الصحة النفسية حالة من العافية التي تمكن الفرد من تفعيل قدراته وإمكانياته بحيث يستطيع التعامل والتكيف مع ظروف الحياة المختلفة، والعمل بإنتاجية والمساهمة.

الصحة النفسية حالة من العافية التي تمكن الفرد من تفعيل قدراته وإمكانياته بحيث يستطيع التعامل والتكيف مع ظروف الحياة المختلفة، والعمل بإنتاجية والمساهمة بشكل فعال في الأسرة والمجتمع. الاضطرابات النفسية تعيق الفرد من ممارسة حياته بالشكل المطلوب و احيانا تؤدي الى الوفاة بالاضافة الى الاعاقة

Mental health: facts Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disabilities and developmental disorders including autism. There are effective strategies for preventing mental disorders such as depression. There are effective treatments for mental disorders and ways to alleviate the suffering caused by them. Access to health care and social services capable of providing treatment and social support is key.

Mental health: facts Stigma and discrimination against patients and families prevent people from seeking mental health care Human rights violations of people with mental and psychosocial disability are routinely reported in most countries Globally, there is huge inequity in the distribution of skilled human resources for mental health

Mental health is determined by many factors including:
Genetic and biological factors such as, imbalances in chemicals in the brain Social factors such as stigma, discrimination, poverty Mental health is determined by many factors including: Genetic and biological factors such as, imbalances in chemicals in the brain Social factors such as stigma, discrimination, poverty Psychological factors such as severe stress, abuse, and trauma. Mental disorders are not contagious and can affect anyone. Psychological factors such as severe stress, abuse, and trauma. 4

Mental health problems don't affect me.
Children don't experience mental health problems. People with mental health problems are violent and unpredictable. People with mental health needs, even those who are managing their mental illness, cannot tolerate the stress of holding down a job. Personality weakness or character flaws cause mental health problems. People with mental health problems can snap out of it if they try hard enough. There is no hope for people with mental health problems. Once a friend or family member develops mental health problems, he or she will never recover.

صح أو خطأ الاضطرابات النفسية معدية
معظم الأشخاص الذين يعانون من اضطرابات نفسية خطيرون الاضطرابات النفسية تنجم عن السحر أو الاستحواذات أو الأرواح الشريرة [this also seems to go better with stigma along with the previous slide] Discussion Duration: 5 min Use the discussion that came up from the previous slide to link it to some of these common misconceptions regarding mental disorders. Start a discussion by asking participants to answer TRUE or FALSE to each of these questions. Use these questions to explore their knowledge, beliefs, and perceptions of mental disorders.

World Health Organization
September 27, 2009 September 27, 2009 Mental illness is one of the great invisible burdens on all societies, accounting for 4 of the 10 leading causes of disability worldwide. Yet in low-income countries, there is only one psychiatrist per every two million people and psychologists or social workers are in short supply. This slider ranks the top 5 conditions contributing to the burden of disease. By 2030, it is projected that depression alone is likely to be the second highest cause of disease burden – second only to HIV/AIDS. In high-income countries, depression will become the single highest contributor to the overall disease burden. Road traffic accidents, for which a major risk factor is alcohol, will be the fourth leading cause of disease burden in 2030. Therefore within the 5 leading causes of disease burden 2 will be related to mental health and substance abuse. Road traffic accidents are very much influenced by/ related to alcohol intake. The disease burden /% DALYs are influenced by prevalence, mortality and disability. The higher the prevalence , the higher the mortality and the more disability resulting from a condition; the higher the DALY will be. It is therefore important to go through each of these dimensions individually. Rank 2000 2030 1 الالتهابات السفلية للجهاز التنفسي الايدز 2 التشوهات الخلقية الاكتئاب 3 امراض الفلب و الشرايين 4 حوادث الطرق 5 الامراض المسببة للاسهال 7

