The Reality of Mental Health in Yemen

Mental health is a key factor in ensuring the well-being of individuals and communities. It contributes to emotional and mental balance and strengthens the ability to cope with various life challenges. In Yemen, people are suffering from immense psychological pressure due to the ongoing conflict, the deteriorating economic situation, and the general decline in health and public services.

This report aims to discuss the concept of mental health and its indicators in Yemen, along with an overview of the reality of mental health services the impact of the conflict and the economic crisis on Yemeni society, and the level of health services for the most affected groups, such as children and women, as well as the most common mental disorders prevalent in times of conflict.

The Concept of Mental Health and its Indicators

Good mental health is a state of integration of the individual’s different energies, leading to a positive investment in reality. It is a broad, undefined concept, and culturally and relatively defined by nature, changing with the changes in information about life, what it should be like, what we discover about ourselves and our behavior, and what we should achieve in our lives.

Mental health does not merely mean the absence of mental disorders; it also refers to a general state of emotional and mental well-being that enables individuals to recognize their abilities, work effectively, adapt to life stresses, and contribute positively to society.

Good mental health indicators have several aspects including:

1- Ability to deal with challenges: such as the ability to face crises and stressful situations without psychological breakdown.
2- Positive social interaction: where individuals can form positive relationships with others and maintain strong social bonds.
3- Emotional stability: this includes balance in emotional responses; the individual is not overly affected by external factors.
4- Ability to work and produce: meaning that the individual can perform their daily duties and work effectively while maintaining a level of self-satisfaction.

In Yemen, with the conflict continuing for years, these indicators are greatly negatively impacted. Individuals suffer from insecurity, extreme poverty, and displacement, making it a major challenge to maintain their psychological balance.

Importance of Mental Health for the Individual and Society

Mental health plays a major role in choosing the right and balanced therapeutic approaches for social problems that may affect the individual’s psychological development, and some of the important points for mental health can be summarized as follows:

1- Self-stability of the individual: their life is free from tensions and fears, and they often feel calm, peaceful, and self-assured.
2- Mental health creates stable and well-adjusted individuals: the more parents enjoy the right level of mental health, the greater the impact on stability. A family that raises psychologically healthy children enjoys cohesion, synergy, and stable psychological strength, internally and externally.
3- Mental health is effective for the individual: it allows them to open up their minds, the ability to understand themselves and those around them, and makes them more capable of controlling their emotions, feelings, and desires, and guiding behavior in a healthy way away from maladaptive responses.
4- Having mental health makes the individual more adaptable to deal with different problems positively: balancing their emotions when facing various life pressures, overcoming them, and taking responsibility without escaping or withdrawing.
5- Mental health makes individuals congruent with themselves and adapted to their society: Their behaviors are often healthy, likable, and satisfactory to those around them. Just as mental health has great importance at the economic and productive levels and contributes to achieving the principle of sustainable social development, the individual who enjoys mental health is capable of taking responsibility and utilizing their energy, abilities, and skills to the fullest, making them more effective and productive as well.

The Reality of Mental Health in Yemen

Mental health services in Yemen are in a terrible state, both in terms of infrastructure and specialized staff. Historically, mental health hasn’t been a priority in the Yemeni healthcare system, but things have gotten worse since 2015. Here are some of the biggest challenges:

1. Not enough specialized mental health facilities: There are only a handful of hospitals and centers in Yemen that offer specialized mental health services. Most of them are in big cities like Sana’a, Aden, and Taiz. With the security situation getting worse, a lot of these facilities have been damaged or closed down.
2. Lack of specialized staff: The mental health system is seriously lacking in psychiatrists, trained nurses, and behavioral therapists. The national mental health strategy for Yemen from 2022-2026 shows that there are only 26 psychiatric consultants (25 men, 1 woman), 37 psychiatric practitioners (29 men, 8 women), 12 psychiatric trainees (9 men, 3 women), 88 psychotherapists, 141 psychiatric nurses, and 1 rehabilitation specialist.

It gets worse because not many people want to study psychology in government universities because there aren’t many jobs for graduates in psychology departments at the College of Education and Arts. There are also only a few psychiatrists, as mentioned, and the lack of a psychology department at government universities and a lack of funding for studying abroad in this field make things even worse.

