More than a quarter of the Lebanese suffered from psychiatric disorders

The mental health of the Lebanese does not seem to be perfectly sound... as it appears from the results of a nationwide comprehensive survey, which shows through analyses and statistics, the extent of the prevalence of mental health issues and their toll on the Lebanese people.

Ghada Izzat - Beirut

A project on Lebanese mental health (a part of the comprehensive initiative launched by AFKAR, funded by the European Union and implemented by the Office of the Minister of State for Administrative Reform - OMSAR), was launched in 2003 when the comprehensive national study L.E.B.A.N.O.N was conducted. This study is the first of its kind in Lebanon and the Arab world. It analyzed a sample of three thousand individuals who were selected on the basis of scientific criteria under the supervision of the IDRAAC society, representing the various segments of Lebanese society. The same survey was conducted simultaneously in 27 countries as part of the World Mental Health Surveys initiative, while the Lebanese side undertook the training of some officials in Arab countries to conduct the same survey, as Lebanon was the first Arab country to implement it.

It should be mentioned here that IDRAAC is a non-governmental organization that has been working in the field of mental health and related fields since the eighties. It also provides free consultations, conducts studies and surveys and promotes research. It gained a formal framework in 1997. Currently, IDRAAC brings together a group of psychologists, psychiatrists, sociologists, nurses and volunteers - mostly university students. Their primary focus is on the protection of the psychiatric patient’s rights, and on securing the appropriate humanitarian and legal frameworks for the patient’s treatment.

In the end, the study produced a detailed set of information and statistics regarding many aspects of the Lebanese individual’s life, including his (or her) mental health, general health and the modes of treatments followed, family-related conditions, economic status, marital life, and the general family atmosphere...

Psychiatric disorders
For instance, the study showed that more than a quarter of the Lebanese people have suffered from one or more psychiatric disorders, and that 80 percent of those who suffered one or more mental disorders, did not receive any treatment or even consultations at a psychiatric clinic.

According to Dr. George Karam, a specialist in mental and psychological illness, “the results obtained through this survey that is being conducted for the first time in Lebanon, present comprehensive figures regarding many aspects of the Lebanese citizen’s mental health, whether in terms of depression, or exhaustion and the medicines being used in these cases. Based on these figures, we launched a more in-depth study, funded by the European Union, to analyze the data available to us regarding the toll of psychiatric disorders on the Lebanese people.”

The European funding for the project, which amounts to more than 80%, or 100 thousand Euros (IDRAAC funded the rest) allowed, according to Dr. George Karam, “the measurement of the toll of mental disorders on the Lebanese people, for the first time at the national level, especially in terms of the impact this entails on the individual’s professional productivity, family relationships and marital life. This then led us to identify new ways for treatment and the obstacles preventing the necessary treatment for the victims of these psychiatric and mental illnesses.”

Ottoman laws
Dr. Karam also stressed that “the current laws in force in Lebanon date back to the days of the Ottomans. In 1984, some amendments were made to the law of the so-called “asylums for the insane” at the time. Nonetheless, the law continued to lag behind those in other countries. For this reason, the decision was taken to work on drafting new legislations concerned with mental and psychological health in Lebanon”. According to Dr. George Karam, this “necessitated the collection and analysis of the laws relevant to mental health in many Arab countries, including Egypt, Morocco, Saudi Arabia, Bahrain, Qatar and Tunisia... in addition to several European countries (France, Spain...) and countries in the Americas. These were then compared with each other, and the appropriate conclusions were drawn in what regards the Lebanese conditions.”

It must be noted that IDRAAC collaborated with the Lebanese government’s National Advisory Committee on the Ethics of Life Sciences and Health, which expressed great interest in the project, at a time when this committee had prepared the draft legislation entitled “the care, treatment and protection of patients with mental or psychiatric disorders”. Thanks to this collaboration between the two sides, several amendments were introduced to the draft legislation as proposed by IDRAAC, based on the results of discussions among experts.

According to the Secretary General of the Ethics Committee Dr. Fouad Bustani, the law on the care, treatment and protection of psychiatric patients issued in 1983 addressed the administrative issues related to psychiatric and mental disorders, but did not tackle the issue of the patient’s rights at all. There is an urgent need to issue legislations concerned with the patient’s rights, and with the definition of voluntary admission, which identifies which cases should be hospitalized, the method of treatment, and the cases where the patient - or a legal guardian - has to agree prior to being admitted... Bustani also added: “last year, we submitted the law to the competent authorities, and we are still waiting for it to be referred to the Lebanese parliament for approval. The draft law includes the grounds for approval, the types of treatment, the patient’s rights, the procedures for compulsory hospitalization, and exceptional treatments”.

The mental health of the Lebanese in figures
Several important issues were examined by this comprehensive study, including the reality of treating psychiatric patients as insane individuals, and the absence of laws that manage the admission of patients into psychiatric hospitals for treatment and identify the cases where the patient needs to be admitted to hospital. This is in addition to the absence of laws that define the rights of the patient to treatment and hospitalization, and the [psychiatric] hospitals’ duties vis-a-vis the patient.

In Dr. George Karam’s opinion, “the need to devise the proper framework for the treatment of the psychiatric patient and the protection of his or her rights does not only stem from the reality of daily and habitual psychological pressures that the Lebanese suffer from, but also from the need for keeping up with the applicable legislations in Europe and the Americas, and which give priority to public awareness in the field of mental health, and whose main goals include the protection of patients’ rights”.

On the other hand, Dr Elie Karam, specialist in psychological and mental disorders and one of the founders of IDRAAC, stressed the importance of this study as being “the first of its kind in the history of Lebanon and the region, where we did not have any concrete data regarding the prevalence of mental and psychiatric disorders. The study is very useful in the fields of educating people, carrying out the required planning, and in training the individuals involved in this field, whether they are non-specialist doctors, clerics, school and university teachers and employers... This is because the toll involved not only touches on individuals’ lives, but also affects households, family environments and society at large, a toll that often becomes a massive financial burden that reduces the individual’s productivity, and creates problems with the patient’s environment and at all levels. Dr. Elie Karam then cites some numbers that have important indications mentioned in the study; this includes for instance that one out of six Lebanese adults have suffered from psychiatric disorders in the course of last year. The most common cases involve anxiety (11%), depression (2%), mania (2%), and substance abuse (1.3%)... Also, according to statistics, a quarter of those suffering from mental and psychiatric disorders have ‘advanced’ cases, while women were found to be more susceptible to these disorders.

War and depression
In the context of treatment, one out of ten individuals consulted a specialist (during the course of last year), including a cleric, general physician or nurse... As for advanced cases, 14 % consulted a specialist, and in non-severe cases, less than 5 % sought professional help. Some patients waited for a period ranging from 6 to 14 years before consulting a specialist. It seemed also that war was one of the important factors that exacerbated the cases of depression, anxiety and mania among the various generations. Also, 4.3 % considered suicide during the course of their lives (1.7 % made plans for suicide, while 2% attempted suicide)...

Dr. Elie Karam also said: “With the help of the European Union, we were able to study the toll of mental and psychiatric disorders (depression, anxiety, bipolar disorder, social anxiety...) on personal and intimate relationships, and on employment, the household and social environment. Also, physiological conditions were compared against physiological conditions and their impact on the individual, and on work attendance.”