Mental Health In Yemen obstacles &Challenges

1. Mental Health In Yemen obstacles &Challenges Prepared By: DR. Maan A .Bari Qasem Saleh Associate Professor Fulbright Scholar Depart. Of Psychology Arizona State University (President Yemeni Mental Health Association)

2. The Content • Introduction • Objectives • Definitions • Human Resources • Mental Health Services • Mental Health Institutions • Epidemiology • Conclusions • Recommendations • Different sight of Yemen (Pictures) Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

3. Yemen profile • Full name: Republic of Yemen • Population: 20 million ( 2004) • Capital: Sana’a • Area: 536,869 sq km (207,286 sq miles) • Major language: Arabic • Major religion: Islam, with small Jewish minority • Life expectancy: 59 years (men), 62 years (women) (UN) • Main exports: Crude oil, cotton, coffee, fish • GNI per capita: US $600 (World Bank, 2006) Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

4. Politics: President Ali Abdallah Saleh has been in power since 1978. Elected as a president in1999 and reelected for the second time – and should be the last- in 2006?! • Economy: Yemen is the poorest country in the Middle East; economic difficulties have sparked unrest • International: Yemen has been co-operating in the US-led "war on terror", risking domestic resentment Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

5. Introduction • In Yemen, mental health issues have close connections with myths, superstitions and distorted religious concepts relevant to witchcraft, Jinns or devils. • The social stigma toward mental health issues continues to cast heavy shadows and will likely continue in the future. • Yemeni national and social development was seen in the last three decades only. • The ghost of wars, internal struggles, poverty, increases in the rate of reproduction and illiteracy problems still persist. • T he main change was happened through human resource where countless students were sent to study psychiatry, psychology, social sciences, and psychiatric nursing in other Arab countries , former socialist countries and Western countries Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

6. Objectives • The aims are to provide scientifically based information relevant to: • Specialists and other professionals who work in the field of mental health. • Mental health services already operating in both government and private hospitals and clinics, • Governmental and non-governmental organizations (NGOs), that provide mental health services in Yemen, • Epidemiology of mental illness • Information database development that can serve as a reliable reference for studies, research, projects and future planning Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

7. Definition of Mental Health • Good health does not only mean a physically healthy body, but it also refers to both a state characterized by the absence of disease and a high level of mental and physical fitness. Accordingly, a healthy person must enjoy physical and mental health. • A mentally healthy person must be capable of thinking clearly, solving various day-to-day challenges, enjoying good relationships with friends, work colleagues, and family, feeling spiritual comfort and bringing happiness to others in society. • Although we are speaking about one’s mental state and body as if they were separated, in reality, they are two faces of the same coin. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

8. Human Resources • The data collected and relevant to this subject point to the obvious limited abilities of human resource in Yemen, though an accurate and reliable official document about human resources is not available, and so, numerous survey sources (private and institutional) are sourced in this respect. • The Yemeni Mental Health Association contributed in large part to these data conducted in the years 2002 to 2006. The results obtained through the surveys indicted to the following estimations: Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

9. Psychiatrists • 165 532 psychiatrists in the world WHO-2001). • 2,582 of them are in the Middle East. • The mean ratio is 3.96 psychiatrists/100,000 individuals in the world and 0.06/100,000 in the low-income countries • compared to a ration of 9.0/100,000 in high-income countries. • In Yemen, about 45 psychiatrists and Neurologists (0.02/100,000) translate into one physician for every 500,000 people. • The population of Yemen according to 2004 census is about 20 million. More telling, there are only three designated psychiatrists for the entire population of Yemeni children and these are shared between hospitals and universities Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

10. Psychologists • 147 019 psychologists working in mental health worldwide (WHO-2001). • 2,387 psychologists working in the Middle East. • The mean ratio of psychologists for each 100,000 individuals for the world’s population is 6.34 (6.34/100,000). • 3000 psychologists in Yemen. (1.5/100,000) • 135 psychologists working in academic institutions, 75 in the health sector and 45 in social work Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

