The World Health Organisation’s key requirements for mental health treatment include “physical security, social support networks, employment, access to education and healthcare and the opportunities for self-actualisation.” These conditions don’t exist in Palestine, where they are needed most.
Bethlehem Psychiatric Hospital (Photo: Liza Noteris)
Palestinians are exposed to extraordinarily high levels of trauma, the effects of which can last a lifetime. War, imprisonment, restricted movement, daily humiliation, poverty, house demolitions or evictions have all had a corrosive effect on the psychological wellbeing of the Palestinian population.
This acute and chronic stress which accompanies daily life for many Palestinians makes them more likely to suffer psychological problems. Symptoms of anxiety and depression are common across the territories. According to the Humanitarian Practice Network one out of three Palestinians is in need of mental help.
Traditionally close ties within families mean that mentally ill people are often cared for at home, rather than being referred to professional services. There are no support systems to assist home care, even if a family appeals for it.
Such appeals are rare, as mental health problems remain heavily stigmatised. Families are often in denial over their relative’s condition. Men are especially unwilling to confront mental problems, as they are commonly taken as a sign of weakness. Palestinian mental health workers face difficulties in accessing and encouraging people to deal with their issues.
Awareness of mental healthcare is relatively new in Palestine. In 2002 the World Health Organization discovered that Gaza and the West Bank had no mental health policy and almost no public mental health services. Firyal Khader Yasin, head nurse in Bethlehem Psychiatric Hospital, told us his facility received no support.
“For a long period, the psychiatric hospital in Bethlehem was neglected from all directions; the Ministry of Health, international funders, local NGOs. This caused us to feel totally isolated, neglected and marginalised – even though we are dealing with a very sensitive, stigmatised and vulnerable population who need an enormous amount of support from us and the community”.
The humanitarian priority in the Palestinian Territories has always been the provision of basic aid through supplying food and financial assistance. Currently two mental hospitals are operational, the Bethlehem Psychiatric Hospital in the West Bank, founded 12 years ago, and the Gaza Hospital. Both institutions employ a worryingly old-fashioned approach, based around conventional pharmacological therapies and electroshock therapy.
The sparse occupational therapy room (Photo: Liza Noteris)
The Bethlehem Psychiatric Hospital suffers from staff shortages. Three psychiatrists, one psychologist, five social workers and approximately 75 nurses are employed. Most nurses’ only qualification is a general nursing degree and do not have adequate training to provide psychological assistance. Due to the deficiency of psychiatrists, nurses prescribe medication although they are not familiar with dosing guidelines or diagnosing symptoms.
When families or police deliver potential patients to the hospital, a simple test is used to decide whether the person is mentally ill. In some cases there is no direct contact between a mental health expert and the patient. Sometimes psychiatrists subscribe medicines over the telephone, without ever having examined the patient.
Psychiatrists are limited to diagnoses and prescribing medication. In Bethlehem Psychiatric Hospital, 75% of patients have been declared schizophrenic. Jorge Castro, psychologist, believes that the hospital staff frequently label people as schizophrenic without the necessary evidence. Consequently patients are given incorrect medicines. No equipment for more sophisticated treatment is available.
In the USA and Europe the causes of mental illnesses are treated with extensive therapy and follow-ups. In Bethlehem only the symptoms are given any consideration, ensuring that any benefits will only be short-term. The hospital also struggles to afford expensive modern medicines, only three types are available and all are out-dated.
For alternative treatment, Bethlehem Psychiatric Hospital continues to use controversial electroshock therapy, all but abandoned in better-resourced countries. Electroshocks are adopted when antidepressants are ineffective. The director of the hospital explained that “electroshocks keep the people alive”. The treatment roughly functions to reset the brain, but carries damaging side-effects of memory loss and disorientation.
In western countries, electroshock therapy is used only in the most extreme cases, when no alternatives are available. In Bethlehem it is used on a daily basis. Electroshocks are administered to seven to 10 people, twice a week in a treatment of ten sessions. The psychiatrist defines who gets the treatment. The director of the hospital explained that approximately 16% of patients are given the brutal electroshocks.
The electroshock machine (Photo: Liza Noteris)
The Bethlehem Psychiatric Hospital is the most advanced mental health facility in the Palestinian Territories and it belongs to the Stone Age. Inadequately trained staff, resource shortages and an attachment to old-fashioned treatments mean that the most vulnerable members of Palestinian society receive appalling care.