Download Mental Health In Yemen obstacles &Challenges

Mental Health In
Yemen obstacles
&Challenges
Prepared By:
DR. Maan A .Bari Qasem Saleh
Associate Professor
Fulbright Scholar
Depart. Of Psychology
Arizona State University
(President Yemeni Mental Health Association)
The Content
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Introduction
Objectives
Definitions
Human Resources
Mental Health Services
Mental Health Institutions
Epidemiology
Conclusions
Recommendations
Different sight of Yemen (Pictures)
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Yemen profile
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Full name: Republic of Yemen
Population: 20 million ( 2004)
Capital: Sana’a
Area: 536,869 sq km (207,286 sq miles)
Major language: Arabic
Major religion: Islam, with small Jewish minority
Life expectancy: 59 years (men), 62 years (women)
(UN)
 Main exports: Crude oil, cotton, coffee, fish
 GNI per capita: US $600 (World Bank, 2006)
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
 Politics: President Ali Abdallah Saleh has
been in power since 1978. Elected as a
president in1999 and reelected for the second
time – and should be the last- in 2006?!
 Economy: Yemen is the poorest country in the
Middle East; economic difficulties have
sparked unrest
 International: Yemen has been co-operating
in the US-led "war on terror", risking domestic
resentment
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Introduction
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In Yemen, mental health issues have close connections with
myths, superstitions and distorted religious concepts relevant
to witchcraft, Jinns or devils.
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The social stigma toward mental health issues continues to
cast heavy shadows and will likely continue in the future.
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Yemeni national and social development was seen in the last
three decades only.
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The ghost of wars, internal struggles, poverty, increases in the
rate of reproduction and illiteracy problems still persist.
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T he main change was happened through human resource
where countless students were sent to study psychiatry,
psychology, social sciences, and psychiatric nursing in other
Arab countries , former socialist countries and Western
countries
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Objectives
 The aims are to provide scientifically based information relevant to:
 Specialists and other professionals who work in the field of mental
health.
 Mental health services already operating in both government and
private hospitals and clinics,
 Governmental and non-governmental organizations (NGOs), that
provide mental health services in Yemen,
 Epidemiology of mental illness
 Information database development that can serve as a reliable reference
for studies, research, projects and future planning
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Definition of Mental Health
 Good health does not only mean a physically healthy
body, but it also refers to both a state characterized by the
absence of disease and a high level of mental and
physical fitness. Accordingly, a healthy person must enjoy
physical and mental health.
 A mentally healthy person must be capable of thinking
clearly, solving various day-to-day challenges, enjoying
good relationships with friends, work colleagues, and
family, feeling spiritual comfort and bringing happiness to
others in society.
 Although we are speaking about one’s mental state and
body as if they were separated, in reality, they are two
faces of the same coin.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Human Resources
 The data collected and relevant to this subject
point to the obvious limited abilities of human
resource in Yemen, though an accurate and
reliable official document about human resources
is not available, and so, numerous survey sources
(private and institutional) are sourced in this
respect.
 The Yemeni Mental Health Association
contributed in large part to these data conducted
in the years 2002 to 2006. The results obtained
through the surveys indicted to the following
estimations:
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Psychiatrists
 165 532 psychiatrists in the world WHO-2001).
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2,582 of them are in the Middle East.
 The mean ratio is 3.96 psychiatrists/100,000 individuals in the
world and 0.06/100,000 in the low-income countries
 compared to a ration of 9.0/100,000 in high-income countries.
 In Yemen, about 45 psychiatrists and Neurologists (0.02/100,000)
translate into one physician for every 500,000 people.
 The population of Yemen according to 2004 census is about 20
million. More telling, there are only three designated psychiatrists
for the entire population of Yemeni children and these are shared
between hospitals and universities
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Psychologists
 147 019 psychologists working in mental health worldwide (WHO2001).
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2,387 psychologists working in the Middle East.
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The mean ratio of psychologists for each 100,000 individuals for
the world’s population is 6.34 (6.34/100,000).
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3000 psychologists in Yemen. (1.5/100,000)
 135 psychologists working in academic institutions, 75 in the
health sector and 45 in social work
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Academic qualifications
 The local academic qualification programs in
psychiatry and clinical psychology started in 2003 by
the Yemeni Medical board under the Ministry of Health.