11. Academic qualifications • The local academic qualification programs in psychiatry and clinical psychology started in 2003 by the Yemeni Medical board under the Ministry of Health. • Clinical psychology specialization. Yet, 30 individuals have graduated at the diploma level (one-year program) • There are also higher education programs (Master's degree) in General Psychology in the Arts faculty of Yemeni Universities . Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

12. Psychiatric nursing • worldwide , there are 471 123 psychiatric nurses. • These include 7,955 in the Middle East (WHO-2001). • In addition, the mean ratio (nurse to individual) is 2.3 per 100,000. • In Yemen, about 197 psychiatric nurses work in the health care sector Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

13. Mental Health Services • 4/Mental Hospitals – 850 beds • 12/Psychiatric Clinics in General Hospitals • 3/Psychiatric Clinics in the Prisons(188beds) • 5/Private Nursing Home- (100beds) • 45/Private clinics • Diagnostic Techniques • Management and Psychotherapy Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

14. Diagnostic Techniques • At present, EEG and CT scans are available. • However, the utilization of modern techniques (e.g., MRI) in the diagnosis of mental illness is not available in this field of specialization. This due to two reasons; the cost of equipment is prohibitive and the non-existence of qualified candidates to interact with such equipment. • In the case of mental assessments, unfortunately there are no legal and official assessments that can be used according to the particularities of the Yemeni social and cultural environment. • The non-existence of specified official protocols for diagnosis according to international criteria such as the International Classification and Diagnostic Guide for Mental Disorders known as the ICD-10, or the Diagnostic and Statistical Manual by the American Psychiatric Association, known as the DSM-IV-TR, continue to serve as a barrier to consistent and informed diagnosis. • Thus, the majority of the cases are diagnosed depending on personal experience, academic background and knowledge of each physician. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

15. Management and Psychotherapy • Successfully treating mental illness often involves the use of psychopharmacologic drugs for patients. • While effective, the use of such medications is prevented in the Yemeni situation, as their cost is prohibitive for most patients. • The use of ECT remains widespread, while there are unfortunately few programs and evidence-based models in the treatment of mental illness (behavioral, psycho-educational or cognitive) that are proven effective and appropriate for the Yemeni context. The role of both institutional and individual willingness is implicated in these causes. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

16. Psycho-Counseling services • Hotline Telephone for Psychological Aid (Aden) This tele-counseling service was established by YMHA on April 8, 2000 b. School Behavioral Counseling Program This program was established by YMHA in June of 2002. c. Hotline Telephone for Psychosocial and Legal support (Sana’a) This service belongs to the Arab Human Rights Institution and was established in March of 2002. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

17. d. Educational and Psychological Counseling Center (Sana’a University) The Center was established in September of 2005 e. Student Counseling Center (Taiz University) This Counseling Center was established in May of 2006 f. Telephone Hotline of the Mental Health Unit of the Cultural Health Center This service was established in Sana’a in 1996. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

18. Mental Health Institutions 1- The Higher Council for Mental Health This Council was established in 2002. 2- National Mental Health Program The National Mental Health Program was established in the late 1980s with the help of the WHO Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

19. 3-Academic departments in Yemeni Universities • We can consider that the(4 )departments of Psychiatry in the Faculty of Medicine, and the(11 )departments of Psychology in the Faculties of Arts and Education faculties in Yemeni Universities as the providers of research and accredited professional development 4-Mental Health NGOs • Eighty-eight per cent of countries have NGOs that involve mental health as their primary activity while providing support, treatment, rehabilitation and prevention services (WHO, 2001) • In Yemen there are currently seven mental health associations that comprise a membership of 1, 280 members (Maan, 2006). Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

20. Epidemiology • Epidemiologic studies or data collection systems are only available in 43% of low income countries compared to 77% of high-income countries.. • Estimations of Mental Health Patient Epidemiology : • WHO (2001) estimated that about 20% of the population suffers from behavioral and emotional disturbances. • This means that there are potentially up to four million people in Yemen who need mental health supports • while only one psychiatrist per 100,000 residents exists to meet this need. • Approximately two million children suffer from emotionaland behavioral disturbances. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

