropriate programmes of support for high-risk fami- AND ADOLESCENTS lies, with multidisciplinary approaches prioritised. Upgrading of the prevention programme PROVISION OF PREVENTION SERVICES, EARLY provided by home care nurses/medical technicians DIAGNOSIS AND INTEGRATED TREATMENT at the young mother’s and baby’s home, with back-up FOR CHILDREN AND ADOLESCENTS prevention visits and treatment for vulnerable families AND THEIR FAMILIES IN THEIR LOCAL and additional care elements in relation to mental health 3. ENVIRONMENTS problems, child neglect and maltreatment, and domestic SPECIFIC OBJECTIVE 1: ‘GOOD START’ PROVISION/ violence (e.g. home-based parenting programmes). CARE FOR THE MENTAL HEALTH OF PREGNANT WOMEN, MOTHERS AND FAMILIES DURING SPECIFIC OBJECTIVE 2: EARLY IDENTIFICATION PREGNANCY AND AFTER BIRTH OF CHILDREN’S PHYSICAL AND MENTAL Line ministries: Ministry of Health, Ministry of Labour, DEVELOPMENTAL ISSUES Family, Social Affairs and Equal Opportunities, Ministry of Line ministries: Ministry of Health, Ministry of Educa-Education, Science and Sport tion, Science and Sport, Ministry of Labour, Family, Social Strengthening of parenting and commu- Affairs and Equal Opportunities nication skills and of the mental health of future parents Regular systematic preventive checks for as part of group-based health education (preparations children and adolescents in accordance with the rules of for birth and parenthood). implementation. Introduction of screening, early detection Early provision for children with identified and the appropriate treatment of mental health prob- developmental disorders within the developmental clin- lems as part of primary-level antenatal and postnatal ics network. The network also incorporates regional early healthcare (gynaecology teams, paediatric teams, gen- treatment centres, which are responsible for primary- eral practitioners, home nursing service, adult mental level early integrated and multidisciplinary provision for health centres). children with developmental neurological disorders. The Provision of access, at adult mental centres are integrated into the developmental clinics health centres and maternity units, to adequate treat- network. ment for pregnant women or young mothers experienc- ing mental health problems. SPECIFIC OBJECTIVE 3: PROVISION OF ACCESS Early identification of vulnerable preg- TO INTERDISCIPLINARY TEAMS AND SERVICES nant women, families and children by social services, RESPONSIBLE FOR DEALING WITH CHILDREN AND health services and education institutions, and referral to ADOLESCENTS SUFFERING FROM MENTAL HEALTH For mental health Mira resolucija A4 ANG sept 2020.indd 37 30/09/2020 21:45 PROBLEMS, AND THEIR FAMILIES, AT THE PRIMARY standards of operation, and the enlargement of hospital HEALTHCARE LEVEL AND IN COOPERATION WITH teams in line with these standards. SOCIAL CARE, FAMILY AND EDUCATION SERVICES Establishment of sub-specialist outpa- Line ministries: Ministry of Health, Ministry of Labour, tient teams at national or regional levels for treating Family, Social Affairs and Equal Opportunities, Ministry of children and adolescents with more complex problems Education, Science and Sport and comorbidities. Establishment of a network of 25 region- ADEQUATE PROVISION FOR CHILDREN al mental health centres for children and adolescents AND ADOLESCENTS WITH BEHAVIOURAL responsible for prevention services and for integrated, PROBLEMS AND ONGOING AGGRESSIVE multidisciplinary clinic- and community-based provision BEHAVIOUR for children and adolescents, covering geographical ar- eas of approx. 80,000 people, including approx. 16,000 SPECIFIC OBJECTIVE 1: ADEQUATE PROVISION FOR children and adolescents aged up to 19 (mental health CHILDREN AND ADOLESCENTS WITH BEHAVIOURAL centres for children and adolescents are defined in the PROBLEMS AND ONGOING AGGRESSIVE BEHAVIOUR Glossary (Appendix)). Line ministries: Ministry of Education, Science and Organisation of an admissions/first-aid Sport, Ministry of Health, Ministry of Labour, Family, Social service at all mental health centres for children and ado-Affairs and Equal Opportunities lescents, with the preparation of first-aid protocols by Preparation of systemic intersectoral all regional teams. In the period leading up to the es- solution for ensuring the adequate diagnosis and treat- tablishment of the full network of mental health centres ment of children and adolescents with behavioural prob- for children and adolescents, two first-aid/emergency lems and ongoing aggressive behaviour, with protocols centres will be set up at the university medical centres in of cooperation between responsible entities in the fields Ljubljana and Maribor for the treatment of urgent cases of healthcare, social care, the family and education. involving children or adolescents facing acute threats Updating of the network of education due to mental illness. All specialist staff and adolescent institutions and the drafting of standards for staff and psychiatrists in the public healthcare network will be in- programmes involved in interdisciplinary mental health volved in working at these two centres. After the network provision. of mental health centres for children and adolescents is Overhauling of the education programme established, they will take over the treatment of urgent for children and adolescents with emotional and conduct cases, thereby ensuring access at the local level. disorders, and the definition of the forms and methods Active identification of and the provision of work suitable for specific problems, disorders and in- of support to children and adolescents who are particu- terests. larly at risk, and the preparation of protocols for the per- Preparation and implementation of formance of these activities. Mental health centres for community-based services for children, adolescents and children and adolescents will proactively provide help to families at home and in local settings in cooperation with the children of parents suffering from mental illness or the Ministry of Health, the Ministry of Labour, Family, So- addiction, children exposed to other traumatic life expe- cial Affairs and Equal Opportunities and the Ministry of riences (e.g. separation from parents, loss of people who Education, Science and Sport, initially with the introduc- provided support), migrant children and their support tion of pilot projects involving mobile teams and later groups, and foster families. through systemic implementation. ACCESS TO INTERDISCIPLINARY CHILDREN’S AND ADOLESCENTS’ MENTAL HEALTH MENTAL HEALTH NETWORK FOR ADULTS, SERVICES AT THE SECONDARY AND TERTIARY INCLUDING OLDER PEOPLE HEALTHCARE LEVELS PREVENTION, EARLY DIAGNOSIS SPECIFIC OBJECTIVE 1: ACCESS TO AND ACCESSIBLE, HIGH-QUALITY INTERDISCIPLINARY HOSPITAL AND SUB-SPECIALIST INTERDISCIPLINARY PROVISION FOR ADULTS OUTPATIENT PROVISION WITH MENTAL HEALTH PROBLEMS AT THE Line ministry: Ministry of Health PRIMARY HEALTHCARE LEVEL, WITH AN Gradual provision of hospital psychiatric EMPHASIS ON COMMUNITY-BASED CARE units for children and adolescents with regulations and National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 38 30/09/2020 21:45 3. SPECIFIC OBJECTIVE 1: EARLY DETECTION OF MENTAL mental health centres are defined in the Glossary (Ap- ILLNESS AND THE PSYCHOLOGICAL EDUCATION OF pendix)). PEOPLE WITH MENTAL HEALTH PROBLEMS Establishment of first-aid and consulting Line ministry: Ministry of Health services at adult mental health centres. Screening, early detection and treatment Establishment of a network of regional of mental illness and the provision of counselling ser-community-based psychiatric teams to make critical vices at reference family practice clinics and the home interventions and carry out intensive monitoring, health nursing service. treatment and rehabilitation. Establishment of commu- Organisation of psycho-educational sup- nity-based teams, with priority given to areas with the port workshops for people with mental health problems highest suicide rates and other critical mental health and their families at health promotion centres and adult indicators. mental health centres. Harmonisation and standardisation of the standards, protocols and activities of integrated SPECIFIC OBJECTIVE 2: ACCESS TO PRIMARY-LEVEL treatment teams. INTERDISCIPLINARY TEAMS AND COMMUNITY-BASED Long-term, integrated and multidiscipli- PROVISION FOR ADULTS SUFFERING FROM MENTAL nary provision for people with several simultaneous se- ILLNESS vere mental illnesses. Line ministries: Ministry of Health, Ministry of Labour, Programme evaluation. Family, Social Affairs and Equal Opportunities Establishment of a network of 25 regional ACCESSIBLE, HIGH-QUALITY SECOND-LEVEL adult mental health centres responsible for prevention PROVISION FOR ACUTE CASES services and for integrated, multidisciplinary clinic- and community-based provision for adults and older people, SPECIFIC OBJECTIVE 1: STATE-OF-THE-ART HOSPITAL- covering geographical areas of approx. 80,000 people, BASED PSYCHIATRIC CARE ACCESSIBLE TO ALL including approx. 