|
Overview
Mental health
Summary update (Mental health atlas,
2005)
Additional Sources of
Information
Overview
Jordan,
with an area of 89 440 km2, lies east of the River Jordan.
About 80% of the land area of Jordan is desert. The
population is concentrated in the northern and central highlands where
the rainfall is sufficient to support cultivation. The population is
estimated at 5 617 000 and the proportion of the population below 15
years and above 65 years of age is 37.1% and 3.5%, respectively. The
adult literacy rate and the female adult literacy rate are estimated to
be 90% and 85%, respectively. The infant mortality rate is estimated at
22.1 per 1000 live births and under-5 mortality rate 27 per 1000 live
births (2002). Life expectancy at birth is 71.5 years (2003). The crude
birth rate per 1000 population is 29. The maternal mortality ratio is
estimated at 4.0 per 10 000 live births (2004).
The per capita gross national product is US$ 1773
(2004). The Ministry of Health budget represents 6% of the national
budget, comprising 2.6% of gross national product. The per capita
expenditure by the Ministry of Health is US$ 165 (2004) There are 22.4
7.3, 32.5, and 17 physicians, dentists, nurses/midwives and hospital
beds per 10 000 of the population, respectively (2004).
The constitution of Jordan states that it is the
responsibility of the government to make health available to all
citizens. There is political commitment at the highest level to achieve
the goal of health for all. The Higher Health Council was established by
law and is headed by the Prime Minister; its membership comprises
representatives of the various health sectors. This council plays a
major role in health planning and in adopting new health
strategies.
Three sectors remain the main providers of health
in the country, namely the public, the private and the international
donor agencies. The public sector is composed of the Ministry of Health
(which is the principal provider), the Royal Medical Services (for armed
forces), the University
of Jordan and the
social security organization. The private sector provides services
through 29 hospitals with 1563 beds, in addition to private outpatient
clinics and the facilities run by nongovernmental organizations. The
international sector includes the United Nations Relief and Works Agency
for Palestine Refugees in the Near East (UNRWA) and other UN bodies, as
well as foreign charitable organizations.
The Ministry of Health provides services through a
series of primary health care centres and district hospitals. Each of
the districts is self sufficient in services, and referrals to the capital
and other large cities are made only for individuals needing specialized
tertiary care.
Monitoring and evaluation are conducted at the
national level. A standard format for monitoring and evaluating the
activities of primary health care exists and is used for assessment
purposes. Various training courses, including the leadership development
programme organized by WHO, have been made available for the purpose of
increasing the managerial capabilities of staff working at the Ministry
of Health.
Primary health care committees have been formed at
the level of the health centre and are composed of members of the
community. These committees meet regularly in order to identify needs
and problems and find solutions. Representatives from these primary
health care committees are also members of the Higher Health Council and
other councils concerned with health. Communities are also involved in
the provision of resources through donation of buildings or plots of
land for health centres.
Health education is included in school educational
curricula in order to increase awareness of health problems. In
addition, health education as a separate subject has been included in
the curricula of nursing and paramedical staff. Moreover, the time
allocated to the various health education programmes in the mass media
has been increased.
Nongovernmental organizations also contribute to
the implementation of health strategies by coordinating with the
Ministry of Health on various projects.
When extensive development projects are initiated,
a committee is formed made up of representatives from the health and
other sectors to determine the effect of such projects on health; for
example, the effect of major irrigation projects on the spread of
schistosomiasis, or that of various industrial projects on environmental
pollution.
The national health plan is part of the
socioeconomic development plan and is implemented through a health
system based mainly on primary health care. Efforts have been made to
orient the private sector towards primary health care by drawing up
contracts with physicians in the private sector, making them responsible
for performing primary health care duties such as immunization, maternal
and child care services, and registration of vital statistics, with
occasional referral to health centres for diagnostic purposes. The
physicians’ contracts also bind them to work in any geographic or
medical catchment area specified by the Ministry of Health. Existing
health centres offer primary health care to 95.5% of the community, and
86.1% of the population can reach these centres in less than 30 minutes.
