Helping Iraq Restore Its Mental Health System (Part 2)

Recommending Action

Participants then split into four work groups, with Dr. Sadik urging them to come up with "clear and defined decisions" rather than recommendations.

One of the most important decisions was to create a mental health system very different from the country's previous one.

"The Iraqis had a very medicalized, institution-based model of mental health care in the past, but there was clear agreement at the conference that the country would now prioritize the development of an integrated, community-based care model," explained Ms. Mitchell. "Iraq will not only be re-establishing mental health care, but doing it around a different model."

Closing Al-Rashad Hospital wasn't the only suggestion to come out of the Mental Health Services Work Group. Other recommendations include integrating mental health and primary care; establishing rehabilitation programs for people with chronic and severe mental illness; creating substance abuse treatment programs; developing specialty services for children, older adults, and forensic patients; and reaching out to spiritual leaders of all faiths.

The Mental Health Policy and Support Work Group compiled a list of action items designed to promote coordination and collaboration within Iraq's Ministry of Health and the government as a whole. The government should allow the National Mental Health Council to "steer" the country's mental health program, the group urged. The group also called for joint training in mental health issues for government employees working in health, criminal justice, education, and other areas.

Other urgent action items include developing a code of practice outlining patient rights and practitioner standards, developing a referral system for primary care physicians, creating a medical records system, and launching a general public awareness campaign on mental health.

The Mental Health Training and Education Work Group sought ways to overcome the country's severe shortage of professionals trained to diagnose and treat mental illness. One key action item is to expand the workforce by developing training programs for primary care physicians, psychologists, clinical social workers, psychiatric nurses, and paraprofessional community mental health workers.

The Scientific Programs and Research Capacity Work Group called for developing policies about research ethics and creating a committee to establish standards, review research proposals, and protect research participants. The group also recommended the creation of at least one "Mental Health Center of Excellence," which would conduct interdisciplinary studies of mental problems common in Iraq, train clinicians and researchers, and provide model programs for clinical services.

The group also urged the National Mental Health Council to work with other ministries to establish research priorities. Studies on stress and coping should be a top priority, the work group recommended. Also important are studies to determine the prevalence of mental disorders and substance abuse in Iraq and the public health, economic, and social burdens these problems place on individuals, families, and the country itself.

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Following Up

Conference participants are already taking action. Iraq's Deputy Minister of Health, Dr. Ammar Al Safar, has approved all of the work groups' recommendations. Dr. Sadik is sharing their recommendations with Iraq's new Minister of Health, Abdel-Muttalib Mohammed Ali Al-Rubayee.

Conference participants are also determined to maintain—and strengthen—the connections made at the conference.

Mr. Curie, for instance, traveled to the United Kingdom in early May to meet with Dr. Lafta and nine other Iraqi psychiatrists who are undergoing 3 months of specialized training with Dr. Sadik at the West Kent National Health Service and Social Care Trust. Dr. Lafta's fellowship focuses on psychotherapy and community-based service delivery; the others are focusing on such topics as child psychiatry, geriatric psychiatry, and forensic psychiatry.

Dr. Husam Alathari

With funding from SAMHSA, Dr. Lafta was also able to come to the United States to visit SAMHSA and service providers, attend the American Psychiatric Association's 2005 annual meeting along with Dr. Everett, and go on rounds with another conference participant, an expatriate Iraqi psychiatrist named Husam Alathari, M.D.

In 2006, the participants plan to meet again—if possible, in Baghdad—for another SAMHSA-sponsored conference, at which participants will report their progress in accomplishing the recommended actions.

In the meantime, participants remain hopeful. "It's easy to get discouraged by the news from Iraq," said Dr. Alathari, who also attended the conference in Jordan. Dr. Alathari is Staff Psychiatrist at the Northern Virginia Mental Health Institute and Assistant Clinical Professor of Psychiatry at George Washington University. He has been in the United States since 1992. "But when I met Dr. Lafta and the other Iraqis, it changed my perspective. They're working very hard at rebuilding the country."

And, Dr. Alathari pointed out, the Iraqis don't have to start from scratch. "Thirty years ago, Iraq was a regional leader in health care," he said. "We're not talking about establishing a new system. It's already there. It has just collapsed." 

« See Part 1—Helping Iraq Restore Its Mental Health System

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In Transition: Al-Rashad Mental Hospital »

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