64,000 adults aged 20 or over (adult Line ministry: Ministry of Health For mental health Mira resolucija A4 ANG sept 2020.indd 39 30/09/2020 21:45 LONG-TERM TREATMENT OF PEOPLE WITH Gradual addition to hospital psychiatric MENTAL HEALTH PROBLEMS AND MENTAL facilities of gerontopsychiatric departments and special- DEVELOPMENTAL DISORDERS ist units for dealing with specific mental illnesses and situations, in accordance with operating regulations and SPECIFIC OBJECTIVE 1: ESTABLISHMENT OF standards. CONDITIONS IN THE COMMUNITY FOR REDUCING AND PREVENTING THE INSTITUTIONALISATION OF PEOPLE WITH MENTAL HEALTH PROBLEMS REHABILITATION OF PEOPLE WITH Line ministries: Ministry of Labour, Family, Social Af-RECURRING MENTAL HEALTH PROBLEMS fairs and Equal Opportunities, Ministry of Health, Ministry SPECIFIC OBJECTIVE 1: STRENGTHENING OF THE of the Environment and Spatial Planning, Government Of- REHABILITATION SERVICES NETWORK fice for Development and European Cohesion Policy Line ministries: Ministry of Labour, Family, Social Af-Establishment of conditions in the com- fairs and Equal Opportunities, Ministry of Health, Ministry munity for reducing the institutionalisation of people with of Education, Science and Sport mental health problems. Provision of access to high-quality hous- Adherence to high standards of protec- ing group programmes for adults and young people with tion of human rights and dignity, and to a guaranteed different levels of support, the option of moving between level of quality of provision in long-term care institutions. different levels of support, and a reduction in inequality among the providers of these programmes. SPECIFIC OBJECTIVE 2: PLANNED GRADUAL Provision of access to high-quality day- REDUCTION IN THE NUMBER OF ADULTS WITH centre programmes, and awareness-raising, counselling MENTAL HEALTH PROBLEMS AND COMBINED and one-to-one assistance programmes. DISORDERS ATTENDING SOCIAL CARE INSTITUTIONS Provision of access to employment, AND THEIR TRANSFER TO COMMUNITY-BASED adapted employment and work-training programmes for FORMS OF LIVING, AND THE CONTINUOUS people with various mental health problems. IMPLEMENTATION OF SOCIAL CARE PROGRAMMES Improvements in access to and the avail- AIMED AT COMMUNITY-BASED PROVISION FOR ability of programmes of assistance in learning, cognitive PEOPLE WITH MENTAL HEALTH PROBLEMS remediation and support to students in the education Line ministries: Ministry of Labour, Family, Social Af-system upon their return to or enrolment in study pro- fairs and Equal Opportunities, Ministry of Health, Ministry grammes following mental illness. of the Environment and Spatial Planning, Government Of- Expansion of therapy and rehabilitation fice for Development and European Cohesion Policy programmes for people experiencing mental health High-quality social care services and pro- problems and drug dependence. grammes aimed at community-based provision for peo- Provision of equal access to advocacy ple with mental health problems. and self-advocacy programmes through the establish- Development of integrated community ment of additional advocacy and self-advocacy offices, support for secure living, employment and treatment for and the provision of education and training to advocates people who have undergone long-term institutional care. and peer-to-peer advocates. Construction of dedicated living units. Provision of access to programmes to strengthen social and everyday skills and foster com- ORGANISATION OF APPROPRIATE INTEGRATED munity inclusion, and other evidence-based assistance CARE FOR PEOPLE WITH MENTAL HEALTH programmes. PROBLEMS WHO EXHIBIT DANGEROUS Provision of activation programmes and BEHAVIOUR other systemic measures to reduce the number of peo- ple suffering from severe and recurring mental illness SPECIFIC OBJECTIVE 1: ESTABLISHMENT OF AN who are living below the poverty line and experiencing INTEGRATED AND EFFECTIVE APPROACH TO PEOPLE social exclusion. WITH MENTAL HEALTH PROBLEMS WHO EXHIBIT Establishment of rehabilitation pro- DANGEROUS BEHAVIOUR, WITH THE AIM OF grammes for children and adolescents experiencing PROVIDING CONTINUOUS, SAFE AND EFFECTIVE CARE mental health problems. Line ministries: Ministry of Health, Ministry of Education, Science and Sport, Ministry of Labour, Family, Social National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 40 30/09/2020 21:45 Affairs and Equal Opportunities, Ministry of Justice, Minis-SPECIFIC OBJECTIVE 2: PROTECTION OF THE RIGHTS try of the Interior OF OLDER PEOPLE Needs assessments for an integrated and Line ministries: Ministry of Labour, Family, Social Af-effective approach to people with mental health prob- fairs and Equal Opportunities, Ministry of Health lems who exhibit dangerous behaviour. Education and awareness-raising for Establishment of the appropriate condi- the general public and target populations on the need tions for addressing people with mental health problems to protect the rights of older people, particularly women who exhibit dangerous behaviour in special social care and the economically deprived, to include identification and education institutions, with adequate standards for of the signs of violence against older people. staff, knowledge, skills and premises. Strengthening of the skills of care staff in Establishment of a multidisciplinary ap- order to prevent violence against older people. proach to people explicitly ordered to undergo compul- Support for advocacy programmes that sory outpatient psychiatric treatment. Preparation of offer free legal aid to older people and promote peer- protocols and standards for the safety measure of com- to-peer assistance in the areas of representation and pulsory outpatient psychiatric treatment (collaboration advocacy. with community-based providers). Organisation of counsellors/assistants in Establishment of a community-based local settings or at larger hospitals and social protection multidisciplinary approach to people with mental health institutions for the guidance and provision of assistance problems who exhibit dangerous behaviour. Preparation to older people in the use of organisations/services, in- of protocols and standards for the provision of psycho- cluding the promotion of self-help peer-to-peer groups social rehabilitation programmes. and organisations via formal providers in the local envi- Organisation of rehabilitation following ronment. the completion of a measure of compulsory psychiatric PSYCHOLOGY AND PSYCHOTHERAPY treatment. Preparation of protocols and standards for ACTIVITIES the provision of rehabilitation programmes. Establishment of a specialised approach SPECIFIC OBJECTIVE 1: INCREASED ACCESS TO 3. to addressing people who are suffering from the most PSYCHOLOGY AND PSYCHOTHERAPY SERVICES severe forms of mental illness and who are at risk of Line ministries: Ministry of Health, Ministry of Labour, committing a (further) criminal offence (heteroaggres-Family, Social Affairs and Equal Opportunities, Ministry of sive behaviour). Education, Science and Sport Regulation of standards for psychology and psychotherapy activities. ADDRESSING THE SPECIFIC MENTAL HEALTH Regulation of standards for publicly fund- NEEDS OF OLDER PEOPLE ed psychology and psychotherapy services. SPECIFIC OBJECTIVE 1: EARLY DIAGNOSIS AND Establishment of regulations and stand- TREATMENT OF MENTAL ILLNESS AMONG OLDER ards for psychology and psychotherapy services for the PEOPLE treatment of mental illness. Line ministries: Ministry of Health, Ministry of Labour, Systemic regulation of the financing and Family, Social Affairs and Equal Opportunities publication of calls for applications for specialist clinical Strengthening of the network of teams of psychology disciplines. family practitioners and of their knowledge and skills in Publication of calls for applications for dealing with older people in line with their needs. 25–30 specialist clinical psychology specialisations a year Strengthening of the preventive role of over the next ten-year period. the home nursing and care service when dealing with Recruitment into the mental health net- older people in their home environment. work of adequate numbers of staff responsible for pro- Provision of access to specialist interdis- viding psychology and psychotherapy services. ciplinary treatment at the primary healthcare level within adult mental health centres and social care services, and a community-based approach to older people experienc- ing mental health problems. For mental health Mira resolucija A4 ANG sept 2020.indd 41 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 42 30/09/2020 21:45 Alcohol and mental health ALCOHOL AND MENTAL HEALTH use of alcohol (short counselling sessions, motivational SPECIFIC OBJECTIVE 1: RAISING OF AWARENESS interviews) to change alcohol consumption habits at the OF THE CONSEQUENCES OF THE HARMFUL USE OF primary healthcare level (general/family practice clinics, ALCOHOL ON MENTAL HEALTH reference clinics, gynaecology clinics and home nursing Line ministries: Ministry of Health, Ministry of Labour, services), and the insertion of these processes into social Family, Social Affairs and Equal Opportunities care and family services. Measure 1: Organisation of activities and pro- Measure 3: Regular evaluation of the programme of 4. grammes to raise public awareness of the consequences psychosocial and educational workshops for drink driv- of the harmful use of alcohol on the mental health of ers. the individual and their loved ones for a range of target Measure 4: Education of psychosocial and educa- groups. tional workshop providers for drink drivers and their in- Measure 2: Destigmatisation of alcohol dependence tegration into the interdisciplinary profession in order to treatment programmes and of the users of these pro- provide further appropriate treatment to people depend- grammes. ent on alcohol. Measure 3: Development of a critical attitude to Measure 5: Establishment of protocols for identifying alcohol consumption by changing societal norms and and dealing with the risky and harmful use of alcohol, promoting responsible communication on the subject of and the appropriate referral to a higher health treatment alcohol. level in cases of alcohol dependence. Measure 6: Referral of people dependent on alcohol SPECIFIC OBJECTIVE 2: PROVISION FOR THE RISKY for treatment at an adult mental health centre. AND HARMFUL USE OF ALCOHOL WITHIN THE Measure 7: Provision of equal access to health ser- HEALTHCARE SYSTEM, AND COLLABORATION WITH vices for the