Mental Health and Psychosocial Support Programme

WHO Lebanon

Size of the problem:Projected prevalence rates

• baseline data: from World Mental Health Survey 2000 (published in Lancet 2006 by Karam et al)

• Projected data after disaster: interpretation of world literature

• Observed rates will vary with– Case definition and assessment method– Community and sociocultural context

• extent of previous and current disaster exposure of different communities

• local ways of coping and supporting• willingness to endorse questions in surveys

BEFORE CURRENT

WAR: 12-month

prevalence

AFTER CURRENT

WAR:

12-month prevalence

Severe disorder

(e.g., psychosis, severe depression, severely

disabling form of anxiety disorder)

5% 6%

Mild or moderate mental disorder

(e.g., mild and moderate forms of depression

and anxiety disorders)

12%

20%

(reduces to approx 15% with

natural recovery)

Moderate or severe psychological / social

distress (no disorder)

No estimate

Large percentage

(reduces to unknown extent

due to natural recovery)

None or mild psychological / social

distress, which may resolve over time

No estimate Small percentage

(increases over time due

to natural recovery)

Summary Table of WHO Projections

Concerns in the post War scenario:

• Current security or/and political situation

• Displacement (even if it was short. We have to mention that as soon as the ceasefire took place; people started returning to their villages although there were still security concerns)

• Unemployment

• Lack of justice and of state control, lack of basic services, and the instability of the situation.

Activities To Date

• National Plan

• Capacity Building

• School Mental health programme

• Public education and awareness raising

Guiding Principles of the Plan: (Adapted from IASC guidelines)

• Human Rights (respecting right of protection and care, non-discriminatory care, access to all groups…)

• Participation and Inclusiveness (community and stake holders involvement in planning & implementation)

• Promoting Resiliency (most people with signs of distress will recover but with appropriate support)

• Normalization of daily life (reestablish family & community connections, provide opportunities to resume activities of daily living)

• Community-based (strengthen the ability of the community institutions, leaders and members to support and help one another)

• Capacity building (training and support to community members, religious structures, educational, health and social services…)

• Do No Harm (identify & minimize risks and unintended negative impacts of the program)

• Intersectoral Collaboration (collaborate with all stakeholders in all sectors)• Foster Public Mental Health Education And Awareness.• Development Of Mental Health Services In A Sustainable And Integrated

manner.

Aims And Objectives of the Plan

AIM:• Promoting the mental and

psychosocial well being of the children, women, and men of Lebanon with the aim to improve their quality of life.

Short Term Objectives :

• Develop the capacity of Primary Health Care professionals to identify, manage and refer common psychological and mental health problems.

• Provide psychological first aid focusing on people in distress, which may be especially likely among vulnerable groups like women , children, elderly and disabled.

• Identify individuals with serious mental illness and ensure provision of appropriate mental health services including essential psychotropic medication and basic psychosocial support.

• Promote positive mental health and psychosocial well being through Public education and awareness raising of the communities through involvement of the communal institutions.

Proposed Long Term Objectives

Proposed Long Term Objectives (These attainment of these objectives need the development of a separate plan and programme under the umbrella of a national mental health policy)

• Develop a comprehensive national plan and program for mental and psychological health in the context of an overarching policy focusing on: – Capacity building through training of all cadres of health care

professionals – Integrate the services into the general health system in the

country . – Coordinate and Collaborate with existing mental health centers

to develop Mental Health Services accessible for the mentally ill in the country.

• Promote mental health and prevent mental ill health with collaborative action across sectors like Education, NGO’s, social and religious groups and community stakeholders.

• Promote indigenous research and build in evaluation component to ensure evidence based planning and implementation of the mental health programmes.

• Develop and organize specialized mental health services including rehabilitation services for the mentally ill.

• Develop Mental Health Legislation.

Rationale for Mental health Integration In PHC

The unique positioning of the primary health care network:

• To support primary care services who are already overwhelmed with high levels of consultation by people with common mental disorders, usually presenting as somatic complaints.

• To obtain care for people with mental disorder who have no access to specialist care (in some areas of the country there may not be a specialist doctor or nurse easily accessible )

• To ensure that the physical health care needs of people with mental illness are not neglected ( Physical and mental illness frequently coexist. People with severe mental illness have relatively high standardised mortality ratios from cardiac disease, respiratory disease, malignancy and, in low income countries, infectious disease.

• To address accompanying social needs Many psychiatric disorders are connected with family problems and social difficulties and are only understandable when viewed against this background. Primary care teams with their continuing contact with the local population are well placed to have such detailed knowledge

• To provide continuity of care Primary care teams are well placed to provide long term follow up and support without frequent changes of personnel

• To take account of the patient’s perspective Many patients with mental disorders do not consider themselves in need of psychiatric care and there is less stigma if the patient is seen in primary care

Building up the Capacity of PHC personnel:

PHASE I Target Population: PHC personnel including nurses and social workers working PHC facilities in the effected areas

Learning objectives: Stress responses to war and the process of grief following the human and material losses sustained by the survivors

Differentiation between distress and mental disorders

Provision of basic psychosocial support (PFA)

Identification of common mental disorders among the survivors

Identification of people who require referral for specialist assistance.

Education of the community about mental health and psychosocial issues commonly encountered by the surviving community members.

PHASE II Target Population: Doctors working in PHC facilities in the

effected areas)

Learning objectives:Stress responses to war and the process of grief following

the human and material losses sustained by the survivors.

Differentiation between distress and mental disorders.

Provision of basic psychosocial support (PFA)

Identification of common mental disorders among the survivors

Management of common mental disorders among the survivors

Identification of people who require referral for specialist assistance.

Education of the community about mental health and psychosocial issues commonly encountered by the

surviving community members.

Provision of referral support to their staff.

The training package consists of 5 modules:

Module I: Introduction (Normal stress response, differentiation between stress and distress, differentiation between distress and disorder, grief and bereavement)

Module II: Individual interventions (Relaxation, problem solving, grief counselling, and non-pharmacological interventions for pain and sleep disturbances, PFA);

Module III Care of Special Groups (Children, adolescents, women, old people, amputees )

Module IV: care of self for relief workers

Module V: Identification, Management and referral of mental disorders (Post Traumatic Stress Disorder, anxiety disorder, depressive illness, psychosis, substance use disorders and epilepsy)

School Mental Health ProgrammeIn the immediate term( 2006) • Training school teachers in all public and private schools on the

identification, dealing with, and referring psychological /behavioural problems and mental health disorders seen in schools. (material ready)

• A system of linking the schools with the health systems for referral also needs to be established to respond to the emerging needs identified.

• Public education about mental health coping mechanisms after the crisis.

In the short term (year 2006-2007)• Evaluation of the effectiveness of different mental health interventions in

schools, with pilot testing in selected schools, aiming at identifying the best approach to integrate mental health into the context of the Lebanese education system.

In the long term (starting 2007-2008), • Efficient integration of the mental health component into the school

health program, including a curriculum for schools, a curriculum for teachers, and setting up referral mechanisms.

Public Education And Awareness Raising Plan

In the immediate term( 2006) • Preparation and printing of Brochures and

posters--- ready by 20th October. In the short term (year 2006-2007)• Distribution to all the Media, Health , Community

organizations and Educational outlets including Pharmacies

In the long term (starting 2007-2008), • Efficient integration of the mental health

component into the National Health education strategy for NCDs

Tyre Mental Health and psychosocial Support coordination

• Who is doing what and where.

• Coordination and collaboration among partners.

Saturday 21.10.2006, 11.00 am