Innovation summary

Lebanon is a small, middle-income country, with a population of about 4,350,000, including 400,000 Palestine refugees and a long history of civil war and political unrest. Following the Syrian crisis, the total resident population suddenly increased due to the influx of displaced persons and reached a high of more than 30% in 2013. This demographic change has contributed to the overstraining of the health system with increased utilization of services and a surge in demand for non-communicable diseases services, including mental health.1 This has widened the gap in mental health services already available due to the chronic under-funding and the inclination of funding towards curative hospital-based care.

In 2014, in response to the urgent need to strengthen the mental health system in the country, and building on the support provided by the World Health Organization (WHO), UNICEF and International Medical Corps (IMC), the MoPH launched the NMHP to reform the mental health system in the country and scale up services. In May 2015, after a process involving all key mental health stakeholders in the country, the Programme launched the “Mental Health and Substance Use Strategy for Lebanon 2015-2020”.2 

Impact summary

“The result of this participatory endeavour is a well-informed national strategy owned and supported by all relevant actors. This in particular will change the life of many people and will improve mental health in Lebanon” 

 

- H.E. Mr Wael Abou Faour Minister of Public Health Republic of Lebanon

Innovation details

In 2014, in response to the urgent need to strengthen the mental health system in the country, and building on the support provided by WHO, UNICEF and IMC, the MoPH launched the NMHP to reform the mental health system in the country and scale up services with the following components:

  • Vision: All people living in Lebanon will have the opportunity to enjoy the best possible mental health and wellbeing.
  • Mission: To ensure the development of a sustainable mental health system that guarantees the provision and universal accessibility of high quality mental health curative and preventive services through a cost-effective, evidence-based and multidisciplinary approach, with an emphasis on community involvement, continuum of care, human rights, and cultural relevance.
  • Values and guiding principles: Autonomy, Dignity, Participation, Empowerment, Accountability and integrity, Quality.

In May 2015, after a process involving all key mental health stakeholders in the country, the Programme launched the “Mental Health and Substance Use Strategy for Lebanon 2015-2020”. (4) A priority goal of this strategy is the reorientation of services towards a cost-effective community-based model, in line with Human Rights and the latest evidence for best practices. In line with the Strategy, seven cost-effective and evidence-based strategic interventions are being implemented to increase universal accessibility to high-quality preventive and curative mental health services. These interventions include:

  • Integration of mental health into primary health care using the WHO Mental Health Gap Action Programme adapted for Lebanon
  • Development of community-based multidisciplinary mental health teams
  • Evidence-based psychotherapies (Inter-personal Psychotherapy) training
  • Piloting guided self-help e-mental health services
  • Development of an inter-sectoral referral system for crisis management
  • Rolling-out Psychological First Aid training
  • Regular monitoring of mental health facilities to ensure protection of human, child and women’s rights of persons with mental disorders using the WHO Quality rights toolkit

In addition, to coordinate the MHPSS response to the Syrian crisis, the MOPH established and is currently chairing with WHO and UNICEF the Mental Health and Psychosocial Support Task Force (MHPSS TF). This task force currently includes more than 60 organizations working on the Syrian crisis response in Lebanon with the aim of harmonizing and mainstreaming MHPSS in all sectors and improving access to care. An action plan for the MHPSS TF is set every year to address challenges faced in MHPSS work. A priority of the 2016 action plan is the development of a national inter-sectoral referral system linking all levels of care, with a main focus on mental health, protection and shelter.

Key drivers

  • Merging of humanitarian and development agendas: bridging of humanitarian response with stabilization and development
  • Effective collaboration fostered between all stakeholders
  • Stakeholder involvement and consensus-building: driving forces towards the establishment of the national strategy
  • Participation of different actors from various sectors in policy development and implementation

Challenges

  • Absence of stable funding for full implementation of the Mental Health and Substance Use Strategy for Lebanon 2015-2020”, which currently heavily relies on humanitarian aid

Continuation

The “Mental Health and Substance Use Strategy for Lebanon 2015-2020” aims at building a sustainable mental health system for all persons living in Lebanon and not exclusively for the Lebanese.