treatment of people dependent on alcohol, OTHER SECTORS and tailored treatment programmes for people with as- Line ministries: Ministry of Health, Ministry of Labour, sociated mental health problems. Family, Social Affairs and Equal Opportunities Measure 8: Provision of equal access to support ser- Measure 1: Strengthening of knowledge and skills for vices for the psychosocial rehabilitation of patients and the early identification of problems resulting from alcohol their families following treatment for alcohol depend- consumption and/or alcohol dependence, including social ence (e.g. specialist-led clubs and societies for people care services, family services, work organisations and ed-recovering from alcohol dependence). ucation institutions, in addition to the health service. Measure 2: Systemic implementation of screening and intervention processes for the risky and harmful For mental health Mira resolucija A4 ANG sept 2020.indd 43 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 44 30/09/2020 21:45 prevention Continuous education of all frontline workers and SPECIFIC OBJECTIVE 1: RAISING OF MENTAL HEALTH others (e.g. paediatricians, general practitioners, AWARENESS AND LITERACY, PARTICULARLY IN psychologists, nurses and medical technicians, social RELATION TO SUICIDE workers, police officers, firefighters, teachers, and Line ministries: Ministry of Health, Ministry of Labour, other people working in the non-governmental sec-Family, Social Affairs and Equal Opportunities, Ministry of tor), and the strengthening of their ability to identify Education, Science and Sport and respond to suicidal behaviour. 5. Development and implementation of pro- Establishment of protocols of cooperation and the grammes that identify and take early action in response demarcation of competencies/responsibilities be- to suicidal behaviour (adapted to the general public and tween different frontline workers and community- other local community representatives). based services. Introduction of a standardised psychological first- Provision of immediate intervention by community- aid programme (dissemination of knowledge of the based services in the event of suicide risk, particu- causes, symptoms and signs of suicidal behaviour larly among older people. and the strengthening of the ability to take action). Ongoing screening of the population for Dissemination of information on suicidal behaviour, its suicide risk (PHQ-9 in reference clinics) and data moni- prevention and the options for taking action (e.g. talks toring (in order to improve provision for at-risk individu- and workshops for the general public) among a range als or for epidemiological research purposes). of population groups (children, adults, the elderly, etc.). Continuous contact with the media in or- SPECIFIC OBJECTIVE 3: ACCESS TO HELP AND der to encourage them to report responsibly on suicide MENTAL HEALTH PROVISION FOR PEOPLE AT RISK OF and mental health/illness in the wider sense. SUICIDE Line ministries: Ministry of Health, Ministry of Labour, SPECIFIC OBJECTIVE 2: EARLY IDENTIFICATION OF Family, Social Affairs and Equal Opportunities, Ministry of PEOPLE AT RISK Education, Science and Sport Line ministries: Ministry of Health, Ministry of Labour, Development and implementation of pro-Family, Social Affairs and Equal Opportunities, Ministry of grammes of help and the active monitoring of those at Education, Science and Sport risk of suicide in different populations (priority access to Development and implementation of pro-free clinical psychology, psychiatric and psychotherapy grammes to enable specialists to identify and take early treatment, priority community- and clinic-based treat- action in response to suicidal behaviour among a range ment, establishment of an emergency/first-aid service, of population groups. clinics for acute cases, provision of continuous/long- For mental health Mira resolucija A4 ANG sept 2020.indd 45 30/09/2020 21:45 term help or monitoring following a suicide attempt, ac- cess to programmes of help to reintegrate individuals into everyday life, provision of programmes of help for families after a member’s suicide/suicide attempt, psy- chotherapy services). Establishment of links and continuous cooperation between health services, social services and the non-governmental sector, and support for their work. SPECIFIC OBJECTIVE 4: REDUCTION IN ALCOHOL USE Line ministries: Ministry of Health, Ministry of Education, Science and Sport, Ministry of Labour, Family, Social Affairs and Equal Opportunities Implementation of measures to reduce the consequences of harmful alcohol use and alcohol dependence (measures referred to under the priority area dealing specifically with alcohol). SPECIFIC OBJECTIVE 5: RESTRICTION OF ACCESS TO THE MEANS OF SUICIDE Line ministries: Ministry of the Interior, Ministry of Justice, Ministry of Health, Ministry of the Environment and Spatial Planning Review and amendment of legislation re- lating to the provision of safe environments and access to technical means and devices that could be used in suicide attempts, including access to poisons and drugs. Provision of safety measures at critical points (erection of fencing at railway crossings and on high buildings and bridges). Provision of safe spaces at hospitals, prisons and other institutions where the suicide risk is greater because of the nature of the population or other risk factors. National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 46 30/09/2020 21:45 5. For mental health Mira resolucija A4 ANG sept 2020.indd 47 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 48 30/09/2020 21:45 Education, research, monitoring and evaluation EDUCATION Measure 2: Provision of education for interdiscipli-SPECIFIC OBJECTIVE 1: PROVISION OF CURRICULAR nary teams of general practitioners, including the home CONTENT ON THE IMPORTANCE OF SAFEGUARDING nursing service for the early detection and treatment of MENTAL HEALTH common mental illnesses and for interdisciplinary and Line ministries: Ministry of Education, Science and intersectoral cooperation in this area. Sport, Ministry of Health, Ministry of Labour, Family, Social Measure 3: Provision of education for interdiscipli-Affairs and Equal Opportunities, Ministry of Justice, Minis- nary teams at mental health centres for children and 6. try of the Interior adolescents and interdisciplinary teams at adult mental Measure 1: Inclusion of educational content in curricu-health centres on prevention and the integrated treat- lar and cross-curricular topics in primary and secondary ment of people suffering from mental illness, psychologi- schools on the importance of safeguarding mental health. cal first aid, and interdisciplinary and intersectoral coop- Measure 2: Inclusion or strengthening of educational eration in this field. content on mental health promotion and the prevention Measure 4: Education and training of specialists in of mental illness in vocational education at the second- community-based psychiatric treatment. ary and higher education levels for health, social, family Measure 5: Education and training of interdiscipli-care and education professions. nary specialists involved in dealing with people suffering Measure 3: Inclusion of mental health content in or- from mental illness and exhibiting violent behaviour. dinary further professional education and training for all Measure 6: Introduction of undergraduate courses professional groups that work with people (healthcare, in health and social care, with specialisations in men-social and family care, education, justice and prosecution tal health for healthcare, and the upgrading of educa- authorities). tion and training for health workers and professionals in other fields. SPECIFIC OBJECTIVE 2: PROVISION OF APPROPRIATE TRAINING TO HEALTH WORKERS AND SPECIFIC OBJECTIVE 3: EDUCATION FOR ADVOCACY PROFESSIONALS IN OTHER SECTORS ON WORK WITH AND THE COORDINATION OF COMMUNITY-BASED PEOPLE SUFFERING FROM MENTAL ILLNESS PROVISION Line ministries: Ministry of Education, Science and Line ministries: Ministry of Labour, Family, Social Af-Sport, Ministry of Health, Ministry of Labour, Family, Social fairs and Equal Opportunities, Ministry of Health Affairs and Equal Opportunities, Ministry of the Interior Measure 1: Continuous education and training of ad- Measure 1: Development or updating of teaching vocates of people’s mental health rights. modules for interdisciplinary work and work with people Measure 2: Continuous education and training for experiencing mental health problems. coordinators of community-based provision. For mental health Mira resolucija A4 ANG sept 2020.indd 49 30/09/2020 21:45 MONITORING AND EVALUATION OF THE NATIONAL PROGRAMME The assessment or evaluation of the National Men- tal Health Programme 2018–2028 is an important activity and one that will help us to identify those areas of work that have met with success and those in which improve- ments are possible. The aim of the evaluation of the National Programme is:  to conduct an ongoing assessment of the success or otherwise of the action plan at two-year intervals and the continuous adjustment of implementation within the frameworks of the action plan for the next two years;  to establish the effectiveness of the entire pro- gramme over the 2018–2028 period, with an emphasis on identifying whether all eight strategic objectives have been achieved. The National Programme envisages the monitoring of structural, procedural and outcome indicators. Structural indicators define the elements that enable programme RESEARCH implementation, e.g. staff, equipment, information re- SPECIFIC OBJECTIVE 1: MONITORING OF MENTAL sources, organisational networks, etc. Process indicators HEALTH relate to actual implementation of the programme and Line ministries: Ministry of Health, Ministry of Labour, the interventions and activities conducted within it, and Family, Social Affairs and Equal Opportunities, Ministry of describe the mechanisms through which the structures Education, Science and Sport facilitate the achievement of outcomes. The outcomes Measure 1: Establishment of a set of internationally are the effects of the programme. As with structure and comparable indicators for monitoring the mental health processes, these outcomes can appear at the strate- of men and women of all age groups (by sex), and of at- gic (programme) level or the level of a specific activity. risk population groups. Process evaluations are usually conducted during imple- Measure 2: Establishment and implementation of ap- mentation to allow us to establish what we are doing propriate continuous monitoring and study of the mental and how effective we are, and to give us the option of health of men and women, and of the effectiveness of making improvements as we go along. An evaluation of measures for all ages and at-risk groups of the population. the effects is conducted before the end of the measure Measure 3: Establishment of a working group to to assess efficiency and effectiveness and, after comple-study methods of monitoring suicide and suicide at- tion, to assess the final effectiveness of the programme. tempts (register of suicides and suicide attempts). In order to evaluate the National Programme, the in- dicators for the monitoring of its strategic objectives are SPECIFIC OBJECTIVE 2: WIDENING OF THE SCOPE OF defined at the beginning of the Resolution. The final set MENTAL HEALTH RESEARCH of indicators used to evaluate achievement of the pur- Line ministries: Ministry of Health, Ministry of Labour, pose and objectives will be compiled by a working group Family, Social Affairs and Equal Opportunities, Ministry of of experts, who will carry out an evaluation on the basis Education, Science and Sport of a special methodological document. Measure 1: Provision of resources for research into mental health, broken down by sex and among different populations (children and adolescents, adults, the elderly, particularly at-risk populations, etc.). Measure 2: Introduction of applied and qualitative community-based research involving users and providers. National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 50 30/09/2020 21:45 6. For mental health Mira resolucija A4 ANG sept 2020.indd 51 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 52 30/09/2020 21:45 management bodies, interdisciplinary working groups, and the expert and programme councils. Ihe implementation of an extensive set of intercon- nected and interdependent National Mental Health Programme activities can only be successful if The Programme Council monitors the implementa- there is a well-planned network of experts in place at tion of the national programme, formulates proposals for national, regional and local levels who manage and co- overcoming challenges arising during implementation of ordinate activities in line with the National Programme the National Programme, and operates as an advisory and bring stakeholders and providers into contact with body to the Expert Council and interdisciplinary working each other. The tasks of the national and regional/lo-groups. cal management of the implementation of the ten-year The Expert Council leads National Mental Health Pro- mental health programme will be performed by the NIJZ, gramme activities, plans and supports the specialist and which will establish a complex management structure developmental tasks of specific interdisciplinary working for the purpose (Figure 8). In implementing tasks relat- groups, and provides expert support to ministries in a ing to management of the implementation of the Na-range of tasks and in the development of strategic, regu- tional Mental Health Programme, the NIJZ will work with latory and other solutions in the field of mental health. and bring into the management process specialists from The interdisciplinary working groups design and various disciplines and sectors, advocacy and humani- implement substantive, organisational and structural tarian organisations working in mental health, as well as measures in accordance with the National Programme representatives of service users, who will operate within and the action plans. For mental health Mira resolucija A4 ANG sept 2020.indd 53 30/09/2020 21:45 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 54 30/09/2020 21:45 mplementation of the National Mental Health Pro- istry of Education, Science and Sport, Ministry of Labour, gramme requires the support of the whole of soci- Family, Social Affairs and Equal Opportunities, Ministry of ety, political circles, the profession and civil society. Justice and other relevant ministries), operates under the A commitment is required from all government levels, aegis of the Ministry of Health, aims to work proactively as well as from political actors at national and local lev- to resolve intersectoral challenges in the mental health els, if implementation is to be provided with the required field, and takes part in the development and implementa- support. Formal structures are therefore being estab- tion of intersectoral mental health measures and tasks. lished at national (the government’s own Mental Health Regional mental health councils comprise local Council) and local levels (the Regional Mental Health political representatives and mental health networks in Council), along with local health groups, to ensure that areas covered by mental health centres (approx. 80,000 mental health objectives are included in the agendas inhabitants). Based on an assessment of the situation of all government actors, and that local political actors and needs, it designs a regional mental health plan, sup- also recognise the importance of mental health and lend ports implementation of the priority tasks set out in that their weight to the community-based implementation of plan and organises regional mental health conferences. mental health initiatives. The bodies charged with imple- Local health groups are already in place in areas menting the National Mental Health Programme at the covered by a community medical centre and include all political level and the stakeholders involved in the pro- important stakeholders whose decision-making and/or cess are listed below. operations have an important impact on health. Local The Government Mental Health Council supports health groups manage and coordinate the health pro- the implementation of tasks set out in the National Men- motion centres that are incorporated into community tal Health Programme and the achievement and moni- medical centres. The task of a local health group is to in- toring of the sectoral objectives, handles intersectoral tegrate the local mental health improvement action plan elements, working reports and action plans and, once into the wider health improvement plan designed by the every two years, reports to the National Assembly on the group for its area, including an assessment of the situa- implementation of the National Programme. tion and needs and the measures for improving mental The intersectoral working group, comprising repre- health and reducing mental health inequality among the sentatives of the key ministries (Ministry of Health, Min- local population. For mental health Mira resolucija A4 ANG sept 2020.indd 55 30/09/2020 21:46 Organisational chart for the management of implementation of the National Mental Health Programme MENTAL HEALTH COUNCIL MZ MIZŠ MDDSZ OTHER MINISTRIES Intersectoral working group National Institute of Public Health vel Programme Council National head of the programme and their deputy National le Expert Council Organisational/technical support Interdisciplinary Expert support working groups Regional mental health council vel Regional NIJZ – coordinators Regional unit Regional mental health centres for children and adolescents, and for adults Medical Health promotion Local (mental) Regional/local le centre centre health groups Figure 8 Organisational chart of national and regional/local management of implementation of the National Mental Health Programme National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 56 30/09/2020 21:46 Organisational chart for the management of implementation of the National Mental Health Programme For mental health Mira resolucija A4 ANG sept 2020.indd 57 30/09/2020 21:46 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 58 30/09/2020 21:46 for high-risk families (health partnerships with families) and the ‘Neverjetna leta’ (Unbelievable years) parenting In the fields of healthcare, social care and the fam- programmes, are part of the strategy recommended by ily, we constantly come up against a mismatch between the WHO. The cost-effectiveness of programmes aimed needs and resources (both human and financial), which at providing help to families in the first six months of is why we must use good organisation to allocate our a child’s life is considerable and persists over the long modest resources so that they bring the greatest pos- term, from 1: 2.3 to 1: 33 for programmes that help high- sible benefits to service users and the community. When risk families with children. it comes to investing in the protection of mental health, As well as producing a heavy public financial burden cost-effectiveness increases if adequate funds are ear- on countries, child maltreatment, which includes emo- marked for promoting mental health and preventing tional, physical and sexual abuse and child neglect, also mental illness, detecting mental illness early on, and presents a serious risk to the mental health of children dealing effectively with mental illness in the commu- and adults and of the