Breaking barriers to mental health care in Lebanon

Hiyam Al Hujairi is wearing sunglasses to hide her tears as she listens to her 18-year-old daughter Rawan share her experience of struggling with mental health problems. Rawan’s voice is trembling as she recounts how she suffered at home due to troubled family relations. She admits that she is still terrified of her father. Rawan describes how she became an introvert, fearing any contact with people and how the care she is receiving now has helped her to confront those fears. 

“At first, I vehemently refused to seek mental health care,” says Rawan. “But as I became increasingly frustrated and sad about the changing attitude of the people around me, who I felt were alienating me, I decided to seek help.”

Like her daughter, Hiyam, a 50-year-old Lebanese mother who has devoted her life to her children, decided to seek care for her mental health when she realised how her marital problems were affecting her relationship with her children, as well as their mental health. 

“The only thing I regret now is that I delayed seeking mental health care. I tried to find solutions on my own, but I was clearly unable to do so,” says Hiyam. “As a result, my desire to be alone grew stronger, while my ability to tolerate my children and to communicate with them properly decreased. I used to be full of energy, but now I’m always tired, nervous and crying all the time.”

The care Hiyam received was crucial for her relationships. 

“I have changed a lot and I am so glad that such treatment is available here in Arsal,” Hiyam says. “I feel much more energetic and no longer afraid of leaving my comfort zone. Bit by bit I have regained my self-esteem.”  

In Lebanon, Médecins Sans Frontières (MSF) provides mental health services in south Beirut, in the Bekaa Valley, and in northern Lebanon. Our teams offer psychotherapy, drug therapy by trained public health doctors under the supervision of psychiatrists, and referrals of more complex cases after examination to other organisations.

The daily struggle 

Each day in our clinics, our teams witness how mental health has a heavy impact on adults and children in Lebanon. We see people whose marital problems affect their relationships, and their professional and social life. We see refugees suffering in silence. We see people who are suffering from bullying and other social pressures. We see people who have fallen into a deep depression following the loss of loved ones. 

When we speak about mental health, we rarely hear the stories of men. Antar Daoud, a 50-year-old Syrian refugee living in Hermel, began his battle with mental health after he fell into a coma due to an accident. When he woke up, he had lost his memory and had regular epilepsy seizures and other health problems. 

“I had such severe epileptic seizures that I even reached a state where I was not able to recognise my children,” says Antar. “I didn’t know what I was doing and turned into someone completely different. My wife and children simply did not recognise me anymore.” 

“Six years ago, following one of my seizures, I unconsciously bit my little daughter,” says Antar. “She is still scared of me today. That is very painful and difficult to accept. As a parent the last thing you want is to harm your children.”

Besides his health problems, Antar has also come under heavy pressure due to the difficult living conditions for refugees and because he has lost the ability to work. Unemployment and the rapidly degrading living standard for his family made him think about taking his own life. 

“When I reached that point, I decided to seek help for the sake of my family,” says Antar. “I can’t control the economic and social situation, but I can get help regarding my mental health.”

Stigma, misconceptions and economic crisis 

The economic crisis in Lebanon is also affecting the health sector. If the state of health services today is bad, the services for mental health are even worse. There are multiple barriers to accessing mental health care. Since most mental health services in Lebanon are privatised, the most vulnerable communities, such as the poor and refugees, struggle to access treatment because they simply cannot afford it. 

Furthermore, the public health sector’s lack of experienced and qualified medical staff has worsened due to the massive brain drain of medical personnel over the past two years. Many medical staff have left the troubled country for a better life abroad. Add to that the lack of funds available to ensure mental health care falls within basic (and free) healthcare services.

All of these barriers mean that accessing mental health care is virtually unattainable, particularly for vulnerable communities and people living in remote areas.

“Mental health problems are unfortunately too often ignored and left untreated,” says Rima Makki, MSF mental health programme manager. “On top of all the economic challenges facing mental health care in the country, comes the stigma associated with mental health, which makes people very reluctant to seek professional care.”

“There is a widespread misconception that mental illness cannot be cured,” says Makki. “However, treatment is very effective. People also need to be treated in order to avoid further health consequences, such as chronic conditions and having their daily life impacted in terms of performance, isolation and social relationships.”

Awareness, training and progress

Since 2017, MSF has been supporting the Lebanese Ministry of Public Health with the implementation of the ‘Mental Health Gap Program’, launched by the World Health Organization. The programme aims to include mental health services within general healthcare services as a direct recognition of the importance of mental health care and the right to access these services for all, without any discrimination on the basis of social status or nationality.

Our teams participate by training nurses in public health centres in providing psychological counselling under the supervision of psychologists and doctors. The aim is to provide a quick and integrated response for patients with mental health issues.