MENTAL HEALTH SERVICES IN NORTH AFRICA

MENTAL HEALTH SERVICES IN EGYPT

TA. Okasha
Institute of Psychiatry, Ain Shams University, Cairo, Egypt

Six hundred years ago, before Europe had mental health services in general hospitals, Egypt had such a service in Kalawoon hospital in Cairo. In fact, in that hospital there were four wards : surgery, medicine, ophthalmology and psychiatry. In 1942 Egypt started to implement the concept of psychiatric services in general hospitals. Egypt lies on the Mediterranean Sea ; part of it lies in Africa and part of it (Sinai) lies in Asia. Egypt is considered African, Mediterranean, Arab and a Middle Eastern country at the same time. Egypt is one million square kilometers, with a population of 70 million. 97% of Egyptians live on 4% of the land, mainly in the Delta region and the Nile valley. The population density in Egypt is 59/sqKm, while the population in Cairo is about 15-16 million in the daytime, and approximately 12 million during the night. The population density in Cairo is 31,697/sqKm. Cairo is considered one of the most crowded cities in the world. Egypt is divided into 24 governorates and has around 130,000 doctors, 1000 psychiatrists, 250 clinical psychologists and 1355 psychiatric nurses. Psychiatric services are provided through general hospitals, state hospitals, university hospitals and private hospitals, amounting to about 9000 beds. Egypt is moving towards primary care in psychiatry through general practitioners and this has been incorporated into the National Mental Health Program for the past 12 years, rather than community care, which is not feasible because of financial, cultural and religious beliefs. This presentation will review the mental health services in Egypt at the moment together with future plans.

MENTAL HEALTH SERVICES IN MOROCCO

D. Moussaoui
Ibn Rushd University Psychiatric Center, Casablanca, Morocco

There are about 300 psychiatrists in Morocco, 620 psychiatric nurses, 75 clinical psychologists. There are very few social workers and no occupational therapist. The three academic departments in Casablanca, Rabat, and Marrakech are in charge of training psychiatrists and psychiatric nurses, as well as undergraduates. Concerning psychiatric institutions, there are 1,900 psychiatric beds in the entire country (30 million inhabitants) divided between psychiatric hospitals and psychiatric wards integrated into general hospitals. This low figure of psychiatric beds is even worse when one considers that there is no psychiatric institution for children and adolescents, and no private clinic in psychiatry. Most of the activities of mental health is done in the outpatient sector. For example, more than 60,000 patients are seen in the ambulatory mental health units of Casablanca every year. A national epidemiological survey will be finalized in the coming months and its results will allow planning for better mental health services.

MENTAL HEALTH SERVICES IN SUDAN

A. Abdelrahman
University of Khartoum, Sudan

Sudan is the largest country in Africa, with a million square miles, 33 million people and nine neighboring countries. As many countries in Africa, Sudan suffered much from poverty, illiteracy, drought and civil war. The effects of these problems on the mental health of people are considerable. The objectives of this presentation are to highlight the situation of mental health services in Sudan and share ideas with colleagues from other African countries in the region. Currently there is a great shortage of services, with one psychiatrist for a million population. The majority of facilities are urban based, with over 70% in the capital city Khartoum. Psychologists and psychiatric social workers are very few. Psychiatric medical assistants act as psychiatrists in many regions. A national mental health program has been established recently, with a recognizable effort to improve the situation. Major areas of interest in the program include training of general practitioners, paramedical staff and teachers. Training manuals and other materials are in preparation. Despite many endeavors, the mental health act has not been endorsed yet. There are many constrains and health planners still need to be convinced and encouraged to put more emphasis on this issue. Mental health services at the primary health care level are an important priority. Training is crucial. With expectation of peace in the country soon, the future looks better. Mental health is expected to improve.

MENTAL HEALTH SERVICES IN ETHIOPIA

M. Araya
Department of Psychiatry, University of Addis Ababa, Ethiopia

Ethiopia is a country located in the Horn of Africa with a population of about seventy million. It is a federal government consisting of nine states representing over eighty nations and nationalities. The establishment of modern mental health services in Ethiopia dates back to the time of the departure of Italian occupants in 1939 where the general hospital they used for the indigenous people was later turned into a mental asylum. For almost half a century, the psychiatric hospital remained a place of confinement for the mentally ill and persons with behavior incompatible to the societal as well as political norms of the country. The department of psychiatry was established in 1966 as a unit in the department of medicine by a Dutch psychiatrist, R. Giel, from the University of Groningen. Both the psychiatric hospital with 360 beds and the outpatient department in a general hospital in Addis Ababa, the capital of Ethiopia, serve as treatment, training and research centers for the whole country. The department is run by three full time psychiatrists, while five psychiatrists work in the psychiatric hospital. All the psychiatrists are stationed in Addis Ababa ; therefore, most of the psychiatric service throughout the country is given by psychiatric nurses. Besides treatment service, the main activities include teaching clinical psychiatry to medical students, psychiatric nurses and residents in psychiatry. Continuing medical education to general medical practitioners and other specialists is also given on a regular basis. Community oriented mental health research is also an integral part of the general mental health service in the country. Since 1966, over fifty papers were published in reputable journals and several epidemiological surveys and clinical trials are ongoing.

MENTAL HEALTH SERVICES IN TUNISIA

S. Douki, E Nacef, S. Ben Zineb
Hospital Razi, Tunis, Tunisia

Until recently, mental health was given low priority in Tunisia, as in other developing countries faced with major health concerns such as epidemic diseases or infant mortality. Thus, while remarkable progresses were achieved in the field of physical health, psychiatry remained the « Cinderella » of medicine. Nowadays, only 150 psychiatrists (representing 4% of the total specialists) and 800 beds (representing 5% of the total hospital capacity) are available to a population of 10 millions. Consequently, a significant proportion of the population does not have access to mental health facilities, while epidemiological data and many indicators have been highlighting, for years, a huge growth in mental health care needs. The result is a practice of « psychiatry in emergency », providing an immediate solution to severe psychiatric breakdowns but failing to provide sustained care or to deal with the many mental health problems challenging today our societies. But, this shortage gives us the great opportunity to build up a mental health care system more complying with the current knowledge and with our specific context. We have thus the unique chance to skip the desinstitutionalization stage with its significant casualties and to move directly to community care where a strong family support and a dense primary care network are major resources to rely on. This is the aim of the national mental health program adopted in 1992. It appears paradoxical that a lack of traditional services is probably the source of more opportunities than constraints in our countries, providing the possibility to implement the most cost-effective strategy to cope with the modern needs in matters of care.