development of chronic physi- nity. If there is an appropriate ratio between the above cal illness in adulthood. Even in the developed world, factors, the average cost-effectiveness ratio is 1:12.5, between 9 and 29% of children are exposed to various although programmes to prevent mental illness among forms of abuse. The indirect and direct costs of abuse children and adolescents can have an even higher ratio, are extremely high: in the US alone, they are estimated with one dollar invested bringing a profit of 80 dollars. at 210,000 dollars per victim per year (which is compa- Investing in programmes that reduce the possibil- rable to the cost of a stroke or diabetes). In total, this ity of child maltreatment, such as programmes of help constitutes more than 1% of GDP, with research assessing For mental health Mira resolucija A4 ANG sept 2020.indd 59 30/09/2020 21:46 of the National Mental Health Programme 2018–2028 a reduction in the costs of sickness benefits for people a reduction in the with mental health problems costs of psychotropic and their families medications a reduction in the costs a reduction in judicial costs of inpatient psychiatric treatment a reduction in local community expenditure on institutional care a reduction in the costs of social transfers a reduction in the burden caused by children’s and adolescents’ emotional and conduct disorders National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 60 30/09/2020 21:46 the costs of the child maltreatment in Italy and Germany producing comparable figures. A recent study has found that individuals with several risk factors in early childhood (approx. 20% of children) account for the majority of the economic burden on so- In past decades, the major part of investments ciety in various sectors during adulthood. in mental health went to institutional care in both the The risk factors that can be identified in the first healthcare and social care sectors. To illustrate: prior to three years account for 60 to 80% of the costs that end the adoption of the National Mental Health Programme, of the National Mental Health Programme 2018–2028 up being borne by society in the form of social transfers, the direct costs of treating people with mental health single-parent families, smoking, the number of days off problems in the healthcare sector amounted to EUR 80 sick from work, medical prescriptions and crime. Pro- million, with 85% of this total going to the hospital treat- grammes that effectively reduce the long-term risks for ment of people with mental health problems. these children therefore represent important opportuni- The National Mental Health Programme proposes a ties for us to take action together as a society. shift in the way mental healthcare is delivered to the A few more justified investments in mental health Slovenian population towards improving mental health, can be mentioned here: training general practitioners to preventing the development of mental health problems recognise suicidal behaviour in their patients produces in all settings, and bringing accessible, integrated institu-a return on investment of 1: 54.45, early identification of tions and services closer to people suffering from men- psychosis a return of 1: 10.27, workplace mental health tal health problems at the primary level and within the promotion a return of 1: 9.69, and the early identification community. The planned funding is also in line with these and treatment of depression in the active population a objectives. return of 1: 5.03. If the objectives of the National Mental Health Pro- A Canadian document on the return on investments gramme are to be achieved, the workings of sectoral- in the mental health of the population, a WHO document specific policies must be coordinated and the sectoral on investments in mental health, and the press release budgets that enable implementation of the interconnect- published jointly by the World Bank and the WHO all sum- ed and intersectoral measures planned in the ten-year marise the research findings on the cost-effectiveness programme on an ongoing basis. This requires respon- of mental health measures and the treatment of mental sible decision-makers, major intersectoral cooperation illness. They conclude that action in the field of mental and coordinated investments in mental health; only in health is required not only to prevent individual suffering, this way can the programme’s objectives be achieved, but also for the well-being and economic prosperity of optimal benefits and savings be produced for society and society. Evidence of a link between economic productiv- the economy, and human rights and needs in the field of ity and mental health is solid: for example, investments mental health be met. in programmes to promote mental health and prevent From the financial aspect, the National Mental Health mental illness in the field of depression and anxiety alone Programme contains two types of measure: bring a fourfold saving to society. The president of the some have no financially defined items in terms of World Bank acknowledges that mental health is not only the additional investment of funds as they are con- a public health issue, but a development issue as well. ceptual changes or procedural upgrades within the Productivity losses from mental illness are something system already in place; the global economy cannot afford. certain National Mental Health Programme measures The European Data Preview project shows that invest- also bring structural changes that entail an increase ments in tried-and-tested preventive and promotional in- in investments in staff, staff training and develop- terventions among children, at the workplace and among ment, and the implementation of tried-and-tested older people significantly reduces the cost of mental programmes to protect mental health, prevent the health provision for these groups in all sectors of the sys- development of mental health problems and provide tem. Facts about public health and the economy point to care to people with mental health problems. the importance of taking an integrated, community-based The measures contained in the National Mental approach to mental healthcare provision, having adequate Health Programme will be (co-)financed from a variety of social security systems and safe workplace programmes, sources: the budgets of the line ministries (the ministries supporting families and parents, supporting debt resolu- of health, of education, and of labour, family, social af- tion initiatives, and having an active alcohol policy. fairs and equal opportunities), European Union funds and For mental health Mira resolucija A4 ANG sept 2020.indd 61 30/09/2020 21:46 other international sources, funds from the Norwegian Financial Mechanism, ZZZS funds and local community budgets. Budget funding from the various ministries will cover the implementation of measures from the priority areas of mental health promotion, and the prevention and des- tigmatisation of mental illness for different target groups, some of the measures relating to alcohol and mental health, suicide prevention, education and research, and the monitoring and evaluation of the National Mental Health Programme. The funding of measures that in- clude social care, advocacy and user-run programmes is part of the budget funding of the mental health network. The management of the implementation of the Na- tional Mental Health Programme has planned partial funding. Management of the establishment and opera- tion of mental health centres and other mental health services within the healthcare sector is financed by the ZZZS, while management of the implementation of public health measures from other priority areas is expected to be funded from the Ministry of Health budget. ZZZS funds are earmarked for the additional inser- tion of interdisciplinary early treatment centre teams into the network of 22 development clinics, the establishment of new teams at 25 mental health centres for children and adolescents, 25 adult mental health centres with clinic- and community-based psychiatric provision, three tertiary-level clinical teams for priority provision of care to children and adolescents with mental health problems, seven sub-specialist outpatient clinical teams at the national or regional level charged with addressing children and adolescents suffering from more complex disorders and comorbidities, the bolstering of hospital- based child psychiatry teams, and the establishment of hospital-based gerontopsychiatric units and specialist units for the treatment of specific mental health disor- ders. The teams will be set up at equal intervals over a ten-year period according to the principle of priority in environments with elevated mental health risks and reduced access to services. costs will be known after the staff standards and the Example of the evaluation of the costs of investing standards applying to programmes of care and help for in the establishment of new mental health centres: the children and adolescents with learning difficulties are establishment of 25 mental health centres for children defined, and after the systemic foundations are laid by and adolescents, 25 adult mental health centres and the the Ministry of Education, Science and Sport. 