A community mental health project in Lebanon
Depression is the fourth leading cause of disability worldwide and by 2020 it is expected to have climbed to second place. Epidemiological research shows growing levels of mental health illness particularly in developing countries. Most of the time, these disorders are neither diagnosed nor treated. Violence, human rights abuses, poverty, gender inequality and low levels of education all exacerbate mental health problems.
Research in Lebanon has found that 17% of the population have been identified as meeting the criteria for having a mental disorder. Psychological problems were found to be even more widespread amongst the large Palestinian refugee community who live there, without the right to work or to become a citizen. 37% of women and 19% of men attending refugee health clinics reported feeling medium or high levels of anxiety.
However, very few people in need of mental health support in Lebanon are receiving it, due to factors including lack of service and qualified staff. The few services that do exist mainly target children. But a fear of being stigmatised as having a mental disorder, as well as people’s inability to pay for services also contribute.
MSF was alerted to the gap in the provision of mental healthcare in Lebanon after its intervention during the 2006 war. In 2008, an MSF team conducted an in-depth assessment of humanitarian needs which led to the launching of a community mental health project on the outskirts of Beirut in December of that year.
MSF’s community mental health centre near the large Palestinian camp in Burj El Barajneh offers free mental health treatment, counselling and care that targets the most excluded people in the community, Lebanese citizens as well as Palestinian and Iraqi refugees. In addition to direct support, a secondary objective of the project is to increase awareness about mental health in the general community.
Farah Malyani is a Palestinian psychiatric nurse working at the Burj El Barajneh community mental health centre.
Farah at work at the community centre. 2009
Photo by MSF
“The MSF centre is situated in an area where there is a lot of suffering and poverty. We see people who's basic needs are not being met. They have experienced several wars and there are generations of refugees living in camps. This has created a range of mental health problems that are unique. I have worked with psychiatric patients in a hospital in Beirut, but the problems I see here are totally different.
Working here involves a mixture of feelings. Sometimes, when people start talking about the difficulties of everyday living, finding something to eat, where to sleep.... I am reminded that they are fighting for their basic human needs. It’s difficult not to get emotional or too involved. I meet mothers who are unable to take care of their families because of their depression. I can’t help but think: if I were in her place, I would be really lost... but at the end of the day it’s my job and I have to be strong for the people I’m helping.
At first, I was overwhelmed, I asked myself how can we help? Is simply listening and giving out medication going to be enough? But eventually I was able to see that people are supported when they are given the space to be listened to. Also medication can help relieve their anxiety and depression. It makes a big difference. They have been able to go back to their jobs and to take care of their children. Although this is quite a new project, we have already noticed a lot of progress in our patients and it’s really wonderful to see.
As a team, we are also working on changing the perception of mental health in the community and trying to remove the stigma associated with it. Many times, a patient will say to me: ‘I am not crazy! Don’t think I am crazy!’ I tell them that their condition is a mental illness and, like hypertension or diabetes, it can be treated.”
Salwa is a Lebanese woman who is married to a Palestinian man and is a mother of four children. She has been receiving treatment at MSF’s community mental health centre. For years she suffered from inexplicable body pain, chronic fatigue and panic attacks that made it impossible for her to lead a normal life.
“A few months ago, following the advice of a close friend, I started going to the MSF centre where I heard they offered psychological help for free. I could not afford to pay.
Session after session, I began to feel better. I even started participating in the social activities at the centre and I had the chance to meet other women who have similar problems to mine. I no longer felt alone and I began to feel better about myself.”
My life has taken on a new meaning now. Today, I am able to talk about my psychological problem and to accept them, without being afraid of how society sees me. In the past, I used to be worried about being described as ‘crazy’ or ‘unbalanced’, but now I’m just grateful that I’ve found someone who I can talk to and who has helped me to believe in myself for the first time.
I have really started to love life, to see the glass as half full and not as half empty. I’ve also been encouraging other people in my community to come along if they feel the need. It’s nothing to be ashamed of. It has changed my life.”