3. Shortage of treatment and psychological support programs: There aren’t any comprehensive programs to provide psychological support in conflict zones or to help displaced people. Some NGOs and humanitarian organizations are providing limited services, but it’s not enough for the growing need. Even though organizations like UNICEF, the WHO, and local institutions are trying to offer psychological aid, the infrastructure for mental health services in Yemen still can’t handle the huge number of mental illnesses. These cases are increasing all the time, especially as the economy gets worse in the second half of 2024.

Statistics show that there are more than 8 million people with mental illnesses in Yemen, which is a huge number compared to the population. Based on last year’s statistics from 2023, the Mental and Nervous Diseases Hospital in Taiz receives around 5650 cases each year, and in the last few months of 2024, they’ve been seeing around 30-40 cases every day. Local organizations and institutions in Taiz say there’s almost nothing in the way of programs for mental health treatment like cognitive therapy, behavioral or humanistic rehabilitation, or psychoanalysis.

A unique and successful initiative that has helped relieve a lot of psychological pressure is the Family Development and Guidance Foundation, which has several branches in Sana’a, Aden, and Taiz. They have organized awareness campaigns to prevent mental illness and promote mental health, along with running lots of specialized psychological camps supervised by psychiatrists. They’ve also set up a free hotline (8000136) that can be called from every province in Yemen and every local phone company so callers can get help with their mental health issues. All of these services have been available since 2011.

By analyzing the weaknesses in Yemen’s mental health situation, we find the following:

1. Funding: There’s limited money for healthcare in general, and mental health in particular. There haven’t been any financial incentives (salaries) for healthcare workers since the crisis began, and there’s been a lack of training and development for specialists in the mental health field.
2. Access to service: The quality of services provided by healthcare facilities is low because there are staff shortages, facilities have been damaged or destroyed, and the quality of service in many facilities is poor. Mental health services are concentrated in big cities and are rarely offered in rural areas across Yemen. The social stigma attached to mental illness makes things worse because people don’t get the specialized mental health services they need.
3. Capacity and social barriers: These include a lack of technical expertise in the mental health field coupled with weak current capabilities. Healthcare workers are reluctant to study mental health because of the stigma. There aren’t evidence-based approaches to mental health in training and qualifying mental health providers, and there’s no integrated management of cases with mental health services and policies in health, education, and other sectors.
4. Legislation: There’s no mental health law or legislation to support related interventions for capacity building.

The Psychological and Social Impact of the Political Conflict

The ongoing conflict in Yemen since 2015 has had a deep impact on Yemeni society, not just physically, but also mentally and socially. Some of the most significant psychological impacts on people include the emergence of many mental disorders, most notably:

1. Post-Traumatic Stress Disorder (PTSD): PTSD is one of the most common mental disorders in Yemen due to the continuous fighting. Many people have experienced traumatic events like losing loved ones, being subjected to extreme violence, or surviving bombing attacks. This has led to an increase in cases, and the symptoms include recurring painful memories and nightmares in both children and adults.
2. Anxiety and Depression: The ongoing uncertainty and unclear future, whether due to fear of bombing, hunger, displacement, or skyrocketing prices, contribute to a rise in anxiety and depression rates among Yemenis. Some studies show that depression is more prevalent in Arab countries like Yemen, Egypt, and Tunisia. Symptoms include constant worry, obsessing over future anxieties, feeling constantly sad, and not enjoying previously enjoyable activities. This can even lead to thoughts of suicide and death.
3. Addiction: Cases of addiction have increased significantly, especially with the absence of control and the entry of narcotics. Unemployment has also led to an increase in addiction, whether as victims or drug dealers, including sedatives, khat, alcohol, and others.

Negative Impacts of Conflict on the Social Level

The conflict has weakened social relationships and increased distrust among people. Many families have been separated due to displacement or fighting, negatively impacting traditional social ties.

• Divorce rates have increased due to marital disputes arising from the inability to bear the burdens of married life and raising children. This is compounded by a lack of or weak skills in handling family pressure, limited employment opportunities, and the negative impact on family breakdown.
• The conflict has not only impacted individuals mentally but also changed society’s dynamics as a whole. It has led to the collapse of educational, social, and health institutions, creating social chaos.
• Cases of domestic violence have worsened amid psychological stress and economic pressure. Crime and violence rates have also increased due to the deteriorating overall situation.
• Social illnesses like endemic poverty, malnutrition, disability, economic and social decline, and mental and social illnesses that disrupt social balance have become widespread.

