More than 15,000
calls received since 2017
More than 4,500
consultations
More than 100
operators take emergency calls around the clock
The social, economic, and political situation in Lebanon has plunged many residents into brutal impoverishment. In a country where mental health care is still taboo, the NGO Embrace has been providing customized psychological support to the growing number of people suffering from mental distress since 2014. A valuable initiative for thousands of people trying to regain hope.

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."
 

Hiba Dandachli, directrice de communication de l’ONG Embrace

 

“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

NGO Embrace
1564
1564: Lives on the Line
Since 2014, people suffering from emotional or mental distress have had recourse to 1564, an emergency phone number, known as the "lifeline," where four trained operators answer calls for emotional support and suicide prevention some 21 hours a day. About 140 volunteer operators work on a rotating basis.

Fatima has been working here for over two years. At 24 years old, she is a psychiatric nurse: "I've always been passionate about mental health. But I always wondered how I could help. And when a friend told me about Embrace, I didn't hesitate."
But what do you say on the phone to someone who is at the end of their tether? "Most people don't talk to us to get us to tell them something," said Fatima. “They talk because they are about to explode and they need to be listened to. We need to listen and think about their situation and emotions, give them time and space to express themselves without judging them. And if necessary, we explore with them the possibility of referring them to a mental health specialist. We also have a team that can go into the field. We can hospitalize them if necessary. ”
2
New needs created by the crisis
Years of political and economic instability came to a head with the twin explosions that rocked Beirut on August 4, 2020. The crisis caused a new category to be added, for people whose situation no longer allows them to face daily difficulties.

“Most of them tell us they need medication but can't find it, or they can’t afford therapy,” explained Fatima. “There are also people who call us because they can't feed themselves anymore.” As a result of the crisis, the number of calls has risen from 6,000 for all of last year, to 7,500 for the 10 months ending in October 2021. The lifeline has withstood the pressure and made a difference: 1564’s operators have reported no suicides since its creation. "The Lebanese need to be embraced now more than ever," said Fatima.
Yara Chamoun, psychiatrist
Overcoming taboos to ask for help

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. ”

The Symptoms of the Crisis

The Banks

Decline of Lebanon's economy since 2019
Due to angry protests, Lebanese banks have installed armor plating on their facades


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.


Port Explosion 

The port of Beirut after the explosion on August 4, 2020 | © Rashid Khreiss / Unsplash

The port of Beirut after the explosion on August 4, 2020 | © Rashid Khreiss / Unsplash


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.


Shortages

Le Liban fait face à de graves pénuries dues notamment à la crise économique que traverse le pays

A pharmacy in Beirut


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.

A Long-Term Mission

1564, le numéro de téléphone d’urgence à l’écoute des Libanais en état de détresse émotionnelle ou mentale​​​​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.