Mental health
Historical aspects
Mental health services in Jordan
reflect the various changes in the history of the country. Until 1966,
mental health services in Jordan
were delivered through only one mental hospital in Bethlehem, covering both East and West
Banks. After the 1967 war, patients on the East Bank had no access to
the services of this hospital. Hence, the Ministry of Health established
a 60-bed mental hospital at Fuhais, just outside Amman, with a specialized clinic three
days a week. In 1987, the National Centre for Mental Health was opened
in Amman
to provide mental health services. In 1987, a national committee was
formed for the development and implementation of the national programme
of mental health.
Mental health
facilities
Mental health services in Jordan consist of the National Centre for
Mental Health, with 200 beds, and two public mental hospitals with 390
beds, at Fuhais and Na’our, south of Amman. The National Centre for Mental
Health has the additional role of promoting the training of hospital
residents, nurses, social workers, psychologists and medical students.
In addition, the Royal Medical Services mental health unit offers 40
beds, and there is one day-care centre and one rehabilitation centre.
There are 31 psychiatric clinics in cities and towns all over the
country, 22 of which are in the private sector. Establishment of
psychiatric units in general hospitals has yet to be implemented. There
are two private hospitals with a total of 118 beds and two geriatric
homes with a total of 200 beds.
Mental health human
resources
There are 70 psychiatrists in the country. Of
these, 12 work under the health ministry, 3 in the academic departments,
22 in the private sector and the rest in other sectors. There are 13
psychologists working for the mental health services. Of these, 8 have
BS degrees, 3 have MS degrees, and 2 have PhDs. There are only eight
psychiatric nurses. There are 26 social workers in the mental health
services. In addition, there are over 300 educational psychologists
working in the Ministry of Education. There is a psychiatry residency
programme with two positions in the University of Jordan Medical School.
Medical undergraduates receive 120 hours devoted to psychiatry, and the
clinical training consists of clinical work and internship.
National mental health
programme, legislation and related policies
A national programme of mental health was
formulated by a national committee and discussed in a national workshop
in Amman
in July 1988 but was adopted in 1994. A policy on therapeutic and
essential medicines was formulated in 1988 while a narcotics and substance
abuse policy was adopted in 2000. A psychiatric special committee is
reviewing the Jordan Mental Health Act. There is also a special
committee of the Ministry of Justice planning the amendments to the
sectors relevant to mental health in Jordanian criminal law, Jordanian
civil law and the Jordanian law of correct procedures. Currently, chapters
49, 50 and 51 of the common law deal with mental health.
The mental health programme objectives are
integrating mental health services therein; preventing mental disorders
and promoting public awareness in this respect; and treating mental
cases in a more efficient and less costly way. The national mental
health programme also outlined the service strategies, training
strategies, management strategies and strategies for mental health
promotion.
It was envisaged that by 1995 the national mental
health programme would provide diagnostic aids in at least 50% of the
health centres in the country; establish mental health sections in 50%
of public hospitals; establish mental guidance centres in 50% of
schools; initiate a programme for mental health promotion; include
psychosocial components in the health curricula of educational
institutions; and provide rehabilitation centres for at least 50% of mentally handicapped
people in the country. Some progress has been made in
implementation of these goals. At present, the mental health programme
is integrated in the work of some primary health care centres. Of
course, as it is true for all the countries of the Region, further
attempts are needed.
Progress of the
national mental health programme
Since the formulation of the national mental health
programme, 105 general physicians and 70 nurses have been trained in
mental health care. A school mental health programme has been initiated.
Preventive activities have been implemented through primary health care
centres, schools and the mass media. Mental health has been promoted
through disseminating information to the public, primary health care
physicians and leading health administrators.
The problem of drug abuse and dependence is an
important priority and it is being tackled in collaboration with other
sectors as a national strategy.
A major problem has been the limited human
resources. Many professionals seek vacancies with better salaries in
neighbouring countries while others move to the private sector.
Therefore, there is a shortage of qualified psychiatrists in the
Ministry of Health. The problems in implementing rehabilitation and
occupational therapy efficiently stem from a lack of continuous
financial support as well as a lack of experts in this field.
Summary update (Mental
health atlas, 2005)
Epidemiology
Al Jaddou and Malkawi (1997) administered an Arabic
version of the general health questionnaire (GHQ-28) to 794 primary care
patients and found the prevalence of psychiatric morbidity to be 61%.
