Community mental healthcare in Lebanon

Capacity building and community of practice for women community health workers in low-resource settings: long-term evaluation of the Mobile University For Health (MUH)

Background

Lebanon has been facing a series of crises, significantly increasing health challenges, and straining its healthcare infrastructure. This caused deficiencies in the system's ability to attend to population health needs, and it profoundly impacted vulnerable and refugee communities who face additional challenges accessing healthcare services. In response, the Global Health Institute at the American University of Beirut designed and implemented the Mobile University for Health (MUH), which promotes task-shifting through capacity building complemented by communities of practice (CoP). The program aimed to prepare vulnerable women to assume the role of community health workers (CHW) within their communities, and to promote positive health knowledge and behaviours.

Methods

A mixed-methods approach was used to evaluate MUHs' three certificates (women's health, mental health and psychosocial support, and non-communicable diseases). Implementation took place between 2019 and 2022, with 83 CHWs graduating from the program. Short-term data including knowledge assessments, course evaluations, and community member feedback surveys were collected. 93 semi-structured interviews with CHWs and 14 focus group discussions with community members were conducted to evaluate the long-term impact of the capacity building and CoP components.

Results

Data revealed multiple strengths of the initiative, including increased access to education for the community, effectiveness of blended learning modality, successful planning and delivery of CoP sessions, and improved knowledge, skills, and health behaviours over time. The supplementary CoP sessions fostered trust in CHWs, increased community empowerment, and increased leadership skills among CHWs. However, some challenges persisted, including limited access to healthcare services, implementation logistical issues, difficulties with some aspects of the learning modality, and some resistance within the communities.

Conclusion

MUH promoted and improved positive health knowledge and behaviours within targeted vulnerable populations in Lebanon. The supplementary CoP component proved instrumental in empowering CHWs and enhancing their impact within their communities. The study highlights the need for ongoing training and support for CHWs and underscores the importance of continued investment and adaptation of such initiatives through a gendered lens. This evaluation provides evidence on the successes of a capacity building model that has strong potential for scale and replication across health topics in conflict-affected contexts.

Global Mental Health in South Lebanon: Psychoeducation, Translation, and Culture

In this article I examine the unintended consequences of global mental health reform in postwar South Lebanon. I follow the integration of mental health in primary health care centers. Three key tensions emerge: First, integrating mental health led to separating mental health from socioeconomic conditions. Second, culture was simultaneously conceived as a barrier to therapy and a local context requiring adaptation. Third, the use of personality disorders as psychological interpretations of social life resulted in psychologizing gender and class. The article contributes to growing ethnographic research on global mental health and calls for attention to structural competence in similar settings.SECOND LANGUAGE ABSTRACTفي هذا المقال، أستكشف العواقب غير المقصودة لإصلاحات الصحة النفسية العالمية في جنوب لبنان بعد الحرب. أتابع دمج الصحة النفسية في مراكز الرعاية الصحية الأولية. تظهر هنا ثلاث معضلات رئيسية: أولاً ، أدّى دمج الصحة النفسية إلى فصلها عن الظروف الاجتماعية والاقتصادية المحيطة بها. ثانيًا، تم تصوير مفهوم الثقافة كحاجز أمام العلاج النفسي من جهة وكسياق محلي يتطلب تكيفا وترجمة. ثالثًا، أدى استخدام تشخيصات اضطرابات الشخصية كتفسيرات نفسية للحياة الاجتماعية إلى نفسنة الجنس والطبقة. يساهم المقال الى البحوث الإثنوغرافية المتنامية حول الصحة النفسية العالمية ويدعو إلى الاهتمام بالكفاءة الهيكلية للصحة النفسية في بيئات مماثلة                        .

Mental health in the midst of economic turmoil: case study of Lebanese commercial bank employees

Purpose

This study aims to identify the major job stressors that can affect employees’ mental health in the Lebanese commercial banks during the economic turmoil. This study also aims to identify the effects of the mental problems on the employees in addition to the role of human resources in promoting and preventing mental well-being at the workplace.

Design/methodology/approach

The authors interviewed 28 bank employees and the semi-structured interviews last for around 50 min, starting by asking the employees a general question about the concept of mental health disorder. The authors used a purposive sampling in which the population sample is selected based on purpose and the characteristics of a specific category of individuals. Moreover, a thematic analysis is used to analyze the data.

Findings

The findings of this study indicate that most of the employees were suffering from many work-related stressors that have negatively affected their mental well-being. The stress and pressures have significantly increased during the economic crisis. However, most of the interviewees were not or rarely supported by their human resources department and their administration to help them get adapted for such a crisis or for the changes at the workplace.

Originality/value

Mental health disorders are present in the daily normal life and in the workplace as well. The banking industry is not an exceptional one.

Prevalence and associated factors of post-traumatic stress disorder in Lebanon: A literature review

Lebanon has been under continuous conflict for more than four decades, putting millions of Lebanese at a high risk for post-traumatic stress disorder (PTSD) and creating a complex collective trauma. This paper aimed to review all studies from Lebanon reporting on PTSD in order to describe the prevalence of PTSD and its associated risk factors among Lebanese adults. A search of the MEDLINE/PubMed database was conducted in February/March 2021 to identify research articles on PTSD in Lebanese adults. A total of 1064 articles were identified, out of which 11 articles (5875 participants) published between 2003 and 2020 were included. PTSD prevalence estimates were highly variable across the individual studies, ranging from 2 % to 98 %. Female sex, economic hardship, lower educational level, being unemployed, number of witnessed/experienced traumatic events, and presence of comorbid psychological disorders were associated with higher PTSD rates. In light of the increasing PTSD risk in the Lebanese population as a result of the recent Beirut blast and ongoing social and economic crises, further culturally competent research is needed to provide rigorous evidence on the prevalence, course, and severity of PTSD in Lebanon.