 Clinical psychology specialization. Yet, 30 individuals
have graduated at the diploma level (one-year
program)
 There are also higher education programs (Master's
degree) in General Psychology in the Arts faculty of
Yemeni Universities .
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Psychiatric nursing
 worldwide , there are 471 123 psychiatric nurses.
 These include 7,955 in the Middle East (WHO-2001).
 In addition, the mean ratio (nurse to individual) is 2.3
per 100,000.
 In Yemen, about 197 psychiatric nurses work in the
health care sector
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Mental Health Services
 4/Mental Hospitals – 850 beds
 12/Psychiatric Clinics in General Hospitals
 3/Psychiatric Clinics in the
Prisons(188beds)
 5/Private Nursing Home- (100beds)
 45/Private clinics
 Diagnostic Techniques
 Management and Psychotherapy
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Diagnostic Techniques
 At present, EEG and CT scans are available.
 However, the utilization of modern techniques (e.g., MRI) in the
diagnosis of mental illness is not available in this field of
specialization. This due to two reasons; the cost of equipment is
prohibitive and the non-existence of qualified candidates to
interact with such equipment.
 In the case of mental assessments, unfortunately there are no
legal and official assessments that can be used according to the
particularities of the Yemeni social and cultural environment.
 The non-existence of specified official protocols for diagnosis
according to international criteria such as the International
Classification and Diagnostic Guide for Mental Disorders known
as the ICD-10, or the Diagnostic and Statistical Manual by the
American Psychiatric Association, known as the DSM-IV-TR,
continue to serve as a barrier to consistent and informed
diagnosis.
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Thus, the majority of the cases are diagnosed depending on personal
experience, academic background and knowledge of each physician.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Management and Psychotherapy
 Successfully treating mental illness often involves
the use of psychopharmacologic drugs for
patients.
 While effective, the use of such medications is
prevented in the Yemeni situation, as their cost is
prohibitive for most patients.
 The use of ECT remains widespread, while there
are unfortunately few programs and evidencebased models in the treatment of mental illness
(behavioral, psycho-educational or cognitive) that
are proven effective and appropriate for the Yemeni
context. The role of both institutional and
individual willingness is implicated in these
causes.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Psycho-Counseling services
a.
Hotline Telephone for Psychological Aid (Aden)
This tele-counseling service was established by
YMHA on April 8, 2000
b. School Behavioral Counseling Program
This program was established by YMHA in June of
2002.
c. Hotline Telephone for Psychosocial and Legal support
(Sana’a)
This service belongs to the Arab Human Rights
Institution and was established in March of 2002.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
d. Educational and Psychological Counseling Center
(Sana’a University)
The Center was established in September of 2005
e. Student Counseling Center (Taiz University)
This Counseling Center was established in May of
2006
f. Telephone Hotline of the Mental Health Unit of the
Cultural Health Center
This service was established in Sana’a in 1996.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Mental Health Institutions
1- The Higher Council for Mental Health
This Council was established in 2002.
2- National Mental Health Program
The National Mental Health Program was established in the late
1980s with the help of the WHO
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
3- Academic
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departments in Yemeni Universities
We can consider that the(4 )departments of Psychiatry in the
Faculty of Medicine, and the(11 )departments of Psychology in
the Faculties of Arts and Education faculties in Yemeni
Universities as the providers of research and accredited
professional development
4- Mental Health NGOs
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Eighty-eight per cent of countries have NGOs that involve mental
health as their primary activity while providing support,
treatment, rehabilitation and prevention services (WHO, 2001)
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In Yemen there are currently seven mental health associations
that comprise a membership of 1, 280 members (Maan, 2006).
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Epidemiology
 Epidemiologic studies or data collection systems are only
available in 43% of low income countries compared to 77% of
high-income countries..
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Estimations of Mental Health Patient Epidemiology :
 WHO (2001) estimated that about 20% of the population suffers
from behavioral and emotional disturbances.
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This means that there are potentially up to four million people in
Yemen who need mental health supports
 while only one psychiatrist per 100,000 residents exists to meet
this need.
