Debates on mental health in Kosovo have proliferated since COVID-19. Isolation, dealing with the danger of the virus and the general uncertainty that gripped the world exposed systemic issues in how mental health is addressed, in Kosovo and beyond.
Until these systemic issues became apparent, little effort was made in Kosovo to address mental health. Numerous gaps have persisted, not only in the post-pandemic years but also in the political programs ahead of the February 9 general elections.
Currently, the public mental health system, which came into force a decade ago, is largely regulated by the Law on Mental Health. This law outlines the types of services available and institutions’ responsibilities toward a patient.
These institutions include psychiatric departments in hospitals, mental health centers and integration homes such as: the Center for Integration, Rehabilitation and Resocialization of Chronic Psychiatric Patients (CIRCPP) in Shtime, the Psychiatric Clinic in Prishtina, the Kosovo Forensic Psychiatry Institute (KFPI) and an Institute of Addiction Diseases — which has yet to be established.
The implementation of this law remains weak. In 2022, the Committee on Health and Welfare in the Kosovo Assembly drafted a monitoring report highlighting its limitations. The report cites multiple reasons for these shortcomings, including failure to issue bylaws, dysfunctionality of departments and committees, a lack of personnel, failure to regulate the status of certain institutions and an insufficient budget and access to medication.
As a result, the committee recommended drafting a new law and, in 2022, the Ministry of Health began the process. In an effort to achieve this, the ministry established a working group drawing on members of civil society to draft a new mental health law.
These efforts failed to yield any substantial development over the existing Law on Mental h=Health. One of the reasons was the lack of direct involvement of patients in the drafting process. A new draft was published by the Ministry of Health in 2023, yet it failed to address several fundamental criticisms of the current law. The draft law’s status remains unclear.
Since 2018, the Center for Information and Social Improvement (QIPS) — a nongovernmental organization working in the field of mental health — has advocated for state institutions to engage in suicide prevention. This includes drafting a suicide prevention policy, institutionalizing the suicide prevention hotline — Lifeline — and implementing social policies aimed at reducing suicide rates.
In 2021, the Regulatory Authority for Electronic and Postal Communications (ARKEP) designated a special access codes — 116-123 — for a mental health helpline, which includes suicide prevention. However, this has yet to be implemented. Linja e jetës, or Lifeline, a nongovernmental initiative — reachable by phone at 0800-12345 — remains the only service of its kind.
Due to the lack of commitment and political will to implement these policies, a group of nongovernmental organizations launched a petition calling for a law on suicide prevention. In 2024, this petition gathered over 10,000 signatures and was submitted to the Kosovo Assembly, where it is expected to be addressed after a new government is formed.
Rehabilitation and resocialization through community activities is considered a primary focus for mental health centers. In Kosovo, however, the neglect of mental health in the public system has led to an overcrowding of individuals who are functional but lack the financial means to build an independent life. As a result, these centers end up functioning as lower-resourced psychiatric clinics.
Beyond these mental health services and initiatives, Kosovo’s laws hardly recognize a broader scope. These include grief counseling, specialized services for neurodivergent individuals and employment initiatives for people with mental health disorders.
Existing mental health services are also inadequate. According to the Ministry of Health, state mental health services total an employment of 281 nurses, 49 psychiatrists, nine psychologists, one social worker and seven psychosocial counselors. Support for older citizens is almost entirely absent.
These circumstances allow the private health care system to flourish, although private health care also lacks thorough oversight and is costly, making access to mental health services a privilege. As a result, the public healthcare system has failed to reach its citizens, leading to suffering, distress and even preventable deaths.
Ahead of the February 9 elections, political party pledges don’t come out of nowhere. These promises are shaped by a political and structural framework that has sidelined mental health, turning efforts into a business opportunity rather than a public priority.
This presents an opportunity to assess whether any party intends to address these systemic issues and introduce meaningful policy changes. What do the election programs of the four largest political entities — Vetëvendosje (VV), the Democratic Party of Kosovo (PDK), the Democratic League of Kosovo (LDK) and the Alliance for the Future of Kosovo (AAK), running in coalition with the Social Democratic Initiative — propose for mental health?
VV
VV’s current program has no direct reference to mental health. However, since VV promises to continue the work initiated by its current mandate, it is useful to examine some of the efforts VV has made to improve mental health services.
In October 2024, the government launched two legal initiatives aimed at improving access to psychological services. One of these initiatives was a draft directive that, for the first time, would regulate the licensing procedures for school psychologists and establish clear guidelines for their responsibilities. This draft remained open for public consultation until November 2024. The final version has not yet been published.
The second initiative, the new draft law on health, includes provisions for clinical psychologists as professional associates in primary health care. Each municipality would be required to provide this service through family medicine centers. However, these policies were only introduced at the end of the mandate and have yet to be implemented — the draft law has yet to be sent to the Kosovo Assembly.
Additionally, work began on relocating CIRCPP, from Shtime, to a new facility on the outskirts of the municipality. A draft decision was also approved for the construction of a residential center for individuals — including children, adults and the elderly — with autism, Down syndrome and other disabilities. While these projects remain unfinished, several concerns have been raised regarding their implementation.