100 home-care teams being added to existing home- The programmes and services that come under the care capacities in order to better tackle mental health responsibility of the Ministry of Labour, Family, Social problems will cost the ZZZS EUR 28 million, which is only Affairs and Equal Opportunities must be expanded and a little more than one third of the costs of hospital treat- upgraded in line with the strategic documents already ment of people with mental health problems. There are adopted and the pilot projects carried out in the 2018– plans to add to and expand the network of counselling 2020 period; in this period, the ministry will also prepare centres for at-risk children and adolescents. The precise a draft new strategic social care 2021–2030 document. National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 62 30/09/2020 21:46 This document must include the planning and financing In order to upgrade the programmes, develop new of social care programmes in the field of mental health, models and approaches in the field of mental health, lay as envisaged by the National Mental Health Programme. the foundations for deinstitutionalisation and carry out Social care programmes must be set up in local environ- upgraded community-based programmes for addressing ments in line with needs and contemporaneously with people experiencing long-term mental health problems, the establishment of new mental health centres in order the ministries of labour, family, social affairs and equal to guarantee comprehensive and integrated provision opportunities, of health, and of education, science and for people with mental health problems in the local com-sport will be involved in the funding process with the help munity. This programme and financial planning requires of existing budget funds, as well as of funds from the close cooperation between both ministries: the Ministry new programming period of the European Social Fund of Health and the Ministry of Labour, Family, Social Affairs (ESF) and European Fund for Regional Development and Equal Opportunities. (EFRD), and other sources. For mental health Mira resolucija A4 ANG sept 2020.indd 63 30/09/2020 21:46 National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 64 30/09/2020 21:46 ADHD Attention Deficit Hyperactivity Disorders CINDI Countrywide Integrated Non-Communicable Disease Intervention EU European Union ICT Information and communication technology MDDSZ Ministry of Labour, Family, Social Affairs and Equal Opportunities MGRT Ministry of Economic Development and Technology MIZŠ Ministry of Education, Science and Sport MJU Ministry of Public Administration MOP Ministry of the Environment and Spatial Planning MP Ministry of Justice MZ Ministry of Health NIJZ National Institute of Public Health NPDZ National Mental Health Programme 2018–2028 NGO Non-governmental organisation OE NIJZ National Institute of Public Health regional unit RNPDZ Resolution on the National Mental Health Plan 2018–2028 FASD Fetal alcohol spectrum disorder WHO World Health Organization UKC University Medical Centre UPK University Psychiatric Clinic UN United Nations ZVDZ Occupational Health and Safety Act ZZZS Health Insurance Institute of Slovenia For mental health Mira resolucija A4 ANG sept 2020.indd 65 30/09/2020 21:46 Absenteeism: Sickness absenteeism is temporary and activities to improve health and reduce health in-absence from work for reasons of illness (another term equalities in the local environment (in these fields, they for absenteeism is ‘sick leave’). Absenteeism is a social, work and have links with social work centres, employ- organisational and legal problem that has economic con- ment offices, municipalities, education institutions, life-sequences for workers, employers, the economy and the style improvement organisations, patients’ organisations, compulsory health insurance system. work organisations and others that are able to contrib- ute to the health of local populations). Burden of disease: An analysis that evaluates the health outcomes of a disease or the state of health of Early treatment centres: These are responsible a selected population. It is measured in terms of eco- for early primary-level comprehensive/multidisciplinary nomic cost, mortality, morbidity and other indicators, and provision for children with identified developmental is often evaluated in terms of QALY (‘quality-adjusted life disorders. They are integrated into developmental clin- year’) or DALY (disability-adjusted life year). Both indica- ics, and are defined in the Integrated Early Treatment tors show the number of years lost to illness. One disa-of Preschool Children with Special Needs Act (Zakon o bility-adjusted life year is one healthy year lost by the pa-celostni zgodnji obravnavi predšolskih otrok s posebnimi tient, while the total burden of disease is a measurement potrebami, Uradni list RS/Official Gazette of the Republic of the life gap, i.e. the difference between the current of Slovenia, 41/17). and ideal state of health (where it is assumed that the individual reaches an age without illness or disability). Destigmatisation: A process or activity that works in a targeted way towards reducing the stigma attached to Adult mental health centre: Adult mental health certain health conditions or diseases. Destigmatisation centres are located within medical centres, provide adult helps to increase awareness of a problem and make it mental health services, and cover the needs of between more accepted within society. 50,000 and 70,000 adults aged over 19. They organise their services in such a way as to enable equal access to Long-term care: Long-term care comprises a series the entire population of the area they cover, work with of services required by people with reduced physical and locally based services and provide integrated interdisci- cognitive abilities who are dependent over a longer pe- plinary intervention services; they also offer community- riod of time on assistance in performing basic or every- based psychiatric and outpatient treatment, including day support tasks. With an ageing population, this field psychological first-aid and consulting services. will become an increasingly challenging one in the future, with trends also indicating that this population will re- Mental health centre for children and adolescents: quire support to carry out basic day-to-day activities as Mental health centres for children and adolescents their capacities further decline with age. are located within community medical centres, provide mental health services to children and adolescents, and Mental illness: Mental illness is a temporary or per- cover the needs of between 12,000 and 16,000 children manent disorder in the functioning of the brain mani-and adolescents. They organise their services in such a fested as changes to thinking, emotions, perceptions, be- way as to enable equal access to the entire population of haviour, and the concept of oneself and the environment. the area they cover, work with locally based services and A failure to adapt to the moral, social, political or other provide integrated interdisciplinary intervention services. values of a society are not in themselves regarded as mental illness. Health promotion centre: Health promotion centres are independent organisational units located within com- Mental health: The World Health Organization defines munity medical centres. They carry out health promotion mental health as ‘a state of well-being in which the in- programmes (group workshops and one-to-one coun- dividual realizes his or her own abilities, can cope with selling aimed at instituting lasting changes in lifestyle the normal stresses of life, can work productively and habits that will lead to improved well-being and health) fruitfully, and is able to make a contribution to his or her National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 66 30/09/2020 21:46 community’ (WHO, 2014). Good mental health enables an individual to realise their mental and emotional capaci- ties and to be successful in their professional, social and private lives. In recent years, mental health has been un- derstood not only as a state of well-being as opposed to a state of ill health, but as a continuum. Incidence: Incidence is the number of new cases, ep- isodes or events that appear over a specific (observed) period, usually of one year, in a specific area. Interdisciplinary working groups: Interdisciplinary working groups are expert groups organised within the Programme Council and comprising specialists from a variety of disciplines and sectors. They meet at working meetings and perform coordinated tasks relating to the development of interventions, education, management, coordination and the evaluation of the National Pro- gramme implementation. Comorbidity: Comorbidity is the simultaneous and non-causal appearance of different conditions. It is usually the simultaneous appearance of two (or more) men- tal disorders (or a combination of a mental disorder with a chronic physical disease or a disorder resulting from the use of psychoactive drugs). Cure: Cure or treatment are various procedures and medications used to aid a return to good (mental) health or to improve the physical or mental functions affected by disease. Mental health network: In the context of the National Mental Health Programme, the mental health net- work comprises interconnected providers of health and social services and others providing mental health pro- motion and improvement, mental illness prevention and treatment, psychosocial rehabilitation and other mental health services (co-)financed from budget funds, health- care funds, pension insurance and other public funds. Mental health inequalities: Mental health inequali- ties are systematic, preventable and unjust differences in mental health between population groups. The many policies and interventions that have a positive effect on the health of the general population frequently do not reach those at critical risk or those from more vulner-For mental health Mira resolucija A4 ANG sept 2020.indd 67 30/09/2020 21:46 able socioeconomic groups, and can even exacerbate Prevalence: Prevalence is the proportion of a given social differences. Interventions must be adjusted to the population found to be affected by a specific symptom