Psychosocial support after the 2023 floods in Slovenia through multi-stakeholder collaboration

Climate change is increasing the frequency and intensity of extreme weather events in Europe, including heavy precipitation and flood-related disasters. This makes the mental health and psychosocial consequences of climate-related hazards an increasingly important component of climate adaptation and disaster risk management. 
 
In August 2023, Slovenia was hit by torrential rainfall far beyond what is expected even in a 1-in-250-year event. The rainfall caused devastating river floods and more than 5,000 landslides. More than 85% of Slovenian municipalities were affected. Up to 15,000 households were directly impacted, more than 8,000 people were evacuated, six people died, and homes, roads and essential services such as drinking water, electricity and gas were severely damaged. The total direct damage was estimated at nearly EUR 10 billion, equivalent to about 16% of the national GDP.1,2,3 

The floods posed serious physical health risks, including injuries and waterborne diseases. Mental health was also significantly impacted, with many experiencing stress, anxiety, and fatigue during, immediately after and even months after the floods due to various psychosocial stressors. People experienced financial hardship due to the loss of homes and possessions, disrupted livelihoods, food and water insecurity, and loss of cultural places.  

Children, the elderly, and those with pre-existing physical and mental health conditions were especially vulnerable to these impacts. For a portion of the population, the flood event was traumatic and caused acute mental distress, resulting in conditions including depression, anxiety, and PTSD. Increases in behavioural problems among children, incidents of domestic violence, and deterioration in pre‑existing mental health conditions were also reported. 

The floods created an unprecedented challenge for Slovenia’s health, social care and civil protection systems. A large, geographically dispersed population required different levels of support, ranging from basic information and practical aid to specialised mental health care. Some affected communities were difficult to reach physically, and psychological stress was often intensified by difficulties in accessing basic services, safe accommodation, financial assistance and reliable information. 

A further challenge was that mental health needs changed over time. In the acute phase, people required immediate support and reassurance. In later weeks and months, stress and delayed psychological reactions emerged, especially as media attention and immediate assistance decreased. This required a flexible response able to shift from crisis intervention to follow-up, community support and targeted assistance for vulnerable groups. 

The psychosocial response originated in the context of Slovenia’s national emergency response following the August 2023 floods. After Slovenia declared an emergency, the Administration for Civil Protection and Disaster Relief took over coordination of the overall disaster response. On 16 August 2023, it issued a decree to strengthen mental health support for flood-affected populations, integrating mental health and psychosocial support into the disaster response alongside physical aid. 

The Slovenian Government, through the Ministry of Health, tasked NIJZ with leading coordination of the comprehensive psychosocial support response. The Mental Health Centre within the National Institute of Public Health established a dedicated coordination committee on the same day. 

The case also built on Slovenia’s ongoing mental health reform, which has shifted the mental health system towards community-based care. Community Mental Health Centres for Adults, located within primary healthcare settings, already operated mobile teams before the floods to reach underserved populations. This existing community-based model provided an important basis for the emergency response. Public mental health capacity had also been expanded through mental health coordinators in all nine regional units of the National Institute of Public Health, supporting cooperation with municipalities, communities and non-governmental organisations. 

The intervention is also relevant to wider disaster risk reduction, public health preparedness and climate adaptation policy objectives, as it strengthens the capacity of institutions and communities to respond to the health impacts of climate-related extreme events. 

The main objective was to reduce the short- and medium-term mental health impacts of the catastrophic floods by providing coordinated mental health and psychosocial support to affected populations. 

Specific objectives were to: 

• identify people and communities experiencing psychological distress; 

• provide timely psychological first aid, counselling and psychosocial support; 

• refer people with severe or complex mental health needs to specialised care; 

• maintain support beyond the acute emergency phase to address delayed impacts; 

• strengthen community resilience and social cohesion; 

• ensure cooperation between health services, civil protection, social services, humanitarian organisations, schools and local actors; 

• reduce the risk that vulnerable groups would be left without support; 

• improve preparedness for future climate-related disasters by learning from the response. 

The intervention contributed to public health, disaster risk reduction and climate adaptation objectives by addressing the mental health consequences of an extreme weather event and by strengthening systems for future climate-related emergencies. 

