In Turkey, the number of people suffering from anxiety and depression has increased significantly in recent years due to factors such as repeated natural disasters, migration, economic downturn, and the COVID-19 pandemic. According to data from the Turkish Ministry of Health (MoH), 17% of the population suffers from mental health problems, 3.2 million people suffer from depression, and antidepressant consumption has increased by 56% in five years. Of a population of about 83 million, about 9 million people seek mental health support in Turkey every year. Add to this the fact that Turkey is the country that hosts the largest number of refugees in the world, with over 3.6 million Syrian refugees, and you have a major social problem: mental health. 2020 was also the year that the COVID-19 pandemic hit, amplifying the challenges.
The EU-funded project Social Inclusion of People with Mental Disabilities aimed to address the mental health challenges mentioned above. Launched in 2018, the project received technical support from the WHO Turkey Office (WCO) with the Ministry of Health and the Ministry of Family, Labor and Social Services (MoFLSS) as beneficiaries. The project aimed to upskill the workforce providing health services to people with mental disabilities and improve community-based health services at a national scale. Another objective was to increase the capacity of those providing health services to both refugees and host communities, with an emphasis on person-centred care.
A revision of National Mental Health Action Plans was initiated in line with the WHO World Mental Health Action Plan, the WHO 13th General Plan of Action, and the European Action Plan “United Action for Promoting Health in Europe”. The WCO developed technical guidelines for the functioning of local steering committees on mental health, enabling improved governance support at state level. In addition, the WCO provided training modules for Ministry of Health and Ministry of Foreign Affairs personnel working in primary health care services, refugee medical centres, community mental health centres (CMHCs) and residential care facilities. As a result, 500 health workers were trained using the Local Steering Committee Guidelines. Furthermore, based on the Mental Health Gap Action Plan (mhGAP), the WCO provided training workshops for Syrian and Turkish general practitioners, community health workers and mental health staff to improve their knowledge and acquire the latest practices on diagnosis, referral and treatment processes in addressing the mental health and psychosocial needs of refugees. More than 3,400 Syrian and Turkish health professionals were trained to address a range of issues related to mental health and psychosocial support (e.g. mental health GAP, early childhood development, gender-based violence and psychosocial support).
WHO expanded support for mental health, focusing especially on improving the quality of services to respond to COVID-19 related needs in a timely manner. WCO supported the Ministry of Health and the Ministry of Family Welfare in efforts aimed at public awareness and advocacy, development of guidelines and algorithms to support psychosocial hotlines, development of guidelines for the transitional period for CMHCs, and online training for managers of social care centres of CMHCs. The webinars covered issues such as the provision of mental health services to 175 CMHCs during the pandemic. The training sessions and webinars covered all residential care facilities managed by MoFLSS and 85% of CMHCs managed by the Ministry of Health. The guidelines developed are being used by all psychosocial hotlines and CMHC staff across the country.
In response to new limitations on meetings imposed by the pandemic, the WCO has updated and translated into Turkish the Quality Rights e-training platform, WHO’s online learning tool to improve mental health service delivery and promote human rights for people with psychosocial, intellectual and cognitive disabilities worldwide. 773 people registered and 90 completed the training on topics such as human rights, mental health, disability and human rights, right to recovery and health in mental health and social services, legal capacity and decision-making rights in mental health and social services, and mental health and social services free from coercion, violence and abuse.
COVID-19 hotline online meetings, webinars and psychosocial support algorithms were implemented in 81 states across the country. The hotline provided support to 236,000 people between April and December 2020, helping them cope with stressors caused by the changes resulting from the COVID-19 pandemic. The hotline also supported individuals with chronic mental illnesses and provided a referral mechanism for those in need to access social services.
Another important project implemented by WHO was the Refugee Health Programme, which specifically addressed mental health issues among refugees and migrants hosted in Turkey. WHO is still working closely with the Turkish Ministry of Health to provide health services to Syrian refugees. The project crossed language and cultural barriers and acted as a patient guide for primary, secondary and tertiary care. In addition, WCO coordinated the provision of continuing medical education to Turkish and Syrian health workers on the diagnosis and treatment of mental health conditions such as depression, anxiety and post-traumatic disorders. In addition, WCO advised on guidelines and algorithms for a psychosocial support hotline, providing 80,000 consultations per year in seven refugee health training centres.
Given the close relationship between WHO and the Ministry of Health, a key element in the successful design and implementation of the planned activities was working closely with various government stakeholders, including relevant line ministries (specifically the Ministry of Health and MoLFSS), academic institutions, professional organizations, service user organizations, as well as staff from provincial health and social welfare departments and health and social welfare centres.
As part of a coherent, structured and coordinated effort, these projects form the most extensive training initiative on mental health and psychosocial support in Turkey and the region in recent years. Overall, through these projects, Turkey has strengthened the capacity of its health workforce through in-service training and rapid response to health emergencies.
Photo caption: Family doctors from Turkey and Syria participated in the Training on Strengthening Mental Health Services in Primary Care Programmes, organised within the framework of MhGAP, which aims to expand mental health services in non-specialty settings towards achieving universal health coverage.
Photo credit: WHO
