World Mental Health Day calls out to us nationally

World Mental Health Day, celebrated on October 10 each year, is an opportunity to raise public awareness about health mentality and mobilize energies in its favor. Especially since the finding does not really lend to optimism. Indeed, one in four individuals would be affected by mental health problems in their lifetime, and more than 300 million people worldwide today suffer from depression, according to the World Health Organization (WHO).

The Covid-19 pandemic and the long months of confinement have significantly changed the way we live on a daily basis and have also contributed to the rise in levels of depression and anxiety among the population. Whether on the side of caregivers who have had to provide care in difficult circumstances, or for students, who have had to adapt to distance education, having little contact with their teachers and friends and being worried about their future, for workers whose livelihoods are constantly threatened, or for a large number of people in vulnerable situations.

Today the situation remains as heavy and delicate as ever, for the patients themselves, but also for their loved ones. Especially since the psychiatric services in Morocco seriously lack human and logistical resources.

At Morocco, one psychiatrist for 85,000 inhabitants

Today, there are nearly 400 psychiatrists to practice in Morocco. Or one practitioner for 85,000 inhabitants. A completely derisory figure, far behind our Maghreb neighbors. As for European countries, no comparison is possible, of course. In Switzerland, the city of Geneva alone has 750 psychiatrists, for 120,000 inhabitants. In Morocco, for the time being, we cannot claim such a feat. But will our country be able to at least reach the minimum necessary threshold which, according to the WHO, is 2.5 psychiatrists per 100,000 inhabitants?

A question all the more nagging as a former national survey, carried out by the Ministry of Health, in partnership with the WHO, demonstrated the urgency and sharpness. 48.9% of people questioned in this context, presented at least one sign of a particular mental disorder, ranging from simple obsessive disorder or transient insomnia to more serious manifestations such as psychosis. In addition, 25.6% of the people targeted by this survey presented with depression. Despite the large number of people suffering from mental disorders in our country, there are only a few thousand psychiatric beds.

Casablanca, a large metropolis with more than 100,000 mental patients, has only nearly 300 beds, divided between the University Psychiatric Center (CPU), the hospital Baouafi, Mohammedia hospital and the Tit-Mellil center. Still, these beds are far from being all functional. “In my opinion, this is clearly insufficient, given the number of inhabitants of Casablanca, which is around 5 million. This lack of beds in psychiatry generates a lot of problems “, explains Dr O. Redoine, addictologist psychiatrist,” in the first place, the non-hospitalization of certain patients who are dangerous for themselves (suicide) or for others (hetero-aggressiveness). ). Among the other difficulties, linked to this lack of hospital beds, there is the irregular follow-up, even the abandonment of all care, and the exhaustion, in the end, of the families who try as best they can to take care of them. charge their patients outside the hospital. It sometimes happens that these families feel abandoned by the healthcare team, ”explains our source.

Regarding the very small number of psychiatrists in our country, Dr O. Redoine believes that there are multiple reasons for this. “First of all, psychiatry is a relatively new discipline in our country. The collective imagination considers that the mentally ill are quite particular, and that the people who take care of them are quite strange, when they are not sick themselves. This certainly does not motivate young doctors to choose this specialty. On the other hand, psychiatry has not always been included in the agenda of decision-makers in the health field. Therefore, it has not benefited from public investment. This partly explains the glaring shortage of human resources (psychiatrists, psychologists, nurses, social workers, etc.), ”he explains. And to add: “I think that the number of positions opened by the Ministry of Health, for residents in psychiatry (Editor’s note: those who specialize in psychiatry) is clearly insufficient. We have to ask ourselves the question whether we should not create a specific residency for the psychiatric specialty, with the aim of increasing the number of psychiatrists. In Algeria, by way of comparison, there are nearly 800 psychiatrists, for a population roughly similar to ours. And for Tunisia, which is much less populated, they are already almost 200 psychiatrists. In France, this number reaches 12,000 psychiatrists ”.

