Stigma deters mental health care in Jordan
AMMAN // Basem, 49, will not let anyone touch his computer because he believes Jordanian intelligence is spying on him. Eight years ago, Basem was diagnosed with schizophrenia, a mental illness affecting about seven out of every 1,000 adults worldwide, according to the World Health Organisation. In the past two years, Basem has been admitted twice to a psychiatric hospital and improved temporarily before suffering a relapse when he stopped taking his medication. Two months ago, Basem acted on his delusions and travelled to the United States seeking political asylum. "He browses the internet and strongly believes that the medication prescribed by his doctors has severe side effects," his younger brother said, asking not to be named because of the stigma attached to mental illness. There are no definitive figures for mental illness in Jordan, but the National Centre for Mental Health (NCMH) said 20 per cent of the population of 5.8 million is in need of psychiatric care, a figure in line with global figures. But 75 per cent of those suffering from mental disorders in developing countries receive no medical attention at all, according to the WHO. And in Jordan, prevailing taboos deter treatment. "There is a stigma attached to seeing a psychiatrist in Arab societies and people feel embarrassed by how society perceives them," said Mohammed Asfour, head of the NCMH. "Instead they resort to imposters who claim that they cure mental disorders. These imposters associate mental disorders with magic and the presence of jinnis [spirits]." A psychiatrist at a health ministry psychiatric clinic said families tend to try and cover up an individual's mental illness. "When someone has his appendix removed, his relatives visit him at the hospital with flowers. But when one is admitted to a hospital with mental disorders, his family wouldn't want anyone to know," the psychiatrist said. Last month, the United Nations marked World Mental Health Day, and urged countries around the globe to promote awareness and highlight mental health issues. The ministry of health in Amman said it will review its mental health policies and draw up a new, comprehensive strategy for combating mental illness. Dr Asfour said the ministry will launch a survey early next year to determine how many Jordanians suffer from mental illnesses. "We need to find out the magnitude of the problem so that we can determine how many are in need of services ? related to counselling and awareness." By the year 2020, the WHO estimates, mental illness will be the second leading cause of death and disability worldwide after heart disease.
And stemming the growth of mental illness will not be an easy task for Jordan, where there is a severe shortage of psychiatrists - estimated to number only 60 - in both the private and public sectors. Moreover, several Jordanian psychiatrists work in neighbouring countries because psychiatry, they said, is looked down upon in Jordan as the lowest of the sciences. All of which leaves the government's 33 psychiatric consultancy clinics critically understaffed. "On average, each clinic deals with 40 to 50 cases a day," said Nabhan Abu Islaieh, head of the psychiatry department at the health ministry. "Patients are usually unaware of their disorders and those who seek help are their parents." There are dozens of clinics in the private sector, but many Jordanians cannot afford the cost of treatment. Dr Abu Islaieh said many of his patients suffer from depression, obsessive compulsive disorder and anxiety, outnumbering the cases of schizophrenics. He said one of his patients diagnosed with obsessive compulsive behaviour used to take a bath once every two weeks, believing that if he scrubs himself he will get hurt. Unlike many patients, he was aware that his thoughts were irrational but he could not stop them. "He used to tell me that 'Obsession is king.' But he has improved with the treatment and started taking a bath more often," Dr Abu Islaieh said. The number of patients with mental disorders who were admitted to the 473-bed NCMH hospitals, in addition to citizens who sought consultancy at the mental care clinics run by the health ministry, have increased by 30 per cent in the past five years. Last year, 2,090 Jordanians with mental disorders were admitted to the NCMH Hospital in Fuheis, 20km north-west of Amman, the largest mental health hospital with a capacity of 260 beds. Each patient costs the health ministry between US$100 (Dh367) to $115 a day. The NCMH in Fuheis plans to add another hundred beds in 18 months. For its part, the government has been trying to raise awareness about mental illnesses. "In recent years we started focusing on the concept of mental care rather than mental disorders in our workshops, so that [mental illness] will become more acceptable in society," Dr Abu Islaieh said. But awareness is not enough, said Walid Sarhan, a consultant psychiatrist working in the private sector, adding that limited facilities exacerbates the problem. "The psychiatric services are lacking," he said. "There needs to be a mental health team of psychologist and occupational therapists working with psychiatrists." email@example.com
Updated: November 16, 2008 04:00 AM