Lebanon’s Crisis Pushes Mental Health Services to the Limit

Lebanese psychologist Bernard Sousse started offering online therapy sessions when patients said surging fuel prices meant they could no longer drive in to see him - but then the power cuts began.

Five minutes into one recent virtual session, the back-up generator in Sousse’s building sputtered out, plunging him into darkness and cutting off his patient in mid flow.

Lebanon’s economic collapse, COVID-19 and a huge explosion in Beirut last year have taken a heavy toll on people’s mental health - piling pressure on support services that are struggling to operate normally due to the country’s multiple woes.

“You have to wait for the electricity to come back on, and in the meantime make up for it with a few WhatsApp messages to finish off the idea,” Sousse said.

“It’s extremely disruptive and makes sessions less effective at a time of dire need.”

Many Lebanese are struggling with depression and burnout, but for many people therapy is out of reach as their incomes shrink, Sousse told the Thomson Reuters Foundation.

The Lebanese lira has lost more than 90% of its value against the US dollar and inflation has ramped up prices across the board, with a therapy session now three times as expensive in local currency.

Besides the acute fuel shortages and regular power cuts, most psychiatric medications - from antidepressants to treatments for bipolar disorder - have been unavailable in pharmacies since March.

Distressed callers
Mental health providers have adapted as best they can, turning to technology or renewable energy sources.

When diesel shortages forced Lebanon’s only suicide helpline to limit its hours, operators secured funds for solar panels to make sure sudden blackouts would not cut off distressed callers, said Rabih Chammai, head of the National Mental Health Program, a state-sponsored body.

“We’re also rolling out an app called Step by Step - it’s a guided self-help program to help people with depression - which is timely with the coronavirus, the lack of fuel and the economic crisis,” Chammai said.

Instagram pages including @medonations and @medsforlebanon coordinate efforts to bring unavailable medications into Lebanon, and regularly feature requests for antidepressants and drugs used to treat anxiety.

New initiatives offering free or inexpensive online therapy sessions have popped up as more established NGOs struggle to meet the increase in demand.

Be Brave Beirut, a grassroots organization set up after the August 2020 explosion, offers free therapy with certified psychologists, as well as more informal sessions with a growing network of emotional support volunteers around the world.

They can be reached on LinkedIn or Instagram, sessions take place on WhatsApp - sometimes even by texting - and trainers hold online webinars to coach volunteers in psychological first aid and other methods.

Co-founder Bana Itani said the informal structure meant volunteers and beneficiaries could adapt to power cuts - “but if there’s an internet blackout, yes, of course we’d be in serious trouble”, she said.

Some parts of Lebanon have dealt with intermittent internet outages because transmission towers lack the fuel to operate, the country’s state internet provider Ogero has said.

Start-ups and stop-gaps
Another community initiative, Lebanon For You, said it was inundated with requests for free therapy sessions.

“People used to contact us just through direct messages. Now a lot of people contact me via WhatsApp, even at 11 pm, needing therapy sessions. They call, they use LinkedIn, Facebook - we didn’t see that kind of outreach before,” said co-founder Ghida Allam.

But as needs mushroom, capacities are shrinking: at least 13 of their network’s 40 psychologists have emigrated and others have taken time off to deal with their own burnout.

Chammai said such initiatives would only be a stop-gap for as long as the underlying causes of Lebanon’s mental health crisis persist.

“If you have a broken sidewalk and people are breaking their legs all the time by walking on it, do you ask whether you should treat people or fix the sidewalk? No, you do both,” he said.

For the country’s worn-down mental health carers, however, the focus is day-to-day survival, said Pia Zeinoun, vice president of Embrace, which runs the suicide helpline and a mental health center.

“We worked for years to remove barriers to treatment: the barrier of stigma by raising awareness - the barrier of money by giving free services, the barrier of distance by going online,” Zeinoun said.

“But the barriers of the nation just keep piling up - onto the people and onto us.”

Piles of fishing nets lay on land unused in the southern Lebanese port of Sidon on Tuesday as fishermen stayed ashore after the Israeli military warned of strikes against fighters along the coast.

Commercial vessels and leisure boats were anchored in the harbor, while the city's ancient fish market fell unusually quiet, with traders trying to peddle the catch from earlier in the week.

"The Lebanese army told us we weren't allowed to go out, and we're respecting that," said Mohammed Bidawi, a member of the local fishermen's union.

"If it continues like this, the market will close too."

After nearly a year of cross-border clashes, Israel intensified its bombing campaign in Lebanon on September 23, killing more than 1,100 people and displacing over a million from their homes, according to official figures.

The Israeli army warned late Monday that it would expand its operations against Lebanese armed group Hezbollah to Lebanon's coast.

It warned people to stay away from the shore in the area south of the Al-Awali river, which flows into the sea to the north of Sidon.

Issam Haboush, another fisherman, said he was worried about his family.

"Fishing is the way we support our children. If we don't go out to sea, we won't be able to feed ourselves," he said, adding that hundreds of families depended on the trade.

Bidawi said the de facto ban on fishing in Sidon had plunged around "5,000 to 6,000 people" into difficulty, the latest blow after a huge financial crisis in the country since 2019.

"The fishermen and traders at the fish market are going to need help," he said.

Before the war, Lebanon's fleet of 3,000 fishing boats reaped in between 3,000 and 3,500 tons of fish each year, the UN's Food and Agriculture Organization said in 2021.

Fisherman Hamza Sonbol said he and his colleagues had become destitute overnight.

"We've become like the country's displaced," he said.

- 'Upsetting' -

Freediving instructor Marwan Hariri, 47, also has a boat in the port to take students out on for lessons.

"Since yesterday I've been feeling very down," he said.

He had already lost 70 percent of his students in the past year of border clashes, as they largely came from southern areas under heavy Israeli bombardment, he said.

"I haven't even been opening the diving center. I've just been going down to the sea to go spearfishing," he said.

Despite the financial crisis and the tensions in the south, he was still enjoying diving with his speargun which he said was a way to temporarily escape from the news.

On Monday, he put his catch up for auction among acquaintances and managed to sell it for $56.

Then the Israeli military issued its warning.

Despite the perfect weather conditions on Monday morning, when he went down to the beach, he saw no fishermen coming back on their boats.

"It was really upsetting," he said.

Lebanon’s Crisis Pushes Mental Health Services to the Limit