Example 7: Embrace Mental Health Organization in Beirut, Lebanon

BACKGROUND

Every one in four Lebanese will suffer from a mental illness at one point during his or her lifetime (Karam et al., 2008). Failure to properly diagnose and treat mental illness can result in disability or even fatalities, however, due to the stigma and social taboos surrounding the subject of mental health in the Arab region, many who are in need of treatment will not seek it out. Negative attitudes, opinions, and misinformation hold people back from seeking the necessary help required to live healthy and productive lives and enhance their well-being. The cost of proper treatment for psychiatric or psychological care can be also be expensive and overwhelming.

Convene A Planning Group:
Embrace, a mental health organization in Lebanon and the Middle East, is the lead organization with this planning effort. Affiliated with the Department of Psychiatry at the American University of Beirut Medical Center (AUBMC), Embrace seeks to help inform and support people who need help by dispelling the myths and misinformation surrounding mental illness. It provides information for those who reside in Lebanon about the resources available, and raises money to help provide necessary treatment and care for those who cannot afford it. The organization strives to supply information, community awareness, and support to break down the stigma of mental illness in Lebanon.

DESCRIBE THE VISION

People with mental illness are empowered to seek and access appropriate care without shame.

STATE THE MISSION

Empowering people with mental illness to access appropriate care through positive representation of those with mental illness, supportive community programs, and policy advocacy.

STATE THE OBJECTIVES

Over the course of the upcoming 5 years, Embrace’s aims include:

• Reducing the suffering of patients and their families and prevent the disabling consequences resulting from untreated mental illnesses
• Increasing public awareness of mental health issues
• Advocating for the support of mental health at all levels of policymaking
• Ensuring that individuals suffering from mental illnesses in Lebanon have access to psychiatric and psychological care

IDENTIFY THE STRATEGIES OF THE GROUP

The strategies utilized by Embrace address multiple levels: individuals, community, institutional, and cultural and legal/policy level.

Individual Level:
Embrace’s core audience are those living with mental illness. For them, the initiative has an annual Into the Dawn suicide memorial walk, which seeks to provide community support for patients as well as people who have suffered from a loss. Financial assistance for patients is also offered, and there are awareness campaigns every year that aim at informing the public about the facts and myths of mental illness.

Community Level:
Embracing My Mental Health talks have grown increasingly frequent in Lebanon, where people with mental illness and current/former patients offer insight into their own personal journeys, and answer questions that audience members pose. The local community, as well as the speakers, benefit from these outreach programs.

Institutional Level:
Before targeting institutions, round table discussions among Executive and Advisory Board members of Embrace take place to brainstorm how to approach this level. The members meet individually with different insurance companies to lobby for fair private insurance practices for mental illnesses, as currently health expenses with regards to mental health care are barely covered in Lebanon.

Cultural and Legal Level:
At the highest level (cultural and legal), the initiative is working to launch an official, formal media advisory service. It will allow journalists who are interested in writing about mental health to refer to the Embrace website and Embrace office for proper information, as well as guide them on the proper way to discuss it in regards to the media. It is hoped that, for the future, this plan can influence a cultural shift.

Embrace is also involved in the discussions regarding the mental health draft law, which aims to change current practices and policies that are unjust towards those who live with mental illness. The organization seeks to represent patients and patient’s advocates at public debates for this draft law, which is currently waiting for parliamentary approval.

DEVELOP (OR REFINE) THE ACTION PLAN BY STATING THE SPECIFIC COMMUNITY/SYSTEM CHANGES TO BE SOUGHT

The information described here and below pertains to one of the organization’s major projects: The National Suicide Prevention Helpline.

Lebanon, being a low-to-middle income country in the Middle East, lacks a Helpline service and has limited support networks for people and their caregivers who are dealing with mental illnesses. Embrace’s aim is to launch a National Helpline. This is a specialized telephone line that provides accurate information about mental illness, immediate emotional support, risk assessment of suicide risk factors and referral to appropriate community-based services or resources. The helpline’s beneficiaries will be those experiencing suicidal ideation, people with mental illness who are suffering from an emotional crisis who require referral, and affected survivors.

