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How To Help?

Any assistance from the United States or the international community, Mr. Curie emphasizes, must be "guided by the Iraqi government and the Iraqi professionals who make up the mental health field there."

The new Iraqi Ministry of Health and the Coalition Provisional Authority have decided to focus their efforts on integrating mental health within the primary care clinics that are being established throughout the country, an approach that Mr. Curie strongly supports.

Photos of Iraqi citizens, courtesy of U.S. Agency for International Development (USAID) Web site at www.usaid.gov/iraq/photogallery. Thomas Hartwell and Debbi Morello, photographers.

"Because the approach to treating mental illness in Iraq is based primarily on a medical model, initial thinking from individuals there was to rebuild institutions and hospitals," he says. But considering the small number of psychiatrists, that is not a viable option. "The Iraqis need a longer-term workforce development plan," Mr. Curie says, "that includes training not only for psychologists and social workers, but also for nurses and behavioral health aides."

In addition, he points out, "We have models here in the United States that would enable the Iraqis to use methods that are much more cost-effective and treatment-effective." He cites an example from his visit to the Al Alwiya women's clinic in Baghdad.

"The physician there, to her credit, recognized that women with breast cancer facing mastectomies need emotional support and assistance with mental health—both before and after the surgery and throughout treatment. She was eager to have a psychiatrist come to the clinic more often than the 2 days a week he comes now. In the United States, we have seen that oftentimes the best people to counsel a woman through a mastectomy are other women who have had this procedure themselves. We have found the model of the recovery support group to be very helpful in the treatment of cancer as well as in the treatment of other diseases. This option might be useful at the Al Alwiya women's clinic."

The Ministry of Health has established a behavioral health care task force, Mr. Curie says, that is developing an overall strategic plan to address both mental health and substance abuse issues. In addition to supporting the plan to integrate such services within the primary health care clinics, Mr. Curie observes that such a system also provides an opportunity for the Iraqis to build a community-based mental health system of care from the ground up.

The specifics of a possible SAMHSA plan to assist the Iraqis are still to be determined. However, SAMHSA is focusing on expanding the capacity of Iraqi health care service providers to assess mental health and substance abuse and on enhancing training for primary care physicians as well as psychologists, social workers, nurses, and health care aides. SAMHSA is considering the possibility of funding a mental health expert to assist the Iraqi behavioral health care task force.

"It's essential that this individual speak Arabic fluently, and understand Arabic and Moslem culture and concepts of mental health," Mr. Curie says. "We must engage the Iraqis by approaching them in a culturally sensitive way that includes the ability to connect with tribal and faith-based leaders."

As a second phase, Mr. Curie suggests, SAMHSA officials are exploring with mental health authorities in England and New Zealand the possibility of sending a team of staff from all three countries to Iraq to provide hands-on consultation and technical assistance.

"Both England and New Zealand are aligned around the same recovery model of mental health that is growing here in the United States," Mr. Curie says. "The recovery model recognizes that people with mental and substance use disorders can and do recover, and encourages the use of practices that are evidence-based and consumer-driven. Our efforts may be better received by the Iraqis if offered through a team that is international in scope."

Accompanying Secretary Tommy G. Thompson (center row, fourth from left) on his visit to Iraq were (next to Secretary Thompson, left to right) National Cancer Institute Director Andrew C. von Eschenbach, M.D.; National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, M.D.; SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W.; and Deputy Assistant Secretary for Health Howard A. Zucker, M.D.

Priority populations for treatment include individuals with serious mental illness—in particular, women and children—and Iraqi victims of torture. Efforts will also address the mental health needs of the general population, still profoundly traumatized.

"On my visit, I was reminded of the universality of human needs," Mr. Curie said. "Fundamentally, all people—whether American or Iraqi—seek lives with jobs, homes, and meaningful relationships with family and friends, all of which contribute to a sense of stability and fulfillment. We want to communicate to the Iraqi people that the United States supports them as they strive for a better life."