continued (Part 2)
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
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
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."
Cover Page: Across Borders: Reaching Out to Iraq
Part 1: Across Borders: Reaching Out to Iraq
Also Related ContentFrom the Administrator:
Mental Health In Iraq »
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