In Lebanon, a country rife with crises, talking about mental health seems to be a luxury.
There’s little fuel, less electricity and medicine shortages have emerged; the foods in the supermarkets aren’t what they used to be. Add to that Covid-19 which has added further stress on a failed economy.
The country, and those who reside in it, are in survival mode.
The Lebanese are accustomed to lacking electricity, but now, the situation has deteriorated, and food poisoning rates are up as meat in refrigerators goes bad.
For workers, many of whom in the 21st century rely on the internet (which requires electricity) to do their jobs, the situation is tenuous.
“In day-to-day life you’re always in a state of stress. Imagine coupling that with having to work and make ends meet or else you’ll starve,” Lara Abdulmalak, editor-in-chief at Unlock Blockchain, who lives outside Beirut told Arabian Business ahead of joining the protests marking the one-year anniversary of the port explosion.
She recounted some of the quotidian problems those in Lebanon now face. The internet cuts for three hours or more a day because there’s not enough fuel to run the generator. The bank won’t disperse a check at one time because of the dollar shortage, so individuals and business owners have to make multiple trips to the bank over multiple weeks.
“And suddenly the lira is down more than it was before,” she said, referring to the inflation that has taken hold since October 2019, which caused the value of the pound to lose over 90 percent of its value.
“When you go to the supermarket you never know if you have enough money to pay for the stuff because from one month to another things go up in price, sometimes you don’t find the things you need,” she said.
At some offices, the foreign workers who used to clean have gone back to their home countries as companies could no longer pay salaries.
“Employees have had to start cleaning the bathrooms,” Abdulmalak said of her sister’s work place. “Now they go to work, there’s no toilet paper and there’s no Kleenex in the building. Imagine having to bring your own toilet paper to work.”
Rapid change
The stressors seem to never end. And then, one year ago today, the explosion at the Beirut port decimated much of the city.
The number of those seeking mental health care has skyrocketed, with rising cases of insomnia, depression and anxiety.
“Definitely in Lebanon the level of stress is not standard for any society,” Dr. Joseph Khoury, chief of psychiatry and behavioral health at American Hospital Dubai, told Arabian Business.
Dr Khoury likened mental health to a glass of water that’s nearly overflowing. One more drop of water – i.e. one more stressor – added to the glass and it sends water gushing over the top.
“Suddenly there can be this very small event in your life that can be very personal, and that can be the one where you cross the clinical threshold where you need help and you’re no longer able to function,” he said.
Before the August 4 explosion that left over 200 dead, thousands injured and thousands more homeless, the entrenched economic crisis had rendered over half the population below the poverty line, and Covid-19, which put many more out of work, at least temporarily, was just one more drop in the glass.
“But the change is what also creates the stress. So moving from a state of being semi-comfortable or semi-stable, so fast into collapse or degradation and the lack of comfort or safety is an added stress, compared to where people have adjusted over years of living there,” Dr Khoury said.
And Lebanon collapsed fast. And hard. Throughout 2019, murmurs of the worsening economy could be heard everywhere, but by October economic chaos had ensued. Banks withheld depositors’ money, electricity shortages that were commonplace increased, and a sense of anxiety spread as protests broke out across the country.
Dr. Georges Karam, head of public relations at the Institute for Development, Research, Advocacy and Applied Care (IDRAAC) told Reuters the centre, which provides free mental health care, had seen a fourfold increase in patients since the financial crisis erupted in October 2019.
In the weeks after the explosion, around 20 patients a day visited the walk-in clinic, Reuters quoted Karam as saying.
In the wake of the Beirut blast, new initiatives emerged. Two entrepreneurs designed an online therapy and counselling app, Mindsome, to help people find a specialist. Over in Dubai, start-up Seez that has a team in Beirut, as well as Lebanese who work in the Gulf, stepped into help their team.
“After the August 4 explosion we hosted several different kinds of therapy sessions to help our Beirut-based team process what happened. Our therapist took the team through a series of collaborative discussions and exercises to help them deal with the tragedy and its repercussions on different levels,” Tarek Kabrit, CEO of Seez told Arabian Business.
“We also aided in relocating some of the team to our Dubai and Abu Dhabi hubs as many of them had already been thinking about leaving Lebanon for economic reasons, but the explosion was really a turning point.
“At Seez we’ve really focused on mental health since the start of the pandemic, when we brought in a therapist to give our team regular individual and group sessions, as well as organized other wellness-related activities like monthly yoga sessions and team-building exercises.”
Since 2019, the Lebanese have become more comfortable talking about mental health
A luxury good
But in a country where the government is unable to provide basic services, mental health is no exception.
Dr Khoury said there are around 60-70 fully operational psychiatrists in the country with a population of between 5 and 6 million.
Now, Lebanon’s medical sector has seen an exodus as doctors, like Dr Khoury, who left Beirut six months after the blast, emigrate in search of stability.
Even before the crisis, to see a specialist the cost was between LBP100,000 ($67 at the pegged exchange rate) and LBP200,000 (around $120 at the pegged rate).
“Since 2019, with the fees going up and especially after August 4, the situation is disastrous,” he said. “The absolute minimum is probably 200,000 to see a psychiatrist, but it goes up to 1.5 million,” as doctors are trying to maintain their same level of income and offset inflation.
“It’s become an exclusive club at a time where the help is most needed,” he said.
International non-governmental organisations and religious organisations have for years tried to fill the gap, but they lack resources.
Since 2019, the Lebanese have become more comfortable talking about mental health. For years the topic had been taboo, which Dr Khoury points to regarding the lack of statistics for mental health in Lebanon.
“We can’t pinpoint which part of this crisis has most directly contributed to the issue. With mental health it’s hard to pinpoint one aspect of your life. It’s a multi-layered perspective on things,” he said.
Covid-19 has added further stress on a failed economy
Self-medication
But with people becoming more comfortable talking about mental health, they’ve also become more comfortable self-medicating.
People posting on Twitter and Facebook in search of anti-depressants or anti-anxiety medication have become common.
“You should not be able to get an anti-depressant off the internet,” Khoury said, adding that he knows people are changing their dosage or medication, or stopping medication, without proper medical guidance.
“We haven’t seen the full impact of this yet because it takes time for psychiatric disorders to manifest once you change any of this,” he said. “But if the situation isn’t addressed in the coming months, I expect real, personal crisis, which will have a social impact.
“Patients are experimenting, so the doctor is now giving advice based on rationing, which is not the way to practice medicine. It’s like we’re practicing field medicine, or emergency medicine. You can do that for two to three weeks or a couple months, but it’s not sustainable.”
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