Mental Health In Yemen obstacles &Challenges Prepared By: DR. Maan A.Bari Qasem Saleh Associate Professor Fulbright Scholar Depart. Of Psychology Arizona.

Mental Health In Mental Health In Yemen obstacles Yemen obstacles &Challenges&Challenges

Prepared By:Prepared By:DR. Maan A .Bari Qasem SalehDR. Maan A .Bari Qasem SalehAssociate ProfessorAssociate ProfessorFulbright ScholarFulbright ScholarDepart. Of PsychologyDepart. Of PsychologyArizona State UniversityArizona State University(President Yemeni Mental Health Association)(President Yemeni Mental Health Association)

Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges Dr. Maan A.Bari : Mental Health in Yemen Obstacles & Challenges

The Content The Content

Introduction Introduction ObjectivesObjectives DefinitionsDefinitions Human Resources Human Resources Mental Health Services Mental Health Services Mental Health Institutions Mental Health Institutions EpidemiologyEpidemiology ConclusionsConclusions RecommendationsRecommendations Different sight of Yemen (Pictures)Different sight of Yemen (Pictures)


Yemen profileYemen profile

Full name: Full name: Republic of Yemen Republic of Yemen Population: Population: 20 million ( 2004)20 million ( 2004) Capital: Capital: Sana’a Sana’a Area: Area: 536,869 sq km (207,286 sq miles) 536,869 sq km (207,286 sq miles) Major language: Major language: Arabic Arabic Major religion: Major religion: Islam, with small Jewish minority Islam, with small Jewish minority Life expectancy: Life expectancy: 59 years (men), 62 years (women) 59 years (men), 62 years (women)

(UN) (UN) Main exports: Main exports: Crude oil, cotton, coffee, fish Crude oil, cotton, coffee, fish GNI per capita:GNI per capita: US $600 (World Bank, 2006) US $600 (World Bank, 2006)


Politics: Politics: President Ali Abdallah Saleh has President Ali Abdallah Saleh has been in power since 1978. Elected as a been in power since 1978. Elected as a president in1999 and reelected for the second president in1999 and reelected for the second time – and should be the last- in 2006?!time – and should be the last- in 2006?!

Economy: Economy: Yemen is the poorest country in the Yemen is the poorest country in the Middle East; economic difficulties have Middle East; economic difficulties have sparked unrest sparked unrest

International: International: Yemen has been co-operating Yemen has been co-operating in the US-led "war on terror", risking domestic in the US-led "war on terror", risking domestic resentmentresentment


Introduction Introduction

In Yemen, mental health issues have close connections with myths, superstitions and distorted religious concepts relevant to witchcraft, Jinns or devils.

The social stigma toward mental health issues continues to cast heavy shadows and will likely continue in the future.

Yemeni national and social development was seen in the last three decades only.

The ghost of wars, internal struggles, poverty, increases in the rate of reproduction and illiteracy problems still persist.

T he main change was happened through human resource where countless students were sent to study psychiatry, psychology, social sciences, and psychiatric nursing in other Arab countries , former socialist countries and Western countries


ObjectivesObjectives

The aims are to provide scientifically based information relevant to:The aims are to provide scientifically based information relevant to:

Specialists and other professionals who work in the field of mental Specialists and other professionals who work in the field of mental health.health.

Mental health services already operating in both government and Mental health services already operating in both government and private hospitals and clinics,private hospitals and clinics,

Governmental and non-governmental organizations (NGOs), that Governmental and non-governmental organizations (NGOs), that provide mental health services in Yemen,provide mental health services in Yemen,

Epidemiology of mental illnessEpidemiology of mental illness

Information database development that can serve as a reliable reference Information database development that can serve as a reliable reference for studies, research, projects and future planning for studies, research, projects and future planning


Definition of Mental Definition of Mental Health Health

Good health does not only mean a physically healthy Good health does not only mean a physically healthy body, but it also refers to both a state characterized by the body, but it also refers to both a state characterized by the absence of disease and a high level of mental and absence of disease and a high level of mental and physical fitness. Accordingly, a healthy person must physical fitness. Accordingly, a healthy person must enjoy physical and mental health.enjoy physical and mental health.