Multiple logistic regression analysis revealed that unemployment and
perceived severity of physical illness were positively correlated with
psychiatric disorders.
Haddad and Malak (2002) interviewed randomly selected
cluster samples drawn from medical and engineering colleges (n =
650) using the modified Arabic version of the WHO smoking questionnaire
and the attitudes towards smoking questionnaire. The prevalence of
smoking was 28.6% (50.2% among males and 6.5% among females). Smoking
commenced after 15 years of age in four-fifths of the cases. Warren et al (2000), who conducted the Global Youth Tobacco Survey, reported that
tobacco use in the surveyed age group ranged from 10% to 33% in various
countries. Oweis (2001) interviewed about 280 primiparous women with no
previous history of psychiatric illness and complicated pregnancy and
childbirth using a number of standardized and locally validated tools
including the Edinburgh postnatal depression scale (EPDS). They found
a high rate of postpartum depression. The prevalence of postpartum
depression was associated with perceived stress of childbirth, having a
girl child, years of education and income and giving birth in a public
or military hospital (as against a private hospital, which was perceived
as less stressful). Shuriquie et al (1999) assessed 201 female nursing
students (17–21 years) with the Arabic version of the abnormal eating
attitude scale. They found abnormal eating attitudes and over-concern
with food and body image in 12.4%. Abnormal attitudes were inversely
correlated with socioeconomic status.
Daradkeh (1989) found that the annual suicide rate
during 1985–1990 was 2.1 per 100 000. The peak suicide rate was in the
age group 15–34 years. The majority of males who committed suicide were
single and either unemployed or unskilled manual workers. Over
two-thirds of females who committed suicide were either housewives or
students. Nearly two-thirds of the total population that committed
suicide had previous psychiatric treatment. Violent methods of suicide
were most frequently used. Abu al-Ragheb and Salhab (1989) reported that
during the 13-year period (1973–1985) at least 329 deaths in
Jordan
resulted from poisoning by pesticides (organophosphates: 93.6%) of which
61% were due to self-ingestion. Three fifths of the suicides were in the
15–24 year age group. Significantly fewer parasuicides were reported
during Ramadan than the month preceding it and the month that follows (Daradkeh, 1992). Kharabsheh et al (2001)
reported on a mass psychogenic illness involving more than 800 young
people who believed they had suffered from the side-effects of DPT
vaccine administered at school; 122 of them were admitted to hospital. The
media, the children’s parents and the medical profession played a role
in the escalation of this mass reaction. Janson and Dawani (1994) examined
2528 children aged 0–7 years representing 95% of a catchment area.
Almost 7.8% had a disability or a chronic disease. Severe mental retardation
was one of the commonest disabilities.
Mental health resources
Mental health policy
A mental health policy exists. A draft for the
mental health policy had been prepared in 1986, but is still to be
implemented.
Substance abuse policy
A substance abuse policy is exists. The policy was
initially formulated in 2000.
National mental health programme
A national mental health programme exists. The
programme was formulated in 1994. The national mental health programme
aims to integrate mental health into public health and to promote mental
health awareness. It also outlines service strategies, training
strategies and management and promotion strategies.
National therapeutic medicines policy/essential list
of medicines
A national therapeutic medicines policy/essential list
of medicines is present. It was formulated in 1988.
Mental health legislation
Chapter 49/50/51 from the Law of Common Health is
regarding the compulsory admission to psychiatric hospitals. The latest
legislation was enacted in 2003.
Mental health financing
There are no budget allocations for mental health.
Details about expenditure on mental health are not available. The
primary sources of mental health financing in descending order are
tax-based and out-of-pocket expenditure by the patient or family. The
country has disability benefits for persons with mental disorders.
Mental health facilities
Mental health is a part of the primary health care
system. Actual treatment of severe mental disorders is available at the
primary level. There have been initiatives to train general physicians
and nurses on aspects of mental health care. Regular training of primary
care professionals is carried out in the field of mental health. In 2003–2004
about 160 personnel were trained.
There are no community care facilities for patients
with mental disorders. Psychiatrists now cover health centres in five
regions. Psychological counselling centres have been established in the
main schools.
