Helping Iraq Restore Its Mental Health System (Part 2)
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
"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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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 maintainand
strengthenthe 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.
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 againif
possible, in Baghdadfor 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
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 1Helping Iraq Restore Its Mental Health System
In Transition: Al-Rashad Mental Hospital »
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