September 27, 2009 September 27, 2009 September 27, 2009 Mental disorders are very prevalent worldwide Globally, an estimated 350 million people are affected by depression. More women are affected than men. Bipolar affective disorder affects about 60 million people worldwide. Schizophrenia is a severe mental disorder, affecting about 21 million people worldwide. Worldwide, 47.5 million people have dementia. About people commit suicide every year Global rates for serve mental disorders are estimated to be 3% for severe mental disorders and 10% for common mental disorders. As can be seen from this table the rates vary considerably across countries. Prevalence rates has been shown to range from 4% to 26%. This range is based on data from 14 different countries participating in the WHO World Mental Health Survey Consortium. (using CIDI interviews/instrument) These differences are partly related to the validity of survey instruments, and partly due to the stigma associated with mental disorders/reporting metal symptoms in some countries. Balanced sex ratio: the overall prevalence of mental disorders has been found to be almost the same for men and women, even though women may be proportionally more affected by depression, anxiety and eating disorders and man by attention-deficit/hyperactivity disorder, autism and substance abuse disorders. Children: Approximately one in five children suffers from a mental disorder. Older people present the same prevalence as their younger adult counterparts for common mental disorders. Only certain disorders are more common in this age group, in particular dementia and other cognitive impairment, bereavement and suicide. 8 8

September 27, 2009 September 27, 2009 هنالك ارتباط وثيق بين الامراض الجسدية و النفسية حيث نجد ان الافراد المصابين بامراض جسدية مزمنة هم اكثر عرضة للاصابة بالاضطرابات النفسية . و تتزايد نسبة حدوث الامراض الجسدية عند الافراد المصابين بالاضطرابات النفسية و لا ننسى ايضا ان هناك اعراض و شكاوى جسدية تعود الى مشاكل نفسية. Now moving on specifically to discuss comorbidity. We have seen how people with mental disorders are at higher risk of dying from a physical health problem. This is because mental and physical health problems are interwoven. 1- Physical health problems are common in people with mental disorders Mental disorders influence physical health and illness in several ways. • Anxious and depressed moods initiate a cascade of adverse changes in endocrine and immune functioning, and create increased susceptibility to a range of physical illnesses. • Mental disorders also can compromise health risk behaviour. For example, disorders such as schizophrenia and depression can reduce adherence to medication therapies. People with mental disorders are at heightened risk of contracting HIV and tuberculosis. • People with mental disorders sometimes have trouble accessing needed physical health care. • Some treatment interventions for mental disorders, particularly those for schizophrenia, can lead to an increased risk of metabolic syndrome and diabetes. As a result, people with mental disorders are more likely than others to develop significant physical health conditions and they have a mortality rate higher than the general population. 2- Mental health problems are common in people with physical disorders The diagnosis and treatment of physical disorders can generate mental health problems in affected individuals, which in turn can adversely affect health outcomes. Depression, anxiety and cognitive impairment are the most common consequences of physical health problems. For example, in a large-scale national community survey, 52% of people with cardiovascular disease displayed symptoms of depression and among these, 30% met the criteria for a major depressive episode. 3- Lastly, mental health problems can be somaticized Around one third of all somatic symptoms are medically unexplained in general health care settings. These medically unexplained symptoms include pain, fatigue and dizziness or syndromes such irritable bowel syndrome, fibromyalgia or chronic fatigue syndrome. They are often (15%) coupled with psychological stress and help-seeking behaviour. A mental disability of an individual also affect the mental and physical health of other household members, either his/her caregiver or dependent thereby multiplying the impact of the disorder (extending beyond he individual). For example, parental depression leads to poorer physical growth and mental health of children. There is also an increase in the use of emergency departments and inpatient and specialty services for children who have depressed parents, compared with children who do not have depressed parents. It is estimated that 20% of stunting of growth could be averted by interventions to treat maternal depression. babies of mothers who were depressed during pregnancy and in the postnatal period had a risk more than five times greater of being underweight and stunted at six months than babies of nondepressed mothers, 9

