Psychiatric News November 5, 2004
Volume 39 Number 21
© 2004 American Psychiatric Association
p. 19
Americans Help Iraqis Build Community Mental Health System
Christine Lehmann
Experts from U.S. and Iraqi mental health agencies collaborate on
planning community-based mental health care in Iraq and integrating it with
primary care services.
Iraqis could have access to
mental health care in their local primary care clinics in a few years if a
U.S.-backed plan succeeds. Charles Curie, M.A., director of the Substance
Abuse and Mental Health Services Administration (SAMHSA), visited Iraq in
February and found that care is provided in psychiatric hospitals
only—there are no community mental health clinics. Curie proposed U.S.
help in developing community mental health care to his Iraqi counterpart Sabah
Sadik, M.D. (Psychiatric News, April 2).
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Charles Curie, M.A., is the director of the Substance Abuse and Mental
Health Services Administration.
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Sadik, an Iraqi psychiatrist who has lived for 25 years in the United
Kingdom, is the interim mental health advisor to Iraq Minister of Health Alaa
El-Din Alwan, M.D. Sadik told Psychiatric News that he agreed with
Curie about focusing on creating a community-based mental health care system
that can be integrated into the approximately 1,200 primary care clinics
across the country.
Meanwhile, Curie has established a federal interagency planning group to
work with Sabah and Jeffrey Brinkley, R.N., the new American health
attaché to U.S. Ambassador John Negroponte in Baghdad.
The planning group is made up of representatives from the U.S. Army, the
Department of Health and Human Services Office of Global Health Affairs,
SAMHSA, and the National Institute of Mental Health, Curie told
Psychiatric News.
Psychiatrist Col. E. Cameron Ritchie, M.C., is a consultant to the Army
surgeon general and a member of the federal interagency planning group.
"I am excited to be part of the planning team that is working toward
improving mental health care for all Iraqis," Ritchie told
Psychiatric News. She has visited Baghdad twice and represents APA in
the Medical Coalition for Iraq (see
page 1). She is also a
member of the APA Committee on Psychiatric Dimensions of Disasters.
Sadik also wants to expand the number of psychiatric units at general
hospitals in Iraq from an estimated five to 20 units. This fits with Alwan's
strategy of "folding psychiatry into general health services rather than
excluding and isolating patients in a separate place," according to a
July 12 interview with Alwan by Integrated Regional Information Networks.
Alwan and Sadik have said they will keep the only two psychiatric hospitals
in Iraq open, at least in the short run (see page 19).
The concept of integrating mental health care and primary care is not new
to Iraq, said Numan Ali, M.D., secretary-general of the Iraqi Society of
Psychiatrists, in an interview with Psychiatric News. He is a
psychiatric consultant at Ibn Rushd Psychiatric Hospital in Baghdad.
Iraqi psychiatrists began training primary care professionals to diagnose
and treat mental illnesses in 1989 under the guidance of the World Health
Organization (WHO), but their efforts were slowed by the U.N.-imposed economic
sanctions, said Ali.
"We support the continuation of this effort so more Iraqis can obtain
basic mental health services," Ali said.
Sadik recently asked Curie for U.S. expertise to address drug abuse and
dependence, which is a new problem for Iraq. Ali attributed the recent
appearance of illegal drug trafficking in opium and marijuana to Iraq's
opening its border with Iran.
"Under Saddam, the border was closed, and anyone caught in possession
of illegal drugs faced capital punishment," Ali said.
Ibn Rushd Hospital in Baghdad has a small drug-dependence unit. "It's
not sophisticated, but we do the best we can with limited resources. We
provide detoxification and counseling and discharge the patient to his or her
family for monitoring," Ali explained apologetically.
Curie and Sadik agreed that the first priority is training
interdisciplinary teams of Iraqi psychiatrists, psychologists, social workers,
and nurses in psychiatric best practices. Sabah sees psychiatrists in the role
of "team leaders much like in the United States."
Curie would like to train Iraqi interdisciplinary teams at academic
institutions in the United States. "Many Iraqi physicians aren't
familiar with the latest medical technology and equipment and best practices
because of sanctions and deprivation under Saddam Hussein."
Sadik said Iraqi officials would rather conduct the training in Iraq, but
they understand American security concerns about visiting Baghdad in
particular.
The U.S.-Iraqi planning group will hold its first conference in December or
January in the Middle East. Baghdad was chosen to host the conference, but due
to the ongoing violence other sites are being considered including Kurdistan
in northern Iraq; Cairo, Egypt; and Amman, Jordan, Curie said.
Ali was frustrated that meetings to plan Iraqi mental health care may be
held outside of Iraq. "All this talk about improving mental health in
Iraq, yet no one wants to come to Baghdad and see for themselves what is
happening here."
U.S. State Department updates on Iraq are posted online at
<http://usinfo.state.gov/mena/middle_east_north_africa/iraq.html>.
News about Iraq's Ministry of Health is posted at
<www.mohiraq.org/news.htm>.
Related Article:
-
Iraq Desperate To Rebuild Shattered Health System
- Christine Lehmann
Psychiatr News 2004 39: 1-19.
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