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Abstract
Mental health services are the means by which effective interventions for mental health are delivered and it depends on several sociodemographic and need variables which significantly influence the likelihood of use of mental health services and consequently policy planning.
Mental health services for addiction include open access services, legal services, medical management services, counseling services, family services, after care services, vocational services, referral services, religious and spiritual services and community liaison and participation services.
Addiction is a complex problem for society, patient and also for therapists and adequate organization of the treatment services is mandatory to achieve better outcome.
Mental health services for addiction can also provide treatment services for patient with mental illness either co-morbidity or drug induced psychiatric disorders, both pharmacological and psychological treatment services.
To ensure effective service planning and delivery, it should follow available international standards which conforms to nationally agreed best practice and takes into account different individual requirements in a well co-ordinated manner following evidence-based practice.
WHO standards of care in poly substance use treatment include: standards on access, availability , and admission criteria, standards on assessment , standards on treatment content, provision, and organization, standards on discharge, aftercare, and referral , standards on outreach and early intervention, standards on patient’s rights, standards on physical aspects of treatment services and standards on staffing.
To evaluate following these standards, international guidelines are introduced. These guidelines describe methods for the evaluation of treatment services and systems for substance use disorders.
These guidelines include assessment of needs, process evaluation, client satisfaction evaluation, outcome evaluation and economic evaluation.
Another way of assessment of mental health systems is the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) which can be used as a tool to enable low and middle income countries to assess key components of their mental health systems, and thereby generate essential information that can be used to strengthen mental health policy and service delivery.
WHO-AIMS include six domains as follow:-
1-Domain 1: Policy and Legislative framework which addresses issues concerned with mental health policy, mental health plan , mental health legislation, monitoring human rights implementation and financing of mental health services.
2-Domain 2: Mental Health Services which addresses issues concerned with organizational integration of services , mental health out patient facilities, day treatment facilities , community –based psychiatric inpatient units, community residential facilities, mental hospitals, forensic inpatient units, other residential facilities, availability of psychosocial treatment in mental health facilities , availability of psychotropic medicines and equity of access to mental health services.
3-Domain 3: Mental Health in Primary Health care which addresses issues concerned with physician-based primary health care, non-physician-based primary health care and interaction with complementary/alternative/traditional practitioners.
4-Domain 4: Human Resources which addresses issues concerned with number of human resources, training professionals in mental health, consumer association and family associations and activities of user/consumer associations and family associations and other NGOs involved in mental health.
5-Domain 5: Public education and links with other sectors which addresses issues concerned with public education and awareness campaigns on mental health, formal links with other sectors and links with other sectors activities.
6-Domain 6: Monitoring and research which addresses issues concerned with monitoring and mental health services and mental health research.
Reviewing the current status in Egypt revealed that addiction is considered one of the serious problems that worry both the people and the government as it affects young people within their productive years leading to many problems such as social maladaptations, decreased work productivity and job loss.
In the beginning of the 20th century, heroin and cocaine became widely used in Egypt but bango remains the most common drug abused. Also studies demonstrated DROP in the mean age of abuse and addiction being more common in males than females with other different sociodemographic variables related to prevalence of substance abuse.
Also Egyptian surveys found a gradual increase in consumption of alcohol among Egyptians with prediction that it will be the commonest abuse in the next years.
According to the national survey on drug use carried under supervision of the Ministry of Health and Population, the percentage of substance abusers was 9.8% and this percentage is expected to rise significantly in near future.
On application of WHO-AIMS on the problem of substance abuse in Egypt, certain facts were obtained:
Regarding policy and legislative framework, Egypt’s mental health policy was recently revised and includes different components concerned with organization of services, human resources, involvement of users and families, advocacy and promotion, human rights protection of users, equity of access to mental health services across different groups, financing, quality improvement and a monitoring system. The use of illicit drugs and other narcotic substances is covered by a drug law which seems to have achievement in dramatic reduction in national economic cost of imported illicit narcotics and hashish.
On revising financing of mental health services, 2% of health care expenditure by the government health department are devoted to mental health and there is no separate finances devoted to patients with substance abuse disorders.
A national human rights review body exists and it has the authority of regular inspection in mental health facilities and revise all procedures involved in the treatment process.
Regarding mental health services, the mental health authority is involved in service planning, service management and co-ordination and monitoring and quality assessment of mental health services.
There are 10 inpatient units for treatment of addiction allover Egypt with a total capacity of 431 beds; there are 17 outpatient clinics for addiction available in the country with limited aftercare services.
Regarding mental health in primary health care, there is lack of training in mental health care for primary care staff and restrictions in prescription of psychotropic medicines.
Regarding human resources, Egypt has about 1000 psychiatrists –limited number of them is specialized in addiction medicine , more than 1300 psychiatric nurses and about 200 clinical psychologists with about 17 psychiatric department distributed allover the 17 medical schools offering undergraduate and postgraduate training in the field of psychiatry and addiction.
Regarding public education and links with other sectors, government agencies, NGOs, professional associations and international agencies have promoted public education and awareness campaigns which target the general population, children, adolescents and women. Also, there is formal collaboration between the governmental services for substance abuse and the agencies responsible for primary health care, HIV/AIDS, and criminal justice.
Regarding monitoring and research, Mental Health Secretariat receives monthly reports from all mental health facilities including data about inpatient units and outpatient clinics.
Detection of barriers against effective service provision and provision of adequate solution to these barriers is an important step in planning of mental health services. Barriers are diverse and include those related to financial and human resources, barriers related to organization of services, barriers related to referral systems and barriers related to policy and legislation.
Regarding financial and human resources, small ratio (2%) of the governmental health expenditure is directed towards mental health, also lack of health insurance coverage constitutes an important barrier to provision of mental health services to individuals in need. The number of human resources involved in the process of mental health services provision is less than the accepted number.
Revision of organization of services reveals other barriers as clustering of services in urban areas, lack of after care services, defects in the referral system and lack of statistics and studies in the field of mental health services.