The action plan for establishing the Helpline is composed of four phases:

1. Survey of needs and preliminary preparation
2. Detailed planning and development (current phase)
3. Call center set up and pilot testing
4. Launch the helpline and monitor for quality control

Throughout the course of the past year, Embrace has completed the first phase of the action plan and is now currently working on the project planning and development phase (Phase 2), planned to be completed by August 2016. The helpline is expected to launch in 2017.

Impact Evaluation

A process evaluation in Phase 2 will be used to inform how to set up and test the suicide prevention helpline.

For part of the evaluation, a computerized data capture tool will be developed to record to record information about the number/types of calls and callers. This will ultimately serve as a management tool to monitor and evaluate the helpline service and its impact. In addition to all the relevant demographics, the data collection will also include:

• Location of caller: It is anticipated that communities or areas where services are lacking will contact the helpline. Information such as that will aid in advocating for future services in those locations.
• Type of calls: The types of calls going through to the helpline are anticipated to be either information-providing calls or counseling calls. If it is more of the latter, added training in counseling skills for helpline staff will ensue. This information will also affect how we promote the service.
• Referrals: This data will reveal which types of services are in demand and which are lacking.
• How did the caller know the hotline number? Gathering information on how the caller found out about the hotline helps direct the promotional efforts by showing what media work best for people of different sex/genders and people of different age groups.
• Time of day of calls: This information will help indicate the peak hours of the helpline and, subsequently, when more operators on duty are needed.
• Volume of calls: This information will reveal the helpline’s utilization, as well as direct promotion efforts and staffing needs.

EVALUATE CRITICALLY THE APPROPRIATENESS OF THE ACTION PLAN

The helpline is supported by donations from The Mustafa Trust and the crowdfunding campaign that was launched in September 2015 (which generated a total of $37,000). Continuous fundraising efforts are taking place to secure the remaining budget for the first two years of operation.

For the training of the Helpline operators, Embrace has adopted the Train-the-Trainer (ToT) model, which ensures transfer of skills and supports the continuity of the Helpline.

Fundraising remains challenging, therefore a more sustainable way of securing the yearly operational budget is being sought in order to ensure continuity.

INDICATE HOW YOU WILL USE THE STRATEGIC AND ACTION PLANS

When an opportunity arises, it gets discussed among the executive committee of Embrace. If it has strategic relevance, it is taken to the advisory board composed of people from different disciplines: business, psychology, philanthropy, finance, and so forth, that meets every three months. Feedback is given, and depending on their advice and the opportunities’ consistency with Embrace’s goals, it is either pursued or put to rest. Embrace’s core values are also important to consider—inclusion and collaboration is a large part of what the organization stands for—in selecting opportunities.

If there are disagreements within the executive committee, there are debates on all major issues where diplomatic discussions are held and votes are taken.

One of the five core values of Embrace is collaboration, i.e., to seek partners and promote the organization’s goals rather than the group itself. 

In all, its large scale awareness events (national campaigns, the Suicide Prevention Helpline, and other initiatives), Embrace reaches out to other mental health stakeholders in the Lebanese community, including NGOs working in mental health or related fields (LGBT, gender-based violence organizations), mental health practitioners, major hospitals in Lebanon, and the Ministry of Public Health National Mental Health Program representatives. They provide their feedback and input, which is considered valuable to the success of the project, and to foster an open line of dialogue and cooperation between all of the organizations.

Embrace is also officially part of the Mental Health Task Force of the MOPH National Mental Health Program, and the members are regularly participants in the monthly task force meetings held at the Ministry.

Changes at the core level (individuals and community) are definitely needed first, in order to create the demand for mental health, change the way people perceive it through educating the public, create awareness about the rights of patients, and erase stigma. As soon as the community is mobilized, then institutional/legal/cultural changes as more likely to effectively take place.

References

Karam, E. G., Mneimneh, Z. N., Dimassi, H., Fayyad, J. A., Karam, A. N., Nasser, S. C., ... & Kessler, R. C. (2008). Lifetime prevalence of mental disorders in Lebanon: first onset, treatment, and exposure to war. PLoS Med, 5(4), e61.

Contributed by Leah Soweid, American University of Beirut, Intern with the Community Tool Box.