A mentally healthy person must be capable of thinking A mentally healthy person must be capable of thinking clearly, solving various day-to-day challenges, enjoying clearly, solving various day-to-day challenges, enjoying good relationships with friends, work colleagues, and good relationships with friends, work colleagues, and family, feeling spiritual comfort and bringing happiness to family, feeling spiritual comfort and bringing happiness to others in society.others in society.

Although we are speaking about one’s mental state and Although we are speaking about one’s mental state and body as if they were separated, in reality, body as if they were separated, in reality, they are two they are two faces of the same coin.faces of the same coin.


Human ResourcesHuman Resources The data collected and relevant to this subject The data collected and relevant to this subject

point to the obvious limited abilities of human point to the obvious limited abilities of human resource in Yemen, though an accurate and resource in Yemen, though an accurate and reliable official document about human resources reliable official document about human resources is not available, and so, numerous survey sources is not available, and so, numerous survey sources (private and institutional) are sourced in this (private and institutional) are sourced in this respect. respect.

The Yemeni Mental Health Association The Yemeni Mental Health Association contributed in large part to these data conducted contributed in large part to these data conducted in the years 2002 to 2006in the years 2002 to 2006. The results obtained . The results obtained through the surveys indicted to the following through the surveys indicted to the following estimations: estimations:


Psychiatrists Psychiatrists

165 532 psychiatrists in the world WHO-2001).165 532 psychiatrists in the world WHO-2001).

2,582 of them are in the Middle East. 2,582 of them are in the Middle East.

The mean ratio is 3.96 psychiatrists/100,000 individuals in the The mean ratio is 3.96 psychiatrists/100,000 individuals in the world and 0.06/100,000 in the low-income countries world and 0.06/100,000 in the low-income countries

compared to a ration of 9.0/100,000 in high-income countries.compared to a ration of 9.0/100,000 in high-income countries. In Yemen, about 45 psychiatrists and Neurologists (0.02/100,000) In Yemen, about 45 psychiatrists and Neurologists (0.02/100,000)

translate into one physician for every 500,000 people. translate into one physician for every 500,000 people.

The population of Yemen according to 2004 census is about 20 The population of Yemen according to 2004 census is about 20 million. million. More telling, there are only three designated psychiatrists More telling, there are only three designated psychiatrists for the entire population of Yemeni children and these are shared for the entire population of Yemeni children and these are shared between hospitals and universitiesbetween hospitals and universities


PsychologistsPsychologists

147 019 psychologists working in mental health worldwide 147 019 psychologists working in mental health worldwide (WHO-2001). (WHO-2001).

2,387 psychologists working in the Middle East.2,387 psychologists working in the Middle East.

The mean ratio of psychologists for each 100,000 individuals for The mean ratio of psychologists for each 100,000 individuals for the world’s population is 6.34 (6.34/100,000). the world’s population is 6.34 (6.34/100,000).

3000 psychologists in Yemen. (1.5/100,000)3000 psychologists in Yemen. (1.5/100,000)

135 psychologists working in academic institutions, 75 in the 135 psychologists working in academic institutions, 75 in the health sector and 45 in social work health sector and 45 in social work


Academic qualificationsAcademic qualifications

The local academic qualification programs in The local academic qualification programs in psychiatry and clinical psychology started in 2003 by psychiatry and clinical psychology started in 2003 by the Yemeni Medical board under the Ministry of Health. the Yemeni Medical board under the Ministry of Health.

