K2P Policy Brief: Securing Access to Quality Mental Health Services in Primary Health Care in Lebanon

Abstract

The overall problem is the limited access of a large proportion of individuals suffering from mental health problems and their families to mental health care services in primary health care (PHC) settings in Lebanon. The current health system arrangements do not ensure equitable access to high quality mental health services. Mental disorders are a leading direct cause of disease burden worldwide (Ferrari et al., 2013; Lin et al. 2008). An estimated one million out of four million Lebanese suffer from at least one mental disorder throughout their lives (Karam et al., 2008). Only a minority of those obtain treatment, and there are prolonged delays to seeking treatment ranging from six years for mood disorders to 28 years for anxiety disorders (Karam et al., 2008). Such delays are critical because early assessment and intervention can positively alter the natural progression of mental disorders into chronic and disabling conditions. The burden of mental disorders extends to other diseases as they worsen the outcome of co-occurring conditions such as cancer, heart disease and diabetes (WHO, 2011-a; Lin et al., 2008). Mental health disorders are costly to national economies in terms of expenditure and loss of productivity (WHO, 2005-a). When present in caretakers, mental disorders impact children’s health and development (WHO 2003; Dixon et al. 2006; Knapp et al. 2006). In Lebanon, the exposure to war-related trauma, internal conflicts, and political instability have increased the prevalence of some mental health disorders (Chahine & Chemali, 2009; Karam et al. 2006; Farhood & Dimassi, 2012). The underlying factors of the problem stem from the health system arrangements in place. From the perspective of service delivery, currently, the only way to access mental health care in the public sector is through psychiatric institutions (Kerbage, El Chammay & Richa, 2013), which does not promote prevention or community integration. The integration of mental health into the PHC network is still weak (WHO, 2011-b; WHO & MOPH, 2010; Hijazi et al., 2011). PHC centres often lack essential psychotropic medications as well as assessment and treatment protocols necessary to provide frontline basic psychological and psychiatric interventions and a few of them regularly refer patients to specialized mental health care clinics when needed. In addition, evidence-based multidisciplinary treatment practices for mental health patients are rarely implemented. From a financing perspective, mental health services in Lebanon are poorly financed. Coverage of mental health services in Lebanon is extremely low as the primary source of financing for mental health is out-of-pocket payment. There are disparities in the coverage of public funding mechanisms for mental health services, and private insurance and mutual funds do not explicitly cover these services. The dependence of the current system on out-of-pocket expenditure for mental health creates an access barrier for individuals with low incomes and who are at highest risk (WHO, 2003).