New approach to mental illness in Bethlehem (Nov. 2014) – WHO article

A new approach to mental illness in Bethlehem, November 2014

November 2014, In an area where the psychiatric illness is often misunderstood and stigmatized, a residential psychiatric hospital with a trailblazing occupational therapy programme, offers new hope for mentally ill Palestinians.

Bethlehem Psychiatric Hospital provides the only facilities of this type in the occupied Palestinian territory. Currently 180 psychiatric patients can be accommodated here, receiving the support and therapy they need to manage their conditions and, sometimes, develop the necessary life skills to eventually move back in with their families.

Dyala Abualia became one of the first occupational therapists in the oPt when she started work at the hospital in 2002. She was in only the second group of students to graduate from Bethlehem University’s occupational therapy (OT) course, and says she was attracted to the area as it was a “new profession” and she liked the idea of being “one of the pioneers”.

Her enthusiasm for innovation has helped develop the OT department, which is a crucial component of the hospital’s rehabilitation programme, over the 12 years she has been there. Her proposal for a greenhouse was supported by WHO soon after she began at the hospital, and she is currently planning a candle making project.

One patient she describes witnessing remarkable improvement in is Omar (not his real name), a chronic schizophrenic who had been in the hospital for 10 years before OT started. He has a wife and four children, but they only visited once a year, occasionally taking him home for a day or two at Eid.

After he started work in the greenhouse, he began to develop work and personal skills such as tolerance and problem solving, Dyala says. As he improved, his wife started to visit more often.

“His wife joined therapy sessions to talk about her fears about if he came back home,” Dyala says, explaining that his wife had not known he was schizophrenic when she married him, and was scared by his erratic and sometimes aggressive behaviour. “Through these sessions she started to understand and accept him more, and we started to close the gap between the patient and his family.”

When Omar first earned money from his work in the greenhouse he would spend it on coffee and cigarettes, says Dyala. Then he started wanting to buy clothes and shoes. Then one Eid he decided to buy presents for his family. It was the first time he had been able to give any support to his family in years. And that Eid, four years from when he started OT, he stayed at home for four months.

Since then he has been back to the hospital for a month or two at a time, but has been home since June this year. Living at home he is able to work part-time in his brother’s shop and continue to help support his family.

Another patient who participates in OT activities is Sama (not her real name), who has been living in the hospital for more than 15 years. Sama says she likes sewing and enjoys using the gym equipment in the OT department.

Before she came to the hospital she says she was scared – her brother used to threaten her by saying he would send her away, and she didn’t know anyone there.  But once she began OT, things improved.

“I liked being around the OT students [university students on placements] and I started to get to know other patients, and that made me more relaxed. In occupational therapy I felt like I could do things I wanted to do,” Sama says.

Sama makes embroidered wallets, wall hangings and other items. With the money she earns she buys items such as clothes, shampoo and accessories.

Dyala says the programme has enhanced Sama’s self esteem and has helped her gain skills in self-care and hygiene. Dyala adds that initially Sama had difficulty managing money and would often be overcharged by shopkeepers, but now she is a good negotiator. “She’s better than me, I should take her to the market with me,” jokes Dyala.

“People with chronic mental health problems who have been institutionalized for long periods of time tend to loose their social and daily life skills, as well as occupational skills. Regaining these skills and being able to earn an income again helps them regain their status in society, and lessens the stigma they face,” says WHO Mental Health Officer Rajiah Abu Sway. “The rehabilitation programme supports patients to develop skills, according to their needs.”

WHO has supported the development of mental health services in the West Bank and Gaza for over a decade. Currently WHO implements a project to strengthen mental health service provision and to improve awareness and address stigma concerning mental illness. The project aims to shift the focus of mental health care from a traditional psychiatric hospital-based model of care towards community based services. Project component include policy development, capacity building, integration of mental health services into primary health care, and establishment of mental health friends and family associations. WHO promotes a recovery approach, aimed at reintegration of mental health patients into community life.

WHO supports the programme at Bethlehem Psychiatric Hospital with funding from the European Union.