PSYCHOLOGICAL HEALTH & AWARENESS SOCIETY IN EGYPT

وعيوعي

p.h.a.s.e

والصحة للتوعية المصرية الجمعية النفسية

MISSION & PROGRAMS

POST-REVOLUTIONEGYPT’S PSYCHOLOGICAL WELL-BEING

Photo: Reuters

Egyptian Society

First Major Example of Mental Healthcare as a Major Priority for a Society

in History

First Known Psychiatric Text -2000 Years BC-

First Known Mental Hospital  -Saqqara-

Temple of Imhotep at Memphis -2900 Years BC- popular

center for mental illness treatment

Methods of Treatment:

• opium  

• rituals or prayers

• "sleep therapy“ as dream interpretations

Sleep Therapy

About P.H.A.S.E…

• Egyptian Non-Profit Civil Society Organization

• 2006

• Maadi Cairo, Egypt

• Professionals

• 70 Active Members

P.H.A.S.E… The Mission

TO IMPROVE PSYCHOLOGICAL WELLNESS IN THE COMMUNITY

• Increase Awareness

• Improve Healthcare Services

• Address Social Component

for Psychological & Psychiatric conditions

INTER-RELATEDNESS OF P.H.A.S.E PSYCHOSOCIAL AREAS OF INTEREST

Substance Abuse, Violence, Coping with chronic illnesses :

Psychosocial Illnesses…

Improving Psychological WELLNESS iN the commu nity

Through 1. Improving quality of psychological health care : by Improving

efficiency of experts in specific areas

Addiction Violence Exposure to traumatic events (life threatening or

chronic diseases)

P.H.A.S.E….Objectives:

2. Increasing public awareness:

Complications of addiction: (HIV, STD, Psychiatric conditions, Psychosocial & Economic drawbacks etc.) & means of prevention

Psychosocial impact of violence & EXPOSURE to traumatic events : on individuals, families, surroundings & society

Funding Agencies: Italian Cooperation in Egypt Drosos Foundation & Family Health International Al Fanar Foundation

National & International Organizations: National Council for Childhood & Motherhoood European Union (Child Trauma Network)

Educational Institutions: Kasr El Aini Medical School Egypt Faculty of Medicine Temple University-USA Faculte de Medecine Universite Pierre et Marie Curie

-Paris- France Universitad Complutense de Madrid-Spain Laval University, Canada

P.H.A.S.E… The Partners

P.H.A.S.E… The Partners…

• Public Services: Giza Primary & Preparatory Schools

South Cairo Primary & Preparatory Schools

• Public and Private Business Companies

Te data Masreyyoun Dedd El 3ounf

National Awareness Campaign Against Violence

Ministry of Solidarity

• Association of Diplomats spouses in Egypt

Arabs

Asians

• UNITED NATIONS AGENCIES

UN-Women; UNICEF; UNODC

P.H.A.S.E… The Networks…

Professional Associations: World Association for Social Psychiatry World Psychiatric Association Egyptian Psychiatric Association Arab Psychiatric Association

Civil society institutions: Egyptian NGOs working with vulnerable population

refugees (Catholic Relief Services, Médecins Sans Frontières) women & children victims of domestic violence ( around 15

NGOs) street children (SAMU Social, Banaty Foundation, Establ Antar) patients with chronic illness (HIV/AIDS; Hepatitis C; Cancer;

Diabetes) Women’s Associations

P.H.A.S.E… The Networks• Child Trauma Network: European Union Project

P.H.A.S.E THE INITIATIVE…

Psychological Health: important component of Social Wellbeing

Total number of human resources working in mental health facilities in Egypt 4.98 per 100,000 population:

Psychiatrists: 1.44 /100,000nurses : 2.6 /100,000,psychologists : 0.11 /100,000social workers : 0.27/ 100,000

62 outpatient mental health facilities (only 2 for children & adolescent)•Users of these facilities (2004) 254/100000

•34% females •12% children or adolescents.( Children under 15 years are 34% of Egypt population)

2% of health care expenditures by government health department for mental health • 59% for mental hospitals•Lack of Community Mental Health Structure

