S. Douki. S. Ben Zineb, E Nacef :ACCESS TO CARE IMPEDIMENTS : THE EXAMPLE

Up until recently, mental health was afforded low priority in Tunisia as in other developing countries faced with major health concerns such as epidemic diseases or infant mortality. Consequently, despite steady advances, psychiatric care did not share the progress of the rest oi medicine and remains greatly underdeveloped. Thus, today, the access to mental health care is significantly hampered by a crucial shortage of resources (one bed/10,000) and manpower (one psychiatrist175.000) facing a huge growing request of care. Furthermore, the expressed needs are far below the potential needs, as shown by some wpiderniological data. As an example, less than 10% of patients with major depressive disorder and only 50%, of individuals with schizophrenia are seeking professional help and benefit from specific treatments. In fact, many cultural constraints still stand in the way of mental health care seeking and access, such as the strong belief in a variety of supernatural causes of mental illnesses, the cultural-bound -somatoform symptomatology », and above all the stigmatisation of mental disorders and psychiatric care. Last but not least, health care is becoming increasingly expensive and low-income people cannot benefit from the new but costly therapeutic opportunities that can optimise the compliance and minimize the risk of relapse. Information and sensitisation are the best tools to enhance mental health care access in countries where psychiatric care hasn’t always been fully in harmony with the prevailing cultural norms in the community.