With alarming numbers of conflict-affected Afghans suffering from mental illness and substance abuse, International Medical Corps has launched an 18-month mental health and substance abuse prevention and treatment program in Kabul, Afghanistan. With support from the European Commission, and in partnership with the Ministry of Public Health (MoPH), the program will provide quality mental health services and care in the MoPH Psychiatric and Drug Dependency Hospital, Kabul. International Medical Corps also will work with the Ministries of Higher Education and Public Health to improve advanced psychiatric education at medical universities in Afghanistan.
International Medical Corps will improve the overall management, administration, physical infrastructure, availability of equipment and technical capacity of the staff at the mental health hospital and the drug dependency unit (also known as the Jangalak substance misuse centre) to provide high quality care. International Medical Corps will work with and train 128 staff, improving knowledge and changing attitudes to appropriate treatment and care. The staff includes trainer psychiatrists, resident trainee doctors, psychologists, psychiatric nurses, social workers, occupational therapists and administration and management. In addition, International Medical Corps will work with the Ministries of Higher Education and Public Health to agree on and improve the undergraduate and postgraduate training curricula currently used.
While local authorities and international bodies suspect high levels of mental health problems among Afghanistan’s population, comprehensive data and accurate analysis of the problem is lacking. However, there is wide agreement that the normal, expected levels of mental illness have escalated due to more than a generation of ongoing war, displacement and violence. Of the 21,000 patient consultations at the MoPH Psychiatric and Drug Dependency Hospital in 2009, nearly half of patients were treated for depression and approximately 5,000 were treated for psychosis.
Afghanistan is also suffering from extremely high levels of substance abuse – in particular, heroin and opium addiction. According to the United Nations Office on Drugs and Crime 2009 survey, ‘Drug Use in Afghanistan’: “Easy access to cheap drugs, and limited access to drug treatment, combined with three decades of war-related trauma, have resulted in problem drug-use among almost one million Afghans. … At twice the global average this…is debilitating, not only for those affected, but also for their families, communities, and the country as a whole.” In 2009 the Jangalak substance misuse center saw more than 800 inpatients, 60% of them treated for heroin addiction and 40% for opium addiction.
While the MoPH has recognized the increasing importance of improving mental health care at all levels of the public health care system – including increased outpatient care and outreach at the primary and secondary levels – tertiary care facilities like the 60-bed mental health Hospital and 40-bed Jangalak detox center, which are mandated to accept patients from across Afghanistan, lack the resources, space, qualified personnel and internal systems to provide appropriate, humane care for patients.
An assessment of the MoPH Psychiatric and Drug Dependency Hospital carried out by International Medical Corps in July 2010 found that physical conditions, resources and staff capacity were insufficient to provide an appropriate level of care. Treatment for mental health and substance misuse relied on inpatient treatment at the expense of outpatient, community-based care, often under sub-standard conditions and methods of treatment. With no follow-up treatment post-discharge, staff witnessed high relapse rates among addicts and patients with mental health conditions.
International Medical Corps will support the Ministry of Health and Afghanistan’s cadre of mental health staff in improving psychiatric education and the prevention and treatment of mental health and substance misuse across Afghanistan, in line with international standards and best practices. This program, working under the stewardship of the MoPH, is a first step towards achieving that goal.