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Mental health at a crossroad

with the right investment and tools, healthcare can gain its prominence

by Joseph el-Khoury

Unfortunately, mental healthcare has never been a priority for Lebanon’s public or private sectors. The responsibility for this essential service has largely been outsourced to benevolent organizations and funded through meager subsidies. Psychiatric institutions have managed to survive primarily out of necessity, rather than adequate resources. Privately, the field remains under-resourced in terms of workforce and facilities. There are around 70 psychiatrists available to provide hospital-based psychiatric care, and the number has dwindled due to the crisis. Over 30 percent of these doctors were seeking relocation abroad in part or in full, according to a 2021 survey by the Lebanese Psychiatric Society which indicated that most are unlikely to return unless there is a radical change in the country’s situation. Psychiatric nursing, which has always been a weak element in the care system, struggles to recruit and retain professionals, with many being lured away by opportunities in the Gulf Cooperation Council, Europe, and the United States. However, the situation is slightly better for psychologists. With 800 now licensed by the newly established Lebanese Order of Psychologists their numbers are higher, and their influence has grown in recent decades. Despite the significant number of professionals relocating, those who remain have risen to the challenge and filled the gap at least when it comes to generic interventions. 

It is worth noting that Lebanon used to be a destination for individuals in the region seeking specialized psychiatric care. Many local institutions developed a solid reputation for inpatient hospitalization of the most common psychiatric conditions and addiction disorders. However, this role has all but disappeared in the current crisis. On a positive note, no other country in the region has replaced Lebanon in this area of healthcare, and there is an opportunity for the country to regain its prominence with the right investment in facilities, training, and marketing.

A Regional reputation

Academically, major institutions in Lebanon have managed to maintain their standards and produce consistent output despite the crisis. Health departments at the American University of Beirut, Saint Joseph University, and Balamand University, as well as the Lebanese University among others, are recognized internationally. However, the patients are more likely to benefit in the short to medium run from aligning academic output and clinical priorities. This includes finalizing and implementing mental health legislation, shifting first level interventions to the primary care sector, developing appropriate community services for severe mental disorders, advocating for insurance coverage, updating and rationalizing public provision of services or subsidization of treatments to the most vulnerable and needy. 

The proliferation of non-governmental organizations (NGO) locally has served to move the mental health cause higher on the public agenda. Lebanon continues to lead the way at the regional level in terms of harm reduction services with the only nationwide opiate substitution treatment (for people with substance dependence) in the Arab world, and a network of services targeting vulnerable populations. The endorsement of a highly visible hotline for those in need from local NGO Embrace by the National Mental Health Program and the Ministry of Public Health has contributed to local and global interest in funding mental health projects. In parallel, the protracted Syrian refugee crisis, now in its 12th year, has also played a part in developing specialist services serving refugees and host communities alike in areas that had been previously deprived. The tragedy of the Beirut blast was another occasion to highlight the public health importance of trauma and its complications. Yet, sustainability and upscaling remain an inherent challenge to these models. 

 The relative reduction in social stigma and increase in demand for care should be a catalyst for investment from the private sector, backed by a mixed funding model. While Lebanon remains far from political stability, the adaptability of its resident population mixed with the resilient loyalty of its expatriates to its healthcare sector means that waiting for an ideal ecosystem is not essential. What we need is the vision, the leadership and the stamina.  

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Joseph el-Khoury

Joseph el-Khoury is an assistant professor of psychiatry and an addiction specialist at the American University of Beirut. He has been involved in committees and initiatives relating to drug treatments and policies in Lebanon. He is also a co-founder of the drugs awareness website mukhadder.com

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