The main solution was the creation of a coordinated, multi-level mental health and psychosocial support response for flood-affected populations. Different levels of support were provided across three phases. The acute phase, which lasted up to two weeks, focused on non‑obtrusive outreach and “screening” households for psychosocial needs. The sub‑acute phase provided targeted specialist support to vulnerable individuals, established clear communication channels with affected municipalities, and initiated non‑specialist activities. The recovery phase focused on non‑specialist support for communities and follow‑up activities to detect individuals with delayed effects of the floods. Across those phases, activities covered with increasing level of specialization according to MHPSS intervention pyramid4 basic services for everyone, community and family support to strengthen community resilience, non-specialized support provided by trained workers to individuals to cope with distress, and specialized support provided by trained specialists to assess and treat people with severe of complex mental health conditions.  

Multidisciplinary mobile teams5played a central role in identifying people experiencing mental distress, providing initial psychosocial support and, in severe cases, referring them to specialized mental health care. The Community Mental Health Centres for Adults, which provide specialized mental health services within primary healthcare settings, had already started to work with mobile teams before the flood to offer community-based services and reach out to underserved populations. During the emergency, seven mobile teams were deployed in the flood affected areas. The teams consisted of a psychologist or a specialist in clinical psychology, a social worker, a registered nurse, a representative of the Red Cross or Caritas or local non-governmental organizations and, if necessary, a representative of the fire brigade, the Slovenian Armed Forces, or the police.  

Three organizations provided targeted specialist and non-specialist support via telephone services due to the difficulties in reaching some of the affected populations with mobile teams. The Community Mental Health Centres for Adults provided specialized mental health services particularly for individuals with severe mental health needs. The Center for Psychological Counseling "Posvet" offered counselling via a hotline and in-person through 18 counselling offices for adults and eight for adolescents aged 14 to 18; it experienced very high demand and offered multiple consultations for people in need. The Slovenian Psychologists' Association (DPS) operated a free telephone line for one-time psychological support, which had already proofed to be efficient during the pandemic.  

Furthermore, non-specialised support was provided by workers trained in basic psychological and social support to individuals or small groups in need. For example, the Slovenian Red Cross trained emergency responders and volunteers in psychological first aid, which offers immediate support to people in acute distress, and in psychosocial support, which addresses emotional and social needs.6 The Slovenian Caritas complemented these efforts by deploying psychotherapists in the field to provide individual and group counselling for emerging mental health concerns. 

Challenges in accessing basic services during an emergency can significantly exacerbate psychological stress, underscoring how closely mental health is linked to access to essential goods and reliable information. Demand for practical aid was higher than expected. Social Work Centres, the Red Cross, Caritas, and other organizations distributed emergency supplies, such as water, food, hygiene articles, and vouchers. Social Work Centres also provided support in accessing financial aid, arranged accommodation for evacuees, and offered access to psychosocial support. Their presence and trust within communities enabled frontline responders to identify people in distress and alert mobile teams or make direct referrals. Hence, the practical support on the ground played a crucial role in opening doors for mental health professionals. This close collaboration also supported the well‑being of frontline responders, who felt reassured knowing that distressed individuals and households they encountered would receive follow‑up mental health support. 

The government also established the Call Centre 1147 which provided information on flood impacts, evacuation plans, compensation for damaged homes, and access to aid, including shelter, food, water, and emergency care. Staffed by personnel from multiple ministries, the police, and other institutions, the call centre offered an innovative way to provide centralized support during the crisis. 

While the affected populations showed a remarkable resilience and community spirit during the floods, the community support activities helped dealing with the long-term effects after the cameras had turned away. Community resilience was strengthened through a bottom‑up approach, with local residents and local organizations proposing activities tailored to their specific needs and context. Interventions included mental health first aid sessions addressing increased alcohol use reported two to three months after the floods, and art exhibitions showcasing children's work to help them focus on positive experiences during difficult times. Caritas also organized regular “tea party” relief talks in affected villages, offering group discussions with psychologists and psychotherapists about worries and uncertainties related to flood‑related livelihood impacts. 

Some initiatives promoted social cohesion while others raised awareness of the mental health impacts of floods through workshops and information materials. NIJZ, for instance, shared guidance on coping with stress and grief, while the National Education Institute Slovenia developed resources and training for schools. NIJZ followed up with schools to ensure support for children showing signs of distress, though reporting of cases remained low.  

The floods created an unprecedented challenge that required a comprehensive and coordinated psychosocial response at the national, community, and individual levels, serving a diverse and geographically widespread population. The goal of the time-limited intervention was to mitigate the mental health effects of the catastrophic floods in the short and mid-term by providing coordinated services to affected populations in collaboration with multiple organizations.  