عائلة من كل اربع عائلات تواجه تعرض أحد أفرادها لمشكلة نفسية في إحدى مراحل حياته.مما يشكل عبئ كبيرعلى جميع أفراد العائلة وعلى نوعية الحياة التي تعيشها العائلة. تكلف الاضطرابات النفسية الاقتصاد الوطني عالميا عدة بليارات الدولارات حيث ان التعرض للإضطرابات النفسية يؤثر قدرة الشخص على العمل و الانتاجية و هذا ينعكس سلبا على الدخل الشخصي للفرد و اسهاماته في الاقتصاد الوطني.

September 27, 2009 September 27, 2009 الاثر الاقتصادي للاضطرابات النفسية الاثر الواقع على الفرد و الاسرة المصاريف المباشرة على الادوية و العلاجات المصاريف الغير مباشرة على المواصلات و الاحتياجات الاخرى المتعلقة بالشخص المصاب و القائمين على رعايته فقدان الانتاجية او هبوطها التمييز و الرفض المجتمعي سواءا للفرد المصاب او عائلته الاثر الواقع على المجتمع التخلف عن العمل و قلة الانتاجية في المجتمع و التقاعد السابق لأوانه انخفاض الدخل Indeed mental disorders have a major economic impact both for individuals, their household and the entire society. First of all, when seeking care, people need to spend money on consultations, hospitalisation fees and medication. Such costs can represent a significant/important share of the household budget and it is often difficult to manage this situation for long periods of time. In addition to these direct health expenditures, when care is provided in specialised settings located far from most people’s community, people also need to spend money on transport and accommodation. People with mental disability need to be accompanied . This means that at least one person (but most likely two) will need to pay transport and accommodation and will not be able to work during the time necessary to reach the health facility and receive the care needed. During periods of illness, mental disability reduces people’s productivity as well as the availability of their caregiver to work. People are often discriminated against in terms of employment, being less able to access employment and more likely to lose their job as a result of having a mental disability. At a society level, the economic impact has been estimated to be very significant. This is a consequence of absenteeism,, low productivity (“presenteeism”), premature retirement, disability benefits and the costs associated with managing these problems. For individuals, business, society and the state, these indirect costs reduce income generation. For industry, losses will result in poor production outputs and reduced profits which will in turn negatively affect employment and/or wages and the country’s economic performance. At the other end of the scale, households affected by mental illness face the possibility of catastrophic poverty. The combination of these impacts in concert with the costs incurred by the state and health insurers will negatively affect national economic growth, employment and poverty reduction. 12

September 27, 2009 الفقر و الامراض النفسية... Physical Disorders Mental Disorders Poverty People with mental health problems are more likely to descend into poverty and people living in poverty are more likely to have mental health problems maintaining a vicious cycle between mental ill-health and poverty. Studies over the last 20 years provide considerable data linking mental ill health with poverty. Common mental disorders are about twice as frequent among the poor as among the rich. People experiencing hunger or facing debts, or people living in poor and over crowded housing are more likely to suffer from common mental disorders. For example, evidence indicates that depression is 1.5 to 2 times more prevalent among the low-income groups of a population. People with the lowest levels of education or people who are unemployed are also found to have higher prevalence of mental disorders. For evidence, people with schizophrenia, in comparison with people without mental disorders, are 4 times more likely to be unemployed or partly employed. In turn, people with mental disorders are less likely to access education, employment, good housing conditions and more generally are more likely to miss on life opportunities.

الصحة النفسية و حقوق الانسان
في جميع انحاء العالم يتعرض الاشخاص المصابين باضطرابات نفسية لعدد هائل من الانتهاكات لحقوقهم الانسانية في مختلف مناحي الحياة. وهذه الانتهاكات بدورها تؤثر بشكل سلبي على الصحة النفسية للافراد. هؤلاء الافراد هم جزء من الجتمع!

