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Mental Health in the Eastern Mediterranean Region Reaching the Unreached

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Mental Health in the Eastern Mediterranean Region Reaching the Unreached WHO Regional Publications, Eastern Mediterranean Series 29 Mental health in the Eastern Mediterranean Region: reaching theunreached reaching Mediterranean Region: Mental health intheEastern Mental health in the Eastern Mediterranean Region: reaching the unreached Mental health in the In 2001 mental health was brought to the focus of international attention when the World Health Organization devoted its World Health Day campaign and The world health report to the subject. In many countries around the world, and particularly in Eastern Mediterranean Region developing countries, mental health has long been a neglected area of health care, more often than not considered in terms of institutions and exclusion, rather than the care and needs of the human being. Current knowledge emphasizes early identification Reaching the unreached and intervention, care in the community and the rights of mentally ill individuals. The countries of the Eastern Mediterranean Region represent many challenges for the organization of mental health care. Many countries are in a state of rapid social change, some are in conflict or suffering the aftermath of conflict, while others are witnessing the growing problem of substance abuse, with associated HIV/AIDS rapidly becoming a public health priority. This publication addresses three aspects: the planning of mental health services; the current mental health situation in each of the countries of the Region, along with the innovative approaches developed during the past two decades, and the challenges and opportunities for addressing the mental health needs of the diverse populations. Bringing together the experiences of the Region provides an opportunity to learn from the past as well as for greater collaboration and cooperation in the future between countries facing similar problems. ISBN 92-9021-339-6 1 mmhcover.inddhcover.indd 1 224/07/20064/07/2006 114:00:174:00:17 WHO Regional Publications, Eastern Mediterranean Series 29 Mental health in the Eastern Mediterranean Region Reaching the unreached WHO Regional Office for the Eastern Mediterranean Mental health in the Eastern Mediterranean Region: reaching the unreached / WHO Regional Office for the Eastern Mediterranean. p. (WHO Regional Publications, Eastern Mediterranean Series; 29) ISBN 978 92 9021 543 1 ISSN 1020-041X 1. Mental Health 2. Eastern Mediterranean Region I. Title II. Series [NLM Classification: WM 105] The image used on the front cover incorporates the World Health Day 2001 logo, which was designed by Marc Bizet under the slogan “Stop exclusion: Dare to care” Permission to reproduce the logo is gratefully acknowledged © World Health Organization 2006 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt (tel: +202 670 2535, fax: +202 670 2492; email: [email protected]). Requests for permission to reproduce WHO EMRO publications, in part or in whole, or to translate them – whether for sale or for noncommercial distribution – should be addressed to the Regional Adviser, Health and Biomedical Information, at the above address (fax: +202 276 5400; email [email protected]). Printed by ESDUCK, Cairo Contents Foreword........................................................................................................7 Preface ..........................................................................................................9 Part 1. Strengthening mental health programmes Chapter 1. Introduction ................................................................................17 Chapter 2. Historical aspects.......................................................................22 Activities of the Regional Office 1949–2000..........................................22 Country activities ...................................................................................24 Chapter 3. Overview of mental health in the countries of the Region.........26 Chapter 4. Developing programmes of mental health at country level........29 The need for national programmes of mental health.............................29 Steps for the development of national programmes of mental health ...29 Follow-up steps for finalizing a mental health national programme ......35 Adoption of the national programme of mental health by the Ministry of Health...................................................................................36 Chapter 5. Development of services for treatment and rehabilitation in primary health care......................................................................................38 Primary health care in the Region.........................................................38 The general principle of the primary health care approach...................38 Support mechanisms required for the provision of services for the treatment of persons suffering from neuropsychiatric illnesses ............39 Chapter 6. The role of training in the context of national mental health programmes ................................................................................................47 Integrating with primary health care ......................................................47 Training of primary care physicians .......................................................49 Evaluation and monitoring of training programmes...............................50 Constraints in the implementation of training programmes...................51 Special aspects of training of auxiliaries and other health personnel working at primary health care level......................................................52 Chapter 7. Developing programmes for the prevention of mental disorders and the promotion of mental health.................................54 Strategies for prevention of mental, neurological and psychosocial disorders in national mental health programmes ..................................54 Strategies for the promotion of mental health and healthy lifestyles in the framework of national health programmes ..................................55 Role of psychology and the behavioural sciences in the development of strategies..................................................................... 60 Involvement of university/academic centres in national mental health programmes.......................................................................................... 61 Chapter 8. Needs assessment, research and evaluation........................... 63 Importance of research......................................................................... 63 Promoting research .............................................................................. 64 Chapter 9. Advancing the global mental health agenda............................. 68 An increasing burden............................................................................ 68 Mental health, mental disorders and the Millennium Development Goals..................................................................................................... 70 Mental health, global development and the public health agenda........ 71 Mental health and WHO’s agenda ........................................................ 71 WHO’s strategic agenda ....................................................................... 73 Goals for 2016 ...................................................................................... 76 Main lines for mental health action in countries in the Eastern Mediterranean Region .......................................................................... 77 Part 2. Country profiles Afghanistan................................................................................................. 83 Bahrain........................................................................................................ 94 Djibouti...................................................................................................... 102 Egypt......................................................................................................... 108 Islamic Republic of Iran ............................................................................ 124 Iraq............................................................................................................ 146 Jordan....................................................................................................... 157 Kuwait ....................................................................................................... 167 Lebanon...................................................................................................
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