Morocco struggles to meet citizens' mental health needs

2009-04-03

Morocco trails Algeria and Tunisia for access to in-patient mental health care. With Moroccans often struggling to care for sick family members, the country hopes to boost psychiatric treatment options.

By Sarah Touahri for Magharebia in Rabat – 03/04/09

[Sarah Touahri] Shortages of personnel and resources affect most Moroccan hospitals.

Outrage over the triple murder committed March 26th by a deranged young man in Rabat has prompted government officials and health care professionals to take a closer look at the effectiveness of psychiatric treatment in Morocco. From representatives of charities working in the sector to family members of patients, people are speaking out about what they see as a perilously inadequate mental health care system.

According to official statistics, the health ministry employs a total of 116 psychiatrists at 9 mental hospitals and 16 provincial medical centres. There are also 14 psychologists to provide assistance for hospital patients. The country has 1,910 hospital beds.

"Our Algerian and Tunisian neighbours", however, have three times the number of beds available to Moroccans, says Driss Moussaoui, director of the Ibn Rochd University psychiatric centre.

The infrastructure problem goes beyond a mere lack of beds. There is also a desperate shortage of qualified personnel. Across the whole country, there are just 350 psychiatrists, or one for every 100,000 people.

Faced with this situation, Moroccan families are often left to fend for themselves when it comes to providing care for their mentally ill relatives. "Many lack adequate support," Naima Trachen, the chairman of Amali, an association dedicated to outreach and training for families of people with psychiatric problems.

Parents live with the terrible burden of trying to manage their children's illness. Some are faced with an untenable choice: to care for a sick relative or else abandon their jobs.

Wassila Himmadi has a 23-year-old son who suffers from a mental illness; his condition was detected at the age of fifteen. She used to work as a teacher, but had to leave work to look after her son. For eight years, she has been watching over him day and night.

Sometimes he becomes aggressive and causes enormous damage to his surroundings.

"I would have loved to place Saâd with a specialist organisation so that he could be properly cared for and develop his full potential despite his handicap. But unfortunately, mental health centres are sadly lacking. Those which do exist can only take on chronic cases," she tells Magharebia, sad but resigned.

Her case is like that of many other families. Still, Wassila is able to manage from day to day, thanks to her husband’s comfortable financial situation.

Others are not so fortunate.

Siham’s life is a nightmare. She has no financial resources. Every morning, she locks her 20-year-old mentally-ill daughter in her room to go and find work. "When I'm not there, she shouts and breaks everything. But I'm forced to leave her so that I can put food on the table and pay the rent for our room," she says.

In the five years since her husband abandoned the family, her daughter’s condition has deteriorated. Siham does not have the money to buy the drugs a doctor prescribed to keep her daughter calm, so she has to suffer her offspring’s extreme mood swings.

"The neighbours have turned their backs on me because they've all been mistreated by Aïcha. I too have to suffer her bad temper when I return home. But I'm her mother and I have to put up with it all, even though I sometimes wonder whether the State shouldn't accept some responsibility for its sick citizens who need special permanent care," she adds.

There is one question which constantly eats away at her: "What will become of my daughter when I'm no longer in the world?"

Some families eventually give up on this "delicate and exhausting calling" of caring for the mentally-ill. They choose to abandon their sick relatives, leaving them to face the realities of life on the streets alone.

Saïd M., who is in his sixties, tells Magharebia the story of his brother Moha, who suffered for ten years because of his wife's mental illness. Moha finally left Kenza to her fate in Marrakech, where charitable visitors might give her alms.

"He tried everything to get her better," Saïd explains. "He looked after her. But he decided to leave her alone in a mausoleum when he had used up his finances and could no longer take care of her. After that, we heard nothing more about her."

"Perhaps she’s dead now, or wandering the streets," he says.

To respond to the needs of the population, doctors and nurses are calling on the government to broaden the health care infrastructure and train more personnel.

"It is inconceivable to have a hospital with 180 patients and no ambulances," says Hassan Rami, a nurse at Berrchid psychiatric hospital.

Moussaoui, a university professor, says that while the situation in Morocco is certainly worrisome, it is still better than it was three decades ago.

Despite improvements in recent years, the Health Ministry recognises that much still needs to be done. Under the 2008-2012 national action plan, Morocco aims to improve psychiatric care and combat the discrimination and stigma which cause suffering among the mentally ill. Another element of the plan addresses mental health in children and teenagers, paying particular attention to the problem of drugs.

In practical terms, the plan will create 1,000 hospital beds and 100 outpatient venues. Four specialty care facilities for children and teenagers will open over the next three years.

Patients will have guaranteed no-cost access to certain psychotropic drugs and the ministry will train hundreds of psychiatrists and psychiatric nurses.

A 2007 national survey of the prevalence of mental illness in the general population – the first of its kind in Morocco – showed that 48.9% respondents displayed at least one sign of poor mental health, such as nervous tic, insomnia, anxiety, or depression.

According to the Health Ministry report, mental disorders affect at least 5% of the adult population. In other words, there are 1.5 million Moroccans in need some sort of mental health care.