ما هي الوصمة؟ وصمة العار....هي علامة خجل أو خزي أو استنكار و رفض والتي ينتج عنها شعور الشخص بأنه مرفوض من الآخرين» (منظمة الصحة العالمية) ينظر المجتمع إلى كثير من المصابين باضطرابات نفسية على أنهم ضعفاء، لاإنسانيون، خطيرون، أو دونيّون، بسبب الأعراض التي يُظهرونها. يمكن لوصمة العار أن تجعل الأشخاص المصابين باضطرابات نفسية بحالة أسوأ كنتيجة لوصمة العار، إما أن يتم استبعاد هؤلاء الأشخاص، أو يقوم الأشخاص هم باستبعاد أنفسهم [may be better to start with questions of exploring stigma around mental illness with participants as in next slide before going over concepts] - One reason why maintaining confidentiality and privacy is important is because of stigma.

September 27, 2009 September 27, 2009 الرفض المجتمعى و الحرمان من التمتع بالحقوق الاساسية للانسان التصويت الزواج و الاطفال التعليم التوظيف الرعاية الصحية In most countries around the world people with mental disorders are denied basic rights such as the right to vote or the right to get married and have children. Access to basic needs such as education employment or health care is also severely hampered. Education: children with mental illness are amongst the most marginalised groups in terms of access to education (Richler, 2004); in developing countries only 2% of children with any disability are enrolled in school (Richler, 2004). Children of parents with mental disorders are also more likely to drop out of school. Employment: for PWMD, one of the greatest challenges is gaining and retaining employment. In United Kingdom, for example, 75% of PWMD are unemployed (ILO, 2007). There is no such figures available for developing countries (also more difficult to assess as the informal work sector is far more important) but we have indications that unemployment amongst PWMD is high too (Araya, et al., 2001; Lorant et al, 2003; Patel & Kleinman, 2003). Health care: as described in the first part of my presentation, the health burden is significant in terms of disability, prevalence, excess mortality, disability and co-morbidity. A substantial reason for this is the huge treatment gap. Thus people are unable to access treatment and care 16

الابنية قديمة منهتكة تفتقر الى النظافة
الانتهاكات التي يتعرض لها الفراد المصابين باضطرابات نفسية في داخل المصحات النفسية ظروف معيشية سيئة الابنية قديمة منهتكة تفتقر الى النظافة ينقصهم اللباس الناسب و المياه النظيفة و الغذاء و السكن الملائم تهوية سيئة و درجة الحرارة لا تتناسب مع الجو لا يتمتعون بحقهم بالخصوصية Violations in the mental health care context As we've seen in pandit lecture and in film Michelle showed people with mental disabilities experience terrible human rights violations in psychiatric institutions. I won't go over these again in detail, but just to highlight the overarching issues, that people in institutions live in: Appalling living conditions Buildings are decrepit and filthy, poor sanitation and hygiene People lack proper clothes, clean water, food, heating, decent bedding or privacy Inhuman and degrading treatment: Abusive use of seclusion and restraints Violence and rape No stimulation Over-medication ************************************************ Patients in many mental health facilities around the world experience appalling living conditions: Buildings are decrepit and filthy, lacking even basic sanitation and hygiene standards. People do lack proper clothes, clean water, food, heating, decent bedding or privacy. There was a recent report (Feb 2004) for example of 18 people dying in an institution in Roumania due to of hypothermia and malnutrition) Many people living in psychiatric institutions are exposed inhumane or degrading treatment, physical, sexual and mental abuse and neglect: Abusive use of seclusion and restraints are common practice in certain facilities. Patients are locked away in small, prison-like rooms for long periods of time with no human contact. Sometimes, adults and even young children are locked up in caged beds with no hope of movement all day. examples of more harmful, inhuman practices which are still prevalent in Europe (Turkey, Romania, Czech; Slovakia and Slovenia)…(In paraguay a very recent report showed that children with autism are locked away in tiny cells for years – in one case 4 years – where they are not even let out to go to the toilet so have to live in cells filled with their own excrement and urine) In some institutions, adults and children are subjected to horrific violence and rape — sometimes at the hands of the very people who should be caring for them. These practices often go unreported and unpunished, leaving the perpetrators free to continue the abuse. Many people living in institutions receive no form of stimulation, and spend days, months and even years living in excruciating boredom. Some people are over-medicated so that they remain docile and 'easy to manage'.

