On World Mental Health Day, celebrated two days ago, the discussion has shifted from the importance of psychological treatment to how to secure this treatment. The mental health sector in Lebanon is not immune to the effects of the ongoing crisis. While the demand for psychological services has increased, so have the costs of visiting doctors and therapists, many medications have become unavailable, and a significant number of doctors have emigrated.
"If Europe has seen a 30% rise in anxiety and depression cases due to the COVID-19 pandemic and its repercussions, one can only imagine the psychological state in Lebanon, which has experienced a combination of worsening crises since the onset of the financial collapse, including drastic changes to daily life, loss of basic necessities such as food and medicine, insecurity, coupled with rampant violence and the absence of the state and its institutions, exacerbated by a pressing refugee crisis. The explosion at the port on August 4, 2020, further darkened the reality." This is how Professor Wadi Naj jar, head of the Psychiatry Department at Lebanese University, begins his remarks, expressing regret over the lack of statistics or precise surveys on the status of mental illnesses in Lebanon, noting that the last national survey was conducted in 2006.
Dr. Leila Aakouri Al-Dairani, president of the Lebanese Psychologists Syndicate, agrees with her colleague, highlighting that the social isolation imposed by the pandemic, combined with the deteriorating economic situation, negatively affected families with members suffering from certain disorders. Proximity did not soothe tensions but rather exacerbated disagreements and domestic violence. Many children and adolescents lost their direct social communication skills and now face numerous challenges in returning to normal social life.
According to Al-Dairani, the most affected group during the crisis is "those with chronic additional needs (such as individuals with ADHD, learning disabilities among adolescents and adults)... These individuals had previously received extensive support in terms of medical treatment and behavioral and developmental sessions. However, the decline in services has severely impacted their mental and psychological health and that of their surrounding environment."
### Emigration of 50% of Licensed Professionals
From these observations, it can be concluded that the status of medicine and psychological treatment in Lebanon is dire. As the demand for psychological services has risen, so have the costs of visiting doctors and therapists, as well as hospitalization costs, which have skyrocketed. Many medications are no longer available, and those that are available are expensive following the removal of subsidies. The many alternative medications available are often ineffective. According to Naj jar, "You're at the mercy of luck," noting that there is a research lab to test generic alternatives before they are allowed into the market. "I do not know if such tests are being conducted now, especially since Europe has withdrawn many of the alternative medications currently circulating in Lebanon."
Moreover, a significant number of doctors and mental health therapists have emigrated. Al-Dairani reports that "50% of licensed psychologists have emigrated, and even newly licensed individuals are leaving. The number of psychologists registered with the Ministry of Health is 866. This affects geographical coverage of treatments and the strengthening of capabilities."
### Have We Adapted?
In light of this situation, is adaptation the solution? Ultimately, humans are capable of adapting to any circumstance, no matter how dire, says Naj jar. However, he poses the question, "What is the cost they bear to achieve this adaptation? Nothing comes without a cost. Here, the costs are psychological, moral, and physical." Regarding people who do not seem to be psychologically affected despite their difficult circumstances, Naj jar notes that "it's not necessarily accurate to generalize that all Lebanese are miserable and suffer from depression and psychological disorders because humans are composed of nature and nurture. Nature might endow an individual with genetic predispositions to neurological diseases that may emerge under specific conditions, especially when circumstances are favorable. Conversely, if an individual lacks genetic predispositions but has the capacity to cope with crises, they will live their life normally. The opposite is also true; if they lack genetic predispositions to illness but their lifestyle, thinking, and character are detrimental, they are also likely to become ill."
### What to Do?
Regardless of the overall solution that requires reforms at the state level, the focus remains on finding ways to assist individuals, especially those in psychological distress. Al-Dairani advises individuals to "determine their priorities on paper, and try to find space to relax, such as distancing themselves from bad news and preventing themselves from discussing negative situations all the time. Instead, suggest pleasurable activities that are inexpensive, like listening to music, watching movies, dining with family, seeing friends, talking to them on the phone, meditation, deep breathing, and relaxation."
She also emphasizes that the syndicate is working with the national mental health program under the Ministry of Health to support and train psychologists across all governorates. Together with the Ministry of Education, they are also monitoring public schools. She mentions that "the Psychiatry Association's conference scheduled for December aims to develop mechanisms to ensure that mental health services are available because it is a right." Regarding the fees for psychological therapy sessions, Al-Dairani confirms the syndicate's efforts through the finance committee to establish rates for sessions, as situations today are not regulated. Additionally, they are working to implement ongoing training programs to enhance the skills of professional psychologists.
