Mental Health in Yemen: A Comprehensive View and Analysis of Influencing Factors and Future Challenges

Hebah Mohammed – Sawt Al-Amal (Voice of Hope)

Mental health is one of the fundamental issues facing societies today, requiring extensive and continuous attention to ensure individuals’ well-being and psychological stability. In light of the transformations and crises that Yemen is going through, understanding mental health and analyzing the factors affecting it becomes increasingly important to provide effective and appropriate mental health services to the community.

This report aims to provide a comprehensive overview of mental health in Yemen. It analyzes the current situation, explores the factors affecting the mental health of individuals and society as a whole, and presents the challenges facing the mental health system in Yemen.

Mental Health: The Key to Inner Peace

Dr. Ali Rajih, a psychological consultant and head of the Training and Research Unit at the Psychological Counseling Center at Ibb University, says: “The field of mental health is one of the most interesting fields of psychology for people, both specialists and the general public. Perhaps one of the most important reasons that drives us to be interested in this field is that achieving adequate sound mental health is desirable for all people.”

He continues: “People have been interested in their health, both physical and mental, since ancient times, and interest in mental health or the psychological aspect has taken different forms. This topic also relates to both young and old, concerns both the individual and society, and is studied by psychologists, physicians, educators, and researchers in the fields of social service.”

Dr. Rajih points out that people are more concerned about their mental health today than in the past, and that this has evolved with the increase in crises, technological development, the establishment of giant factories, the emergence of deadly weapons, the spread of conflicts, and other factors that have made the world live in almost constant anxiety.

Regarding the scientific concept of mental health, Rajih explained that the World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can make a contribution to his or her community.”

Meanwhile, psychologist Dr. Fadhila Al-Shuaibi says: “Man entered the twenty-first century carrying with him from the last century a heavy burden of economic, political, social, health, and educational problems, especially in the last decade, which witnessed political conflicts that affected most countries, including Yemen.”

Al-Shuaibi also explains that the concept of mental health is one of the symbolic or hypothetical concepts because it does not refer to something quantitative or embodied, but rather refers to the behavior of the individual, including his emotions and thinking, and changes with the change of different viewpoints and varies according to the angle from which theorists and different schools of psychology view it.

In the same context, Dr. Rajih explained that mental health is of paramount importance in the life of the individual and society. For the individual, it helps them solve the problems they face in life to live a healthy social life, focus and emotional balance, security, tranquility, psychological calmness, and success in their professional life. It also works to support their physical health and achieve their productivity and efficiency.

Dr. Mursila Al-Awadhi, a psychotherapist at Dati Mental Health Consulting, Ibb Governorate, adds: “Mental health is closely linked to a person’s adaptation and compatibility with himself and his society, and is not limited to the absence of mental disorders. It is part of a complex chain that varies from person to person, characterized by varying degrees of difficulty and distress, and with social and clinical outcomes that are likely to be very different.”

She adds: “Mental health conditions include mental disorders and psychosocial disabilities, as well as other mental states associated with severe distress, impaired functioning, or risk of self-harm. People with mental health conditions are likely to experience lower levels of well-being, but this is not always or necessarily the case.”

Regarding the levels of mental health in Yemen and the extent of attention paid to it, Dr. Rajih points out: “When we talk about mental health in the country, we are putting ourselves in a vast sea whose shores we cannot reach; attention to mental health only began recently and with limited resources. Before 2006, attention was minimal, and there were only four hospitals specializing in mental and psychological disorders, limited to Sana’a, Aden, Al-Hodeidah, and Taiz, with a capacity of 850 beds.”

He adds: “There were five private clinics with a capacity of 100 beds, also exclusive to the aforementioned cities. As for clinics, there were 45, and the number of mental health nurses in Yemen was 197, with 45 psychiatrists and 3,000 psychologists distributed among academic, medical, and social affairs offices.”

Al-Awadhi mentioned that mental health in Yemen is not among the health priorities and strategies for its promotion, nor does it constitute part of social development plans. The long years of conflict in Yemen have not only cast a dark shadow on its infrastructure but have also extended their effects on the health and well-being of its population.

She asserts that mental health has long been neglected until this hidden crisis has worsened in the depths of society. Many areas in Yemen suffer from a severe shortage of mental health services and psychosocial support due to the small number of trained specialists and treatment centers.

She points out that even in areas where such services are available, some may find it difficult to access them due to social stigma or low income. She mentioned that the number of people suffering from psychological trauma and stress resulting from the ongoing conflict, according to a World Health Organization report in Yemen, is about 7 million people, nearly a quarter of Yemen’s population. While they all need mental health support, only a few have continuous access to services.

Factors Affecting Mental Health

“There are several factors that negatively affect mental health, including psychological pressures, which are the most significant factor affecting an individual’s mental and even physical health. Other factors include dietary patterns, conflicts and crises, social relationships, family environments fraught with disputes, low economic status, and many other factors,” according to Dr. Rajih.