المعاملة المهينة اللا إنسانية العنف باستخدام غرف العزل و القيود
الانتهاكات التي يتعرض لها الافراد المصابين باضطرابات نفسية بما يخص الرعاية المقدمة لهم المعاملة المهينة اللا إنسانية العنف باستخدام غرف العزل و القيود الضرب و الاغتصاب الافتقار الى المحفزات البيئية المبالغة باستخدام الادوية كنوع من العقاب او السيطرة الادخال و العلاج الغير مناسب بدون موافقة الافتراض بان الشخص يفتقر الى الاهلية مما يؤدي الى حذف جملة من حقوقه Violations in the mental health care context Other human rights violations that are associated with the health care context are that : For example - Issues concerning consent for admission and treatment are ignored. People are unjustifiable and arbitrarily locked away for months and sometimes years at time. Psychiatric institutions in countries all over the world are full of people who simply should not be there. Another issue is that there tends to be the presumption that a person with a mental disability is incapable of making decisions about his or her life and consequently they are stripped of their rights to make decisions concerning their treatment and care, to manage their financial and personal affairs etc. These matters are then left at the hands of a substitute decision maker or guardian despite the fact that the person may be perfectly able to make these decisions for him/herself. Patients also lack access to legal processes and mechanisms to protect their rights despite the fact that they have been stripped of some of the fundamental human rights such as the right to liberty and autonomy. Indeed many countries have no independent review mechanisms to systematically review cases of involuntary admission and treatment In many countries there are no mechanisms for people to appeal against decisions to involuntarily admit or treat them. Complaints mechanisms for reporting human rights violations are also missing in many countries throughout the world.

الانتهاكات التي يتعرض لها الافراد المصابين باضطرابات نفسية في المجتمع
في مختلف مناحي الحياة قلة فرص العمل قلة فرص التعليم الحريات و الحقوق المدنية للانسان مثل الزواج و الانتخاب و غيرها الحرمان من الدمج في الجتمع Violations in the community context In addition to violations in psychiatric institutions, people with mental disabilities also face human rights violations in all areas of their lives in the community. Many are discriminated against in seeking employment and others are dismissed from their jobs because of their mental illness. For example, in the majority of European countries where data are available, the employment rates of people with mental disabilities is between 20% and 30% and in the case of people with severe mental health problems like schizophrenia (the majority of whom are capable of and wish to work) employment rates are around 10% percent.( Kilian R, Becker T. “Macro-economic indicators and labour force participation of people with Schizophrenia” Journal of Mental Health. 2007; 16(2): ) People with disabilities are also prone to being accepted only in second rate employment which offer repetitive work, low pay and bad conditions. People with mental disabilities are also very often stripped of their right to education. For instance, in many eastern European countries, children with mental disabilities are institutionalized, and these institutions frequently fail to offer educational opportunities. The institutionalization of children with mental disabilities and the subsequent violation of their right to education occurs in many places throughout the world. Tragically, in doing so, these countries incapacitate the children for the rest of their lives so that they are “destined to spend the whole of their life in an institution. People with mental disabilities also face barriers to access to physical health care. For example many spychiatric institutions don’t provide proper physical health care. Also, very often when someone is diagnosed with a mental illness people tend to put physical issues and ailments of the person down to the mental disorder - so the focus of the treatment and care is always on the mental health aspect and the physical aspect gets ignored. For example, a report in the UK by the Disability Rights Commission found that People with serious mental illness were less likely to get standard checks and treatments, and consequently were more likely to get deadly diseases, to get them younger, and to die of them within 5 years. The report also stated that people with severe mental illness died on average 10 years younger than the general population. People with mental disabilities experience limitations in their right to exercise civil and political rights. People with mental disabilities are also deprived of the right to form families. For instance, in certain places, persons placed under guardianship are not permitted to marry. In Bulgaria, they may not adopt or foster children. In the Russia, they may not file for divorce. In Albania, it is illegal for a person with a mental disability to marry regardless of their current mental state Many countries, including Cameroon, Bermuda, Botswana, Thailand, Turkmenistan and Tanzania deny persons of “unsound mind” the right to vote. In other countries, like Gibraltar, persons with mental disabilities cannot run for office (eg. Gibraltar). In addition, in certain countries, even in places where people with mental disabilities are legally allowed to vote, de facto they are not permitted to do so due to their placement in institutions without access to polls (eg. bulgaria). People with mental disabilities are even denied the right to associate. For instance, in Russia they cannot form or belong to political organizations. In Bulgaria, adults under guardianship cannot found or join non-profit organizations or cooperatives. People all over the world are also denied the opportunity to participate in decision making processes (eg. design and implementation of policies, laws, services) on issues that affect them The denial of these basic human rights means that people with mental disabilities are essentially prevented from fully integrating into society, engaging in social, economic and political life and consequently, from living meaningful and fulfilling lives in the community.

