Mental Health Programs in Areas of Armed Conflict: The Médecins Sans Frontières Counselling Centres in Bosnia-Hercegovina

Mental health programmes in complex emergencies are generally accepted as an important component of aid work. However, this
is a relatively recent development and there is a lack of theory-based practice and little analysis of previous interventions upon which effective, appropriate and sustainable programmes can be based. This article describes the theoretical framework, objectives, implementation and intervention activities of the mental health programme of Médecins Sans Frontières (MSF) in Bosnia-Hercegovina, 1994-1998. Approximately 10,000 individuals were helped during this time. The aims of the programmes
were to provide culturally-appropriate support, assist in coping with extreme stress, counteract helplessness, and reinforce protective factors. Ten counselling centres were established where 70 local counsellors and supervisors worked after a training period of three months. Assistance and interventions provided by the counsellors ranged from mass psycho-education, training, individual outreach activities to crisis intervention and brief psychotherapeutic treatment – psychological structuring, working on (self) control, training self-help techniques, reconnecting the experiences to one’s emotions and discussing the personal meaning of traumatic experiences. Despite general acceptance that war may lead to serious mental health problems, the provision of help is stifled by disagreement on the cultural relevance and effectiveness of different interventions in emergency mental health programmes. This article, describing the establishment of a training programme and counselling centres during a war, and the
continuation of these programmes six years on, provides a strong case in favour of the applicability of these programmes.

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Authors: 
de Jong, K., Kleber, R. and Puratic, V.