Written by Luiza Ghazaryan and Ambika Nair
Each year, the first week of October is marked as National Mental Health Awareness Month and October 10th is World Mental Health Day. In developed countries such as France, there are Medical Psychological Centers that provide mostly free services covered by state health insurance. The situation drastically changes when we look at other parts of the world.
In Lebanon, many individuals are struggling with high inflation: an economic crisis aggravated by COVID-19 pandemic and the 2020 Beirut port explosion. These economic issues have resulted in a scarcity in mental healthcare resources with thirty-six percent of health facilities being affected. Nearly forty percent of doctors and thirty percent of nurses have left the country since the drastic economic events took place. Consequently, the lack of trained personnel per population is affecting the quality of the medical support Lebanese citizens receive.
Money is a major factor when it comes to receiving proper healthcare treatment. According to UN reports, seventy-five percent of the Lebanese population lives below the poverty line. Dr. Azar at the Deir-el-Salib Hospital located ten kilometers outside the capital city, explains that due to the economic crisis, there is also a physical medicine shortage which significantly decreases the quality of help for patients. She highlights how, “sometimes, a patient will arrive at the hospital and it will take days before doctors can source a medication for them – prolonging their need for treatment.” Even before these disasters, the budget for mental health services was only five percent of the total budget for health services. After the economy took a toll, medications specific to hypertension, depression, and schizophrenia experienced a great inflation between three to ninefold the increase of original prices. In Lebanon, as well as in many other countries, the available medical resources are mainly centered around the capital city, leaving residents of rural areas even more interdicted to access to mental health resources – exacerbated in these times of economic turmoil. Barriers to proper mental health care results from a lack of confidentiality, transportation, affordability, and a lack of healthcare specialists. With both a decrease in trained mental healthcare professionals as well as a shortage in accessible mental health medications post-crisis, Lebanon has seen a surge in suicidal residents – with their national suicide prevention hotline receiving double the amount of calls per month since 2020.
In Lebanon, however, we are starting to see some improvement in the sphere of mental health services. “Khoutweh Khoutweh” is a digital mental health intervention service consisting of 5 sessions that users go through on their own and have access to 15 minutes per week, remotely (via phone or message) and guided by a trained non-specialist “e-helper”. The intervention goal is to minimize the mental health treatment gap in the country between the rich and poor.
A similar case is observed in Armenia, where individuals do not receive the necessary mental health care provided by the state. The assistance centered in the capital city of Yerevan is not free, and the healthcare providers are not trained enough to take patients’ needs seriously. Both physical and mental healthcare in rural areas lack the necessary tools for patient treatment. Along with the geographical barrier on psychological help, the situation is exacerbated by stigma towards mental health care. In many rural populations, individuals tend to think that seeking psychiatric help is shameful, which in part may be due to a lack of education surrounding the issue which may only be forwarded in urban areas. Rural residents find themselves choosing to visit medical professionals from the capital city because they are less involved in the local society. On the other hand, local professionals manage to lack confidentiality of patient’s needs, making it even more challenging on top of already existent stigma for patients to ask for professional psychological care.
It is already difficult for people to ask for help regarding their mental health because of the existing stigma, but it gets more stressful when the integration of cultural stigma and economic disparity plays an amplified role in receiving inadequate treatment. State funding is insufficient to assure guaranteed free services for vulnerable groups. In Armenia, only three percent of the overall public healthcare budget is given to mental health. Similar to Lebanon, around twenty percent of psychiatrists in Armenia emigrate to other countries within five years of the completion of their training. These disparities highlight the drastic need in many countries such as Armenia and Lebanon to focus on improving healthcare within the country itself rather than simply receiving an education there and leaving the populations in the dust. The financial resources of most hospitals and institutions are not sufficient to provide even the most basic services or to pay qualified personnel. Moreover, most psychiatric hospitals and institutions do not have the necessary infrastructure to provide adequate care. They are often overpopulated and no distinction is made between patients with differentially diagnosed disorders. For example, in many Armenian medical institutions, people suffering from autism share the same dormitory as people with schizophrenia.
Armenia is rarely included in international systems and finding help is a complicated process. Currently, we are seeing some progress as the mental healthcare rights of Armenians are being protected by volunteer groups. These groups intensified their work after the 2020 Nagorno-Karabakh war and the September 2022 attacks on Armenian lands. Many victims, displaced people, and families of victims have the opportunity to seek support in these therapy groups. The organizations find volunteer specialists who are willing to provide group talk sessions and individual counseling. The services are completely free for everyone, and people can seek support regarding any topic. In the rural areas, residents have telemedicine services with existing phone applications (e.g. SafeYou) so that healthcare can be provided to traditionally unreachable areas.
Across the Arabian Peninsula, nested between Iraq and Saudi Arabia, lies the country of Kuwait. The stigma barriers of mental healthcare in Lebanon and Armenia are due to cultural factors, collectivism, gossip and reputation. Kuwait faces a familiar struggle. Individuals’ behaviors are deeply influenced by how society perceives them since the shame is not only a direct reflection of them, but their family. Nevertheless, unlike Armenia and Lebanon, mental healthcare in Kuwait has had crucial accomplishments on a federal level. In 2019, social media figures started a prominent campaign called #موعيب (translation: no shame) to break the taboo of discussing mental health disorders. As a result, Kuwait’s first Mental Health Law, assuring the protection of the rights of mental health patients, was passed unanimously in the National Assembly. Dr. Nayef al-Harbi, the president of Kuwait’s Center for Mental Health, said, “The law guarantees the patient’s freedom to make decisions and choose the treatment before it is taken by doctors, in addition to the patient’s right to determine visitors and their right to communicate with lawyers and human rights committees.” Therefore, the law touched on a pivotal obstacle to mental health: the culture of stigmatization.
Throughout the world, mental healthcare access and rights are improving thanks to the help of volunteers and youth initiatives. The positive effects will undoubtedly continue growing if governments start emphasizing the importance of psychological health by adopting more laws encouraging seeking help. Influential figures can show support by expanding the budget for mental healthcare and speaking up – this will ensure that every human, in every part of the world will have the right to receive the necessary psychiatric treatment without facing the stigma.