The case was based on extensive multi-stakeholder collaboration across national, regional, local and community levels. The response was coordinated by NIJZ, specifically through its Mental Health Centre, under the mandate of the Ministry of Health. 

The coordination committee included: 

• Government actors: Ministry of Health, Call Centre 114; 

• Civil protection: Administration for Civil Protection and Disaster Relief; 

• Health institutions: National Institute of Public Health, Community Mental Health Centres for Adults, Centre for Psychological Counselling “Posvet”; 

• Social services: Social Work Centres; 

• Education sector: National Education Institute Slovenia and schools; 

• Humanitarian organisations: Slovenian Red Cross and Slovenian Caritas; 

• Professional organisations: Slovenian Psychologists’ Association; 

Participation took place through regular coordination meetings, field reporting, shared referral pathways, joint outreach and community-level activities. The coordination committee met 21 times between August 2023 and September 2024. Meetings allowed organisations to report on needs observed in the field, coordinate their activities and adapt the response as the situation evolved.

A major success factor was the existence of pre-established collaboration mechanisms. NIJZ had already coordinated the mental health response during the COVID-19 pandemic, which meant that institutional relationships, coordination experience and lessons learned could be used during the flood response. The implemented stepped-care model involving a wide range of organizations successfully provided varying levels of support, from practical assistance to specialized mental health care. The close collaboration with organizations and frontline workers on the ground was particularly helpful for building the necessary trust for individuals and communities to accept psychosocial support.   

Another key success factor was Slovenia’s ongoing mental health reform and shift towards community-based care. Each of Slovenia’s 19 community health centres now hosts a mobile mental health team, and all nine regional units of the NIJZ employed mental health coordinators. This enabled faster deployment of support and closer cooperation with municipalities, NGOs and communities. This community‑based model is essential for overcoming stigma and reaching at‑risk groups, including those who may remain unseen. For instance, individuals facing social or family difficulties were particularly vulnerable during and after the floods.  

Stress surfaced in some affected populations weeks after the floods, once immediate support and attention had diminished. NIJZ recognized the need for sustained follow‑up, particularly for vulnerable groups facing disproportionate long‑term impacts and heightened risk of widening inequalities. However, monitoring longer-term mental health outcomes after the flood for instance in collaboration with schools proved difficult as it requires the capacity to identify individuals in need, underscoring the need for systematic approaches to tracking the mental health impacts of climate‑related events over time in close collaboration with other sectors. 

By continuously collecting and assessing qualitative and quantitative data points from multiple sources and levels, the coordination committee was able to adapt to evolving local needs, shifting from immediate crisis intervention to longer-term support. However, timely data remained a challenge, underscoring the need to establish routine monitoring systems and reporting line NIJZ during the preparedness phase.   

NIJZ intends to apply these lessons to strengthen future preparedness by developing clearer psychosocial support protocols, enhancing training for staff and volunteers, and improving communication and coordination mechanisms; it also considers the expanded role and sustained engagement of multidisciplinary mobile teams to bolster community‑based interventions during. 

Quantitative information on the total cost of the psychosocial support intervention was not provided. The intervention provided important adaptation, health and social benefits. It helped affected populations cope with acute and delayed mental health impacts following a major climate-related disaster. It supported early identification of people in distress, referral of severe cases to specialised care and provision of counselling and psychosocial support for individuals, families and communities. 

The response also improved coordination between public health, civil protection, social care, humanitarian organisations, education actors and local communities. This strengthened institutional preparedness for future climate-related events. 

The emergency psychosocial response started on 16 August 2023, shortly after the floods and the emergency declaration. Acute outreach lasted around two weeks, followed by sub-acute and recovery activities. The coordination committee continued meeting until September 2024, meaning the structured response and follow-up lasted approximately 12 months.

The flood-specific intervention was time-limited, with structured coordination and follow-up lasting up to approximately one year. However, several components are expected to continue as part of Slovenia’s public mental health and disaster preparedness system, including community mental health centres, mobile teams, regional mental health coordinators, training activities and improved psychosocial support protocols.

This case study was developed and first published by the WHO European Centre for Environment, Climate Change and Health in the report Strengthening Mental Health in a Changing Climate: Insights from Interventions across the WHO European Region (WHO Regional Office for Europe, 2026; link). 

Strengthening mental health in a changing climate: insights from interventions across the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2026. Licence: CC BY-NC-SA 3.0 IGO. https://iris.who.int/handle/10665/387963