October 2015 - September 2018
|Poverty ratio||28.6% of the population|
|Mental health expenditure||US$0.25 annual per capita|
|Mental health resources||1.41 psychiatrists and 2.12 psychologists for every 100,000 people, most of them in the private sector (according to WHO data 2011, 2013)
Approximately 85% of people with mental health problems do not have access to the treatment they need.
Lebanon is a small middle-income country on the eastern Mediterranean coast. It shares borders with Turkey to the far north, Syria to the north and east, and Israel to the south.
Since Lebanon gained its independence from France in 1944, the country has been faced with political turmoil, internal conflict and border tensions, especially with Israel. The country acknowledges 18 different religious groups.
The United Nations High Commissioner for Refugees (UNHCR) reports that Lebanon hosts the second highest number of Syrian refugees in the world after Turkey (1,069,111 people as of February 2016). The Syrian crisis continues to affect the country greatly, as the growing number of Syrian refugees have concerning effects on political, economic and social stability, as well as on the labor market and infrastructure.
Lebanon is an ideal candidate for an e-mental health project due to its high level of mental health need and its low number of mental health personnel. Technologically, 80% of the population have access to mobile phones and 70% have access to the internet. Furthermore, the Lebanese Ministry of Health explicitly stated an interest in e-mental health as an innovative approach to mental health care in its mental health strategy 2015-2020.
This project seeks to address the high burden of disease associated with anxiety and depression through a computerized psychological self-help therapy, or E-mental health intervention1, that is both cost-effective and scalable.
The computerized, low intensity2, evidence-based psychological intervention will be a software that adapts WHO’s face-to-face cognitive behavioral therapy (CBT) program known as PM+ (Problem Management Plus). It is currently being tested in a number of randomized controlled trials in Pakistan and Kenya. Our intervention in Lebanon will include five sessions using this software. The software consists of an illustrated story patients can relate to and through which they can tackle depression and anxiety.
The first phase of the project will be to translate the c-CBT intervention into a generic English-language software that will become the basis for a comprehensive and culturally-sensitive adaptation of the c-CBT intervention for Lebanon.
The software will then be tested within a limited number of health service settings in Beirut, assessing participant outcomes. At least 200 people (of which at least 100 will be Lebanese) suffering from anxiety or depression will take part in the pilot test. In collaboration with International Medical Corps, this pilot phase will also include other groups currently living in Lebanon, such as Palestinian and Syrian refugees.
In the second phase, the c-CBT intervention will undergo randomized control trials (RCT) throughout Lebanon to provide the highest standard of scientific evidence on its efficacy. Approximately 350-400 people will participate in these RCTs, both Lebanese citizens and Syrian refugees. This will provide rigorous, scientifically sound evidence of the efficacy of an e-mental health approach in a middle-income country.
Successful RCTs will later be followed by the dissemination of findings and gathering of resources required for implementing the intervention throughout Lebanon and, potentially, other countries.
Outcome evaluation is central to this project, and a mixed methods (qualitative and quantitative) approach will be used. Data will be generated through focus groups, key informant interviews and changes in patient symptoms and/or functioning.
The number of beneficiaries is expected to be over 5,000 within a few years after the completion of the project.3
World Health Organization – Department of Mental Health and Substance Abuse
Lebanese Ministry of Health – Department of Mental Health
University of Zurich – Department of Psychology
International Medical Corps
1 E-mental health refers to intervention delivered using technology, which can be provided with or without the help of health care providers.
2 There is no agreed definition of the term “low intensity” but the term generally refers to psychological interventions that require fewer resources than conventional psychological interventions. They often include a technology or self-help component. Please see http://www.ncbi.nlm.nih.gov/books/NBK83456/ for a more in-depth description of low intensity interventions.
3 This figure is based on the experiences of other internet-based interventions. Other beneficiaries will include health care providers who shall be informed and trained in key skills for identifying persons with anxiety and depression.