New dawn for the mentally ill

New national health adviser Dr. Fakri Saieb Sabeh wants to change the way mentally ill people are treated in Iraq. Instead of just making sure they have good living conditions, Sabeh, who was trained in the United Kingdom, wants to focus on their quality of life. He wants to build new centres so they will be able to live closer to their families. Most of all, he wants to teach them more skills so they can work to support themselves. There are 1,325 beds spread out among several buildings in a rundown campus-like setting at Rashad mental hospital in the Iraqi capital, Baghdad. A female patient runs up to a visiting doctor at Rashad, complaining that another patient has bitten her. Although there is a red mark on her wrist, it is impossible to tell what really happened, Imad Fadlawi, the general public health doctor in charge Rashad, told IRIN. He sends a nurse off with the woman to make sure there is no more violence. In another room, women in colourful nightgowns watch TV, several of them banging rhythmically on their chairs in time to the music on the screen. All in all, the women seem to be well cared for and content, living in brightly painted rooms. Women live in one residential building, which has about a hundred patients. Men live in another building nearby. Patients with severe behavioural problems, some 230 women and 250 men, are separated from other mentally ill patients in a building with bars on the windows. A total of 921 patients live there. One woman talks happily about the daily routine, from the cooking she gets to do in the kitchen with fruits and vegetables to the care she takes in cleaning her own room. "We have been well served here," Kareema Hussein, 44, told IRIN. She said she was not sure how long she had been at the hospital. "It is good. We can sew things, we can do the laundry." Another woman asked to go home, saying she was put in the hospital by a brother who was angry with her. Samira Mahmoud Ali Hazaz, 49, a former journalist, says she'd been living in the hospital for 12 years after she refused to marry a well-known businessman her brother decided she should be with. "I stopped taking my drugs for six months, and you can see, I behaved very well," Hazaz told IRIN, before appealing to Fadlawi. Later, Fadlawi said patients such as Hazaz will soon be able to move to a smaller centre being set up in central Baghdad where they will be given more independence. Now, Sabeh wants to do away with the Rashad institution all together in the next five years. "We want to bring up the mental health facilities in Iraq as fast as we can," Sabeh told IRIN. "We think people deserve even better treatment." Sabeh has named a National Council for Mental Health to discuss Iraq's future strategy for the mentally ill. He wants to give the patients the option to live in their own communities. Although no government facilities currently exist for mentally ill patients living outside of Baghdad, plans are afoot to build a hospital in Mosul, in the north, and another one in Basra, he said. Sabeh has sent numerous mental health care nurses and social workers for training programmes in Jordan, Lebanon, Syria and Turkey. He is also working with medical schools in the United States to find out what other services he should provide to patients and families. One of the first issues was nurse training, Sabeh explained. "Nurses know how to deal with mentally ill patients and give out medicine. Now they need to learn more community service skills," he said. Even before the former Saddam Hussein regime fell, International Committee for the Red Cross (ICRC) officials were working with patients, offering occupational therapy training sessions, for example, to help patients learn to care for themselves, Ahmed Khalid al-Rawi, a spokesman for ICRC in Baghdad, told IRIN. The Red Cross has spent more than US $1 million on various projects, re-equipping rooms and buying new air-conditioners to replace those that were looted, al-Rawi said. Just before the US-led invasion of Iraq in April 2003, the patients put on a play called "The Stranger" with help from ICRC officials to draw attention to the way they have been stigmatised in society, al-Rawi said. Now, they are starting to work on a new play. With Sabeh's support, Fadlawi says he is working as fast as he can to make changes to the hospital. The doctor was appointed last summer to run the hospital, which was completely looted when he first started work. Doctors and nurses found patients wandering around the vacant land near the hospital, which is just east of Baghdad, and at relatives' houses.