needs and conditions of the groups concerned. Meas- or illness at a given time. It tells us how many people, ac- ures are increasingly being carried out in policies outside cording to research, have a specific symptom or illness healthcare systems. on a given day regardless of when they fell ill or when the symptoms of illness appeared, and is expressed as Non-governmental organisation: An organisation the absolute number of cases or as a percentage of a that has obtained the status of society operating in the given population. public interest from the competent ministry under the Societies Act (Zakon o društvih, Uradni list RS, 64/11, of- Programme Council: The Programme Council is the ficial consolidated text) or the status of humanitarian management structure for the expert management and organisation under the Humanitarian Organisations Act interdisciplinary and inter-institutional coordination of (Zakon o humanitarnih organizacijah, Uradni list RS, 98/03 National Programme implementation at national, region- and 61/06 – ZDru-1). al and local levels. Interdisciplinary working groups are organised within the Programme Council for the perfor- Mental health literacy: Mental health literacy refers mance of these tasks. to the knowledge, beliefs and opinions regarding mental illness that aid its recognition, management or preven- Prolonged treatment: Treatment intended to ad- tion. dress those diseases and disorders that require longer periods of hospital treatment. Prolonged treatment ena- Psychosocial rehabilitation: Psychosocial rehabilita- bles patients to be monitored continually even after dis- tion is a team-based method of work that helps individu- charge from hospital. als with severe and recurring mental illness to recover and to enjoy as much independence and functionality as Health promotion: Health promotion is a process possible. Tried-and-tested rehabilitation methods include that enables people or communities to increase their training for employment, learning and, the strengthening control over the determinants of health and therefore of social and everyday skills, and the variety of psycho-improve their health. The concept includes impacts on therapy methods that enable individuals to overcome lifestyle and other social, economic, environmental and mental illness and its consequences. personal factors that contribute to health, and requires an intersectoral approach. The areas of influence are: Prevention of mental illness: Prevention activities in the formulation of public health policies, the rerouting the field of mental health can be divided into primary of (primary) healthcare activities, the creation of sup- (universal, selective and indicated), secondary and ter- port environments, training and locally based work. The tiary. Primary prevention aims to prevent mental illness, basic strategies are health advocacy, empowerment and with universal primary prevention aimed at the entire intervention. population, selective prevention aimed at people with an elevated risk of developing mental illness, and indicated Expanded expert committee: An expanded expert primary prevention aimed at people who are already committee is the highest expert body within a specific showing signs of mental illness. Secondary prevention medical field. Its main task is to formulate professional aims at the early identification and timely and effective doctrines. treatment of mental illness, while tertiary prevention re- fers to the prevention of complications and consequenc- Reference clinic: A general practice reference clinic es of mental illness and to rehabilitation. Secondary and is the name given to a general practice clinic with an ex- tertiary forms of prevention are largely carried out within panded team of healthcare professionals, with patients the health and social protection systems. monitored by a graduate nurse as well as by doctors and regular nursing staff. Graduate nurses are responsible Presenteeism: Presenteeism means presence at for monitoring certain chronic disease parameters and work despite an individual suffering ill health, sickness or for prevention activities. disturbances in their private life. National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 68 30/09/2020 21:46 Regional mental health council: Regional mental Social care programmes: Social care programmes health councils are established in regions in which a are professionally certified programmes that comple-mental health centre has been set up. ment or provide an alternative to institutional health and social care services. Rehabilitation: The National Mental Health Pro- gramme refers to ‘psychosocial rehabilitation’ (see Somatoform disorders: Conditions in which physical above). symptoms appear for which there is no medical explana- tion. These disorders are highly varied and recur on a Suicide and attempted suicide: A death is defined as frequent basis. suicide when all three of the following criteria are met: (i) it is the result of an injury or poisoning, (ii) the injury Stigma: The National Programme refers to the or poisoning was caused by the deceased person them- stigma associated with a diagnosis of mental illness. selves and (iii) the injury or poisoning was inflicted by the Stigma is the negative characterisation (labelling) of an deceased person deliberately. The same criteria are ap- individual on account of characteristics or a condition, plied to a suicide attempt, with the difference being that e.g. illness, that set them apart from others. When an the person’s actions did not lead to their death. individual is labelled/stigmatised because of illness, the people around them no longer see them as an individual, Suicidality: A wide term that encompasses ideation but as a member of a group commonly subject to ste- (suicidal thoughts and plans, etc.) and behaviour. The reotyping. Stigma comprises (i) stereotypes (positive or term ‘suicidal behaviour’ (attempted suicide, suicide) is negative social opinions on a certain group of people), also used. Suicidality may take mild (suicidal thoughts, (ii) prejudice (mental and emotional responses to ste-etc.) or more serious forms (suicide attempt, etc.). reotypes) and (iii) discrimination (behavioural response to prejudice). There are several types of discrimination, Self-help group: A self-help group is a small group the most common being labelling by family, professional of people who share the same experience and a com- services and friends, and in the field of employment. Self- mon purpose to resolve a problem or relieve distress. stigmatisation is an internalised stigma that manifests Members have equal status in the group and their role itself in the loss of self-respect. is based on listening and support. A self-help group has a moderator rather than a professional to guide the dis- Mental Health Council: The Mental Health Council is cussion, while every member can find a solution to their a government body providing advice on the supervision problem within themselves through others’ experiences and management of National Programme activities. and discussion. Advocacy and self-advocacy: Advocacy involves the Community-based provision: Community-based self-organisation of users with the aim of providing mu- provision is the overarching term for all forms of inter- tual support, help, self-help or user-to-user help in as- disciplinary provision for people suffering from mental serting joint interests and rights. health problems in a local/home setting. It is provided via a community-based approach. Evidence-based programmes: Evidence-based programmes are programmes in the fields of preven- Community-based approach: The local and inter- tion, promotion and treatment supported by the quality connected operation of mental health services and local indicators defined by the intersectoral working group on communities as a whole that responds to the identified research. needs of the individual and the whole community in re- . gionally delimited areas. Social exclusion: Social exclusion means that an individual is unable to involve themselves in social life and the life of their society as they would like, and does not have the same opportunities as other members of society. For mental health Mira resolucija A4 ANG sept 2020.indd 69 30/09/2020 21:46 ORGANISATIONAL STRUCTURE OF THE MANAGEMENT OF IMPLEMENTATION OF THE NATIONAL PROGRAMME Table 1 Responsibilities of the organisational and functional NPDZ management structures Organisational Tasks Composition and functional structures/units Mental Health – supports the implementation of tasks and the Line ministries, representatives Council achievement and monitoring of the department- of the Government Office for specific objectives set out in the RNPDZ Development and European – addresses pressing intersectoral issues Cohesion Policy, head of the – discusses annual/biennial reports programme, representatives – discusses the action plan for the next two-year period of providers, users and their – reports to the National Assembly on implementation associations, and education of the RNPDZ every two years and research institutions Line ministries - perform tasks in accordance with the RNPDZ and MZ, MIZŠ, MDDSZ, other action plan ministries Intersectoral - helps develop and implement intersectoral mental MZ, MIZŠ, MDDSZ (and other working group health measures and tasks ministries as required) National programme - present and represent the programme to various NIJZ staff and/or external head and their groups (political, lay, professional), defend interests contractors deputy and negotiate on behalf of the programme, oversee coordination of national and regional levels, and direct activities in accordance with the objectives and measures of the RNPDZ Organisational/ - performs organisational/technical