jeudi 30 avril 2009

The Launch of the Iraq Mental Health Survey

Press, UN and Iraqi Officials during Launch of IMHS 2006/07 (UN/Ali Abdul-Jalil)

The First of its Kind: The Launch of the Iraq Mental Health Survey 2006/07

By Randa Jamal

The first of its kind, the Iraq Mental Health Survey (IMHS 2006/07) surveyed 4332 Iraqis over eighteen years of age, across the country’s various governorates and social sectors. Launched on 7 March 2009, the study was conducted throughout by the Iraqi Ministries of Health and Planning in a joint effort with the World Health Organization (WHO).

Logo of IMHS 2006/07: designed by Ms. Ruba Hikmat, WHO

The survey reveals that out of the 16.5% who suffered from a mental health disorder during their lifetime, only 2.2% were recipients of medical care. Alarmingly, anxiety and behavioral disorders are higher among women than men, who have a higher rate of substance abuse. Parliament Representative Member, Ms. Samira Al-Musawi, who chairs The Women, Family and Childhood Committee was not surprised by the higher occurrence of anxiety and behavioral disorders among women. She observed, “Women have lived through very difficult conditions, including having to carry the brunt of caring for the family, making ends meet and raising children—at times completely on their own, especially since there is a high number of widows”.

On a more optimistic note, the prevalence of Post-Traumatic Stress Disorder (PTSD) was 3.6% lower than expected of a war-ridden country and lower than for other countries such as UK, the US, and Brazil. The Iraq WHO Representative, Dr. Naima Al Gaseer attributed this lower rate to the widespread resilience possessed by Iraqis in handling trauma and in moving forward with their lives. However, a higher level of mental health symptoms was reported such as increased phobia and anxiety.

Mental health disorder rates in general could be much higher, but as the Health Minister, Dr. Saleh Al Hasnawi, pointed out “In Iraq there is a considerable stigma attached to having a mental illness”. Such stigma may prevent survey respondents from responding honestly. To address stigma, he added, “We must implement large-scale community education programmes to decrease this stigma and encourage people to come forward to seek the treatment they need”. He emphasized that improving mental health will be a top priority within the domain of health, considering the emotional distress many experience. He also stressed the need for further research to better comprehend the coping strategies Iraqis use to deal with stress and conflict, but emphasized that it is most important “to achieve the stability that will allow all to live peacefully and without fear”.

In addition to prioritizing mental health services, the survey provides insight about the prevalence of mental health disorders in various governorates and regions, across educational levels, social classes, urban and rural environments. This was an important accomplishment, because, as the Minister of Health of the Kurdistan region, Dr. Abdul Rahman Othman Younis, said, “It is important to customize mental health care to serve the needs of the different sectors of the population. The survey has been useful in pointing out these differences.”Dr. Al Gaseer, attributed the success of the survey to three factors:
1) insight into the status of mental health in Iraq;
2) the ability to design health programmes for various targeted groups; and
3) the transfer of knowledge and skills to health professionals working on the ground in conducting such national surveys in Iraq.However, a phenomenon that could impede addressing some of the challenges identified by the survey is the number of the social workers and psychiatrists in Iraq.

For example, Dr. Abdul-Monaf Al-Jadiry, Professor and Chairman of Psychiatry at the University of Jordan, confirms that the survey report of 2006 estimates that the number of “mental health personnel in Iraq is 136 psychiatrists, 224 psychiatric nurses, 46 social worker and 31 psychologists”.

Since 2006, the professor speculates there has been an increase of 40% in mental health personnel (a total of 612 health workers). However, Dr. Al Gaseer stressed that 40% is too high: WHO recommends assessing the number of health professionals and personnel delivering health services in the county.

However, for a population over 27 million, the number of health personnel seems insufficient to meet the mental health needs of an entire population. For example, the survey identified that 16.5% face a mental illness—that translates into millions of people who require mental health care. Clearly, challenges lie ahead with much work needed to improve the country’s fragile infrastructure, especially since resources are minimal and the Government of Iraq has made severe cuts in its annual budget plans. Challenges include providing mental health services to children and adolescents now, to prevent the development of mental disorders into adulthood, and addressing the deeply rooted stigma of mental illness that prevails in several societies.

Another challenge concerns the brain drain phenomenon that has had severe negative ramifications for Iraq and the need to persuade Iraqi professionals residing abroad to return to Iraq. Yet, despite all that is unfolding in their country, Iraqis move forward with resilience and determination: this is imperative to the survival of a people who have experienced horrendous events and circumstances.

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