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Mental Health Care in Afghanistan Challenges - Strategies

Mental Health Care in Afghanistan Challenges - Strategies. Dr. Hamidullah Akbari Prof at Dept of Neuropsychiatry & human behaviour Faculty of Medicine Balkh University Mazar-E-Sharif Afghanistan Rouffach – Feb 15, 2008. CURRENT MENTAL HEALTH CARE IN AFGHANISTAN.

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Mental Health Care in Afghanistan Challenges - Strategies

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  1. Mental Health Care in AfghanistanChallenges - Strategies Dr. Hamidullah Akbari Prof at Dept of Neuropsychiatry & human behaviour Faculty of Medicine Balkh University Mazar-E-Sharif Afghanistan Rouffach – Feb 15, 2008

  2. CURRENT MENTAL HEALTH CARE IN AFGHANISTAN • Severe shortage of mental health professionals • Little attention for mental health in medical faculties (staff) • The very few available facilities are hospital based and concentrated in urban areas • Shortage of psychotropic medication

  3. Lack of appropriate legislation and MH Policy • Low staffing of the National MH Directorate • Lack of technical support to MH Directorate • Lack of Motivation of mental health care providers • Lack of Mental Health awareness among general population

  4. National Mental Health Programused as mental health policy: Enacted in 1986 • Developing community MH services • Downsizing large mental hospitals • Reforming hospitals to provided more comprehensive care • Developing a MH component in primary care • Human resources • Mental health advocacy & promotion • Equity of access to MH services across various groups • Financing • Quality improvement & monitoring system

  5. Budget for Mental Health Developmental budget for health: 289.4 M $ (2004) Mental Health: 0.2 M $ Government contribution: 22.3 M The rest was from international donor contribution Primary source of MH financing Out of pocket expenditure by patient or family

  6. Mental Health Facilities Mental health outpatient facilities No of MH outpatient facilities: 11 -Capital 5 -Provinces 6 Facilities for children & adolescent: None

  7. Day treatment facilities: one Facilities for children & adolescents: None

  8. Community Mental Health Centres No: 4 community Mental Health Centres available in the capital Cover: 0.03 beds per 100 000 population Beds for children & adolescents: 0%

  9. Community residential facilities None Forensic and other residential facilities None Consumer and Family Associations: None

  10. Mental hospitals: one A total of 0.031 beds per 10 000 population Integration with MH OPs: 100% Beds for children & adolescents: 0%

  11. General Hospitals Cover 0.024 psychiatric beds per 10 000 population General psychiatric rehabilitation centres • Two with 160 beds Total psychiatric beds per 10 000 population 0.055

  12. Programmes for special population • Disaster affected population • Trauma & grief programme for traumatized children • Supported by UNICEF

  13. Most available drugs at PHC: Chlorpromazine Haloperidol Diazepam Amitriptyline Phenobarbital Carbamazepine Guideline & treatment protocol Common mental disorders at PHC Substance abuse Therapeutic drugs

  14. Patients treated in mental health facilities by diagnosis

  15. Mental Health Epidemiology in Afghanistan: (self-reported symptoms)

  16. Mean Prevalence:

  17. Human resources Total number of human resources working in MH facilities or private practice: 0.7 per 100 000 population

  18. Breakdown according to profession: (per 100 000 population) • 0.036 psychiatrists • 0.07 psychiatric nurses • 0.07 neurologists • 0.034 neurosurgeons • 0.09 psychologists • 0.2 other medical doctors (not specialized in psychiatry) • 0.2 other medical health workers • 0 social workers (assistante sociale)

  19. MHHR in Workplace: • 0 psychiatrists work in outpatient facilities • 0 in community-based psychiatric units • 0 in mental hospitals Other MH staff: Psychologists, social workers, nurses, occupational therapists • For Gov administered MH facilities: 84% • For NGOs & others: 9% • Both sectors: 6%

  20. Other doctors: • 30 in community-based psychiatric IP units • 20 in mental hospital • 10 in MH OP facilities Nurses: • 21 in community-based psychiatric IP units • 20 in mental hospital • 17 work in OP facilities Other MH or health workers: • 8 work in OP facilities • 8 work in community-based psychiatric IP units • 40 in mental hospital

  21. Psychosocial counselor training Not been identified in MoPH Human Resource Dept yet • 15 counseling centers • 33 psychosocial counselors (17 M & 16 F in 2005 by Caritas Germany) • Women’s Garden in the capital provides psychosocial support for women (supported by Medica Mondiale)

  22. Training professionals in Mental Health: Number of professionals graduated in 2004 in academic institutions per 100 000: • Psychiatrist 0 • Other medical doctors 2.6 (not specialized in psychiatry) • Nurses 2.4 • Psychologist 0 • Social workers 0 • Occupational therapists 0 • Other health or mental health workers 0

  23. Public education & awareness campaigns on mental health Mental health coordinating body to oversee campaigns: None Campaigns & awareness activities in the past: Unknown Target groups: general population

  24. Enacted in 1997 Advocacy Promotion Prevention Treatment Rehabilitation No financial support for psychiatric patients on: Provision for employment Provision against discrimination at work Housing Legislative & financial provisions for persons with mental disorders

  25. Disability Benefit Act from 1980s. For 100% disability: 6 $ /month For 50 – 80% disability: 3 $ /month Psychiatric disorders are now included. Dementia & Epilepsy are included under neurological conditions

  26. Links with other sectors No formal collaboration with the departments/agencies responsible for health Support for child & adolescent health: -none of the primary & secondary schools have either a part-time or full-time MH professional -0 of primary & secondary schools have school-based activities to promote MH and prevent mental disorders

  27. MH activities in criminal justice system: No prisons have regular contact with a MH professional Training of police officers & judges and lawyers: None Percentage of prisoners with Psychosis is unknown

  28. Information gathering system and Research • No mental health reporting system • Hospitals maintain registry books on their inpatient & outpatient information • No data collection system or epidemiological study • Mental hospital submits quarterly reports to MoPH

  29. Mental Health in Primary Health Care

  30. Policy of Government of Afghanistan Priorities in health sector: Basic Package of Health Services • Maternal & newborn health • Child health & Immunization • Public nutrition • Communicable diseases • Mental health • Disability • Supply of essential drugs

  31. Strategic Plan of Afghan Gov • Integration of mental health into the general health care (application of MH strategy for PHC+ interventions on other levels) • Development of Human resources • Public mental health education • Appropriate MH Policy and Legislation

  32. Strategic Plan(Cont.) • Psychological First Aid for Adults • Support of families with mentally ill • Support to voluntary organization and other sectors • Active administrative unit in MoPH • Research support

  33. A pilot case of PTSD 15 year old Roeen who lost his father due to conflicts Experiences: • Periods of fear and anxiety • Nightmares • Detachment & avoidance behaviour

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