Clinical psychology specialization. Yet, Clinical psychology specialization. Yet, 30 individuals 30 individuals have graduated at the diploma level (one-year have graduated at the diploma level (one-year program)program)

There are also higher education programs (Master's There are also higher education programs (Master's degree) in General Psychology in the Arts faculty of degree) in General Psychology in the Arts faculty of Yemeni UniversitiesYemeni Universities . .


Psychiatric nursingPsychiatric nursing

worldwide , there are worldwide , there are 471 123471 123 psychiatric nurses. psychiatric nurses.

These include 7,955 in the Middle East (WHO-2001). These include 7,955 in the Middle East (WHO-2001).

In addition, the mean ratio (nurse to individual) is 2.3 In addition, the mean ratio (nurse to individual) is 2.3 per 100,000. per 100,000.

In Yemen, about 197 psychiatric nurses work in the In Yemen, about 197 psychiatric nurses work in the health care sector health care sector


Mental Health Services Mental Health Services

4/Mental Hospitals – 850 beds4/Mental Hospitals – 850 beds 12/Psychiatric Clinics in General Hospitals12/Psychiatric Clinics in General Hospitals 3/Psychiatric Clinics in the 3/Psychiatric Clinics in the

Prisons(188beds)Prisons(188beds) 5/Private Nursing Home- (100beds)5/Private Nursing Home- (100beds) 45/Private clinics45/Private clinics Diagnostic TechniquesDiagnostic Techniques Management and PsychotherapyManagement and Psychotherapy


Diagnostic TechniquesDiagnostic Techniques At present, EEG and CT scans are available.At present, EEG and CT scans are available. However, the utilization of modern techniques (e.g., MRI) in the However, the utilization of modern techniques (e.g., MRI) in the

diagnosis of mental illness is not available in this field of diagnosis of mental illness is not available in this field of specialization. This due to two reasons; the cost of equipment is specialization. This due to two reasons; the cost of equipment is prohibitive and the non-existence of qualified candidates to prohibitive and the non-existence of qualified candidates to interact with such equipment.interact with such equipment.

In the case of mental assessments, unfortunately there are no In the case of mental assessments, unfortunately there are no legal and official assessments that can be used according to the legal and official assessments that can be used according to the particularities of the Yemeni social and cultural environment. particularities of the Yemeni social and cultural environment.

The non-existence of specified official protocols for diagnosis The non-existence of specified official protocols for diagnosis according to international criteria such as the International according to international criteria such as the International Classification and Diagnostic Guide for Mental Disorders known Classification and Diagnostic Guide for Mental Disorders known as the ICD-10, or the Diagnostic and Statistical Manual by the as the ICD-10, or the Diagnostic and Statistical Manual by the American Psychiatric Association, known as the DSM-IV-TR, American Psychiatric Association, known as the DSM-IV-TR, continue to serve as a barrier to consistent and informed continue to serve as a barrier to consistent and informed diagnosis. diagnosis.

Thus, the majority of the cases are diagnosed depending on personal Thus, the majority of the cases are diagnosed depending on personal experience, academic background and knowledge of each physicianexperience, academic background and knowledge of each physician. .


Management and PsychotherapyManagement and Psychotherapy

Successfully treating mental illness often involves Successfully treating mental illness often involves the use of psychopharmacologic drugs for the use of psychopharmacologic drugs for patients. patients.

While effective, the use of such medications is While effective, the use of such medications is prevented in the Yemeni situation, as their cost is prevented in the Yemeni situation, as their cost is prohibitive for most patients. prohibitive for most patients.

The use of ECT remains widespread, while there The use of ECT remains widespread, while there are unfortunately few programs and evidence-are unfortunately few programs and evidence-based models in the treatment of mental illness based models in the treatment of mental illness (behavioral, psycho-educational or cognitive) that (behavioral, psycho-educational or cognitive) that are proven effective and appropriate for the Yemeni are proven effective and appropriate for the Yemeni context. The role of both institutional and context. The role of both institutional and individual willingness is implicated in these individual willingness is implicated in these causes. causes.


