In Transition: Al-Rashad Mental Hospital

When Muhmmad R. Lafta, M.D., took over as Director of Baghdad's Al-Rashad Mental Hospital 2 years ago, the situation was so dire many of the patients didn't even have clothes. "They were naked," he said.

The lack of clothing was not the only evidence of serious neglect. "Just a few weeks before the war, the ex-regime released the convicted criminal patients into the streets," Dr. Lafta explained. "And during the war, almost all the patients ran away." Two-thirds of them were returned by families, neighbors, or police, but a third never returned. "We lost them."

The hospital itself has been bombed and looted of its equipment and drugs. Patient records have been destroyed. Located on the outskirts of Baghdad, the hospital now has the Americans on one side and insurgents on the other. "When there's fire between them, the patients start to cry and try to run away," said Dr. Lafta. "It's very dangerous."

Even without a war raging outside, the hospital would have a hard time. Iraq's main psychiatric institution, the hospital offers both inpatient and outpatient services. Its 1,200 beds, including 250 forensic beds in a secure unit, are always full. There are only eight psychiatrists to serve these patients, very few allied health professionals, and barely any medications available.

The intense stigma attached to mental disorders and the lack of rehabilitation and government support make families reluctant to take back patients even once they've stabilized. Some of the psychiatrists at the hospital are ashamed to admit where they work.

Now that Dr. Lafta has seen community-based services in England and the United States, he's convinced that's the model to use. He envisions patients living in group homes staffed by nurses or even in their own families' homes. The government could provide small salaries to family members, who would serve as patients' case managers. Psychiatrists could visit weekly or monthly. And Al-Rashad would be transformed into an institution serving only forensic patients.

Trained in Iraq, Dr. Lafta began his studies hoping to be a physician specializing in neurology. Because such specialized training was unavailable, he shifted to the next closest thing—psychiatry. Before coming to Al-Rashad, he served as a psychiatrist and officer in Iraq's army, treating patients in military hospitals and lecturing at the military medical school. "The old regime focused on the army and neglected civilian patients," he explained. What will he do once the hospital closes? "Iraq needs hundreds of psychiatrists," he laughed. "I'm not worried."

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