Human rights is a cornerstone of the Strategy:

  • Vulnerable groups to mental health disorders and human rights violations (e.g. Displaced populations, persons in prisons, survivors of torture, families of the disappeared, LGBT community and foreign domestic workers) were identified as target groups for tailored interventions.  
  • Strategic objectives directly tackling human rights of persons with mental disorders are included in the strategy:
    • Developing a strategy for advocacy and fighting stigma
    • Facilitating the establishment of an independent users association
    • Conducting a QualityRights assessment
    • Promoting a recovery model
    • Building the community services

Partners

The implementation of the national Strategy is being supported by multiple partners including ministries, UN agencies (e.g. WHO, UNICEF, UNHCR), iNGOs (e.g. Pompidou Group, Fondation d’Harcourt, Europeean Monitoring Centre for Drugs and Drug Addiction, IMC, Fundación Promoción Social de la Cultura, Medecins Du Monde), local NGOs (Association Francophone pour les Malades Mentaux, Embrace, IDRAAC), universities (e.g. Lebanese University, Saint-Joseph University, American University of Beirut, University of Balamand, Lebanese American University), professionals associations (e.g. Lebanese Psychiatric Society, Lebanese Psychological Association, Syndicate of Psychotherapists and Psychoanalysts, Lebanese Order of Physicians, Lebanese Order of Nurses, Lebanese Order of Pharmacists, Tabyeen)

Funders

  • World Health Organization
  • UNICEF
  • International Medical Corps

Cost of implementation

The strategy is built around cost-effective interventions recommended by the WHO but a local cost estimation has not been conducted yet.  

Despite the absence of a preliminary budget, “opportunity planning” was conducted and the Strategy was developed and launched as an evidence-based roadmap with cost-effective interventions. Detailed implementation plans with costing are developed for specific strategic objectives upon availability of opportunities for funding. For instance, the implementation of the strategic objective “Adapt and pilot an e-mental health guided self-help programme for Lebanon”, which was targeted to be achieved in 2019, began in 2016 upon an opportunity of collaboration with Fondation d’Harcourt and WHO on its implementation. 

Impact details

Effective coordination mechanism

An effective coordination mechanism, the MHPSS TF, between 62 organizations including the MoPH, UN agencies, and national and international NGOs, was built and is expanding further. Today, the MHPSS TF provides a platform for developing annual action plans that address the challenges faced by all actors on the ground.

NMHP and National Evidence-based Strategy developed through Participatory Approach

The NMHP was successfully established, aiming to ensure the development of a system that can swiftly respond to the mental health needs of the Lebanese and other nationalities living in Lebanon. The strategy launched by the programme and its partners now constitutes a roadmap to promote the allocation of resources based on evidence and through consensus among all stakeholders. Based on the roadmap, strategic objectives are planned in five domains of action, including seven cost-effective and evidence-based strategic interventions.

Multi-level Inter-sectoral Collaboration

At the governmental level

  1. Formalization of collaboration between the MoPH and other Ministries such as those of Social Affairs, Education, Interior and Justice for a more effective implementation of the Strategy
  2. Development of two major sub-Strategies (the Mental Health and Substance Use in Prisons Strategy and the Substance Use Strategy) which will be jointly launched by the ministries allowing for a more effective response with greater resource mobilization and stronger implementation through existing networks of actors and services of each ministry

At the non-governmental level

Building of links between the MHPSS, Protection and Shelter clusters to complement and align actions towards the development of a national inter-sectoral referral system and the integration of mental health into protection programming. 

References

  1.  World Health Organization. 2014. Country Cooperation Strategy at a glance- Lebanon
  2. Ministry of Public Health. 2015. Mental Health and Substance Use- Prevention, Promotion, and Treatment- Situation Analysis and Strategy for Lebanon 2015-2020. Beirut: Lebanon. 
  3. UNICEF, MoPH, UNRWA and IRC. 2015. Providing Community Based Psychosocial Support Through A Systems Strengthening Approach: The Lebanon Case Study.

Research

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