Rebuilding Afghanistan's Mental Health System
(Part 2)
How SAMHSA Can Help
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At the recent
meeting of the Workgroup on Afghanistan Mental
Health: Dr. Kakar (left), SAMHSA's Winnie Mitchell
(center), and SAMHSA Administrator Charles Curie
(right). "SAMHSA's role is to be a partner," Mr.
Curie said. Photo by Meredith Hogan Pond |
In designing its National Strategic Plan for Mental
Health, the Ministry has decided on a bottom-up, community-based
strategy of integrating mental health services into existing
primary care, an approach that can bring at least basic
care to people in need relatively quickly. This strategy
suits the country's limited resources and pressing needs
far better than would a top-down approach of modernizing
existing facilities, training specialist professionals,
and then doing outreach to the nation, Dr. Nassery said.
Already, projects under way in the eastern part of the
country have shown the effectiveness of providing short-term
training in the essentials of mental health care to health
care personnel and supplying psychiatric medications
to local health centers, Dr. Nassery said.
The plan calls for building on such successful experimental
programs, expanding them to other regions, and ultimately,
when adequate capacity and resources are available, to
the country at large. Over the long term, psychiatric
facilities and clinical interventions will be established
and professional training in mental health upgraded and
expanded.
The key to Afghanistan's current strategy is developing
the country's human resources because "we do not
expect NGOs to stay forever," Dr. Nassery said.
Beyond the crash courses for existing health care personnel
needed to carry out the first stages of the Ministry's
strategic plan, educating the rising generation of health
care professionals about mental health will require new
curricula, materials, and programs.
Campaigns to raise public awareness about mental health
issues using mass media, including radio and TV as well
as the cooperation of local leaders, will also require
new materials and training programs. Behavioral health
awareness will also be integrated into the public school
curriculum, and teachers will receive training in how
to teach about it and how to identify possible problems
among their students.
Creating effective educational and awareness programs
for these various sectors will require cooperation among
the Ministry of Public Health and other agencies of Afghanistan's
government such as the Ministry of Higher Education.
Discussions between Ministries are already under way,
according to Dr. Kakar.
Within the priorities articulated by the Ministry of
Public Health, SAMHSA can use its expertise, contacts,
and other resources to help Afghanistan build its mental
health programs and capacity, according to Mr. Curie.
"My vision of SAMHSA's role is to be a partner,"
Mr. Curie said, "standing ready and prepared for
a long commitment to help Afghanistan rebuild. 
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Cultural Traditions Aid Mental
Health Treatment
By Beryl Lieff Benderly
For people in Afghanistan, mental health problems
generally fall into the category of "jinn"—invisible
beings known to English speakers as the genies
of the Arabian Nights.
This cultural belief helps make mental health
treatment acceptable to a wide range of the population,
according to Deputy Minister of Public Health Faizullah
Kakar, Ph.D. Because these powerful and malicious
creatures are believed able to attack anyone at
will—much as Americans believe that everyone
is susceptible to the viruses causing colds and
the flu—mental health issues and treatments
carry less stigma in Afghanistan than they often
do in the West, he told SAMHSA News during
a recent interview at the Embassy of Afghanistan.
Afghan culture has long used traditional methods
to counter the ravages of jinn, including
sojourns at religious shrines, where sufferers
undergo treatments that include deprivation of
food and drink, Dr. Kakar said. In order to affect
real improvement, he noted, "It is important
that people know also that [modern medications]
are good for jinn" and can provide
lasting relief.
During medical training in the United States,
Dr. Kakar recalled, he was struck by the amount
of attention that American mental health professionals
paid to the issue of stigma, a situation much different
in Afghanistan.
The popular belief in jinn, along with
a widespread traditional acceptance of drugs to
change mood, creates a receptive environment for
bringing mental health treatment to a large population
that needs it, he continued. "In a society
where 70 to 80 percent of the people" show
symptoms of anxiety, depression, or other mental
health conditions resulting from decades of warfare,
the suffering that these conditions cause "becomes
normal" and people do not realize that genuine
relief is possible, he said. He emphasized the
importance of informing "the public that they
don't have to suffer" and that, whether or
not jinn caused their conditions, "help
is available."
Often when mental health professionals explain
modern treatments, "the patient is amazed
[and says,] ‘I didn't know there was help
for this.' " This makes all the more urgent
the need to bring modern treatment to as many people
as possible. "If we create lots of expectation,"
he said, "we need the capacity to meet it."
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