لماذا؟ ان الافكار الخاطئة المترسخة عن الاضطرابات النفسية و الاشخاص المصابين بالاضطرابات النفسية تجعل السياسات والتشريعات تتوجه نحو عزل هذه الفئة عن المجتمع لحماية المجتمع منهم بدلا من احترام حقوقهم الانسانية وتقديم الرعاية و الدعم لهم. Links between human rights and mental health Mental health and human rights are often perceived to be at odds with one another. Widespread stigma surrounding people with mental disabilities (that they are dangerous, violent and in need of confinement and seclusion) means that government policies, laws and strategies on mental health often emphasize protection of the general public/society instead of respect for human rights and the provision of good quality care for people with mental disabilities. This is reflected for example, in the fact that – people are treated in psychiatric institutions, and thus kept far away from society, rather than receiving care in the community, close to their homes, families and social support networks. It is also reflected in the mental health laws of many countries, where the emphasis or focus is on involuntarily detaining people or treating them against their will, rather than on the promotion of voluntary admission and care. Because of this belief or perception that people with mental disabilities are dangerous and that they need to be restrained or locked away either for their own good or for the protection of society, the common perception is that mental health and human rights are at odds with one another – and seen as being incompatible. But human rights and mental health are both important approaches to advancing human well-being. There are three main relationships between mental health and human rights: mental health policy affects human rights human rights violations affect mental health promotion of mental health and human rights are mutually reinforcing.

واحد من اربعة... يمكن ان يكون اخوكي او اختك يمكن ان يكون زوجك او صديقك
واحد من اربعة ... يمكن ان يكون ابنك او بنتك. واحد من اربعة.... يمكن ان يكون انا واحد من اربعة... يمكن ان يكون انتي! ما هو دورك؟؟

حقوق الإنسان يتمتع الأشخاص المصابون باضطرابات نفسية بنفس الحقوق التي يتمتع بها الأشخاص الاخرون. لديهم الحق في أن يعامَلوا بكرامة واحترام. لديهم الحق في إعطاء الإذن أو رفض الإحالة أو العلاج أو المتابعة العديد من الأشخاص المصابين باضطرابات نفسية يُعانون بصمت، خوفاً من أن يعلم الناس بهم، ويتجنبون طلب المساعدة. يلعب العاملون في مجال الصحة والحماية دوراً مهماً في تشجيع الأفراد على طلب المساعدة و حماية حقوق الإنسان و التخفيف من آثار الوصمة داخل المجتمع. [this might need some more elaboration and/or examples since CHWs may not be familiar with the concept of human rights]

