Amidst the honking horns and the hum of generators in the Hamra district of Beirut, Embrace's premises provide an enclave of quiet, an atmosphere conducive to healing. But this calm is deceptive: there has been a sharp increase in calls to the "lifeline" - a national emotional support and suicide prevention hotline - as well as an increase in referrals to a specialized clinic.
Today, Embrace has become one of the country's mainstays in mental health treatment. Through the hotline and the mental health clinic, the NGO (which is supported by AFD) has created partnerships with several public health centers, the Internal Security Forces, and the Lebanese Red Cross, and works with the Lebanese Ministry of Public Health's National Mental Health Program (NMHP), which was launched in 2015 and is supported by AFD.
For the provision of its social and healthcare services, Lebanon depends on NGOs, which has led to a great deal of pressure. Embrace is trying to get laws passed that ensure that it’s the state that pays for the mental health of its citizens. Meanwhile, they get on with the daily business of receiving a wide range of people reporting a variety of mental health issues.
"We have tried to create a safe space for everyone, regardless of where they come from, their social status or their religion,” says Hiba Dandachli, Embrace's Communications Director. “That's one of our proudest achievements."
“Embrace has put mental health care on the map in Lebanon."
- Hiba Dandachli, communications director for the NGO Embrace
Text: Wissam Charaf. Photos: © Kassim Dabaji / AFD
Yara Chamoun, a psychiatrist, has been working for a year at a mental health clinic, created thanks to support from Embrace. Here, free care is provided by a multidisciplinary team that includes psychiatrists, psychologists, nurses and social workers. Plans for the clinic were already in place, but the Beirut disaster accelerated everything.
“The founder of Embrace called us the day after the explosion to come and work some volunteer hours," recalled Yara Chamoun. We didn't have anything here yet, just two chairs and that was it. In less than two months, this clinic was up and running. ”
While the clinic was created to meet the immediate needs after the explosion, Yara's team saw that the Lebanese people were in deep trouble due to the multiple crises affecting the country: "There is a collective trauma that results in anxiety, insomnia, depression, substance abuse and alcoholism. All of this is to cope with or escape reality. ”
After a year of care, Yara Chamoun drew her first conclusions: "What has changed is the willingness of the Lebanese to come to us for counseling. People are less hesitant. Before, it was a taboo. The collective aspect of trauma means that as a whole, people are more willing to accept the idea that they are experiencing mental distress. ”
QUESTION & ANSWER SESSION WITH YARA CHAMOUN:
The multi-faceted crisis, medicinal shortages and a wide range of difficulties forces the Embrace team to be highly flexible and able to improvise.
What do you prescribe to patients when most medications are out of stock?
"We ask the patient if they have family or friends overseas who could potentially send them the medication. ”
What about power outages?
"I had to see a patient in the dark. We had to use our cell phones for light. At one point we were forced to close the clinic because there was no electricity, until we received a donation to get our own generator. Sometimes the slots had to be reduced to 20 minutes to accommodate all the patients for the day during the hours when electricity was available. ”
How do you provide for the financial needs of patients, since insurance does not cover mental health care?
"It costs a lot of money and few people can afford it, not even the wealthy who no longer have access to their money in the bank. When someone needs to be hospitalized immediately, we cover the hospitalization costs. ”
In one year, Embrace has saved more than 20 people who were planning on committing suicide, while covering their hospitalization costs.
“When we tell them not to worry about it and we cover their medication costs, hospitalization costs, and see how it relieves them... It's a wonderful feeling. ”
Lebanon has seen its economy decline sharply since 2019. The Lebanese pound has lost nearly 20 times its value. Businesses have closed en masse, thrusting the population into precariousness. Banks have instituted informal capital controls to limit their losses. From one day to the next, account holders, from the poorest to the richest, were denied access to their savings, often the fruit of a lifetime's work. Today, more than two-thirds of the Lebanese population has fallen below the poverty line.
On August 4, 2020, the port of Beirut exploded, killing over 214 people and injuring 6,500. The Lebanese have suffered a collective trauma, with a sharp increase in cases of fear, anxiety, post-traumatic stress, and insomnia. One year later, the investigation that should shed light on the exact circumstances of the disaster has been delayed. A disaster beyond measure for the Lebanese, who are already exhausted by the economic crisis.
As a result of the economic crisis, currency devaluation and the Lebanese government's failure to pay, the country is suffering shortages of gasoline, oil, gas, hospital equipment and medicine, particularly for cancer treatment.
Thanks to AFD's support, Embrace was able to expand the operational capacity of the national lifeline by increasing the availability of the service from 14 hours to 21 hours per day. Since its inception, the Embrace Community Mental Health Clinic has helped more than 1,000 people, with over 4,500 psychiatric and psychological consultations.
“Our goal is to have a 24-hour hotline,” said Hiba Dandachli. “We are always looking for new team members for the mental health center but this requires funding and support. Many specialists are leaving the country for greener pastures. ”
At a time when the country is experiencing one of the most severe economic crises in modern history, and when most of the attention and resources are being devoted to life-saving health care interventions, mental health remains one of the major challenges.