The relocation of CIRCPP to the outskirts of Shtime limits patients’ opportunities to interact with other citizens, bypassing an approach that prioritizes community integration over isolation. Regarding the residential center, instead of developing multiple residences for individuals with disabilities, the government has opted to centralize services in a single location. This approach suggests that VV fails to recognize that individuals with disabilities are not a homogeneous group — they have diverse needs and require tailored solutions.
An initiative for mental health fully implemented during this mandate is the renovation of the child and adolescent psychiatry clinic, which now includes the possibility of hospitalizing young patients. However, this policy contradicts the recommendations of the U.N. and the World Health Organization, which state that “any decision to institutionalize a child violates the rights of the child, including the right to family.” This initiative suggests VV maintains an old status quo.
LDK
Although LDK’s program mentions mental well-being, it lacks a clear explanation of how mental well-being will be concretely addressed. LDK promises to build a prison hospital, specifically for prisoners with psychiatric conditions. This promise stands out as problematic.
With the construction of a new prison hospital, it is unclear what will happen to the KFPI, which was established a decade ago to detain and assess individuals with mental health disorders who have committed criminal offenses. Since KFPI is already functional, the reasoning behind LDK’s proposal to open a second hospital remains unclear.
Detaining patients with criminal offenses in psychiatric hospitals has, over time, proven to be a failed approach. Escapes from the KFPI are frequent and prolonged isolation continues to have a negative impact on patients.
This approach, which stems from a tendency to focus on medication and isolation over the social rehabilitation of individuals, views patients’ challenges solely as a result of their mental illness, rather than as an interaction between mental illness and social circumstances. Such practices fail to restore the decision-making abilities or legal capacity of a patient
LDK also fails to present a model based on successful international practices, for instance Italy’s Residences for the Implementation of Security Measures (REMS). REMS prioritizes psycho-social rehabilitation while also addressing security risks posed by individuals who have committed criminal offenses. This approach incorporates educators, social workers and various other professionals — not just medical staff — to help individuals develop skills for reintegration into the community.
The lack of a comprehensive mental health strategy contradicts some of LDK’s youth branch’s recent initiatives. In 2023, the LDK youth branch launched the With You campaign, organizing discussions and workshops on mental health with young people. The campaign led to the opening of a mental health hotline in Istog. LDK has not integrated the initiative into its broader party platform.
PDK
PDK’s program proposes some commitment to mental health. This includes pledges to assign psychologists to every school and engage sports psychologists. These pledges also lack a comprehensive strategy.
The shortage of school psychologists is an existing problem that hinders the country’s mental health situation. Additionally, engaging sports psychologists could enhance athletes’ mental and physical well-being. However, due to the lack of detail in these pledges, questions remain about the implementation of these promises, which currently face several obstacles.
One obstacle to employing school psychologists is that jurisdiction for this falls to the municipalities, rather than central government. Another barrier is the Administrative Instruction No. 26/2013, which ties the hiring of psychologists to student numbers.
According to this directive on student quota, schools need at least 1,000 students to employ a psychologist. It remains unclear whether PDK intends to amend this regulation or how it plans to collaborate with municipalities to ensure the hiring of school psychologists.
Hiring sports psychologists is a significant challenge, as this specialization does not currently exist in Kosovo. Implementing this initiative would require the specialization to be developed from scratch, establishing it as a viable field and creating administrative guidelines or legal frameworks to regulate it. PDK does not specify how it plans to address these challenges.
The most problematic aspect, however, is the promise to establish a national addiction treatment center in Kamenica. Globally, efforts to centralize mental health services, including addiction treatment and addressing them solely as psychiatric issues, have led to numerous failures and deteriorating patient conditions. Today, Spain and Portugal are considered two of the most advanced countries in the EU for addiction treatment, offering fully decentralized services that include social support programs for patients.
In the examples of Spain and Portugal, a person struggling with addiction issues is not only seen as a patient but as an individual facing socio-economic challenges. Across the country, community centers provide psychotherapy, community engagement and workshops for developing work skills to these individuals — all on a voluntary basis.
Social housing ensures that these individuals do not become unhoused, while specialized clinics for those with advanced addiction offer safe spaces for drug use, contingent on participation in rehabilitation programs. While PDK views the construction of a single center as a step toward decentralizing services or reducing stigma, these alternative models suggest the opposite.
AAK-Nisma Coalition
Across the pages of their election plan, AAK and Nisma address mental health in only one paragraph — promising to build a consultation center to combat addiction. No further details are provided. As is the case with PDK’s proposal, centralizing such services would have limitations, which show little positive impact on mental health.
What can we learn from these programs?
Political parties continue to promise interventions that reinforce the trend of institutionalizing patients rather than investing in long-term, sustainable, community-based solutions. Similarly, the practice of promising new buildings has become common across all parties and issues.
Without concrete, actionable policies to accompany them, these promises have little chance of bringing meaningful change for patients. Instead, they risk perpetuating the same failing structures that already exist in Kosovo.
While discussions on mental health have increased, they are still based on flawed premises — focusing on isolation rather than community, stigma rather than acceptance and incarceration rather than integration.
Feature Image: K2.0.
Disclaimer: The author of this article is the director of the Center for Information and Social Improvement and, in this capacity, participated in the working group for the new draft law on health, along with the organization of the petition mentioned in this article. Some of the data, such as the report of the Parliamentary Commission, was obtained through this engagement.
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