Mental Health Advocacy in Lebanon: Fighting Stigma Without Providing Access

If you look up the work of leading NGOs on mental health in Lebanon today, you will come across numerous awareness campaigns centered around fighting the stigma on mental illness. Embrace, for example, has launched a yearly event entitled “Break the Stigma” in collaboration with the AUB Psychology Student Society, where patients share their experiences with different mental disorders. IDRAAC’s work is also heavily focused on mental health awareness campaigns, including periodic lectures in schools and universities.

Obviously, such initiatives are much needed to challenge the dominant attitudes of ridicule, disrespect, insensitivity, and aversion towards people with mental illness. Breaking the stigma not only means compelling society as a collective to understand the reality of mental illness though; it also helps  individuals recognize the symptoms of mental disorders and urges them to seek care if they present with these symptoms. But, how can one even access mental health care in Lebanon?

With the exception of the free healthcare (of doubtful quality) that one could receive at the primary health centers of the ministry of health's network, one usually has to set aside a hefty budget to get proper mental health treatment. Currently, the overwhelming majority of private insurance companies do not include mental health in their healthcare coverage, not even if one is willing to pay a higher premium for it, and certainly not for outpatient care. This may be the case because people still do not consider psychological or emotional suffering to be “real” or a “medical problem.” But one also has to wonder how much the excessively high prices charged by psychologists and psychiatrists play a part in deterring insurance providers from covering their consultations (especially considering the unique feature of therapy and psychiatric consultations: their need to be repeated periodically).

In the rare cases where mental health is covered, the person seeking care has to overcome many bureaucratic hurdles to secure their right for coverage. For example, to get covered for mental health treatment by Health Insurance Plan (HIP) at AUB, you first have to fill out a request form in person. After a week (if you’re lucky - sometimes it takes up to 3 weeks), you go back to receive a referral to a specific psychiatrist or psychologist on campus. After getting a referral, you take an appointment from the AUBMC psychiatry department. On the day of the appointment, you have to get the referral stamped at the HIP office and give it to the secretary of the psychiatry department. If you do not present this paper before the appointment (but on the same day), HIP refuses to cover the fees. If you need follow-up sessions, you have to ask the doctor to write a report specifying that you are in need of more sessions. This report must be taken to another office to be processed, which usually takes about 1 week. Then, you have to go back and take another referral, specifying how many follow-up sessions will be covered automatically. Again, on the day of the next appointment, you have to take the paper given by UHS and get it signed by HIP. And the cycle continues. (Note: HIP actually only fully covers the first 3 sessions).

Step-by-step guide to HIP mental health coverage prepared for students by the AUB Graduate Student Society

Few patients end up completing this overwhelming bureaucratic process process to actually receive mental health services. I stopped my therapy because of the countless steps required of me; I was too depressed to go from office to office getting signature after signature in order to feel better.

So, if you have been graced by one of the mental health awareness campaigns and realized that you need care, you’d have to pay $50 weekly on average to see a psychologist and maybe an additional $100 periodically to see a psychiatrist, or go through a million procedures (which, ironically,  your mental condition might prevent you from doing) to get coverage.