The Embrace Lifeline (1564) received more than 1,100 calls in December 2019, the highest number that Lebanon’s first national suicide prevention helpline has accepted since its launch in 2017.
The NGO offered several explanations for this call rate, including both greater distress and built-up frustration felt by people in Lebanon due to the ongoing political and economic crisis. Anti-government protests began in Lebanon five months ago, and people continue to demand basic rights and reform to this day. The country’s economic downturn has exacerbated, political upheaval intensified, and activists are increasingly being pressured.
Economic crises can affect mental health either by weakening protective factors such as job security or by increasing risk factors such as loss of socioeconomic status. On November 6, 2019, the World Bank warned that poverty in Lebanon could rise to 50 percent if the economic situation worsens.
On November 14, 2019, the Arab Barometer released their report in which they surveyed 2,400 individuals between September and October 2018. When asked about the economic situation in Lebanon, 23 percent of responders said that it will get worse in the next few years and 36 percent said that it will become much worse. The votes of the latter seem to be the current reality.
Studies that examined health consequences of economic crises suggest a significant relationship between these periods and psychopathology, including psychological distress. A clear mental health agenda should be set to mitigate the impact of the economic crisis on mental health. What is the profile of mental health difficulties during such a crisis, and what actions can be taken to lessen the damage?
The profile of mental health difficulties during an economic crisis
The full impact of the current crisis on mental health remains to be seen, but reports of negative effects have already emerged –such as increased suicide attempts, although we do not adopt that economic hardship is the dominant cause. Economic downturns bring multiple types of economic hardships to the population, such as declines in household economic resources.
Because distress during economic downturn has a fluid nature, some individuals may be affected by one hardship or experience multiple hardships.
Focusing on only one type, such as an individual’s own unemployment, may underestimate negative effects on the mental health of those who did not lose a job but whose well-being was affected by factors such as the unemployment of others who normally contribute to household income.
While research dealing with the consequences of economic turmoil on health and health behaviour is varying, a broad consensus exists regarding the negative consequences of economic crises on the rates of depression, anxiety, insomnia, alcohol abuse, and suicidal behavior.
Specifically on drinking, alcohol use seems to decrease during periods of economic downfall –most likely due to pricing effects. However, there is an increase in binge drinking, alcohol-related harm, and dependence. Lastly, it is important to note that many of the adverse effects of economic downturn on mental health can be pervasive or manifest fully after the onset of the crisis.
Actions on a system level to lessen the impact of the economic crisis
The World Health Organization (WHO) indicates that the association between economic crises and many negative mental health outcomes is avoidable.
On the one hand, there are few international initiatives that address mental health during an economic crisis, such as the guidance published by the European Psychiatric Association. On the other hand, the mental health field in Lebanon experiences several challenges, such prevalent stigma and scarce resources. While such challenges are not unique to this country alone, applying foreign models nonetheless should be exercised with caution.
The health sector on its own cannot achieve good mental health, especially considering that the resources in that sector are often scarce.
A solid plan in this domain requires a holistic approach that calls for interventions across several sectors and takes into account the available resources in adjacent systems that can have an impact on mental health.
Speed up care reforms
To meet the mental health challenges of the economic crisis, both the protection of spending on mental health services and the restructuring of services to meet the needs of the population are required. The mental health care system must liaise with resilience-strengthening elements in the Lebanese community to create a comprehensive and accessible network.
Increased access to community-based services is also advised, as well as increasing cooperation with social services involved in attention of people most affected by the aftermath of the economic downturn.
It is also necessary to continue tackling stigma towards people affected by mental disorders, such as through Neshan’s TV episode on mental disorders in ‘Ana Hek’ and the campaigns of several local NGOs. Awareness can also be established by introducing e-mental health services, such as step-by-step intervention.
Similarly, establishing an evidence-based and cost-effective portfolio of services and programs to tackle the current economic crisis can help meet different mental health challenges.
Debt relief programs
People should be able to return to a dignified and economically active life –partly through preventing people from becoming over-indebted and making it easier for them to pay their fair share.
Strengthen social capital
Social capital covers the resources available to individuals and society which are provided by social relationships or networks. It constitutes a safety net against the adverse effect of macroeconomic changes, with greater levels of perceived helpfulness within communities and participation in group activities being associated with better levels of mental health. Some of the initiatives include “Lebanon Needs,” “Muwaten Lebnene,” and “El Nass La Ba3da.”
Address housing instability and children’s education
Maintaining and promoting children’s education helps enrich a healthy lifestyle and has a long-term impact, which makes a strategy prioritizing active employment and family promotion over passive income maintenance advised.
If homelessness increases, public administrations and NGOs should cooperate to provide in the short run more emergency shelters and transitional housing for homeless people, such as the “Mission Village” initiative. Programs to reduce homelessness and other forms of housing instability should also be started.
Social inequalities may not only be economic. Promoting individual, family, and community connectedness, as well as social integration, and positive attachments to community organizations supports well-being and decreases inequalities.
Social capital serves as a protective factor against poor mental health, including suicidal thoughts. Reforms to social welfare to maintain or strengthen safety nets –especially to those affected by hardship, and taxation systems– and reduce income inequalities is warranted.
Promote the coordination or integration of primary care and psychological care
In the context of an economic downturn, several programs should be included in the interface of primary and mental health care, such as programs for the prevention of suicidal thoughts and behaviors, support for the unemployed and those in debt, interventions for heavy drinkers, and programs to address common mental disorders.
Other applicable courses of action include controlling alcohol price and availability, as well as responsible media coverage of suicides.
Promoting a mental health agenda during an economic crisis should also partly involve policy-makers. It is probably best achieved by advocacy through international organizations that may exert political leverage through lobbying interested parties and backed by evidence on cost-effectiveness. It is furthermore crucial that different mental health providers are supported on the ground.
The economic crisis in Lebanon is putting a strain on many individuals. Generally, several actions can be taken to increase community resilience against economic hardships and mitigate the negative mental health effects of these hardships.
Embrace listed few tips on taking care of oneself during uprisings:
Be informed, know more: Uncertainty can be overwhelming and is normal. Join discussion groups taking place to help you become more informed and answer some questions you may have.
Take a digital break: A few hours every day away from all media outlets to recharge and refuel.
Get enough sleep: Save your energy for day time. Sleep helps keep your mood in balance.
Eat regular meals: While everything in your daily routine may be changing, keeping your meals scheduled will help bring back some structure.
Check in with family and friends: If they are feeling too tired, advise them to get some rest.
Make use of your personal skills: Be active in the ways that suit you most and are close to your skill set and which you are most effective at. You don’t need to do everything at once.
Declutter your social media: Unfollow accounts that may be negatively affecting you or publishing negative content. Also avoid sharing negative content yourself.
Engage in small kinds of acts of kindness: Smile and say “hello,” “thank you,” and “ya3tikon el 3afye” to friends and strangers. It will make their day.
Do not forget to seek professional help should there be a need to do so.