Abstract
BackgroundMental health system reform is urgently needed in Gaza to respond to increasing mental health consequences of conflict. Evidence from mental health systems research is needed to inform decision-making. We aimed to provide new knowledge on current mental health policy and legislation, and services and resource use, in Gaza to identify quality gaps and areas for urgent intervention.MethodsAs part of a mixed methods study, we used the World Health Organization’s Assessment Instrument for Mental Health Systems Version 2·2 to collect data on mental health services and resources. Data collection was carried out in 2011, based on the year 2010.ResultsGaza’s mental health policy suggests some positive steps toward reform such as supporting deinstitutionalisation of mental health services. The decrease in the number of beds in the psychiatric hospital and the progressive transition of mental healthcare toward more community based care are indicative of deinstitutionalisation. However, mental health legislation in support of deinstitutionalisation in Gaza is lacking. The integration of mental health into primary healthcare and general hospitals has not been fully achieved. Mental health in Gaza is underfunded, human rights protection of service users is absent, and human resources, service user advocacy, and mental health training are limited.ConclusionPriority needs to be given to human rights protection, mental health training, and investment in human and organisational resources. Legislation is needed to support policy and plan development. The ongoing political conflict and expected increase in need for mental health services demonstrates an urgent response is necessary.
Highlights
Addressing the high global burden of mental disorders that are associated with substantial individual, social, and economic costs, especially in low- and middle-income countries (LMICs), and post-conflict areas, is an urgent priority [1,2]
The mental health plan was drafted in 2010, consolidated and endorsed in 2011, and adopted by the Minister of Health in Gaza. This plan contains the same components as the mental health policy and mentions reforming the mental hospital to provide more community-based services
Research focused on epidemiological and non-epidemiological studies in community and clinical samples, services research and psychosocial, biology and genetics, and psychotherapeutic interventions. This is the first study to report on current mental health policy, legislation, and services in Gaza, and provides a baseline for future progress and comparison with other countries
Summary
Addressing the high global burden of mental disorders that are associated with substantial individual, social, and economic costs, especially in low- and middle-income countries (LMICs), and post-conflict areas, is an urgent priority [1,2]. PTSD is even higher in boys injured during Al-Aqsa intifada (2000–2007), 77% [9] These prevalence estimates appear to be strikingly high, a systematic review of seventy-one eligible studies on the mental health of children and adolescents living in areas of armed conflict in the Middle East supports the high prevalence estimates, reporting PTSD to be between 23-70% in Palestine [10]. Despite high levels of mental ill health and associated burden in LMICs, and post-conflict areas, and the fact that evidence-based, effective interventions can reduce this burden [13], treated prevalence rates in those areas are low, indicating a treatment gap and an urgent need for improvement in mental health care provision [14]. We aimed to provide new knowledge on current mental health policy and legislation, and services and resource use, in Gaza to identify quality gaps and areas for urgent intervention
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