Mentally traumatized Lebanese seek help amid the wreckage of their lives

Mental health awareness poster and Embrace hotline staff receiving calls. (Photo: Embrace Lebanon Facebook page)
BEIRUT — “There are wounds that are hidden and have not been treated” is the assertion that “Embrace” makes in its latest compelling and chilling video on Facebook. The Lebanese NGO is referring of course to psychological wounds in its mental health awareness video. اضافة اعلان

In the video, a young woman looks at a clock face and starts to sweat as her heart races; she goes to a window and opens it. The time reads 18:08:18, the time the Beirut Port blast ripped apart an entire city on August 4, 2020. She breathes deeply at the open window. The video illustrates just one of several traumatic events the Lebanese have had to endure over the past two years, enough to tax the hardiest among us.

Mia Atweh addressing participants in awareness conference in December. (Photo: Embrace Lebanon Facebook page)

Mia Atweh, founder of “Embrace”, said that mental health is top on international donor agendas for Lebanon, a country greatly lacking in such services.

“At our center in Beirut, opened since August 2020, we have a three-month waiting list, as demand for counseling is very high,” Atweh told Jordan News, adding that the organization ends up referring many people to other centers.

“Keep in mind, we have not advertised this center, people know about us only through word of mouth, if we advertise we would be overwhelmed,” she said.

The center, located in Beirut’s Hamra district, has 16 clinicians seeing 350 patients during 700 sessions a month. Anyone who is in need of counseling can go to the clinic that is completely free of charge.

“Counseling today is extremely unaffordable; at 700,000 Lebanese lira per session (minimum wage is still 600,000 lira per month), it is out of most people’s reach,” Atweh said.

(Photo: Embrace Lebanon Facebook page)

Embrace operates the National Emotional Support and Suicide Prevention Hotline (1564) in Lebanon in partnership with the Ministry of Public Health through its National Mental Health Program, one of the few public programs not funded by the public purse, Atweh said. The hotline is a lifeline for many people. It operates 21 hours a day, from 8:30am to 5:30am.

A population at high risk

Dr. Aimee Nasser Karam, head of clinical psychology at the Saint George Hospital University Medical Center (SGHUMC), worries about the Lebanese population at large and her own students at Balamand University who want to stay and serve in Lebanon. She calls them her heroes.

“The exposure to stress is high and it has been too long, I am worried for our people. It is really unfair, psychology cannot be thought of outside human rights, and we are having difficulties securing basic rights,” Karam told Jordan News.

“It is not enough to ask someone if they are having suicidal thoughts, these thoughts could be transient or they could be very serious,” Karam said, adding that the Lebanese population as a community is going through several traumas.

Anyone is prone to develop acute stress disorder as a result of witnessing multiple traumatic events, and people can experience symptoms that follow trauma, like reliving a traumatic event and experiencing it as if it were happening at the moment, or feelings of fear and insecurity.

“Acute stress disorder can be a risk factor to developing post-traumatic stress disorder (PTSD). After the port blast we (at SGHUMC) had free open clinics for people to come in for consultations and to know how to manage their symptoms,” Karam said.

(Photo: Embrace Lebanon Facebook page)

Immediately after the port blast, she said, was a time when many Lebanese decided to leave the country in record numbers, out of feelings of disgust, insecurity or powerlessness, fearing that anything could happen to them and needing to escape.

How to identify a high risk of suicidality

Karam said that any change in behavior that is uncharacteristic of a person, like being very quiet and uncommunicative, avoiding activities, places, and friends, is to watch out for as it could indicate high risk of suicidality.

“Some people start being more isolated, they do not want to see anyone, they start restricting their lives, staying at home, they may have unexplained crying spells, they do not talk much, have a feeling of estrangement, and do not identify with others” she said.

As for how to respond to a loved one that shows such behaviors, Karam said: “All we need to do is to show them that we are here for them and that things could be processed differently, and that help is possible.”

What should raise alarm bells are people who combine high irritability and impulsivity with a high level of hopelessness, she said, adding that these are very dangerous markers, and such people could be “impulsive about suicide”.

“We should never underestimate the likelihood of this act happening. Even if they just talk about it, we need to take it seriously,” Karam warned.

“Sit with a person, find out how long they have been feeling this way, how often this idea of suicide comes to them, determine if they have a support system, anchors in their lives, significant others or not,” she said, adding that people without a support system and significant others in their lives, or who do not have a good relationships with anyone are at high risk.

The young are at highest risk

Atweh said that the hotline has been getting significantly higher numbers of calls from children and adolescents reporting emotional or physical abuse, which she said is expected when the adults are under enormous stress.

“As we know, anything affecting children in their formative years stays with them long term and has a tremendous impact on their psychological wellbeing,” she said.

In fact, 61 percent of callers on the hotline are aged 18 to 34, and a full 50 percent are unemployed. The hotline has received just over 15,000 calls since it was first set up in 2017. This year alone, up to November, the hotline received 7,959 calls.

“It is worrisome that the mental health of Lebanese youth is at risk, as they are the main drivers of the economy. This will impact their performance at school or university,” Atweh said, adding that the lack of coverage and the shortage of specialized hospitals and hospital beds in the public health care sector for mental health makes Embrace’s job very tough.

Substance abuse, like alcohol, exacerbates the risk of suicide, as does a history of suicidality, either thoughts of suicide or previous attempts, as well as depression. Recurrent thoughts about suicide or planning to do so are also risk factors.

A perfect storm of mental health issues

Karam said that in countries going through financial crises like Lebanon, people are already at higher risk.

“In Lebanon, we have a perfect storm, a recipe for mental health issues, a combination of stressors that take away people’s stability,” she said.

“Anyone who did not have mental health issues before is going to be impacted by what is happening,” Karam said of the situation in Lebanon, where for two years, feelings of anxiety about the future and deep sadness seemed to dominate.

She said that people focused on problem-solving spend less time ruminating on their situation and are less prone to mental health issues.

“Most people who see a sad movie will feel sad for a few minutes or hours, but if someone already has depression, they could feel sad for a week,” Karam said, adding: “When you are psychologically vulnerable or if you have mental health issues, stress factors will impact you more severely.”

The mental health fraternity is trying its best under trying conditions, but it is not enough, Karam said, adding that people have no access to medication to treat their physical ailments, let alone their mental ones.

The feelings of insecurity the Lebanese experience constantly is terrible, and the high level and long-term exposure to stress exacerbates mental health issues. Add to these untreated physical ailments and lack of access to basics, such as power and medicine, and the burden on mental health becomes apparent.

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