Table 1. Number of psychiatric beds and professionals
|
Total psychiatric beds per 10 000 population |
1.57 |
|
Psychiatric beds in mental hospitals per 10 000
population |
1.4 |
|
Psychiatric beds in general hospitals per 10 000
population |
0.08 |
|
Psychiatric beds in other settings per 10 000 population |
0.07 |
|
Number of psychiatrists per 100 000 population |
1 |
|
Number of neurosurgeons per 100 000 population |
0.2 |
|
Number of psychiatric nurses per 100 000 population |
2 |
|
Number of neurologists per 100 000 population |
0.3 |
|
Number of psychologists per 100 000 population |
0.6 |
|
Number of social workers per 100 000 population |
2 |
Prior to 1966, there was only one mental hospital
in Bethlehem.
After the 1967 war, patients on the East Bank did not have access to the
services of the hospital and so a new 60-bed mental hospital was
constructed and in 1987 the National Centre for Mental Health was
opened. A day care centre and a rehabilitation centre are there.
Recently, a 46 bedded centre for treatment of drug abuse was created.
Although there are 3000 psychologists and 2000
social workers only a few work in the field of mental health. Many
professionals seek vacancies with better salaries in neighbouring
countries, while others move to private sectors. Among military
psychiatrists, two have a diploma in forensic psychiatry and one in
child psychiatry (they were trained in the UK). Clinical psychologists
have to obtain a licence from the Ministry to practice.
Nongovernmental organizations
Nongovernmental organizations are involved with
mental health in the country. They are mainly involved in promotion and
rehabilitation.
Information gathering system
There is a mental health reporting system in the
country. The country has no data collection system or epidemiological
study on mental health.
Programmes for special populations
The country has specific programmes for mental
health for elderly and children. Two homes for the elderly with a
capacity for 200 elderly individuals are under construction. As a part of
the national mental health programme, an initiative has been taken to
start a school mental health programme.
Therapeutic medicines
The following therapeutic medicines are generally
available at the primary health care level of the country:
carbamazepine, phenobarbital, phenytoin sodium, sodium valproate,
amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol,
lithium, biperiden. Sinemet is available instead of carbidopa and
levodopa (it combines 25 mg of the former and 250 mg of the latter). The
cost per 100 tablets is US$ 0.47.
Additional sources of information
Abu al-Ragheb SY, Salhab AS. Pesticide mortality. A Jordanian
experience. American journal of forensic medicine and
pathology, 1989, 10:221225.
Al Jaddou H, Malkawi A. Prevalence, recognition and management
of mental disorders in primary health care in northern Jordan.
Acta psychiatrica
Scandinavica,
1997, 96:3135.
Daradkeh TK. Suicide in Jordan 1980-1985.
Acta psychiatrica Scandinavica, 1989, 79:241244.
Daradkeh TK. Parasuicide during Ramadan in
Jordan. Acta psychiatrica Scandinavica, 1992, 86:253254.
Haddad LG., Malak MZ. Smoking habits
and attitudes towards smoking among university students in
Jordan. International journal of nursing studies,
2002, 39:793802.
Janson S, Dawani H. Chronic illness in preschool Jordanian
children. Annals of tropical paediatrics, 1994,
14:137144.
Kharabsheh S, Al-Otoum H, Clements J et al. Mass psychogenic
illness following tetanus-diphtheria toxoid vaccination in
Jordan. Bulletin of the World Health Organization,
2001, 79:764770.
Oweis AI. Relationships among the situational variables of
perceived stress of the childbirth experience, perceived length
and perceived difficulty of labor, selected personal variables,
perceived nursing support and postpartum depression in
primiparous Jordanian women living in Jordan. Widener University
School of Nursing, 2001.
Shuriquie N. Military psychiatrya Jordanian experience.
Psychiatric bulletin, 2003, 27:386388.
Shuriquie N, Elias T, Abdulhamid M. A study of abnormal eating
attitude among Jordanian female college students. Bahrain
medical bulletin, 1999, 21: 8890.
Takriti A. Psychiatry in Jordan. International psychiatry,
2004, 5:911.
Warren CW, Riley L, Asma S et al. Tobacco use by youth: a
surveillance report from the Global Youth Tobacco Survey
project. Bulletin of the World Health Organization,
2000, 78:868876.
|
Jordan