JERUSALEM – For mentally ill Palestinians hope may be on the way: The implementation of a national mental health programme has started, officials involved in the project said.
"We were lacking a system before, and the work was piecemeal, without overall planning," explained Anan al-Masri, deputy minister of health, in Ramallah. "But now it’s all coming together and we are on the right track."
Since the foundation of the Palestinian Authority (PA) in 1994 health officials have talked about the need for a mental health system, as there was not one under the direct Israeli occupation which began in 1967.
At the start of this decade, the World Health Organization and the ministry of health set up committees to organise a community mental health programme. The boycott of the Hamas-led PA governments from 2006 until mid 2007 hampered implementation, but the renewal of aid to the West Bank-based government of Salam Fayyad is allowing the project to move ahead.
The goals, according to Masri, and John Jenkins of the WHO, are to reduce the stigma associated with mental illness, treat patients near their homes rather than in distant psychiatric hospitals, and provide more training.
There are currently only about 15 psychiatrists in the West Bank and a few in the Gaza Strip to service an estimated population of about four million people. There is a similar shortage of clinical psychologists.
Eyad Sarraj from the Gaza Community Mental Health Programme, a non-governmental organisation (NGO), said his group had started offering training in human rights and psychiatry to try and fill a gap.
Sarraj, one of the few psychiatrists in Gaza, told IRIN that when he began his studies in the 1970s people thought he was "crazy" to choose psychiatry over other fields. "Then, in Palestine and in the Arab world in general, there was a stigma associated with mental health," he said, noting some progress had been made.
Médicins Sans Frontières is one of several NGOs running a mental health project in the occupied Palestinian territory.
"Our goal is to try and alleviate the suffering of people affected by conflict, so they can cope with day-to-day life," said Duncan McLean, the head of mission.
However, his group encounters reluctance, particularly amongst young men, to participate in psycho-social sessions.
The conflict with Israel has softened attitudes towards those with illnesses related to trauma or stress, several experts said. It became acceptable to have a mental disorder if it was "caused by the enemy".
Some hope this can lead to a general change in opinion, allowing more people to come forward and receive help. However, trauma caused by internal strife, health workers said, was the hardest to deal with.
"The stress related to the conflict also causes patients with predispositions towards mental illness to relapse more frequently," said Issam Bannoura, director of the psychiatric hospital in Bethlehem, the only one in the West Bank.
For these people, delaying treatment, sometimes for years, because of the stigma, can cause their mental state to deteriorate. Also, while some were willing to take medication for their problems, going to therapy and talking about them was another roadblock that many had to pass.
Furthermore, it is not uncommon to believe a demon is the cause of the illness, rather than a traumatic event or chemical imbalance. "Many people go to traditional healers, because they are frightened," said Gaza’s Sarraj.
"We need to create more awareness about mental disease among the population in general and among medical staff," said the health ministry’s Masri. "Family doctors need to know how to recognise and handle a minor issue and refer more serious ones to a specialist."