Mental health services in Lebanon: an approach focused on recovery – World Health Organization

In September 2018 I was admitted to hospital following a manic episode, says Thurayya Zreik, from Lebanon. This was my third admission. It was the first time, however, that I left with something other than the clothes I arrived in and a doctors prescription. I left with a recovery plan.

Thurayya was diagnosed with bipolar disorder in 2010. The support she received during her third stay in the hospital was in stark contrast to her previous visits.

Thurayya recalls: I remember the time I had gone to emergency services for an anxiety attack and ended up being injected with what I was told was an antihistamine to make me sleepy. The injection was in fact an antipsychotic, because the doctors had seen in my file that I was previously diagnosed with bipolar disorder and decided that I was having some kind of psychotic episode, instead of what I knew was a standard anxiety attack.

I remember waking up and only learning what I had been given after reading the discharge report. I felt unsettled, and had the sinking feeling of being lied to. But I also remember accepting that this was the way things had to be, part-and-parcel of living with a psychosocial disability.

Thurayya's recovery plan, developed during her most recent hospital visit, with the support of a team of medical staff, is one of the central components of WHOs QualityRights programme.

QualityRights, now being introduced or expanded in 31 countries worldwide, aims to improve access to quality mental health and social services for people with mental health conditions and psychosocial, intellectual and cognitive disabilities. Central to the programme is respecting the human rights of people seeking support and a focus on their recovery as active members of their communities.

The recovery plan is based on the preferences of the person in need of support, with regard not just to treatment but also issues such as a support network, ways to cope in crises, and life goals.

Thurayya explains: Developing a plan such as this, centred on my goals and ambitions, was extremely empowering. The trust, of my doctor, psychotherapist, family and friends, in me and my own capacity, translated into trust in myself.

What Thurayya didnt know when her recovery plan was being drawn up was that the facility where she was receiving care had, since her previous visits, started implementing the WHO QualityRights programme.

WHO

This involved an assessment of the service, followed by recommendations for actions to transform the service into one that promotes rights and recovery. A key recommendation was training of facility staff, and offering information sessions for people with mental health conditions or psychosocial disabilities to provide a better understanding of their rights and potential paths to recovery.

Topics covered in the training and information sessions included mental health, disability and human rights; legal capacity and the right to decide; freedom from coercion, violence and abuse; ending seclusion and restraint; and establishing peer support groups.

Changes that Thurayya noticed, on her third hospital visit, was that people using the services had more privacy than before, and treatment options were explained and consent actively sought.

In Lebanon, as part of a comprehensive mental health system reform outlined in a five-year strategy for 2015-2020, there is now a team of more than 30 assessors of mental health services. These include mental health professionals, social workers, lawyers, and service users. All have been through the QualityRights Programme. A further 75 will be training teams of professionals before the end of 2019. Longer-term, the Ministry of Health plans to have all mental health facilities in Lebanon assessed by the end of 2020.

Rabih El Chammay, Head of the Ministry of Public Healths National Mental Health Programme, was in large part responsible for introduction of the Programme in Lebanon. QualityRights makes good sense and adds a lot to improving the quality of services and protecting the rights of persons with lived experience and helping them recover. It is best to have it integrated in the system rather than as a sporadic exercise. Were so lucky and grateful to have Thurayya on the National Mental Health Team, helping scale up QualityRights to the national level, he says.

Inspired by her experience and motivated by her desire to improve the mental health services in Lebanon, Thurayya has become a field manager of the countrys QualityRights programme.

When I returned to work full-time this year, I began working on the QualityRights project as part of the National Mental Health Program at the Ministry of Public Health in Lebanon. As part of this job, I had to spend time studying the material and familiarizing myself with QualityRights principles. I learnt that many recommendations and solutions do not require a huge amount of resources; they require a change in mind-set, from a treatment-based approach of eliminating symptoms to services focused on helping people get better.

The commitment of the team at the Ministry of Health in Lebanon to roll out QualityRights across the country is incredibly encouraging, commented Dr Iman Shankiti, the head of WHOs office in Lebanon. I am hopeful that our experience here will be useful to other countries as they embark on similar efforts to improve the mental health of their populations.

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Lebanon is one of a growing number of countries that has introduced some or all of the components of the QualityRights programme.

Countries that are scaling-up their QualityRights Programmes: Armenia, Bosnia & Herzegovina, Czechia, Croatia, Estonia, Ghana, Kenya, Lithuania, the Philippines, Romania, Slovakia and Turkey.

For more information on QualityRights, contact:

Michelle Funk funkm@who.int Department of Mental Health and Substance Abuse

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Mental health services in Lebanon: an approach focused on recovery - World Health Organization