Transcript Slide 1
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
Summary Table of WHO Projections BEFORE CURRENT WAR: 12-month prevalence
5%
Severe disorder
(e.g., psychosis, severe depression, severely disabling form of anxiety disorder)
Mild or moderate mental disorder
(e.g., mild and moderate forms of depression and anxiety disorders)
Moderate or severe psychological / social
distress (no disorder) 12% No estimate
None or mild psychological / social
distress, which may resolve over time No estimate
AFTER CURRENT WAR: 12-month prevalence
6% 20% (reduces to approx 15% with natural recovery) Large percentage (reduces to unknown extent due to natural recovery) Small percentage (increases over time due to natural recovery)
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
planning & implementation)
Promoting Resiliency
appropriate support) (community and stake holders involvement in (most people with signs of distress will recover but with
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
program) (identify & minimize risks and unintended negative impacts of the
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
high levels of consultation by people with common mental disorders, usually presenting as somatic complaints.
with •
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
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
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 Differentiation between distress and mental disorders.
Provision of basic psychosocial support (PFA) Provision of basic psychosocial support (PFA) survivors Identification of common mental disorders among the Identification of people who require referral for specialist assistance.
Identification of common mental disorders among the survivors Management of common mental disorders among the survivors Education of the community about mental health and psychosocial issues commonly encountered by the surviving community members.
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 Programme
In 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 20 th October.
In the short term
Pharmacies (year 2006-2007) • Distribution to all the Media, Health , Community organizations and Educational outlets including
In the long term
(starting 2007-2008), • Efficient integration of the mental health component into the National Health education strategy for NCDs