According to a study published in March 2022 funded by G.I.Z, the most prominent social problems arising from the conflict are: separation between spouses, separation from children, displacement, forced migration, divorce, gender-based violence, sexual harassment, murder, high cost of living, lack of basic services like water and electricity, extreme poverty, salary cuts in northern areas, and poor healthcare and educational services.

The Impact of Economic Decline and Inflation on Mental Health in Yemen

The political conflict has significantly contributed to the deterioration of Yemen’s economic situation, a key contributor to psychological stress for Yemenis. Some of the most significant negative impacts of the economic decline include:

1. Unemployment: Many people struggle with unemployment or job insecurity. UN reports state that over 80% of the population lives below the poverty line, increasing psychological pressure on individuals and their families.
2. Rising prices and food shortages: Yemenis are experiencing an enormous increase in the cost of living, leading to increased hunger and malnutrition which further increases tension and frustration, especially when struggling to access essentials like food and clean water.
3. Family tension: Financial pressure often leads to escalating tension between family members, resulting in increased domestic violence and separation.
4. Persistent poverty and inflation: This leads to increased mental health issues like depression and anxiety. Feelings of helplessness and despair become prominent signs of psychological stress for individuals. Poverty has also led to the spread of sexual deviance in society across all age groups.

The Impact of the Conflict on the Mental Health of Children and Women

The conflict directly impacts the most vulnerable groups (children, women, and people with disabilities). Here are some of the most significant effects:

1. Children: They are the most affected by the ongoing conflict, which has shattered their childhood. They are exposed to various forms of violence, leading to serious psychological disorders like post-traumatic stress disorder, constant anxiety, bedwetting, aggression, nightmares, memory impairment, learning difficulties, nervousness, isolation, speech disorders (stuttering and lisping), phobias, conversion hysteria, and dissociation.
2. Women: The conflict has made women vulnerable to sexual and physical violence. It has increased psychological pressures associated with losing family members, declining economic conditions, and the effects of displacement. Women sometimes become the sole providers for their families, adding an extra psychological burden. They suffer from mental health issues like depression, anxiety, obsessive-compulsive disorder, schizophrenia, mania, and bipolar disorder due to the harsh experiences they’ve faced.
3. People with Disabilities: With weak care from both society and government agencies, their situation has worsened during the conflict. They lack access to healthcare, education, mental health services, and social support.

The conflict in Yemen is a major source of mental health deterioration in society. It has affected all aspects of people’s daily lives. With a shortage of mental health services and a lack of sufficient support from the international community, Yemenis face significant challenges in dealing with the psychological stress imposed by the conflict. There’s an urgent need for immediate interventions to rebuild the mental health system and support the most affected groups.

Recommendations and Proposals

After reviewing the nature of mental health, its importance, its reality in Yemen, and the impact of the political conflict on the deterioration of mental health and its services in Yemen, we can offer several recommendations and proposals to relevant parties to ensure attention is paid to mental health services, positively impacting individuals and the community. These recommendations are as follows:

• Qualifying government facilities that provide mental health services and equipping them with the necessary resources to achieve sustainable development, with a focus on opening psychiatric departments in hospitals related to receiving cases involving women and children.
• Relevant authorities in the Ministry of Health should seek to employ mental health professionals in health facilities, especially those near population centers and displaced people.
• Training healthcare professionals, especially nurses and general practitioners, in basic psychological support skills and some counseling and psychotherapy skills.
• The Ministry of Health should supervise organizations that provide psychological support projects to ensure monitoring of the programs offered, including the type of specialists implementing the project, its content, the evaluation of its return on investment, and its impact on the target audience.
• Coordinating with universities and accredited training centers to allocate job positions in clinical psychology, psychiatry, or psychiatric nursing, contributing to bridging the gap resulting from a shortage in specialized mental health personnel.
• Recommending that the government sector and organizations operating in Yemen increase funding for mental health programs.
• Integrating mental health programs and services through the national strategy for primary healthcare.
• Conducting a recent survey on the reality of mental health at the national level.
• Implementing mental and social support programs during crises in schools, universities, and areas where displaced people are concentrated.
• Establishing a unified mental health database system that facilitates its circulation and use in all governorates of the republic and can be built upon during interventions and mental emergencies.
• Contributing to periodic community awareness and education campaigns about the dangers of mental disorders, social deviations, drug use and addiction, and their impact on mental health.
• Providing safe spaces to reduce anxiety and promote a sense of security under the supervision of mental health professionals.