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SAMHSA News - May/June 2005, Volume 13, Number 3

Helping Iraq Restore Its Mental Health System (Part 1)

When the idea of closing Baghdad's Al-Rashad Mental Hospital first arose, Director and Consultant Psychiatrist Muhmmad R. Lafta, M.D., didn't believe it was possible. But after exploring the idea further at a recent conference, he's now committed to closing the hospital as soon as possible—even though it means putting himself out of a job. (See In Transition: Al-Rashad Mental Hospital.)

"It's not unusual for patients to spend 20 years in the hospital," explained Dr. Lafta. "These are people without rehabilitation, without goals, without human attachments. They have nothing to do. They spend their days waiting for pills. I'm now convinced that a better way to treat patients is to let them live in the community. Instead of just being left in the hospital, they should be treated like human beings."

The event that changed Dr. Lafta's mind was the Action Planning Conference for Iraq Mental Health held in Amman, Jordan, in March. The conference brought together 30 Iraqis—along with more than 20 American and British experts serving as resources—to figure out how to go about rebuilding the country's mental health system. SAMHSA organized and funded the event.

"The fact that the Iraqis recognize the centrality of mental health bodes well for their country's recovery," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "We're committed to doing what we can to help."

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Working Together

The conference came about when SAMHSA asked Sabah Sadik, MBCHB, FRCPsych, DPM, National Advisor for Mental Health at the Iraqi Ministry of Health, if he needed any help restoring Iraq's mental health system (see SAMHSA News, January/February 2005). Dr. Sadik is a psychiatrist who also serves as Medical Director of the West Kent National Health Service and Social Care Trust in England. In response to that offer of assistance, Dr. Sadik explained that what he needed most was help organizing an action planning conference.

Dr. Sadik and his colleagues were ready. Iraq's National Mental Health Council—a group comprising representatives from several government ministries including the Ministry of Health, as well as other interested persons outside the government—had already developed an initial plan with an ambitious agenda. "The purpose of the conference was really to consider that plan carefully and figure out what was missing and what was most urgent," explained conference organizer Winnie Mitchell, M.P.A., International Officer at SAMHSA.

Another conference goal was to help build a team to take on that work. Developed by a Planning Group on Iraq Mental Health chaired by SAMHSA, the conference brought together Iraqis from all parts of the country. It also brought together Iraqis from all sectors of society, including mental health professionals, government officials, judges, educators, human rights advocates, and religious leaders from the Muslim (including both Shiite and Sunni) and Christian faiths.

"Many of them had never met each other," said Ms. Mitchell. "Dr. Sadik really meant the conference to be a team-building exercise."

Joining the Iraqis were representatives from the United States, the United Kingdom, and international entities such as the World Health Organization and the World Bank. These experts, including Mr. Curie and other SAMHSA representatives, served as resources during the didactic sessions that began the conference.

Mr. Curie and Dr. Sadik, for example, gave a joint presentation on leadership and team building in mental health services. Anita Everett, M.D., Senior Medical Advisor at SAMHSA, summarized the history of deinstitutionalization and the creation of community-based services in the United States. Other topics included the integration of mental health services and primary care, health care financing, and staff and professional development.

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