Indeed, the figures concerning psychiatry in Morocco are scary. Very scared even. This lack of professionals, infrastructure and budget poses a major problem, both socially and economically. This unenviable situation cannot be rectified by the tiny budget allocated to mental health in our country.

Dr. FZ Sekkat and Dr. S. Belbachir, Moroccan psychiatrists, consider in an article entitled “La psychiatrie au Maroc. History, difficulties and challenges ”that the budget allocated to mental health is very insufficient. “Insufficient material, human and institutional resources hamper the development of psychiatry. The current structures do not adequately respond to the increasingly growing mental health needs in Morocco. More than half of the provinces remain totally deprived of any specific psychiatric structure ”, they explain. And to add: “some psychiatric hospitals are neglected and poorly suited to providing care. They further tarnish the image of psychiatry, devaluing it even in the eyes of medical and paramedical personnel. The public sector mental health outpatient centers are very insufficient in number and are in scarcely better condition ”.

Despite the significant progress made in recent decades in Morocco, much remains to be done in the field of psychiatry. In particular, small towns and the most remote regions of the Kingdom should be provided with infrastructure for the management of mental illness. Not to mention the vital need to train psychiatrists and nurses specializing in psychiatry. It is precisely these “ambassadors of reality”, as they are called, who will be able to alleviate the suffering associated with mental illness.

The essential role of family and relatives

The absence of intermediary structures, such as day hospitals, reception and rehabilitation centers for chronically ill patients, does not promote the reintegration of patients, hence an additional burden for them. families and care institutions.

Indeed, loved ones, or caregivers, have an essential role in the world of mental health, but it is often misunderstood, and also misused. Relatives are thus forgotten, put aside. Today as yesterday, relatives are not doing well. The vast majority of relatives approached by Libé stress that most of the assistance systems do not really work or are too difficult to access. “From the start, we need support to put things in place. But it is much too late. We could have avoided a lot of things. We were in a period of doubt, of excessive hospitalizations. We lost a lot of time, ”says Jalal, a brother of a person suffering from schizophrenia disorders.

Everything would therefore have to be reviewed. Especially the pre-diagnosis period which is one of the most difficult to live with for those around and for people living with mental disorders. “What happens to his loved one remains unclear and uncertain, the caregivers are alone in the situation. This period can last more than five years for a third of the people questioned ”, specifies a French study on the subject.

We must also endure a heavy image of mental disorders. For more than two-thirds of relatives, mental illness is presented as anxiety-inducing and stigmatizing. “I was ashamed of my brother’s illness,” Jalal says. I cannot say that my brother is schizophrenic, because immediately that gives extremely negative images of the person who is going to kill ”. “While my brother is quite the opposite. Someone very pacifist, to whom we rather hurt ”, he concludes.

The schools and universities also concerned

Children and young people spend a large part of their life in school. A mental health problem can affect their education. It is therefore difficult to separate health and education. Closely linked, the physical and mental health problems which can prevail there, hamper the success of pupils or other university students by limiting their learning capacities, which leads to situations of academic failure.

Proof that the subject is a major issue in the Kingdom, according to the World Health Organization, 20% of children and young people in Morocco suffer from mental disorders, including half of the cases start at the age of 14. In addition, 48.9% of 15 years and over present mental disorders such as insomnia, anxiety, depression.

Consequently, a not insignificant proportion of this fringe of the population is exposed every day that God makes, to the risks of smoking, drugs, unprotected sex. Either an unhealthy lifestyle to which is added an unbalanced diet and a lack of physical activity. The following figures attest to this: 11% of pupils aged 13 to 15 are smokers; 1% of students aged 13 to 15 consume alcoholic beverages and 4% consume drugs; 14% of this population category have attempted suicide one or more times; 11% are overweight; 82% are physically inactive; 30% have been victims of violence.

And that’s not all. Also according to WHO data, one third of deaths and two thirds of the disease burden in adulthood are due to diseases or unhealthy behaviors adopted during youth.

Mehdi Ouassat