WHO-AIMS REPORT ON MENTAL HEALTH SYSTEM IN EGYPT

A report of the assessment of the mental health system in Egypt using the World Health Organization - Assessment Instrument for Mental Health Systems (WHO-AIMS). Cairo, Egypt 2006

Ministry of Health - Egypt

WHO, Country Office Egypt

WHO, Regional Office for the Eastern Mediterranean (EMRO), Cairo

WHO Department of Mental Health and Substance Abuse (MSD)

Executive Summary

The World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was used to collect information on the mental health system in Egypt. The goal of collecting this information is to improve the mental health system and to provide a baseline for monitoring the change. This will enable Egypt to develop information-based mental health plans with clear base-line information and targets. It will also be useful to monitor progress in implementing reform policies, providing community services, and involving users, families and other stakeholders in mental health promotion, prevention, care and rehabilitation.

A mental health policy and plan, as well as mental health legislation exist in Egypt. An emergency and disaster plan for mental health are currently being developed. In 2004, 2% of the governmental health expenditure was directed towards mental health. The majority of mental health funding is directed towards mental hospitals (59%). All mental disorders and all mental health problems of clinical concern are covered in social insurance schemes. At least 80% of the population has free access to essential psychotropic medicines. A national human rights review body exists. A national mental health authority exists which provides advice to the government on mental health policies and legislation.

There are 62 outpatient mental health facilities available in the country, of which 2 are for children and adolescents only. In 2004, these facilities treated 254 users per 100,000 general population. Female users make up over 50% of the population in all mental health facilities in the country. The proportion of female users is highest in outpatient facilities and mental hospitals and lowest in inpatients units.

The majority of beds in the country are provided by mental hospitals (9.12 beds per 100,000 population), followed by forensic units (1.04 beds per 100,000 population), and community-based inpatient psychiatric units (0.94 beds per 100,000 population). No beds in mental hospitals are reserved for children and adolescents only. There has been an increase in the number of mental hospital beds in the last 5 years. The density of psychiatric beds in or around the largest city is 3.17 times greater than the density of beds in the entire country.

The distribution of diagnoses varies across facilities: in outpatient facilities mood disorders are most common whereas in inpatient facilities and mental hospitals schizophrenia has the highest prevalence. Psychotropic drugs are most widely available in mental hospitals, followed by outpatient units, and then inpatient mental health facilities. Most of mental health facilities are present in or near large cities. In order to promote equity of access to mental health services, Egypt is encouraging the development of community-based psychiatric units and outpatient facilities in each catchments area throughout the country.

Five percent of the training for medical doctors is devoted to mental health, in comparison to 10% of the training for nurses. In terms of refresher training, 5% of primary health care doctors have received at least two days of refresher training in mental health, while 1% of nurses and 6% of non-doctor/non-nurse primary health care workers have received such training. In terms of physician-based primary health care clinics, less than 20% have assessment and treatment protocols for key mental health conditions available. None of the physician-based PHC clinics have at least one psychotropic medicine of each therapeutic category available in the facility or in a near-by pharmacy. However, at least one psychotropic medicine of each therapeutic category is available in mental hospitals or in a near-by pharmacy.

The total number of human resources working in mental health facilities per 100,000 population is 4.98. There are 1.44 psychiatrists and 0.11 psychologists per 100,000 population. In terms of staffing in mental health facilities, there are 0.17 psychiatrists per bed in community-based psychiatric inpatient units, in comparison to 0.07 psychiatrists per bed in mental hospitals. The distribution of human resources between urban and rural areas is disproportionate.The density of psychiatrists in or around the largest city is 1.6 times greater than the density of psychiatrists in the entire country. The density of nurses is 3 times greater in the largest city than the entire country.

In Egypt, there are no consumer or family associations of persons with mental disorders. There is a coordinating body, the General Secretariat of Mental Health, to oversee public education and awareness campaigns on mental health and mental disorders. Government agencies, NGOs, professional associations, and international agencies have promoted public education and awareness campaigns in the last five years. While 97% of primary and secondary schools have either a part-time or fulltime health professional, only about 1% of these professionals are trained in mental health. Because of a new policy regarding mental health of school children, psychologists and social workers are being trained in mental health promotion and prevention programs. Regarding mental health activities in the criminal justice system, no prisons have at least one prisoner per month in treatment contact with a mental health professional. In terms of financial support for users, less than 20% of mental health facilities have access to programs outside the mental health facility that provide outside employment for users with severe mental disorders. Finally, 33% of people who receive social welfare benefits do so for a mental disability.

A formally defined list of individual data items that ought to be collected by all mental health facilities exists; however, the extent and completeness of the data collection is variable among mental health facilities (e.g. 100% of outpatient facilities collected data on the number of user contacts, while only 24% of outpatient facilities collected data on diagnoses). Of all health related research, 4% is conducted on mental health.

رابط

http://www.who.int/mental_health/evidence/who_aims_report_egypt.pdf