Supporting mental health at the community level in Libya

Last year the UN expanded their NCD[1] focus areas from four to five – now including mental health. With World Mental Health Day taking place this week it’s an opportunity to raise awareness of the issues and the responses taking place around the world. At PCI our partners have started to ask us to include elements of mental health more in our work supporting primary care. Then this year we really had the opportunity to put this into practice through working with Libyan clinicians.

The World Health Organisation, with funding from DFID, asked us to deliver a training workshop on mental health in primary care to health centre staff working in Libya. This was to be followed up by distance mentoring and cascade training to further Libyan primary care clinicians. Unsurprisingly mental health is a growing concern in this country where people now live against a backdrop of uncertainty, fighting and loss. In fact, over the course of our work there we adapted our focus to concentrate more on mental health in situations of conflict, including more on grief, anxiety, panic and stress and the particular needs of children and adolescents.

Role play activity during workshop

PCI carried out a face to face training in January – our first training dedicated specifically to mental health. We were supported by two Libyan psychiatrists – of which there are very few in the country. They really valued approaching managing mental health from a different perspective:

‘What this workshop has taught me is that as a psychiatrist I am always focusing narrowly on diagnosis and then treatment – but you Family Medicine doctors have a much wider perspective on what is happening to the patient and the family and how this affects the illness.’

The distance mentoring (via skype and WhatsApp) carried out by our clinical associates ensured that participants of this first face to face training felt well prepared to themselves lead further training sessions, one in Tripoli and one in the East of Libya. These trainings were also supported by one of the Libyan psychiatrists.

The training materials we developed with the trainees-turned-trainers were adapted from the WHO’s mhGAP materials. Each topic used case scenarios designed to help health workers with heavy workloads recognise how common mental health problems may present in primary care, and to be confident in managing these patients using medication and practical psychological interventions.

Results of pre-and post-training tests demonstrated a good increase in knowledge of the participants in both cascade trainings.

“The participants were previously not confident in dealing with grief or anxiety. But by the end of the workshop they were very confident in dealing with mental health problems – in particular they improved their communications skills and knowledge around new drugs.” (Dr Abeer Aborawai, workshop facilitator)

WHO has since been consulted by other NGOs about using the same approach to build capacity in mental health care in other areas of the country, which is some positive news for the people of Libya in need of support.

In addition, it is heartening to hear that the project has stimulated a widespread debate in primary health care in Libya about how to overcome stigma and to ensure staff are ready to receive patients with mental health problems

NCDs in general are often neglected in lower-and middle-income countries, and this can be even more so when it comes to mental health. Lack of funding, of awareness and of training are all huge problems, as is the overarching challenge that exists globally: stigma. Stigma from healthcare staff, from patients, and from the wider community. Increasing awareness, discussion and training will hopefully move us further forwarding to ending some of these challenges. Whilst unfortunately it seems the need for mental health support is far from ending.

[1] Cardiovascular diseases, Diabetes, Cancer, Chronic respiratory diseases