Creation of PHASE

WHO report on mental health system in Egypt 2006

Social Violence & Mental HealthStructural Violence (one of the 3 aspects of social violence with

cultural & symbolic violence)

is accused of being directly responsible for psychological human suffering (Farmer, 1996)

Present Sociopolitical Factors Overpopulation: Cairo 20 millions people (Central Agency

for Public Mobilization and Statistics, 2010)

Massive unstructured urbanization (United Nations Development Program (Egypt), 2003 )

+ 50 % of houses economically supported by women(Radwan et Reiffers, 2006)

Photo: www.sawtalniswa.com

Aspects of psychological suffering

P.H.A.S.E activities & Programs

5 MAIN ACTIVITIES

P.H.A.S.E… The Activities 1. COUNSELING & TREATMENT OF PSYCHOLOGICAL DISORDERS

Addiction Psychological traumas (abuse, domestic violence,

natural disasters, life-threatening diseases…) General Psychiatric conditions

2. PREVENTION & COMMUNITY AWARENESS PROGRAMS

3. TRAINING for psychosocial teams, for education schooling personnel

4. SCIENTIFIC RESEARCH (e.g., instruments adapted to Egyptian population, international conference ICSPE..)

5. REHABILITATION from addiction & trauma (yoga, meditation, empowerment)

SUBSTANCE ABUSE & VIOLENCE: PSYCHOSOCIAL ILLNESSES…

• 1,119,373 drug abusers in Egypt: Extrapolated Prevalence Rate of Drug abuse in Egypt, i.e., population of people who are managing Drug abuse at any given time (US Census Bureau, International Data Base, 2004)

• Addicts spend more than 16 billion Egyptian pounds a year on drugs

• Multi-country Study in 2004 (Chile, Egypt, Philippines & India) identified regular alcohol consumption by husband or partner as a risk factor for any lifetime physical intimate partner violence across all four study countries

• 80 percent of child abuse associated with alcohol and other drugs use

PROGRAMS...

1. Prevention Program Against Substance Abuse in Schools 2007 (National Council for Childhood & Motherhood, UNODC & Italian Embassy

2. HIV/AIDS Prevention for Drug Addicts 2008-2012 (FHI & Drosos foundations)

3. Smoking Prevention Program  2010 (PHASE resources)

A) Substance Abuse 

B) Coping with chronic illness: HIV/AIDS

HIV/AIDS Prevention for Drug Addicts 2008-2012 (FHI & Drosos foundations)

• Number of people living with HIV in Egypt is estimated to be 11,000 in 2009 according to UNAIDS, among which are 2,400 women.

• HIV infection is a chronic life threatening condition.

• To be diagnosed with HIV is a traumatic experience which induces psychological distress that can develop into serious psychological and psychiatric condition jeopardizing the HIV carrier quality of life and productivity.

• Psychological distress due to being HIV carriers has particular characteristics linked to social stigma associated to “shameful” HIV transmission (sexual and intravenous drug-related transmission) (Gore-Felton et al., 2006; Leserman, 2008; Vaughan & Kinnier, 1996).

C) Violence: Psychosocial Illness…Examples

Observatoire National des Droits de l’Enfant (Maroc)

Photo: Women of the Egyptian Revolution www.sawtalniswa.com

Examples of Social Violence: Violence Against Women

47 % of ever-married women experienced physical violence since the age of 15 (Egypt Demographic and Health Survey (EDHS) 2005)

36 % of sample of 5,613 experienced marital violence (emotional, physical, and/or sexual) (Egypt Demographic and Health Survey (EDHS) 2005; US AID , 2009)

Some statistics show that domestic violence is due to o Husbands (72%)o Fathers (43%)o Brothers (37%) (Egypt Demographic and Health

Survey, 2005 ) Violence against women

• Widespread and commonly accepted phenomenon in Egypt

• No accurate & up-to-date statistics on the levels of violence against women ( 98 percent of rape and sexual assault cases are not reported to authorities)

• Difficult to assess nature and degree of such violence in Egypt

Violence: Psychosocial Illness…In Egypt: 63.4% of married women victims of violence (Us AID Violence Against Women Report in Egypt 2009)

