by Loubaba El Wazir
This article is part of our Conflict & Health in the Eastern Mediterranean Series. Read the Series Introduction.
As Lebanon navigates dark times, the country’s youth struggle to manage their mental wellbeing amid economic and political instability. The country witnessed a nation-wide revolution in October 2019 in reaction to rising taxes and projections of economic collapse. Adding fuel to the fire since has been the banking crisis, the COVID-19 pandemic, and a massive explosion in Beirut in summer 2020. In less than a year, Lebanese youth were left with a devalued national currency, skyrocketing inflation, plummeting job opportunities, and a society poised on the precipice of conflict and self-division.
While there is evidence that riots and protests substantially increase the prevalence of Major Depression and Post-Traumatic Stress Disorder[1], research on the impact of economic and political unrest on mental health in developing countries remains widely unavailable. Our understanding of the latter dynamics could alternatively be informed by the narratives and experiences of mental health practitioners. In our interview*, Dr. Joseph El-Khoury argued that youth are at a high risk of developing mental health disorders in these circumstances due to a fluctuating sense of identity, belonging, and stability. Such issues have already been documented among Arab youth who experienced demographic and political crises[2]. Based on the increasing rates of care seekers, Dr. El-Khoury predicts that if the current state of affairs persists “we could witness more chronic disorders, including depression, anxiety, insomnia, and addiction, affecting an entire generation for the long-term”.
Unsurprisingly, signs of increasing mental health problems have already surfaced. The country’s national suicide hotline managed by Embrace, a mental health non-governmental organisation, has gradually been receiving more calls throughout the crises, with calls rising from 219 in September 2019 to 565 in January 2021. Their last report shows that 58% of these were received from individuals aged 18 to 34 years. One can also observe those struggles first-hand on social media platforms, where Lebanese youth express and share their trauma. Following the Beirut explosion, many tweeted sarcastically about the symbol of Lebanon being a rising Phoenix. Others explicitly denounced resilience, which for them is equivalent to an acceptance of their agonizing reality.
Nevertheless, according to Dr. El-Khoury, the number of people who actually seek professional mental health services reflects a treatment gap. This was previously documented by a national study conducted in 2006 and published in The Lancet, estimating that 89.1% of mental health disorders in Lebanon receive no treatment[3]. Yet, this situation is likely further exacerbated by the economic crisis, which has led most psychologists to raise their fees. Salem, a young Lebanese who struggles with mental disorders, told me that the cost of his sessions has more than tripled since last year, jumping from 75,000 LBP to 250,000 LBP per session. This spike is caused by the banking sector’s loss of liquidity and subsequent devaluation of the national currency. While the central bank of Lebanon continues to peg the Lebanese Pound (LBP) to the USD at 1$= 1515 LBP, banks currently operate at a different exchange rate (1$= 3900 LBP) and the black market has a yet different and constantly fluctuating rate that has reached around 1$= 12,000 LBP in the past couple of months. Given that therapy sessions are priced in USD and psychologists have the freedom to choose which exchange rate to operate with, the range of therapy fees has become vast across clinics, with sessions costing between 150,000 LBP and 800,000 LBP. Not only does this situation restrict the population that is financially capable of accessing mental health care, but it also affects the general public trust in the mental health sector.
The economic crisis has also impacted mental health by diminishing resources that are vital to the sector. The main damage it caused was pushing a big portion of the health workforce abroad. In our interview, Dr. El-Khoury expressed that mental health professionals are “both providers of care and in need of care… socially”, adding that many practitioners are forced to immigrate due to inadequate working conditions and salaries. Moreover, psychiatric medications and comprehensive mental health programs have not escaped the influence of the economic crisis, with many medicines and treatments either completely running out or becoming excessively unaffordable.
This dismal situation leads us to the question of mental health access for Lebanese youth. While many foreign donors, including the United Nations and World Health Organisation, have initiated and contributed to initiatives in Lebanon, these remain limited. Dr. El-Khoury said that although certain non-governmental organisations have programs that offer free therapy sessions, their capacity is likely capped at a couple of thousands of patients. This is certainly inadequate for a population of 6 million Lebanese, 55% of whom are in poverty, and more than 50% of whom have no formal health insurance coverage. Among those who do enjoy health insurance, a very small minority get their psychologist sessions covered, given that most insurance programs only cover psychiatric, but not psychological, therapy. The National Social Security Fund plans to incorporate partial coverage for these sessions soon, according to Rabih El Chammay, head of the National Mental Health Programme. Yet, little is to be expected, given that the institution is “broke” and has a history of fragile implementation.
The ability of Lebanese youth to re-establish their mental health well-being following the recent catastrophes seems to be inextricably dependent on political, economic, and institutional reform. Particularly, it is essential to establish a rigorous national mental health system that is funded and organised by the health branch of the Lebanese government. Given that this seems like a distant prospect, it is crucial for mental health organisations to coordinate efforts across the country to ensure accessible care for the most vulnerable. Yet, we should be cautious about claiming that the NGO sector can manage this crisis alone, an idea which, in the words of Dr. El-Khoury, “washes the government’s hands from providing sustainable, free, or at least low-cost services”.
The same oligarchy that murdered and terrorised thousands of families in the 1975 Lebanese Civil War is largely responsible for the economic and social collapse happening now. While strengthening the mental health system is essential to lessen the collective psychological impact of the crisis, what the small Mediterranean country ultimately needs is political reform and accountability, now more than ever.
[1] Ni, Michael Y., Yoona Kim, Ian McDowell, Suki Wong, Hong Qiu, Irene OL Wong, Sandro Galea, and Gabriel M. Leung. “Mental health during and after protests, riots and revolutions: a systematic review.” Australian & New Zealand Journal of Psychiatry 54, no. 3 (2020): 232-243.
[2] Mulderig, M. C. (2013). An uncertain future: Youth frustration and the Arab Spring.
[3] Karam, Elie G., Zeina N. Mneimneh, Aimee N. Karam, John A. Fayyad, Soumana C. Nasser, Somnath Chatterji, and Ronald C. Kessler. “Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey.” The Lancet 367, no. 9515 (2006): 1000-1006.
Loubaba is an MSc. Social and Cultural Psychology student at the London School of Economics and Political Science. She holds a Bachelor in Psychology from the American University of Beirut. She was involved in the Lebanese October 17 Revolution and has an interest in its impact on Lebanese society. Loubaba has completed internships at the Issam Fares Institute for Public Policy and the United Nations ESCWA.