WASHINGTON – Like the United States and other countries around the world, Iraq suffers from a shortage of psychiatrists. But in Iraq, the situation is particularly dire: The country has only about 100 psychiatrists to serve a population of 30 million people, experts say.

That sobering statistic compelled psychiatrists such as Dr. Rebwar Ghareeb Hama of the General Hospital of Sulaimani, Kurdistan, to participate in the Iraq-SAMHSA Partnership on Behavioral Health program. The Substance Abuse and Mental Health Services Administration and the Iraqi government were part of the initiative developed in 2004 to help Iraq reestablish its behavioral health service system.

“We are only a few psychiatrists serving about 2 million people inside Sulaimani,” said Dr. Hama, who was part of the team focused on integrating trauma services into primary health care centers. “We have no clinical psychologists, no clinical social workers, so with these short limits, we want to teach or to train nonexperts inside the health centers like general practitioners [and] nurses to identify those people inside the community … and when they find difficulties in managing them, refer them to our centers inside the psychiatry department in the general hospital.”

After 6 weeks of observing how various mental health care services are provided in the United States, Dr. Hama and 23 other psychiatrists from Iraq were headed home, armed with new strategies and ready to implement local programs they have designed with the help of their American colleagues.

This group is the second set of psychiatrists and other health professionals from Iraq selected to participate in the program. Their time of intensive training and conferences culminated in a closing session Oct. 21 at the Iraqi Cultural Center, where they presented action plans for their war-weary population, ranging from the implementation of an Iraqi Mental Health Act, to ramping up efforts to improve substance-abuse treatment programs for adults and posttraumatic stress disorder treatment (PTSD) programs for children. The first group participated in the program in 2008.

In the plan developed by Dr. Hama's team (which included three other doctors from Kurdistan), they want to create small, multidisciplinary teams of three people – a general practitioner, a nurse, and “medical staff” – and teach them how to identify patients with PTSD. These teams will be trained in 12 health centers in Sulaimani, he said.

Dr. Hama added that his team wants to train both religious leaders because of their influence in the community and teachers, who will often be the first to notice children suffering from PTSD or other problems. “The people will listen to them. Training those teachers will be very helpful to share all of these programs with a huge number of the population.”

In addition to Dr. Hama's team, the other five concentrated on school-based mental health services; forensic, trauma, and substance abuse treatment services; and services for mothers and children with chronic psychiatric disabilities. The projects represented areas across Iraq that included Maysan, Baghdad, Baqubah, Mosul, and Kurdistan.

Each group had a specific area of interest and visited host sites, which included the Johns Hopkins University, Baltimore; the Maryland Department of Health and Mental Hygiene; the National Center on Trauma-Informed Care, Alexandria, Va.; Children's National Medical Center, Washington; INOVA Fairfax (Va.) Comprehensive Addictions Treatment Services; and University of California, Los Angeles, Integrated Substance Abuse Program.

Planning group leaders Dr. Allen R. Dyer, chair of the department of psychiatry at East Tennessee State University, Johnson City, and Dr. Anita S. Everett were each assigned to work with one of the groups. They both felt that the program was more about sharing ideas than forcing the American way of practicing medicine onto the Iraqis.

“We don't feel like we've been exactly teaching them how to do certain things based on the way we do, but rather, exposing them to the way we do things here so they can take that back,” said Dr. Everett of the department of community and general psychiatry at Johns Hopkins.

Dr. Everett, who was a planning group leader for the forensic services team, explained that she was able to share insight on such issues as patient confidentiality, documentation, and medical records, as well as on performance improvement projects and child-abuse reporting. “There's a whole variety of things you can't really teach about so much as have an immersion experience,” she said.

As a planning group leader, Dr. Dyer, also of the International Medical Corps, said his aim was to help the psychiatrists from Iraq “develop the skills they need to move forward.” For his part, Dr. Hama remains optimistic – despite the difficulties he is sure to face when he returns home. “We must try our best, working hard to serve our people,” he said. “They are our people, and they are suffering. We must help them.”

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'The people will listen to [teachers and religious leaders]. Training those teachers will be very helpful.'

Source DR. HAMA

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Several Iraqi mental health professionals spent 6 weeks visiting facilities in the United States.

Source Lorinda Bullock/Elsevier Global Medical News

Iraqi, American Psychiatrists Exchange Ideas