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SAMHSA News - January/February 2006, Volume 14, Number 1

Rebuilding Afghanistan's Mental Health System

(Part 2)

How SAMHSA Can Help

photo of Dr. Faizullah Kakar, Ms. Winnie Mitchell, and Mr. Charles Curie at the meeting of the Workgroup on Afghanistan Mental Health

At the recent meeting of the Workgroup on Afghanistan Mental Health: Dr. Kakar (left), SAMHSA's Winnie Mitchell (center), and SAMHSA Administrator Charles Curie (right). "SAMHSA's role is to be a partner," Mr. Curie said. Photo by Meredith Hogan Pond

In designing its National Strategic Plan for Mental Health, the Ministry has decided on a bottom-up, community-based strategy of integrating mental health services into existing primary care, an approach that can bring at least basic care to people in need relatively quickly. This strategy suits the country's limited resources and pressing needs far better than would a top-down approach of modernizing existing facilities, training specialist professionals, and then doing outreach to the nation, Dr. Nassery said.

Already, projects under way in the eastern part of the country have shown the effectiveness of providing short-term training in the essentials of mental health care to health care personnel and supplying psychiatric medications to local health centers, Dr. Nassery said.

The plan calls for building on such successful experimental programs, expanding them to other regions, and ultimately, when adequate capacity and resources are available, to the country at large. Over the long term, psychiatric facilities and clinical interventions will be established and professional training in mental health upgraded and expanded.

The key to Afghanistan's current strategy is developing the country's human resources because "we do not expect NGOs to stay forever," Dr. Nassery said. Beyond the crash courses for existing health care personnel needed to carry out the first stages of the Ministry's strategic plan, educating the rising generation of health care professionals about mental health will require new curricula, materials, and programs.

Campaigns to raise public awareness about mental health issues using mass media, including radio and TV as well as the cooperation of local leaders, will also require new materials and training programs. Behavioral health awareness will also be integrated into the public school curriculum, and teachers will receive training in how to teach about it and how to identify possible problems among their students.

Creating effective educational and awareness programs for these various sectors will require cooperation among the Ministry of Public Health and other agencies of Afghanistan's government such as the Ministry of Higher Education. Discussions between Ministries are already under way, according to Dr. Kakar.

Within the priorities articulated by the Ministry of Public Health, SAMHSA can use its expertise, contacts, and other resources to help Afghanistan build its mental health programs and capacity, according to Mr. Curie. "My vision of SAMHSA's role is to be a partner," Mr. Curie said, "standing ready and prepared for a long commitment to help Afghanistan rebuild. End of Article

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Cultural Traditions Aid Mental Health Treatment

For people in Afghanistan, mental health problems generally fall into the category of "jinn"—invisible beings known to English speakers as the genies of the Arabian Nights.

This cultural belief helps make mental health treatment acceptable to a wide range of the population, according to Deputy Minister of Public Health Faizullah Kakar, Ph.D. Because these powerful and malicious creatures are believed able to attack anyone at will—much as Americans believe that everyone is susceptible to the viruses causing colds and the flu—mental health issues and treatments carry less stigma in Afghanistan than they often do in the West, he told SAMHSA News during a recent interview at the Embassy of Afghanistan.

Afghan culture has long used traditional methods to counter the ravages of jinn, including sojourns at religious shrines, where sufferers undergo treatments that include deprivation of food and drink, Dr. Kakar said. In order to affect real improvement, he noted, "It is important that people know also that [modern medications] are good for jinn" and can provide lasting relief.

During medical training in the United States, Dr. Kakar recalled, he was struck by the amount of attention that American mental health professionals paid to the issue of stigma, a situation much different in Afghanistan.

The popular belief in jinn, along with a widespread traditional acceptance of drugs to change mood, creates a receptive environment for bringing mental health treatment to a large population that needs it, he continued. "In a society where 70 to 80 percent of the people" show symptoms of anxiety, depression, or other mental health conditions resulting from decades of warfare, the suffering that these conditions cause "becomes normal" and people do not realize that genuine relief is possible, he said. He emphasized the importance of informing "the public that they don't have to suffer" and that, whether or not jinn caused their conditions, "help is available."

Often when mental health professionals explain modern treatments, "the patient is amazed [and says,] ‘I didn't know there was help for this.' " This makes all the more urgent the need to bring modern treatment to as many people as possible. "If we create lots of expectation," he said, "we need the capacity to meet it." End of Article

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Part 1
Part 2

From the Administrator: The Value of Screening

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Mental Health Campaign for Hurricane Survivors

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Rebuilding Afghanistan's Mental Health System
Part 1
Part 2

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SAMHSA News Information

SAMHSA News - January/February 2006, Volume 14, Number 1

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