Kristi Kola is a doctor specialised in psychiatry who works at the Sadik Dinçi Psychiatric Hospital in Elbasan. In addition to his clinical experience, he is a university lecturer on Psychopathology, Psychopharmacology, and Psychiatry. Most recently, he has served as co-trainer in the training of trainers “The use of the clinical guideline on the management of mental health disorders in Primary Health Care”. We spoke with him about the importance of integrating mental health services into primary care and the challenges that must be addressed to make this integration successful alongside traditional health services.
Could you tell us about your experience in the field of mental health?
My journey in mental health began with a long-term psychiatry specialisation at the Mother Teresa University Hospital Centre in Tirana. As a specialised inpatient service within a tertiary hospital, the cases were both numerous and complex, but at the same time, I had the opportunity to work alongside a highly skilled team of specialists from whom I learned a great deal.
Afterwards, I worked in outpatient consultancy services, psychiatric rehabilitation centres, and specialised services for individuals under court-mandated treatment within correctional facilities. These experiences provided me with a broad understanding of the mental health service infrastructure in our country, the referral system, and the avenues available for patients to receive appropriate care for their specific conditions.
Furthermore, I have also been engaged in academia, lecturing on Psychiatry, Psychopathology, and Psychopharmacology in several higher education institutions both in Albania and abroad.
What are the main objectives of the training you are conducting with the family medicine team?
According to WHO studies, a significant proportion (69%) of patients with mental health disorders initially present to their family doctor with physical complaints. This insight led us to prioritise, as a core training objective, the importance of clinical assessment and the early identification of mental health symptoms. This enables timely diagnosis and, where necessary, a multidisciplinary treatment approach tailored to each case.
Another equally important objective has been to equip and guide practitioners in the use of clinical decision-making tools, which aid in the ongoing assessment and management of cases.
Could you provide an overview of the key topics or modules covered in this training programme?
Given the multidisciplinary participation—including doctors, nurses, social workers, and psychologists—the training programme was designed to cover a wide range of concepts. These range from general principles of care and communication to the identification, diagnosis, treatment, and/or referral of specific mental health conditions.
We have been careful to address the distinct roles each professional plays within community health centres and to highlight the importance of coordination among these roles in delivering comprehensive care to patients.
How important is it for the family medicine team to be trained in mental health, and why?
The aforementioned statistics help us understand just how vital the family medicine team is as the first point of contact in the healthcare system. Beyond that, their role in health promotion, early detection of mental health concerns, and psychoeducation is strategic in supporting the population’s overall mental well-being.
For this reason, we consider the training and empowerment of this team to be essential.
What challenges do you foresee in implementing the training knowledge into the daily clinical practice of the family medicine team (GPs, nurses, psychologists/social workers)?
The first major challenge relates to patients’ resistance or reluctance to seek help for mental health conditions. This is largely due to the stigma and prejudices surrounding these disorders.
Other challenges are logistical in nature. Psychiatric interviews are best conducted in quiet environments that ensure patient privacy and confidentiality. There must also be sufficient time allocated and undivided attention from the professional, giving the patient space to express their concerns.
Based on participant feedback during training, we understand that the high patient flow and limited physical space in community health centres make these challenges very real.
What are the main mental health challenges currently facing communities in Albania?
Mental health service provision in our country faces many challenges, similar to those in other parts of the world. Ensuring and maintaining psycho-emotional well-being is one of WHO’s global health priorities. Nevertheless, despite the increased attention and numerous studies in this field, statistics show a global rise in mental health disorders.
One of the key challenges in Albania is stigma. Individuals with mental health issues are often judged and face social exclusion, which fosters shame and reluctance to speak openly about their struggles.
This stigma is primarily driven by a lack of knowledge about the causes, diagnoses, and mechanisms of medications or psychosocial interventions.
Another challenge is the limited number of mental health specialists, especially in services for children and adolescents, which forces individuals to travel long distances to access appropriate care. Furthermore, many of the facilities where these services are provided are run-down and offer only basic conditions, reinforcing public prejudices and increasing resistance to seeking help from state-run services.
Finally, these barriers often push patients towards private sector providers, where the high cost of care frequently results in the premature termination of treatment.
What further training or support would you recommend to strengthen the capacity of the family medicine team (GPs, nurses, psychologists/social workers) in managing mental health disorders within Primary Health Care (PHC)?
In future training sessions, we recommend a greater focus on empowering psychosocial staff. The integration of psychologists and social workers into community health centres would significantly enhance the range of services available to the population. Fully activating these professionals in their roles and ensuring coordinated work with the rest of the team would enable a more holistic, multidisciplinary approach to healthcare, not only for mental health but for overall patient well-being.
Another recommendation is to place greater emphasis on psychosomatic disorders and the evaluation of psychosocial factors in patients with chronic illnesses.