Al-Awadhi mentioned a group of genetic and environmental factors that predispose to mental disorders, saying: “Heredity plays an important role in carrying the predisposition to mental illness, taking into account that genetic factors do not mean the inevitability of developing mental disorders, and that the parents’ or one of them having a mental illness does not necessarily lead to the children or grandchildren being affected, but rather it is one factor among several intertwined and common factors.”

She also pointed out that biological factors, such as brain injuries, meningitis, encephalitis, and malnutrition, have a significant impact on the occurrence of mental health disorders. There are family causes, such as the absence of the mother, especially in the early stages of life, as well as continuous public family disputes between parents, in addition to divorce and the displacement of children, all of which leave deep scars and affect the individual’s mental health.

She also mentioned that wrong upbringing methods based on violence, criticism, comparison, beating, yelling, and ridicule, or excessive pampering, overprotection, and inconsistency in the upbringing process, create shaky personality patterns and cause mental health imbalances. The physical, emotional, or sexual abuse of children is also a factor related to the emergence of mental disorders. Other factors affecting mental health include political and social conflicts, natural disasters, and difficult economic conditions.

From Traditional Asylums to Expanding Services

Al-Shuaibi says: “In 1966, Yemen witnessed the opening of the first mental asylum in the city of Aden, established by the British authorities and continuing until independence in 1967. According to a study entitled “Mental Health in the Republic of Yemen Between the Past, Present, and Future Prospects” by researcher Bilqis Jabbari, the asylum relied on only one foreign doctor and one pharmacy specialist, in addition to seventeen nurses. The asylum consisted of rooms resembling cells, as it received patients from Al-Mansoura Prison.”

Al-Shuaibi added that in North Yemen, in 1976, Al-Salam Asylum was built in the city of Al-Hodeidah, however, it did not provide any mental health services and was confined to the role of housing the mentally ill. In 1978, a Bulgarian psychiatrist was summoned to a specialized clinic at the Republican Hospital in Sana’a, and after a short time, another European doctor was employed at the Neurology Clinic at the Military Hospital to treat severe cases of mental illness.

In 1980, the World Health Organization launched an important initiative in Yemen to develop mental health care by issuing an assessment study on the state of mental health in Yemen. Following this study, the organization established psychiatric departments in three hospitals, in Sana’a, Taiz, and Al-Hodeidah, according to Jabbari’s study.

The study also indicates that Dr. Ahmad Makki was the first Yemeni doctor specializing in psychiatry, and he supervised the Department of Psychiatry at Al-Thawra Hospital in Sana’a in 1981. In the same period, Dr. Abdullah Al-Kathiri began working in Aden, the first Yemeni contribution to the field of mental health in Southern Yemen.

In 1986, a study by Jabbari showed that there were only three psychiatrists in North Yemen, despite a population of nine million. It also revealed that mental health services were officially integrated into primary health care in South Yemen in the early 1980s through the “Mental Health” program launched by the World Health Organization. This program sought to expand mental health services in the southern governorates through training workshops for doctors in Lahj, Hadhramaut, Shabwa, and Abyan, under the supervision of the Ministry of Health.

Later, Aden University Hospital for the treatment of neurological and psychological disorders was opened in 1984. Between 1986 and 1990, the old Aden Asylum was closed, and patients were transferred to the new hospital clinic.

For her part, Al-Shuaibi indicated that after the establishment of the united country, the administrative and supervisory bodies in the organizational structure of the Ministry of Health were developed, the Supreme Council for Mental Health was established, and the National Mental Health Strategy was developed, which the World Health Organization helped prepare in 2004. The strategy aimed to raise mental health awareness and enhance access to services in this field.

A Complex Journey and Ongoing Challenges

Despite the widespread prevalence of mental and psychological disorders among the Yemeni people and the limited spread of mental health services by organizations and other entities, public awareness remains minimal. The stigma and societal perceptions still haunt those suffering mentally, making them refrain from seeking mental health services.

Dr. Rajih believes that this condescending view exacerbates the situation and increases the crisis. He considers it one of the obstacles preventing the service from reaching the citizens. He also mentioned that the most important challenge facing the mental health sector in Yemen is the scarcity of mental health services at all levels, and even when available, they only cover specific governorates or certain areas within those governorates.

Psychotherapist Al-Awadhi adds: “The issue of mental health in Yemen is a matter that deserves attention. Despite efforts to enact a mental health law in 2004, approval by the Yemeni Parliament has not yet happened. To avoid stagnation, amendments and improvements were made to the law, which ultimately led to the preparation of the 2007 Mental Health Bill, to regulate mental health services in the country. Unfortunately, this bill was not approved either.”

She points out that Yemeni doctors face many challenges in securing funding for their clinics. Despite this, national advocacy efforts for mental health issues remain weak, and the problem is compounded by the social stigma surrounding the concept of mental illness. Many Yemenis are hesitant to express their concerns or seek specialized services to deal with their health conditions.

Reports also indicate that Yemeni people suffering from mental illness are being detained in their family homes. Other news reveals that some segments of Yemeni society, including women, face particular challenges in accessing necessary care.

Al-Awadhi explains that the specialization of mental health in university education has its challenges. Some medical professionals believe that the public stigma casts a shadow on the continued interest in the field and attracting enough students.