Psycho-Counseling servicesPsycho-Counseling services

a.a. Hotline Telephone for Psychological Aid (Aden)Hotline Telephone for Psychological Aid (Aden)

This tele-counseling service was established by This tele-counseling service was established by YMHA on April 8, 2000YMHA on April 8, 2000

b. b. School Behavioral Counseling ProgramSchool Behavioral Counseling Program

This program was established by YMHA in June of This program was established by YMHA in June of 2002.2002.

c. c. Hotline Telephone for Psychosocial and Legal support Hotline Telephone for Psychosocial and Legal support (Sana’a)(Sana’a)

This service belongs to the Arab Human Rights This service belongs to the Arab Human Rights Institution and was established in March of 2002. Institution and was established in March of 2002.


d. d. Educational and Psychological Counseling Center Educational and Psychological Counseling Center (Sana’a University(Sana’a University))

The Center was established in September of 2005 The Center was established in September of 2005

e. e. Student Counseling Center (Taiz University)Student Counseling Center (Taiz University)

This Counseling Center was established in May of This Counseling Center was established in May of 2006 2006

f. f. Telephone Hotline of the Mental Health Unit of the Telephone Hotline of the Mental Health Unit of the Cultural Health CenterCultural Health Center

This service was established in Sana’a in 1996.This service was established in Sana’a in 1996.


Mental Health InstitutionsMental Health Institutions

1-1- The Higher Council for Mental Health The Higher Council for Mental Health

This Council was established in 2002.This Council was established in 2002.

2- 2- National Mental Health ProgramNational Mental Health Program

The National Mental Health Program was established in the late The National Mental Health Program was established in the late 1980s with the help of the WHO1980s with the help of the WHO


3-3- Academic departments in Yemeni UniversitiesAcademic departments in Yemeni Universities

We can consider that the(4 )departments of Psychiatry in the We can consider that the(4 )departments of Psychiatry in the Faculty of Medicine, and the(11 )departments of Psychology in Faculty of Medicine, and the(11 )departments of Psychology in the Faculties of Arts and Education faculties in Yemeni the Faculties of Arts and Education faculties in Yemeni Universities as the providers of research and accredited Universities as the providers of research and accredited professional development professional development

4-4- Mental Health NGOsMental Health NGOs

Eighty-eight per cent of countries have NGOs that involve mental Eighty-eight per cent of countries have NGOs that involve mental health as their primary activity while providing support, health as their primary activity while providing support, treatment, rehabilitation and prevention services (WHO, 2001)treatment, rehabilitation and prevention services (WHO, 2001)

In Yemen there are currently seven mental health associations In Yemen there are currently seven mental health associations that comprise a membership of that comprise a membership of 1, 280 members1, 280 members (Maan, 2006). (Maan, 2006).


EpidemiologyEpidemiology

Epidemiologic studies or data collection systems are only Epidemiologic studies or data collection systems are only available in 43% of low income countries compared to 77% of available in 43% of low income countries compared to 77% of high-income countries.. high-income countries..

Estimations of Mental Health Patient Epidemiology :Estimations of Mental Health Patient Epidemiology :

WHO (2001) estimated that about WHO (2001) estimated that about 20% of the population suffers20% of the population suffers from behavioral and emotional disturbances.from behavioral and emotional disturbances.

This means that there are potentially up to This means that there are potentially up to four million people in four million people in YemenYemen who need mental health supports who need mental health supports

while only while only one psychiatrist per 100,000 residentsone psychiatrist per 100,000 residents exists to meet exists to meet this need.this need.

Approximately Approximately two million children suffer from emotionaltwo million children suffer from emotional and and behavioralbehavioral disturbances. disturbances.


Psychiatric Hospital Data in YemenPsychiatric Hospital Data in Yemen

The statistical data obtained in the psychiatric The statistical data obtained in the psychiatric hospitals of Yemen indicate that approximately hospitals of Yemen indicate that approximately 29,519 mentally ill patients frequented these 29,519 mentally ill patients frequented these hospitals during 2006hospitals during 2006

According to disease epidemiology:According to disease epidemiology: paranoia including schizophrenia ranked in paranoia including schizophrenia ranked in

first place first place followed by emotional disturbances like followed by emotional disturbances like

depression and anxiety, depression and anxiety, Epilepsy in third place . Epilepsy in third place .


Suicide EpidemiologySuicide Epidemiology According to the WHO (2006) report, According to the WHO (2006) report, one million individuals one million individuals

commit suicide annually. commit suicide annually. In addition, more than In addition, more than twenty times as many twenty times as many attempt suicide. attempt suicide. Worldwide, Worldwide, 16 individuals per 100,000 commit suicide16 individuals per 100,000 commit suicide while in the Arab countries, this number is estimated to be while in the Arab countries, this number is estimated to be 6 6

persons per 100,000. persons per 100,000. Suicide is Suicide is one of the three main causes of death in the worldone of the three main causes of death in the world, ,

especially in the 15 to 44 age group. especially in the 15 to 44 age group. 90% of committing or attempting suicide are linked to mental 90% of committing or attempting suicide are linked to mental

illness. illness. (WHO-2006 (WHO-2006)) Suicide are already diagnosed with a mental illness, Suicide are already diagnosed with a mental illness,

typically depression, but can also include diagnoses:typically depression, but can also include diagnoses: bipolar disorder, alcoholism, substance abuse and bipolar disorder, alcoholism, substance abuse and

schizophrenia.schizophrenia. Unfortunately, such diagnosis and data are not available in Unfortunately, such diagnosis and data are not available in

developing countries due to poor resources. developing countries due to poor resources. suicides in Yemen totaled 243 cases in 2006(Yemen Interpol)suicides in Yemen totaled 243 cases in 2006(Yemen Interpol)

the the use of a fire weaponuse of a fire weapon being the most common means to being the most common means to achieve this 75%achieve this 75%


Reasons of suicideReasons of suicide

.. Familial problems, with absence of Health, social services to Familial problems, with absence of Health, social services to help families help families

Low standards of living in some families, with corresponding Low standards of living in some families, with corresponding increases in costs, and high rates of unemployment among increases in costs, and high rates of unemployment among youth; youth;

Intensification of mental and neurological illnesses and the Intensification of mental and neurological illnesses and the corresponding inability to pay for treatment (if it exists), and corresponding inability to pay for treatment (if it exists), and familial shame, stigma and secrecy about the mental illness familial shame, stigma and secrecy about the mental illness of family members; of family members;

Fear of retribution because of crimes committed and Fear of retribution because of crimes committed and resulting resulting fear of punishment exacted by familiesfear of punishment exacted by families, i.e. suicide , i.e. suicide becomes a way to escape punishment, being killed one’s self becomes a way to escape punishment, being killed one’s self by the avenging family, and escaping the shame placed on by the avenging family, and escaping the shame placed on one’s family as a result of the family member’s criminal one’s family as a result of the family member’s criminal activity; activity;

Accumulation of debt, bankruptcy, great financial losses, and Accumulation of debt, bankruptcy, great financial losses, and general economic scarcity; and,general economic scarcity; and,

Drug or alcohol use, emotional crises, and the inability to Drug or alcohol use, emotional crises, and the inability to cope with life’s emotional and conflicting demandscope with life’s emotional and conflicting demands . .


ConclusionsConclusions

We can make the following conclusions based on our StudyWe can make the following conclusions based on our Study: :

The awareness of mental health priorities, as well as its impact on The awareness of mental health priorities, as well as its impact on human development is weak. human development is weak.

Limitations in the national strategy of mental health policies still Limitations in the national strategy of mental health policies still exist. exist.

