17. Supporting people-centred reform of mental healthcare in Egypt
Mental health services in Egypt are not geared to meet patients’ needs for rehabilitation and reintegration into society
According to a recent study conducted by the Egyptian Central Agency for Public Mobilization and Statistics (CAPMAS) for the Egyptian Ministry of Health, about 7% of the population suffers from mental illnesses.
However, mental health services in Egypt are inadequate. Services mainly focus on treating acute cases and providing long-term custody for patients with no family or social support; psychosocial rehabilitation of patients and reintegrating them in society are neglected. In addition, the stigma linked to mental illness means that many of those who suffer do not seek help. Finally, only a few attempts have been made to integrate mental health services with primary healthcare, as strongly recommended by the World Health Organization (WHO).
Reorienting the approach to mental healthcare towards rehabilitation and reintegration into society
The Psychosocial Rehabilitation for Mental Disability (REMEDY) project builds on the successful Mehenet project, which introduced to Egypt the model developed in Italy by psychiatrist Franco Basaglia. The Basaglia model recognises the patient as a person (and not as a danger to society), and introduces new forms of assistance such as integrating mental health into the primary healthcare system, adopting the therapeutic community method and offering patients recreational activities with the aim of reintroducing them into society.
REMEDY, promoted by the Alex Workshop Center in partnership with Italian associations and experts was funded under the second phase of the Italian-Egyptian Debt-for-Development Swap Programme. It was implemented between 2013 and 2015 in Alexandria. The project addressed issues facing the mental healthcare sector in Egypt at two levels. First, at the patient level, by promoting psycho-social rehabilitation through artistic laboratories, sheltered workshops, self-help groups, work skills training and supporting work opportunities. Second, at the institutional level, by integrating mental health into the primary healthcare system at district level. The project motivated primary healthcare staff to integrate mental healthcare in their services, built their capacity and knowledge, involved them in helping the recovery of persons with disabilities resulting from mental illness and developed their skills in psychosocial rehabilitation.
The initiative was introduced alongside initiatives of the Egyptian Ministry of Health aimed at expanding the fundamental rights of patients with mental illnesses (addressed by the new Mental Health Act) and integrating mental health in primary healthcare strategies. Integration was an important aspect, as the WHO considers support from government authorities to be a point of strength in attempts to integrate mental healthcare into primary healthcare.
Focus on strong partnerships with non-governmental organisations and local healthcare institutions
The Franco Basaglia model of psychosocial rehabilitation introduced by REMEDY could support the reform of mental health policy in Egypt. The model addresses the rehabilitation of people with mental health disorders which can be effectively provided within the primary healthcare system and can be scaled across districts.
Partnerships were fundamental to the success of the project. First, partnering with Italian non-governmental organisations (NGOs) working on the same issue allowed for the exchange of knowledge and know-how, not only among professionals but also among beneficiaries. Second, partnering with the Directorate of Primary Healthcare in the targeted district was critical to the success of the project. The Directorate proved committed to sustaining the results of the project, creating a department for Primary Mental Health Care as a training department for mental health and psychosocial rehabilitation. This system could be scaled up at a national level with the endorsement and co-operation of relevant authorities.
What next?
In conclusion, it can be said that the project, despite its limited budget and short, two-year life span, has piloted the integration of mental healthcare into primary healthcare in Egypt. It has successfully applied a rehabilitation model in which healthcare professionals co-operate with civil society, and beneficiaries can recover and become part of society.
Building on this successful experience, the Alex Workshop Center is now implementing a new project, Healthy Artistic Recovery for Mental and Other Needs Disabilities (HARMONY), in partnership with the Egyptian Mental Health Secretariat. HARMONY is a further step in helping people with mental health disorders in Egypt recover, as it improves both social and work opportunities for people with hearing and speech impediments, and mental health disorders. The new project will use art as a means of self-expression and, by empowering affected people, will enable them to become productive citizens, actively engaged in the community and capable of earning an income.