Telemental Health as a Tool to Improve Access to Mental Health Services in the Context of Intersecting Crises in Lebanon

This past year, Lebanon suffered three exceptionally major blows that have had a detrimental impact on the country, and that shook its political, economic and security foundations. The economic crisis threatened the day-to-day stability of the population, reduced their purchasing power, and increased poverty and unemployment rates. The COVID-19 pandemic imposed social isolation, anxiety and depression rooted in the fear of contracting the virus. The pandemic additionally disrupted people’s routine and stability, and abruptly imposed significant lifestyle changes. Finally, the recent tragic Beirut port explosion led to hundreds of deaths, thousands of injuries, and hundreds of thousands of displaced individuals. This threatened the population’s survival and basic sense of security, induced trauma, grief, and fear. The intersection of these three crises is anticipated to have severe repercussions, particularly on the populations’ mental health, and this warrants attention. 

As a response to these emergencies, the National Mental Health Program (NMHP) at the Ministry of Public Health (MoPH) in Lebanon, a number of Non-Governmental Organizations (NGOs), and private institutions spearheaded key efforts. For example, the NMHP compiled and advertised a list of volunteer mental health professionals to facilitate referrals to licensed therapists, and initiated concerted efforts to enhance awareness on relevant mental health issues for individuals to care for themselves and for others. Additionally, the NGO Embrace, and Saint George hospital provided free walk-in clinics for individuals affected by the explosion. 

Despite these efforts, very little attention has been placed on Telemental Health (TMH) as a modality to enhance access to mental health services in the context of such crises. TMH utilizes Information and Communications Technology (ICT) for the delivery of remote mental health services such as psychiatric consultations, psychotherapy, medication management, assessment and diagnosis among others. While synchronous (real-time) TMH is most commonly used, asynchronous (store-and-forward) TMH also has important potential, especially in conflict settings as demonstrated by researchers in Syria [1]. TMH is a flexible modality for service delivery that can be applied in various settings such as primary healthcare centers, schools, universities, NGOs, private clinics, community centers, and hospitals. In these settings, clients walk into the facility and connect with professionals working remotely. Home-based TMH can also be applied for individuals who are looking to receive mental health services from their homes. Both applications of TMH have garnered much attention internationally and have widespread scientific support for their utility and effectiveness in comparison to in-person mental health services [2]. 

The potential and utility of TMH in the context of intersecting crises currently overwhelming the Lebanese population cannot be overstated, since it can provide an important complement to current national efforts. TMH has enormous potential in overcoming some of the most common barriers to seeking mental health services. As an example, TMH can overcome the obstacle of services being centralized in Beirut, and can extend the reach of specialized mental health services to remote areas in Lebanon.

In this regard, TMH bypasses geographical concerns and transportation difficulties by allowing patients to connect with mental health professionals remotely. This can be done through visiting a facility within one’s catchment area such as primary healthcare centers, or by using it from their homes [3]. TMH also is important to be used in the context of the COVID-19 since it adheres to social distancing requirements and can be an ideal way to provide services without posing risks on individuals [4]. Also, given the increasing focus on the provision free mental health services, TMH can reduce wait-lists and eliminate over-crowdedness since patients and/or professionals do not have to be physically present to partake in the session [5]. Clinicians using TMH have also been shown to have higher efficiency in their practices, and lower risk of burnout, which is also important to consider in conflict settings [6]. Moreover, TMH can potentially assist in addressing the stigma and barriers surrounding the use of mental health services, since it increases one’s ability to maintain anonymity and thus offers enhanced privacy for people who do not wish to be identified or seen at a clinic. This could be a motivating factor to encourage individuals to seek mental health services. 

Finally, TMH has strong potential for scalability and may in the near future occupy an important cornerstone of the mental healthcare system in Lebanon given increasing interest in telehealth services globally. Further governmental regulatory efforts may be needed to facilitate national-level adoption of this practice, along with the provision of training and capacity building for healthcare personnel to integrate it in their settings and for clinicians to practice it. Although some available guidelines offer support and a direction for application [3][7], actual reports of case studies are needed to evaluate their efficacy, impact, and the experiences of both patients and clinicians.

Filters: Conflict, Research, COVID-19, Beirut Blast, Mental Heath, Telemental Health

Contributors

Hady Naal – Project coordinator – eCAP (evaluation of capacity building); Research coordinator – CREEW (Center for research and education in the ecology of war), Global Health Institute, American University of Beirut, Lebanon

References

[1] Almoshmosh, N., Jefee-Bahloul, H., Abdallah, W., & Barkil-Oteo, A. (2020). Use of store-and-forward telemental health for displaced Syrians. Intervention, 18(1),66-70.

[2] Haidous, M., Tawil, M., Naal, H., & Mahmoud, H. (2020). A review of evaluation approaches for telemental health programs. International Journal of Psychiatry in Clinical Practice, In Press. 

[3] Naal, H., Whaibeh, E., & Mahmoud, H. (2020). Guidelines for primary health care-based telemental health in a low-to middle-income country: The case of Lebanon. International Review of Psychiatry, 1-9

[4] Whaibeh, E., Mahmoud, H., & Naal, H. (2020). Telemental health in the context of a pandemic: The COVID-19 experience. Current Treatment Options in Psychiatry, 7, 198-202

[5] Mahmoud, H., Naal, H., & Cerda, S. (2020). Planning and implementing telepsychiatry in a community mental health setting: A case study report. Community Mental Health Journal. In Press

[6] Mahmoud, H., Naal, H., & Mitchel, B. (2020). Evaluating a multi-component strategy to address burnout, job engagement, and job satisfaction among telepsychiatrists: A case study. Journal of Psychiatric Practice. In Press

[7] Mahmoud, H., Whaibeh, E., & Mitchel, B (2020). Ensuring successful telepsychiatry program implementation: critical components and considerations. Current Treatment Options in Psychiatry, 1-12