Limited or absent mental health services exists across Limited or absent mental health services exists across governorates. governorates.

Civil society development remains a concept in infancy stifling Civil society development remains a concept in infancy stifling the growth of the mental health field along with human and the growth of the mental health field along with human and material resource base needed to do this. material resource base needed to do this.


Absence of legislative mandate to encourage and Absence of legislative mandate to encourage and coordinate mental health activities.coordinate mental health activities.

Limited communication with regional and Limited communication with regional and

international institutions that inform or directly international institutions that inform or directly fund mental health activities. fund mental health activities.

Weaknesses in academic program training and Weaknesses in academic program training and accreditation of professionals.accreditation of professionals.

Weaknesses in data collection and lack of Weaknesses in data collection and lack of transparency in the publication and use of data. transparency in the publication and use of data.


RecommendationsRecommendations

General recommendationsGeneral recommendations

We recommend increasing the number of educational campaigns We recommend increasing the number of educational campaigns to reduce mental illness stigma. to reduce mental illness stigma.

We recommend mandating a political and national strategy for We recommend mandating a political and national strategy for mental health that includes the participation of the Ministry of mental health that includes the participation of the Ministry of Health, Yemeni universities (Faculties of Medicine), and related Health, Yemeni universities (Faculties of Medicine), and related mental health NGOs. mental health NGOs.

We recommend the improvement and development of mental We recommend the improvement and development of mental health services for all governorates in the republic.health services for all governorates in the republic.

We recommend that specialists, activists, and those interested in We recommend that specialists, activists, and those interested in mental health increase their efforts in collaboration together.mental health increase their efforts in collaboration together.


Continuing RecommendationsContinuing Recommendations We recommend that the Ministry of Health, specialized associations, We recommend that the Ministry of Health, specialized associations,

and concerned scientific departments of Yemeni universities to and concerned scientific departments of Yemeni universities to speed up the preparation of laws to protect the mentally ill and to speed up the preparation of laws to protect the mentally ill and to promote and develop the field as a priority. promote and develop the field as a priority.

We recommend strengthening communications with regional and We recommend strengthening communications with regional and international institutions with respect to mental health and its international institutions with respect to mental health and its financing.financing.

We recommend paying importance to the training programs and We recommend paying importance to the training programs and qualification processes in the mental health domain. qualification processes in the mental health domain.

We recommend joining efforts in the formation of an accurate and We recommend joining efforts in the formation of an accurate and informative database that is methodical, up-to date and uses the informative database that is methodical, up-to date and uses the most current techniques in data collection and manipulation so that most current techniques in data collection and manipulation so that future studies and scientific works can be implemented. future studies and scientific works can be implemented.


Special RecommendationsSpecial Recommendations

Recommendations to Ministry of HealthRecommendations to Ministry of Health Recommendation to the Ministry of Education.Recommendation to the Ministry of Education. Recommendation to the Recommendation to the Ministry of Social Affairs.Ministry of Social Affairs.

Recommendation to the Ministry of Justice.Recommendation to the Ministry of Justice. Recommendation to the Ministry of InteriorRecommendation to the Ministry of Interior Recommendation to the Ministry of Defense.Recommendation to the Ministry of Defense. Recommendation to Yemeni UniversitiesRecommendation to Yemeni Universities


Queen of SHEBA TamableQueen of SHEBA Tamable



City Sight from AdenCity Sight from Aden


Aden Elephant BayAden Elephant Bay



Beethoven Symphony in Beethoven Symphony in old city of Sana’a - 2004old city of Sana’a - 2004


Thank you Thank you

Mental Health In Yemen obstacles &Challenges Prepared By: DR. Maan A.Bari Qasem Saleh Associate Professor Fulbright Scholar Depart. Of Psychology Arizona.

Documents

mental health issues

field of mental health

high level of mental

republic of yemen population

healthy person

various daytoday challenges

future planning slide

healthy body