 Approximately two million children suffer from emotional and
behavioral disturbances.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Psychiatric Hospital Data in Yemen
 The statistical data obtained in the psychiatric
hospitals of Yemen indicate that approximately
29,519 mentally ill patients frequented these
hospitals during 2006
 According to disease epidemiology:
 paranoia including schizophrenia ranked in
first place
 followed by emotional disturbances like
depression and anxiety,
 Epilepsy in third place .
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Suicide Epidemiology
 According to the WHO (2006) report, one million individuals
commit suicide annually.
 In addition, more than twenty times as many attempt suicide.
 Worldwide, 16 individuals per 100,000 commit suicide
 while in the Arab countries, this number is estimated to be 6
persons per 100,000.
 Suicide is one of the three main causes of death in the world,
especially in the 15 to 44 age group.
 90% of committing or attempting suicide are linked to mental
illness. (WHO-2006)
 Suicide are already diagnosed with a mental illness,
typically depression, but can also include diagnoses:
 bipolar disorder, alcoholism, substance abuse and
schizophrenia.
 Unfortunately, such diagnosis and data are not available in
developing countries due to poor resources.
 suicides in Yemen totaled 243 cases in 2006(Yemen Interpol)
 the use of a fire weapon being the most common means to
achieve this 75%
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
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Reasons of suicide
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Familial problems, with absence of Health, social services to
help families
Low standards of living in some families, with corresponding
increases in costs, and high rates of unemployment among
youth;
Intensification of mental and neurological illnesses and the
corresponding inability to pay for treatment (if it exists), and
familial shame, stigma and secrecy about the mental illness
of family members;
Fear of retribution because of crimes committed and
resulting fear of punishment exacted by families, i.e. suicide
becomes a way to escape punishment, being killed one’s self
by the avenging family, and escaping the shame placed on
one’s family as a result of the family member’s criminal
activity;
Accumulation of debt, bankruptcy, great financial losses, and
general economic scarcity; and,
Drug or alcohol use, emotional crises, and the inability to
cope with life’s emotional and conflicting demands.
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Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Conclusions
 We can make the following conclusions based on our Study:
 The awareness of mental health priorities, as well as its impact on
human development is weak.
 Limitations in the national strategy of mental health policies still
exist.
 Limited or absent mental health services exists across
governorates.
 Civil society development remains a concept in infancy stifling
the growth of the mental health field along with human and
material resource base needed to do this.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
 Absence of legislative mandate to encourage and
coordinate mental health activities.
 Limited communication with regional and
international institutions that inform or directly
fund mental health activities.
 Weaknesses in academic program training and
accreditation of professionals.
 Weaknesses in data collection and lack of
transparency in the publication and use of data.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Recommendations
 General recommendations
 We recommend increasing the number of educational campaigns
to reduce mental illness stigma.
 We recommend mandating a political and national strategy for
mental health that includes the participation of the Ministry of
Health, Yemeni universities (Faculties of Medicine), and related
mental health NGOs.
 We recommend the improvement and development of mental
health services for all governorates in the republic.
 We recommend that specialists, activists, and those interested in
mental health increase their efforts in collaboration together.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Continuing Recommendations
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We recommend that the Ministry of Health, specialized associations,
and concerned scientific departments of Yemeni universities to
speed up the preparation of laws to protect the mentally ill and to
promote and develop the field as a priority.
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We recommend strengthening communications with regional and
international institutions with respect to mental health and its
financing.
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We recommend paying importance to the training programs and
qualification processes in the mental health domain.
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We recommend joining efforts in the formation of an accurate and
informative database that is methodical, up-to date and uses the
most current techniques in data collection and manipulation so that
future studies and scientific works can be implemented.
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Special
Recommendations
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Recommendations to Ministry of Health
Recommendation to the Ministry of Education.
Recommendation to the Ministry of Social Affairs.
Recommendation to the Ministry of Justice.
Recommendation to the Ministry of Interior
Recommendation to the Ministry of Defense.
Recommendation to Yemeni Universities
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Queen of SHEBA Tamable
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
City Sight from Aden
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Aden Elephant Bay
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Beethoven Symphony in
old city of Sana’a - 2004
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges
Thank you
Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges