A digital platform treats depression and anxiety in Lebanon

BEIRUT – As Lebanon plunges into further economic hardship, access to mental health services has become a luxury few can afford.

For this reason, the World Health Organization (WHO) in collaboration with the National Mental Health Program (NMHP) from the Lebanese Ministry of Public Health has developed a digital intervention to treat people suffering from anxiety and depression.

The application named “Step by step” (“Khoutouwat” in Arabic) is a free self-help program accessible to all Lebanese residents suffering from stress and emotional difficulties, mainly within the areas of Ddepression and aanxiety.

“WHO was looking to develop simple and scalable solutions to increase access to mental health services in countries that lacked them,” said Jinane Abi Ramia, Research Unit, Monitoring and Evaluation Coordinator at NMHP . She told Al-Monitor, “Step-by-Step was extensively tested through multiple research phases for six years until it was found to be effective and cost-effective. We were able to extend it to the service national and launch it in 2021.”

According to Abi Ramia, the app has about 1,000 users in Lebanon of different origins and nationalities, women between the ages of 20 and 30 representing 72% of users.

The self-help program is designed in an interactive storytelling format that can be accessed through the mobile app or the official website. Available in English and Arabic, users can register anonymously, but are only eligible to join sessions after answering a series of questions that help identify people with anxiety or depression.

Users may take 6-8 weeks to complete the five session program. Once admitted to the program, participants choose one of two in-app characters – either married with children or a younger character residing with their parents – assigned to each gender to begin storytelling episodes.

“It’s like watching a series where you follow the lives of individual characters as they tell you about their struggles with mental illness. At the end of each session there is an interactive part where you are offered tips and tools to help you deal with your personal experiences by trying to apply the lessons learned from the stories,” said Abi Ramia.

Behavioral activation techniques, stress management audio exercises, positive self-talk and gratitude exercises, as well as relapse prevention techniques and a mood tracking feature are some of the techniques offered.

“The program is based on various types of therapies usually applied in clinics, such as problem management and stress management techniques which we have facilitated access to,” noted Abi Ramia.

As for incorporating storytelling as a therapeutic tool, a 2007 article titled “The therapeutic narrative revisited” published by the American Journal of Psychotherapy found that well-researched and well-adapted narratives allow patients to externalize the situation they find themselves in to elevate objective observation and decrease defensiveness and resistance towards the messages relayed by the therapist.

Therefore, patients observe a reality reflecting their own, without stigma or fear of social judgment, adding to the normalization of mental health topics in societies like the Lebanese where mental illnesses are considered taboo.

Creating digitized, free, and easy access to psychological services is essential for a population facing an ongoing currency crash and economic collapse that limits access to finance.

Embrace, a non-governmental mental health organization, operates the National Lifeline in Lebanon (1564) for emotional support and suicide prevention, which is also part of the national mental health program of the Ministry of Public Health but is not funded by it.

Abi Ramia said step by step received World Bank funding to keep the app running for 14 months while the team researches more sustainable alternatives. A recent study by the Beirut-based research center”International informationrevealed an 8% increase in suicides this year.

Embrace director Mia Atwi said the number of suicides recorded by the organization in the first seven months of 2022 had reached 83 cases, up from 72 through the end of July 2021.

Atwi noted that she has observed a significant increase in demand for free psychological services, but that an increasing number of therapists are beginning to charge in US dollars for sessions as more skilled mental health providers seek better opportunities to work. employment abroad.

“We offer free mental health consultations at our clinic but have a waiting list of about six months, which is the case with many overworked Lebanese organizations. This highlights the importance of Step-by- Step, which complements the work of mental health organizations and eases some of the burden,” she said.

Incoming calls to the 1564 lifeline increased and reached a record high of around 1,600 calls in June, Atwi added, as more and more people of different nationalities, including Syrian refugees say they are struggling with economic, psychological and family distress.

Step-by-Step offers its users a 15-minute call each week with “e-helpers“, who are trained non-specialists who follow users and review their sessions to discuss psychological developments and provide emotional support and motivation.

A 26-year-old participant in the Step-by-Step program spoke to Al-Monitor about the key role e-helpers played in her healing process.

“They [e-helpers] made me feel heard and supported. Not everyone knows their emotions matter, so you start to feel loved and more optimistic about the prospect of bettering yourself,” she told Al-Monitor on condition of anonymity.

Although she completed all five sessions, she said she still applies the tools learned in the app, such as breathing and grounding methods, as well as using the app to log and schedule. challenges and self-help activities.

“I think using the app for six weeks helped anchor the lessons in my head and the best part is you can use the program offline so it’s like playing a game on your phone with therapeutic benefits,” she added.

In light of the mental health crisis in Lebanon, Abi Ramia said the NMHP is working to integrate psychological services into universal health care programs in primary health care centers, in addition to lobbying for laws facilitating access to mental health services.

Atwi noted that Embrace has already launched a National Mental Health Emergency Response Mechanism, which is a field dispatch group for emergency suicide cases that currently only operates in Beirut.

“We live in dire conditions that require carefully curated systems for an adequate national response, as we fear that protracted crises will push people into greater helplessness while draining their mental capacity to carry on with their daily activities,” concluded Atwi.