CRPD الحفاظ على كرامتهم حقهم بالوصول الى خدمات الصحة النفسية
حقهم بالدمج بالمجتمع التعبير عن رايهم والوصول الى المعلومات التي تخصهم الخصوصية التعليم التاهيل العمل العيش بظروف معيشية لائقة المشاركة السياسية المشاركة بالانشطة الترفيهية حقهم بالوصول الى خدمات الصحة النفسية حقهم بالصحة عدم الحرمان من حرياتهم المساواة امام القانون وحقهم بالوصول للعدالة عدم التعرض للتعديب او العلاج المهين والغير انساني حمايتهم من الاستغلال والعنف

الصحة النفسية في الاردن
في الاردن هناك مليون و نصف المليون شخص يعانون من اضطرابات نفسية. يعتمد نظام الصحة بشكل اساسي على المستشفيات لتقديم الخدمات العلاجية للافراد المصابين بالاضطرابات النفسية و خلال السنوات القليلة الماضية اتجهت الجهود نحو المجتمع عن طريق انشاء العيادات و المراكز الصحية في مختلف مناطق المملكة. و يعاني قطاع الصحة النفسية في الاردن من نقص في الموارد البشرية مما يؤثر بشكل اساسية على توفر الخدمات العلاجية و نوعيتها في كلا القطاعين العام و الخاص.

فحسب ما اظهرته احصاءات جمعية الاطباء النفسيين الاردنية
معالج وظيفي واحد لكل مليون و مئة الف مواطن اخصائي اجتماعي واحد لكل 400 الف مواطن معالج نفسي واحد لكل 440 الف مواطن طبيب نفسي واحد لكل 100 الف مواطن ممرض واحد لكل 25 الف مواطن

Referrals When? How? What to expect? Interagency referral form.

متى تعلم أن شخصاً ما يعاني من اضطراب نفسي؟
أي شخص يمكن أن يختبر الحزن أو القلق أو التشوش الإضطرابات النفسية تختلف عن باقي الضغوط التي يتعرض لها معظم الناس الأشخاص الذين يعانون من اضطرابات نفسية يختبرون هذه المشكلات لمدة طويلة، مما يؤثر على قدرتهم على القيام بالأعمال اليومية بإمكان الشخص إختبار اضطراب نفسي واحد أو أكثر في نفس الوقت (مثال: مشكلات مع الحزن والكحول) [Somewhere in here I think it would also be useful to make the point of how to respond to someone experiencing psychological distress (as in PFA, e.g. supportive listening etc.) even if they do not have a mental disorder. Or is the idea that CHWs would also be trained on PFA separately?] It is normal for everyone to experience some sadness, worry or confusion, in particular when we have experienced a lot of stress or trauma. Mental disorders are different from these experiences that all people experience at some point in their life. - But if these abnormal feelings, thoughts and behaviours are extreme or last for a long time, and is impacting your everyday way of living, it may be beneficial to see a doctor. - Refer to the arrows to explain that feelings, thoughts and behaviours are on a spectrum from normal to abnormal or indicative of a mental disorder. الحالة الطبيعية الاضطراب النفسي أمثلة: الشعور بالحزن أحياناً نسيان بعض الأشياء من حين إلى آخر أمثلة: الشعور بالحزن لوقت طويل إلى درجة تعيق أداء الشخص النسيان المفرط

