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Iraq: Mental Health project helping to rebuild lives
Decades of conflict, political instability and social upheaval have left many Iraqis vulnerable to psychological stress, mental health disorders and in need of mental health care says Médecins Sans Frontières/Doctors Without Borders (MSF) in a new report launched in Baghdad today.
MSF’s new report "Healing Iraqis: The Challenges of Providing Mental Health Care in Iraq", records examples of the impact that constant, day-to-day violence has had on many Iraqi men, women and children, and describes the development, together with the Ministry of Health, of a counselling care programme.
Mental Health taboo
The report emphasizes the urgent need to scale up mental health care services in the country. MSF calls on the Iraqi Ministry of Health, and those who support them, to improve the quality and access to mental health services by integrating counselling in to existing health facilities across Iraq. MSF also notes that more must be done to reduce the stigma of mental health to encourage people to come forward for counselling.
“Many Iraqis have been pushed to their absolute limit as decades of conflict and instability has wreaked devastation. Mentally exhausted by their experiences, many struggle to understand what is happening to them." says Helen O’Neill, MSF’s Iraq Head of Mission.
"The feelings of isolation and hopelessness are compounded by the taboo associated with mental health issues and the lack of mental healthcare services that people can turn to for help.”
Non pharmaceutical approaches
“I started attending the sessions to help improve my speech and help me overcome my fear. I’m scared of everything. My body is always shivering. I can’t spell words correctly anymore. My teacher and my fellow classmates beat me all the time in school. I can’t study or learn anything. I’m unable to concentrate. I don’t talk to anyone. This is the first time I’ve talked to anyone about my problems.” A 10 year old girl
Since 2009 MSF has been working in Iraq providing mental health counselling to men, women and children in conjunction with the Iraqi Ministry of Health. MSF’s programmes focus on non pharmaceutical approaches to address anxiety and depressive disorders commonly experienced by those exposed to violence and uncertainty.
According to patient data collected in 2012 by MSF and the Ministry of Health in Iraq, 97% of people who presented for counselling reported clinically significant psychological symptoms at admission. When measured on the last visit, this figure had reduced to 29%.
Even excluding domestic conflict, almost half of all cases seen in the programme (48%) were violence-related. Nearly all staff and patients in the mental health programme have either experienced or know someone near to them who has been directly impacted by a violent event over the past years.
Proven model of care
Over the past four years MSF and the Iraqi Ministry of Health have introduced psychological counselling services in two hospitals in Baghdad and one in Fallujah. There are plans to use this as a model of care that can be replicated in other health care facilities across the country with the IMOH starting new units in Kut, Karbala and Sulaymaniyah Hospitals. MSF’s also recommends the Iraqi health system integrates psychological counselling into community based primary healthcare services to increase access, particularly to women and children.
“I started attending the mental health counselling sessions when I felt I’m so tired and very sad. I felt I had a psychological problem and that made me disturbed because I’m unable to cope well with others. I lost my husband two years ago and the incident affected my life. It changed my life, it turned my life upside down. I’m now the only one left responsible for raising my kids.” A 36 year old widowed mother of three
Providing care for such traumatic experience is not easy, but the counselling model has proven to be beneficial in help people regain a level of dignity and control of their lives.
Healing Iraqis: Recommendations
- To improve the quality of mental health services by integrating the counselling model into existing mental health facilities throughout Iraq.
- Advertise the availability of services and reduce stigma by talking openly about the issue of mental illness, through for example, a country wide public campaign.
- To Continue training new and experienced counsellors for new sites.
- To provide supervision and quality control of counsellors using the trained team of trainer/supervisors.
- To integrate the use of video conferencing supervision in new sites.
- To expand the telephone helpline services so that any Iraqi with phone access can seek basic information and advice free of charge.
- To assign the necessary budget and human resources to increase health care services and public awareness of available care.