What can be gained? Lebanon’s National MHPSS Response during and beyond COVID-19
Dr Rabih El Chammay is the Head of the National Mental Health Program (NMHP) of the Ministry of Public Health in Lebanon. The NMHP launched in 2014 in collaboration with WHO, UNICEF and the International Medical Corps in response to the Syrian Crisis with the aim of strengthening the existing system and ensuring all people had universal access to high-quality mental health care. In this post, Dr El Chammay outlines Lebanon’s national mental health and psychosocial support (MHPSS) COVID-19 response and considers opportunities to push mental health higher on global and national agendas.
|Central governing body coordinating mental health response is crucial||Mainstreaming MHPSS materials in health worker training and public campaigns|
|COVID-19 presents opportunities to push forward mental health reform||Ministry memo making the provision of urgent mental health care essential at public and private hospitals|
|Now is the time to demand governments invest in comprehensive mental health systems||Checklists for hotline operators and nurses on supporting the mental health of quarantined patients|
So far, Lebanon has been quite effective in containing the spread of COVID-19 due to the readiness of the health system and the drastic and swift lockdown measures taken. However, the outbreak is occurring in the midst of a major economic and political crisis, which culminated in an uprising in October 2019. This crisis had already taken its toll on communities, driving many households under the poverty line. From September to October 2019, we observed a 70% increase in the number of calls to the National Emotional Support and Suicide Prevention Hotline - Embrace Lifeline - related to distress caused by unmet basic needs.
While effective at reducing the spread, the country’s COVID-19 response severely impacts a significant portion of already economically fragile communities. Lockdown restrictions add layers of distress concerning livelihood on top of fears about contracting the virus. This makes a comprehensive response to address MHPSS needs even more urgent.
Building on the momentum of the National Response to COVID-19, the NMHP promptly developed a comprehensive Mental Health and Psycho-Social Support (MHPSS) Action Plan in collaboration with WHO and UNICEF. Implementation is carried out in partnership with all relevant MHPSS actors in the country, such as other Ministries, UN agencies, NGOs, universities and scientific societies.
The action plan has four goals:
- Promote mental health and mitigate COVID-19 related stressors including stigma and discrimination against persons affected and health workers;
- Provide mental health support to persons in quarantine in the hospital or at home;
- Support the mental health of health workers and first responders;
- Ensure continuity of care for persons using mental health services in line with Infection Prevention and Control guidelines.
These goals aim to support all people living in Lebanon, including Palestinian refugees and displaced persons from Syria. The following activities are already being implemented:
- Mainstreaming MHPSS awareness messages in the training of front-line workers;
- Developing specific MHPSS checklists and training for COVID-19 hotline operators, including referral to the national emotional support hotline;
- Developing specific checklists and training for nurses to use with mental health patients in quarantine;
- Ensuring mental health phone-based support for persons in quarantine at home or in the hospital;
- Preparing two national campaigns: one to tackle stigma related to COVID-19 and the other focusing on youth mental health;
- Disseminating MHPSS awareness material to the population, including tips to cope with stress, support for children and older adults and information on where to ask for mental health support.
We are also in the process of developing a national system for phone-based provision of MHPSS care by using a roster of Mental Health Professionals to provide remote support and guidance to people in need.
As with the “Building Back Better” approach used in the launch of the NMHP in 2014, the COVID-19 MHPSS response has provided opportunities to push for mental health system reform. Existing facilitating factors included the Mental Health Strategy 2015-2020, the National Emotional Support and Suicide Prevention hotline, various trainings and referral pathways and strong collaborations with different departments within the Ministry of Public Health (MOPH).
Particularly crucial to our response was having a wide and solid network of multi-sectoral stakeholders and a coordination mechanism - the MHPSS Task Force - operating since 2014 and chaired by the NMHP and co-chaired by WHO and UNICEF.
We have already observed some “quick wins'' that contribute directly to mental health system reform. A request has been made to the Office of the Prime Minister to whitelist the National Emotional Support and Suicide Prevention Hotline. We have discussed with partners ways to improve transportation for people needing urgent mental health care as well as mental health training for health workers and responders on the front-lines. Additionally, a Memo from the Minister of Health made it mandatory for all hospitals with psychiatric wards, including private ones, to provide people in urgent need of inpatient care with services regardless of their capacity to pay. This was fast-tracked after the two biggest psychiatric institutions had to stop admitting new patients due to crowding conditions. This also constitutes a step forward in the long-term goal of de-institutionalising mental health care.
One country’s response will be very different from another's. However, if there is one crucial factor to highlight in Lebanon’s response, it is the existence of a central governing body for mental health at the level of the MOPH coordinating the reform and creating synergies between different stakeholders, sectors and agendas.
Mental health systems are essential components of any health system reform. Now more than ever, governments and communities across the world are realising the importance of investing in health systems and the relevance of mental health. This may be the time all mental health advocates - individuals and organisations - who have been working tirelessly to push mental health higher on the agenda have been waiting for. As a global mental health community, let us make commensurate demands for governments to invest in building comprehensive mental health systems that are properly funded with well-resourced governing bodies.
- Mental Health and Psycho-Social Support Action Plan (NMHP, Ministry of Public Health Lebanon) [Link]
- Checklist for nurses for taking care of the mental health of persons in quarantine (NMHP) [Link]
- Poster: 7 Effective self-care tips on coping with emotional distress during quarantine (NMHP) English [Link] Arabic [Link]
- Leaflet: 7 Effective self-care tips on coping with emotional distress during quarantine (NMHP) English [Link]
- Building Back Better: Sustainable mental health care after emergencies (WHO) [Link]
- Briefing note: Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak (IASC) [Link]
- Mental health and psychosocial considerations during the COVID-19 outbreak (WHO) [Link]