Mental problems untreated in Lebanon

While the physical remnants of war in Lebanon are clearly visible in the pox-marked walls and abandoned buildings in almost every neighborhood, the invisible damage created by the country’s prolonged experience with violence has largely remained ignored.

For most people who suffer from depression or Post-Traumatic Stress Disorder (PTSD), associated with the decades of violence in Lebanon, mental health services are out of reach. Private psychiatrists are rare in Lebanon and expensive. NGOs providing free psychosocial services are few and far between.  Even if such healthcare is readily available and affordable, those with metal health problems face another hurdle: the stigma associated with seeking help.

According to studies by the American University of Beirut, rates of PTSD and depression reach a staggering 30% in some areas of southern Lebanon.  According to a study by the UN Relief and Works Agency for Palestinian refugees (UNRWA), 37% of Palestinian women and 19% of Palestinian men in Lebanon suffer from depression.

Despite the prevalence of mental health problems in the country, there are currently no government programs that adequately address the situation.

“As far as I’m concerned, the government has nothing [for mental healthcare] in Lebanon,” said Dr. Laila Farhood, a professor of psychiatry at AUB and one of the country’s top experts on mental health.

Those suffering from mental illness are forced to seek help from private doctors, though Farhood noted that only “the highly educated and affluent” can afford to go to private mental healthcare providers.

The rest rely on NGOs that offer medicine and counseling, if they have access. And while organizations offering mental health services flooded into Lebanon in the wake of the 2006 war between Hezbollah and Israel, many have since moved on.

One that has stayed is Medicins Sans Frontiers (Doctors Without Borders, MSF), which opened a free mental healthcare clinic in the southern Beirut suburb of Bourj al-Barajneh in 2008.  Bourj al-Barajneh is the site of Beirut’s largest Palestinian refugee camp and many neighborhoods of poor Shia who immigrated to the city; both populations have long experiences with war.

One of the main goals of MSF’s pilot project in Bourj al-Barajneh is to eliminate the stigmas surrounding seeking treatment for mental illness.

“People assume that having depression or anxiety is having a weakness; that it’s an inability to deal with things,” said MSF field coordinator Edgardo Zuniga.

Zungia stressed that MSF is trying to show that mental healthcare should be integrated with primary healthcare and said that the organization is doing its best to educate the public about the realities and severity of mental illnesses.

Other institutions offering free mental healthcare include IDRAAC, based at St. Georges Hospital in Beirut; Doctors of the World, which operates in the Bidawi and Nahr al-Bared refugee camps; and Restart, a Tripoli-based program that rehabilitates those who have witnessed violence and torture.

But even if they can afford private doctors or live near an NGO that offers free mental healthcare services, seeking psychiatric help is not a priority for many Lebanese. “Perhaps Lebanese have to worry about their physical and economic situation before their mental health,” said Farhood, noting, however, that poverty is a strong contributor to depression.

One upside is that despite the higher-than-normal rates of PTSD and depression in Lebanon, there are fewer suicides here than in most countries. Farhood attributes this to strong, intimate social support networks – a safeguard against the absolute desperation and alienation that can lead to suicide.

Also, rates of depression and PTSD can sometimes change over time. According to Farhood, studies conducted by AUB in South Lebanon found that PTSD rates dropped in 2007 from where they were in 2005.  This information is surprising given the relative calm in the area in 2005 – five years on from the Israeli withdrawal and one year before the devastation of the 2006 war.

“People felt empowered; they were able to prevent Israel from occupying their towns,” said Farhood.

Despite such changes, the root causes beneath both depression and PTSD in Lebanon continue to go untreated.  There is a consensus among mental health professionals in the country that education campaigns to eradicate the taboos about seeking psychiatric help should expand along with an increase in the availability of mental healthcare services.

  • Dr M Hakim

    good article dealing with an important issue. however a couple of points come instantly to mind; firstly most mental/psychological illnesses get exacerbated by the on-off war and violence and not just depression and PTSD..almost all diagnostic categories of psych sufferers flock back into treatment after any act of violence in the country. the other quick remark is that the massive seepage of new undetected cases in offspring of traumatized lebanese.these children get a wide potpouri of diagnoses not because of any direct exposure to war violence, rather due to poor parenting skills in several generations of parents who were traumatized by the 3-4 decades of instability and insecurity and ,left untreated ,they lost the ability to effectively deal with childrearing responsibilities and biologically adequate parenting leading to a slew of personality defects and other conditions not commonly attributed to war trauma. but here the chain of causality does start with a war-traumatized pare

    December 8, 2009