The GHI Research Team shares impressions from exploratory fieldwork on a neglected issue.
The Global Health Institute at the American University of Beirut set out to investigate perceptions of mental health and psychosocial support (MHPSS) and associated services in Lebanon.. We conducted this research by interviewing Syrian and Lebanese community members and health providers within two fragile Lebanese settings: Beqaa and Beirut.
Previous research indicated that health services were more accessible within Beirut, and that living conditions were particularly precarious in the Beqaa. We were therefore interested in exploring whether mental health and wellbeing was similarly discussed across settings, including in relation to access to services.
As researchers with an active interest in the topic, we were hoping to witness a high level of awareness about MHPSS and their associated services among the Lebanese and Syrian communities we visited. However, when the participants of our study referred to the perception of their community towards people with mental ill health, they articulated a common standpoint:
“They would say that he is crazy, a lunatic. They might say that to the person´s parents. They might say it to his face”.
This comment from Lebanese women in the Beqaa indicated how people facing mental health issues are considered tainted by their condition, labeled and at risk of losing their credibility.
Other interviewees noted:
“People would say “Do not take into consideration anything he says. Don’t pay attention to him”.
This shows that individuals affected by mental ill health are additionally likely to lose trust within their wider community. It is clear that there is still a long way to go to overcome the stigma surrounding mental illness, as individuals struggling with mental health and psychosocial issues in Lebanon remain victims of judgmental behaviors.
Initial challenges in data collection
We faced several challenges in the early stages of our exploratory fieldwork in Beirut. Given the topic of our research, judgmental attitudes and stigma raised additional issues. We hoped to be able to visit health care clinics to speak to health providers, and additionally to interview persons waiting for their doctors´ appointments.
In public hospitals, our interview requests were frequently declined, despite providing reassurance regarding confidentiality of information disclosed as well as participant autonomy to withdraw from the study at any point. We faced similar challenges when we approached those attending an NGO health care centre. Many Lebanese beneficiaries were hesitant to speak to us due to the sensitivity of the topic; several however reported a lack of time or interest in the research.
The recruitment of Syrian refugees was even more challenging and engagement with this vulnerable group taught us important lessons. For example, during the initial stages of data collection we interviewed a Syrian woman, who was living in one room with her four children and her severely ill new-born. As the interview progressed, it was clear that she would share her thoughts on mental health issues and their associated services, but she first needed to place this in the context of her life experiences and hard living conditions.
Developing insights through interviews in Beqaa
As we began work in the Beqaa area, we were astonished with the openness and the level of awareness of participants to the factors contributing to mental health issues and the need for mental health services, especially among the Syrian population.
“They think a therapist is for crazy people. While in fact, a therapist is the best person to make you feel better”, a Syrian woman from Beqaa reflected.
Another woman from the area drew attention to a man clearly experiencing severe mental ill health: “This person is just like all of us. He is suffering from a mental illness, he experienced something that made him become like this. We should be very aware that this person is just like us but is struggling with a problem”.
Learning from our experiences of addressing challenges, we increasingly saw the importance of carefully employing socially acceptable terms related to mental health and wellbeing in order to avoid any distress for the participants. We also sought to enable those we interviewed to talk about general perceptions of mental health and service provision, rather than them feeling they were expected to share personal and potentially painful experiences.
Our exploratory data collection has significantly improved our knowledge of mental health and psychosocial support at both the level of the community and of healthcare providers.
The feedback from our participants has enriched our understanding of MHPSS and the issues faced by beneficiaries and providers alike.
Going into the future, we hope that this experience will provide useful inputs and guidance for those considering conducting research projects on sensitive topics such as mental health, especially among particular vulnerable groups such as Syrian refugees.