الإحالة إذا كان لديك شك أن شخصاً ما يُظهر علامات اضطراب نفسي، تحدث معه. اسأل بعض الأسئلة واستخدم مهارات تواصل جيدة لا يمكنك اجبار الاشخاص على طلب المساعدة، لكن يمكنك التحدث معهم عن الأشياء التي تمنعهم من طلب المساعدة (مثال: الوصمة أو الخوف) وإعطائهم المعلومات طلب المساعدة فوراً إذا كان الشخص معرّض لخطر إيذاء نفسه أو الآخرين أعلِمهم بأن الإضطرابات النفسية قد تصيب أي شخص وأن العلاج قد يساعد ماذا إذا كنت غير متأكد؟ حدد مشرف أو عامل في مجال الرعاية الصحية الأولية بإمكانه الإجابة على أسئلتك حول الاضطرابات النفسية. CHW play an important role in referring individuals to primary health care professionals if they suspect that someone has a mental disorder. CHW can provide basic information about mental disorders, such as, that they are common and can affect anyone, and that treatments can help. Such information can encourage people to seek the help that they need. 28

Symptoms of distress Some common ways that people show their distress in reaction to a crisis are: physical symptoms: headaches, fatigue, loss of appetite, aches and pains; crying, sadness, grief; anxiety, fear; being on guard, or jumpy; insomnia, nightmares; irritability, anger; guilt, shame (so-called survivors guilt); with daily functioning.

Symptoms of distress confused, in a daze;
withdrawn, or very still (not moving); disorientation (not knowing their name or where they are from); and not being able to care for themselves or their children. Not everyone who experiences a crisis will need or want support. Most people will recover well over time, if they are able to restore their basic needs, find ways to return to normalcy, and get some support when they need it. Access to clinical management is important whenever symptoms interfere

الإحالة كيف تقوم بالإحالة؟
يمكن القيام بالإحالة بطرق مختلفة، وهنا بعض الأمثلة: مهاتفة أو مرافقة الشخص إلى عيادة رعاية صحية اولية أو إلى مستشفى عام في ما يتعلق بالصحة النفسية، بإمكانك إكمال استمارة الإحالة وإعطائها الى مدير الحالة قبل أن تتصل بمدير الحالة، تأكد من حصولك على موافقة من الشخص. وهذا متضمن في استمارة الاحالة. تشجيع عائلة الشخص على مرافقته، إذا كان ذلك مناسباً. Maintaining confidentiality and privacy is particularly important for mental health issues. نموذج الاحالة بين المؤسسات Make sure you ask the individual if it would be okay if you talked to the primary health care worker about them, to give them information about their situation and how they are doing. 31

مبادئ اساسية حافط على هدوئك و تكلم ببطء و لطف
استمع من دون الحكم على الشخص، وأسرته وعلى مقدمي الرعاية شجعهم على طلب المساعدة والدعم من العاملين في الرعاية الصحية الأولية ، ومن عائلاتهم وأصدقائهم ومجتمعاتهم طمأنهم بأنك موجود للمساعدة وأنهم ليسوا وحيدين أعلمهم بأن لديهم اضطراباً نفسياً يمكن معالجته ، وأن هذا لا يجعلهم ضعيفين أو أشخاصاً سيئين حافط على هدوئك و تكلم ببطء و لطف إذا كان الشخص خائفاً بسبب سماع أو مشاهدة أشياء ليست موجودة، اعترف بأن هذه الأشياء مخيفة فعلاً (مثلاً: لا يمكنني سماع الأصوات و لكنني فعلاً أعتقد انك تسمعها و لا بد أنك تخاف منها كثيراً)

الصحة النفسية حالة من العافية التي تمكن الفرد من تفعيل قدراته وإمكانياته بحيث يستطيع التعامل والتكيف مع ظروف الحياة المختلفة، والعمل بإنتاجية والمساهمة.

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الصحة النفسية حالة من العافية التي تمكن الفرد من تفعيل قدراته وإمكانياته بحيث يستطيع التعامل والتكيف مع ظروف الحياة المختلفة، والعمل بإنتاجية والمساهمة.

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