World Mental Health Day posterGlobally, more than 450 million people suffer from mental disorders. Yet historically, mental health problems have been misunderstood. Mental health refers to a broad array of activities directly or indirectly related to the mental well-being component included in the World Health Organization (WHO)'s definition of health: "A state of complete physical, mental and social well-being, and not merely the absence of disease". It is related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders.
Jordan has been identified as a country in need of intense support for strengthening the mental health system. It was chosen as the first country to implement WHO's mental health action programme (mhGAP) from among six countries across the globe.
In 2008, WHO partnered with Jordan's Ministry of Health and the Jordanian Nursing Council, under the Royal Patronage and support of HRH Princess Muna Al Hussein, on a reform of the mental health system, based on evidence and best practices. The first national mental health policy and action plan was developed by a National Steering Committee representing a large number of stakeholders. In the organization of mental health services, the focus has been shifted from purely hospital care to community based services, using the bio-psychosocial model of health that encompasses a multidisciplinary approach among different healthcare team members to address biological, psychological and social influences upon one's functioning.
Integrating mental health into primary health care is one of the main components of the reform, through the implementation of mhGAP. More specifically, the program aims at scaling up services for mental, neurological and substance use disorders while offering treatment options for depression, schizophrenia, epilepsy and other main mental conditions in primary health care facilities, thereby meeting the needs of most of the population even where resources are scarce. The implementation of the mhGAP has started with training and rigorous supervision to health care practitioners in Amman, Irbid and Zarqa. At the secondary level of care, three outpatient community mental health centres have been established in the same areas to ensure availablility, accessibility, and quality service provision where people work and live. In addition, acute inpatient model units within general hospitals in the Ministry of Health and at university facilities have been established instead of being limited to psychiatric hospitals.
Experience sharing and information exchange
Several opportunities for human resource development arose through short trainings and study tours to mental health systems in developed countries. In 2010, a new collaborative opportunity was "patronaged" by HRH Princess Muna Al Hussein who diligently established partnerships with prestigious academic institutions through reciprocal internship programs, thereby resulting in a better understanding of planning and management of mental health services at the macro and micro levels in the country.
Way forward
In order to effect real improvement in the mental health situation in Jordan it remains vital to identify measures to address sustainability and unpredictable continuity of WHO funds, in addition to targeting continued political commitment, institutional support, human resources, lack of children and adolescent mental health services (noting that only 12% of schools offer counselling services), dearth of research, mental health illiteracy, and limited advocacy bodies.