tasks in support of NIJZ staff and external technical support coordination of the implementation process contractors Expert support - provides expert support to the implementation NIJZ staff and external process contractors Programme Council* - monitors the implementation and achievement of Representatives of users, the objectives of the NPDZ and the action plan over a service providers, professional specific period associations, line ministries, - deals promptly with pressing issues and obstacles in institutions (e.g. Health specific fields, addresses implementation of the NPDZ and Insurance Institute of Slovenia, the action plan, and formulates proposals for solutions Association of Health Institutes - represents interests in the efficient, high-quality and of Slovenia, Employment coordinated implementation of the NPDZ and action plan Service of Slovenia, National to ministries, decision-makers, members of professional Education Institute, Social bodies, providers and other interested parties Protection Institute of the represented by the Programme Council members Republic of Slovenia, PI, etc.), National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 70 30/09/2020 21:46 Organisational Tasks Composition and functional structures/units - discusses action plan proposals, Expert Council education institutions, national reports, initiatives, measures and solutions programme head/coordinator - forges links and carries out consultation exercises and their deputy, heads of - meets at least twice a year interdisciplinary working groups Expert Council* - manages and coordinates the implementation of NPDZ National programme head/ and action plan activities over a specific period in line coordinator, their deputy, with its expertise regional coordinators, heads - monitors implementation of the NPDZ and the of interdisciplinary working current action plan by individual area of work of an groups, and representatives interdisciplinary working group of users, expert institutions - makes proposals for expert and development tasks to from other departments individual interdisciplinary working groups not involved (Social Protection Institute in their work plan, if this is important for successful of the Republic of Slovenia, implementation of the NPDZ and action plan Employment Service of - compiles proposals for changes to the system Slovenia, National Education - coordinates interdisciplinary working groups and Institute) and ministries manages them in a horizontal fashion (Ministry of Health, Ministry of - cooperates with various stakeholders for the purpose of Education, Science and Sport, NPDZ implementation Ministry of Labour, Family and - provides expert support to the Ministry of Health and Social Affairs) other ministries in various tasks for the development of strategic, regulatory and other mental health solutions, including expert support to the Mental Health Council - introduces changes to the implementation of the Resolution based on the evaluations conducted, prepares initiatives for changes to the system and proposes them to ministries, specialist and education institutions, etc. - monitors the situation and needs in the field of mental health, and proposes appropriate measures to improve the situation - compiles reports for the Programme Council, specific ministries and the government’s Mental Health Council - compiles the action plan for the next programme period on the basis of proposals submitted by interdisciplinary working groups - performs other expert tasks connected with RNPDZ implementation. Interdisciplinary - monitor and take part in the implementation of Heads of interdisciplinary working groups1* measures and activities from the resolution and the working groups and current action plans stakeholders’ representatives - prepare substantive, organisational and structural (expert, education and research solutions, measures and plans in accordance with the institutions and associations, RNPDZ and the current action plans NGOs, service users) - coordinate and complete the guidelines for specific NIJZ staff areas of implementation For mental health Mira resolucija A4 ANG sept 2020.indd 71 30/09/2020 21:46 Organisational Tasks Composition and functional structures/units - monitor the development of the mental health profession and propose changes/solutions - develop and monitor quality indicators in relation to the field of activities and propose changes to the field - propose/prepare updates to education and training programmes - share information and examples of good practice - monitor regulations and standards relating to human and material resources, and propose changes - prepare expert opinions, analyses and assessments of the situation for administrative authorities, the ZZZS and other contracting authorities - take part in the drafting of legislation - take part in mental health promotion and mental illness prevention activities - take part in the preparation of proposals and guidelines for the new action plan, in accordance with the timetable for the area covered by the interdisciplinary working group - report on the work of an intersectorall working group in a specific area Interdisciplinary working groups adopt an annual plan of work in accordance with the RNPDZ and action plan for a specific area by the end of February for the current year (with due regard to the tasks set out in the rules of procedure), and compile an annual report on their work by the end of December for the current year. By the end of June of the year in which an action plan expires, iInterdisciplinary working groups compile proposals for a new action plan for their respective areas of work. Regional - promote mental health and the RNPDZ at regional NIJZ staff coordinators for level, including through the organisation of campaigns regional NIJZ to reduce stigma in collaboration with other offices stakeholders - coordinate at regional level the various stakeholders and those mental health improvement measures from the RNPDZ that are implemented regionally/locally - take part in and provide support for the establishment and operation of mental health centres - establish and coordinate regional mental health councils - organise regional mental health conferences National Mental Health Programme 2018–2028 Mira resolucija A4 ANG sept 2020.indd 72 30/09/2020 21:46 Organisational Tasks Composition and functional structures/units - provide support for the incorporation of mental health issues into local health councils and the preparation of local mental health action plans - take part in and conduct mental health needs assessments in those environments in which mental health centres have been set up Regional mental - coordinate priorities in the field of mental health Stakeholders (expert, political health councils2 - compile regional mental health plans and NGOs) in the local - help organise regional mental health conferences environments in areas covered by mental health centres Health promotion - work with the NIJZ and mental health centres on centre promoting mental health and the RNPDZ among local stakeholders and in local environments - take part in needs assessment research in the field of mental health in local environments Mental health - work with local (mental) health groups in the centres preparation of mental health action plans - perform mental health activities in accordance with the RNPDZ - work with the NIJZ, local communities and other mental health stakeholders (in accordance with protocols of cooperation) - put forward initiatives to regional mental health councils - help compile regional mental health plans - take part in promoting mental health and preventing mental illness at regional/local level - provide primary-level and community-based mental healthcare in accordance with protocols of cooperation, clinical pathways and evidence-based guidelines Local (mental) - monitor the situation and take part in the preparation Representatives of local health groups of mental health needs assessments stakeholders - produce and implement regional action plans3 in the field of mental health improvement - respond to needs in the local environment 1 The following interdisciplinary working groups are to be set up: Mental health education Mental health promotion and the prevention of mental illness Mental health research, and the monitoring and evaluation of among children and adolescents, among adults (with a focus on NPDZ implementation the workplace), and among older people. Communication in the mental health field Mental health network 2 Regional councils include stakeholders from the municipalities Network of mental health centres for children and adolescents covered by a mental health centre. Network of adult mental health centres 3 As part of the preparation of wider health promotion action Behavioural addiction plan. Alcohol and mental health * In accordance with the rules of procedure. Suicide prevention Community-based approach in NPDZ implementation at local level For mental health Mira resolucija A4 ANG sept 2020.indd 73 30/09/2020 21:46 1. Barry, MM and Friedli, L. The influence of social, demographic and physical factors on positive mental health in children, adults and older people. Foresight Mental Capital and Wellbeing Project. State-of-Science Review: SR-B3. London, UK: Government Office of Science and Innovation, 2008. 2. Beškovnik, L., Konec Juričič, N., Svab, V. Suicide index reduction in Slovenia: The impact of primary care provision. 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For mental health Mira resolucija A4 ANG sept 2020.indd 75 30/09/2020 21:46 Mira resolucija A4 ANG sept 2020.indd 76 30/09/2020 21:46 Mira resolucija A4 ANG sept 2020.indd 1 30/09/2020 21:45 alth al hent me for Ovitek Mira Resolucija ANG sept 2020.indd 1 30/09/2020 21:46