Innovation summary

Reports estimate that 500,000 displaced Iraqis with high rates of psychological distress were living in Jordan in 2007.1 Unlike other refugee situations globally, displaced Iraqis made their homes throughout Jordan, rather than defined camps. Consequently, they were not easily identifiable or easy to reach, with care mainly based within a centralized system.

Through a comprehensive mental health and psychosocial assessment of the situation, WHO identified the most pressing challenges and recommended the reform to focus on the development of community mental health services, not humanitarian agendas. The reform consisted of:

  • National policy and plan development
  • Establishment of new community mental health centers (outpatient and inpatient within general hospitals)
  • Trainings for mental health professionals and for service users
  • Integration of mental health into primary health centers
  • Establishment of a national association of mental health service user

Impact summary

  • 3550 service users have received the bio-psychosocial treatment in outpatient setting and individualized treatment plan, as of 20111
  • $1,350,000 USD cost over three years in addition to the regular MoH budget1

"As nations of this world, our duty is to carry human rights acts and actions to full implementation for people with mental disabilities."

 

- Her Royal Highness Princess Muna Al Hussein of Jordan (2010) 2

Innovation details

Led by the Ministry of Health, reform of the mental health system started in 2008. In 2011, a national mental health policy plan was launched to provide comprehensive bio-psychosocial services in an environment that respects people’s dignity and protects their human rights. The following services were developed: 1-3

  • A new Mental Health Unit within the Ministry of Health (MoH) to lead the governance of mental health
  • Community mental health centres in existing MoH facilities to provide comprehensive bio-psychosocial services in an environment that respects people’s dignity and protects their human rights
  • Mental health care for children and adolescents through the collaboration among MoH, University of Jordan and WHO
  • A new short-stay inpatient unit in the psychiatric hospital
  • Inpatient units within general university hospitals
  • Integration of mental health in primary health care

Other components of the reform included:

  • A multi-sectoral policy development process was undertaken, resulting in Jordan’s first ever national mental health policy and plan
  • Mental health training for general medical and non medical staff
  • Empowerment of service users by providing training in human rights and establishing the national association of service users (“Our Step”)
  • Co-chairing the Mental Health Psychosocial Support Coordination Group
  • Mapping through the 4Ws (Who is Where, When doing What) – Tool developed by WHO for mapping mental health resources available and activities conducted in an emergency setting

 

Key drivers

International Attention

Attention and interest in displaced people by international audiences can serve as a springboard to improve mental health and other services for the entire population.

Pilot Project Success

Success from the pilot created momentum for larger-scale policy reform.

Passion and Dedication

Strong, passionate and dedicated local champions are essential for reform, especially in the face of significant challenges.

Investment in Young Professionals

Investing time and resources in young, local mental health professionals (training, mentoring, and study visits) proved to empower and contributed to their re-prioritized attitude – the ongoing mental health reform over potential personal benefits (such as better salaries or working conditions).

Sustained advocacy

Media e.g. human rights spot on TV and documentary on Jordanian mental health reform provided a great platform for sustained advocacy.

Role of Stakeholders

  • Service Users

Involvement of service users in the development of the mental health policy and plan, in the planning of service and delivery of care and in the development of their treatment is an extremely powerful component of reform. Involvement empowers the service users, giving them dignity and power over their lives and helps to fight stigma and discrimination of people with mental problems.

  • Donors

Pivotal role of donors as participants in reform-related activities (workshops, events, ceremonies) and visits to the newly established services. In the process, they became advocates for continuing and sustaining the reform.

  • National Authorities

Support and active participation of national authorities in the reform process proved necessary.

  • National Stakeholders

Strong participatory approach for national stakeholders throughout the process to create ownership of the reform.

  • World Health Organization (WHO)

Non-traditional dual role of WHO as both technical advisor and co-implementing agency.

Challenges

Initial reluctance among mental health specialists; addressed by:

  • Involving all psychiatrists in the reform process
  • Relying on supportive “champions” to serve as change agents within their fields
  • Harnessing the motivation and determination of other mental health professionals to support reform
  • Benefiting from strong support at the highest political level (different Ministers of Health as well as the Royal Family)

High turnover of the Minister of Health (6 Ministers in 3 years); addressed by:

  • Re-orienting the new Minister of Health on mental health
  • Establishing a strong National Technical Committee

Continuation

Additional Use of the Reform:

  • Innovation has been disseminated in the north, south and the centre of the country
  • 6 Iraqi multidisciplinary teams visited for training within the newly established community based mental health services in Jordan to replicate the same model in Iraq1
  • Mental health policy of Jordan used to draft mental health strategy of Lebanon

Plans for the Future:

  • Implementation of WHO Mental Health Gap Action programme (mhGAP), to help with integration of mental health into primary care
  • Opening inpatient units within MoH general hospitals
  • Service organization and delivery for Syrians refugees

Partners

Funders

Delivery partners

Evaluation methods

There was an evaluation of the health displaced Iraqis program including the mental health component. An evaluation and monitoring program will be implemented soon.

Cost of implementation

$450,000 USD per year from 2008 to 2011 in addition to the regular MoH budget

Impact details

  • Mental Health Unit established within MoH3
  • National Mental Health Policy and Plan launched in 20113
  • Training (as of 2011):1,3
    • 180 Jordanian and 20 Iraqi mental health professionals trained at secondary level of care on the bio-psychosocial approach, multi-disciplinary teamwork, case management system, recovery model and human rights framework
    • 200 PHC workers received orientation on mental health (MoH and University)
    • 25 PHC workers trained on four modules of mhGAP
  • Service Users (as of 2011):1,3
    • 3550 received bio-psychosocial treatment and individualized treatment plan at 3 Community Mental Health Clinics
    • 100 new members of National User Association
    • 130 trained on Human Rights Framework

References

1. World Health Organization (2013) Building Back Better: Sustainable Mental Health Care After Emergencies. Geneva: WHO Press.

2. Funk M (2010) Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. Italy: WHO.

3. World Health Organisation. (2013) WHO MIND Mental Health in Development: Jordan.

Tools

Multimedia

Reports
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