Most of sources of violence were

combined but here are the statistics for the most prevalent

type according to the victim

Lack of national data on child abuse & neglect ,Difficult to measure extent of problem

High levels of corporal punishment & verbal abuseHome 81%, 90%School 91%, 70%Work 27%

(UNICEF ,2010)

70% of mothers have hit or slapped their children on the body 40% have hit or slapped children on the face

2005 EDHS (Egypt Demographic and Health Survey ) on domestic violence

10,000 STREET CHILDREN In The Four Largest Governorates National Council of Childhood and Motherhood (NCCM)

Examples of Social Violence: Violence Against Children

 

C) VIOLENCEVIOLENCE INTERVENTION PROGRAMS :VIP

1. Domestic Violence: Mawadda offers appropriate Health care & Support services to victims of Interpersonal Violence

2. Outreach & Prevention in Community: School-based Violence prevention and early intervention programs

3. Community-based Violence Prevention and Early Intervention Programs  in Cooperation with TEdata Masreyyoun dedd el 3ounf

P.H.A.S.E LEVELS OF INTERVENTION IN VIOLENCE AWARENESS PROGRAMS

DOMESTIC VIOLENCE

مجموع الحاالت الواردة

ORPHANAGES PSYCHOLOGICAL

WELL-BEING PROMOTION

• Start 8 orphanages in Cairo

• In Cooperation with

Ministry of Solidarity

IBM

Al Binaa Foundation

Masr El Kheir

Bank El Shefa

Ajial Foundation

Homat El Mostakbal Foundation

• Pilot project to be extended to more orphanages

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WHAT HAPPENED

PSYCHOLOGICALLY TO EGYPTIANS SINCE

2011 REVOLUTION?

Psychological Effects of Violence, Chronic Conflict & Political Unrest

Increased stress and anxiety

Stress : hindered ability to meet life’s demands due to real or perceived challenges beyond the range of available coping resources (Gunnar & Quevedo, 2007).

Stress disorder:

• Stress response negatively affects a person’s daily functioning (occupational or social obligations) (Olfson et. al., 1997)

• Stress disorders: debilitating nature

loss of energy (depression, poorer quality of life) (Liverant, Suvak, Pineles, & Resick, 2012)

anxiety (Barlow, 1988)

Stressors: varying degrees

Trauma: Extreme stressor threatening their physical integrity (Flannery, 1999)

( violence or violence inflicted on others) (Breslau, 2009))

PTSD:

• re-lives the traumatic event,

• avoids items or settings event,

• heightened sensitivity for stimuli (Flannery, 1999).

PTSD :

• stress & anxiety

• must follow a traumatic event (Breslau, 2009).

• comorbid disorder: depression or drug abuse to cope with trauma (Breslau, 2009).

• Men: more likely to experience traumatic events

• Women are more frequently diagnosed with PTSD (Breslau, 2009).

SIGNIFICANT TRAUMATIC EVENTS DURING REVOLUTION

• 18-day uprisings between January 25 and February 11, 2011

• Violent clashes:

Imbaba in May 2011,

Maspero in October 2011,

Mohamed Mahmoud in November 2011,

Port Said in February 2012, and

Abbaseya Square in May 2012,

Ettehadeyya December 2012

• Proliferation of guns on the streets

• Rate of armed robberies increased by almost 83% in May 2011 compared to the rate before January 25 of that year

• Rate of murder was up 75% as well (Hendawi, 2011b). In 2011, 2,774 murders were reported in Egypt (Fleishman & Hassan, 2012)

MENTAL HEALTH DATA AFTER 2011 REVOLUTION

• 313 people interviewed (Cairo and Giza)

• 60% met the criteria of Post-Traumatic Stress Disorder, which was much higher than they expected

• Females : significantly higher trauma levels compared to males (t = 2.23, p < .05).

• 60.1% of the participants agreed that services offering help for people facing violence, injury, or stress after the uprisings was important

• Most of the people were traumatized by violence they saw on the television (61%)

seeing someone being injured on the streets (47%) knowing someone who got injured (19.8%) being personally injured (8%)

(Abdelmonem et al 2013)

Photo: El Pais

THANK YOU