21. Psychiatric Hospital Data in Yemen • The statistical data obtained in the psychiatric hospitals of Yemen indicate that approximately 29,519 mentally ill patients frequented these hospitals during 2006 • According to disease epidemiology: • paranoia including schizophrenia ranked in first place • followed by emotional disturbances like depression and anxiety, • Epilepsy in third place . Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

22. Suicide Epidemiology • According to the WHO (2006) report, one million individuals commit suicide annually. • In addition, more than twenty times as many attempt suicide. • Worldwide, 16 individuals per 100,000 commit suicide • while in the Arab countries, this number is estimated to be 6 persons per 100,000. • Suicide is one of the three main causes of death in the world, especially in the 15 to 44 age group. • 90% of committing or attempting suicide are linked to mental illness. (WHO-2006) • Suicide are already diagnosed with a mental illness, typically depression, but can also include diagnoses: • bipolar disorder, alcoholism, substance abuse and schizophrenia. • Unfortunately, such diagnosis and data are not available in developing countries due to poor resources. • suicides in Yemen totaled 243 cases in 2006(Yemen Interpol) • the use of a fire weapon being the most common means to achieve this 75% Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

23. Reasons of suicide • . Familial problems, with absence of Health, social services to help families • Low standards of living in some families, with corresponding increases in costs, and high rates of unemployment among youth; • Intensification of mental and neurological illnesses and the corresponding inability to pay for treatment (if it exists), and familial shame, stigma and secrecy about the mental illness of family members; • Fear of retribution because of crimes committed and resulting fear of punishment exacted by families, i.e. suicide becomes a way to escape punishment, being killed one’s self by the avenging family, and escaping the shame placed on one’s family as a result of the family member’s criminal activity; • Accumulation of debt, bankruptcy, great financial losses, and general economic scarcity; and, • Drug or alcohol use, emotional crises, and the inability to cope with life’s emotional and conflicting demands. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

24. Conclusions • We can make the following conclusions based on our Study: • The awareness of mental health priorities, as well as its impact on human development is weak. • Limitations in the national strategy of mental health policies still exist. • Limited or absent mental health services exists across governorates. • Civil society development remains a concept in infancy stifling the growth of the mental health field along with human and material resource base needed to do this. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

25. Absence of legislative mandate to encourage and coordinate mental health activities. • Limited communication with regional and international institutions that inform or directly fund mental health activities. • Weaknesses in academic program training and accreditation of professionals. • Weaknesses in data collection and lack of transparency in the publication and use of data. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

26. Recommendations • General recommendations • We recommend increasing the number of educational campaigns to reduce mental illness stigma. • We recommend mandating a political and national strategy for mental health that includes the participation of the Ministry of Health, Yemeni universities (Faculties of Medicine), and related mental health NGOs. • We recommend the improvement and development of mental health services for all governorates in the republic. • We recommend that specialists, activists, and those interested in mental health increase their efforts in collaboration together. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

27. Continuing Recommendations • We recommend that the Ministry of Health, specialized associations, and concerned scientific departments of Yemeni universities to speed up the preparation of laws to protect the mentally ill and to promote and develop the field as a priority. • We recommend strengthening communications with regional and international institutions with respect to mental health and its financing. • We recommend paying importance to the training programs and qualification processes in the mental health domain. • We recommend joining efforts in the formation of an accurate and informative database that is methodical, up-to date and uses the most current techniques in data collection and manipulation so that future studies and scientific works can be implemented. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

28. Special Recommendations • Recommendations to Ministry of Health • Recommendation to the Ministry of Education. • Recommendation to the Ministry of Social Affairs. • Recommendation to the Ministry of Justice. • Recommendation to the Ministry of Interior • Recommendation to the Ministry of Defense. • Recommendation to Yemeni Universities Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

29. Queen of SHEBA Tamable Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

30. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

31. City Sight from Aden Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

32. Aden Elephant Bay Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

33. Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

34. Beethoven Symphony in old city of Sana’a - 2004 Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

35. Thank you Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges