An Update on Mental Health Services in the West Bank

Article excerpt

Abstract: The continuing development of the mental health services provided in the West Bank over the last fifty years is described. The hospital in Bethlehem was supplemented by the first community clinic in 1974, followed by clinics opening up in all 10 regions of the West Bank. The first Intifada brought actions from many international non-governmental organizations (NGOs). From 1993 the Palestine Authority's Ministry of Health has organized services, although the main addition initially was school counsellors from the Education Ministry. The second Intifada brought a further flurry of disorganized and well-intentioned interventions. A proposal for the reorganization of services from 2004 is in the course of implementation and should influence the training of personnel and structure of services.

Introduction

On February 22nd 2004, the Palestinian Minister of Health signed a technical agreement with the WHO and the international donor community which included a plan for the reorganization of the mental health services in the occupied Palestinian territories. It represents a comprehensive overview of the general consensus as to the rationale and practice for the development of the mental health service in the occupied Palestinian territory in order to best meet the needs of the Palestinian people (1).

Historical Background

The Palestinian health system in the occupied Palestinian territory was originally modeled on the British system of care. The only major mental health facility was the Bethlehem Government Hospital, which was directed by a Maudsley-trained Palestinian psychiatrist who became the hospital director on his return from the U.K. in 1956 and continued to head the hospital until his death in October 1993, when it was named the Mohamed Said Kamal Hospital for Mental Illness in his memory. It remains the only inpatient facility in the West Bank with 200 beds and 65-70% occupancy rate. It is now run by two qualified general psychiatrists, one of whom is the director. In addition there are five trainee psychiatrists and nearly 70 other personel, including nurses, mental health workers and administrative staff (2).

The first mental health clinic was opened in 1974 in Nablus, a city which is nearly 100 km. north of Bethlehem. Since then a community mental health clinic has opened in each of the 10 health districts of the West Bank. It was not until 1996 that community mental health became an independent division separated from the mental hospital and it is now part of the primary health care division.

The community mental health service is providing care for nearly 20,000 registered patients. Onethird of these cases suffer from epilepsy as there is a lack of neurological care in many of the health districts. The work load in these centers is being carried out by 10 psychiatrists, including the director of community mental health, 12 psychologists and 13 social workers.

Psychiatric nursing is a specialty which has not existed in both tiers of the mental health service, inpatient or community. Nursing care is delivered by general nurses who receive in-service training during the course of their mental health work.

The Effect of the Intifada

The first of the two Intitadas that began in December 1987 brought significant changes in the development of the mental health services. The conflict and the consequent severe restriction on travel and movement with approximately 120 Israeli checkpoints made travel between towns and cities virtually impossible.

This factor had a significant impact on the development of community mental health care as the health authority was forced to establish a mental health delivery system in every district to care for the mentally ill who had previously received care from clinics outside their own districts. Coupled with this was the increased number of people who were suffering psychological consequences of the conflict, i. …