Hundreds of thousands of Iraqis are severely traumatized from torture, kidnappings, bombings and other forms of violence. Although torture is most frequent in cities and regions afflicted by sectarian conflict, its use persists even in areas of the country that are experiencing relative stability. Heartland Alliance has established a rural network of paraprofessionals and physicians that is integrated within the Ministry of Health (MoH), and is the only program that combines training and supervision, and integrates mental health in primary healthcare in rural Iraq. These mental health workers serve people with a range of mental health problems, but torture survivors are prominent in their caseload and comprise at least 50% of persons seeking treatment for major depression or PTSD. The Ministry of Health Community Mental Health Workers (CMHWs) require ongoing clinical supervision and training, and the MoH requires management training to maintain and strengthen this network. However, the MoH is constrained by a lack of resources, low salaries and an institutional culture in which supervisory personnel rarely visit the field. In addition, management personnel within the Ministry of Health require some education and advocacy in order to assure that mental health services receive appropriate prioritization within the MoH's internal budget planning and administration to assure that CMHWs receive the support required to continue their work. Addressing structural issues within the Ministry of Health is as important as training and clinical supervision in assuring smooth functioning of this rural network of mental health providers.

Summary

Heartland Alliance is working with Johns Hopkins School of Public Health (JHSPH) to develop a cost-effective, efficacious treatment intervention for traumatic stress, specifically focusing on victims of torture in rural areas that can be implemented by healthcare workers without extensive formal mental health training so as to work in the bounds of the MoH's capabilities. The project also seeks to improve the mental health status of persons in these areas suffering from PTSD, major depression and other sequelae of trauma related to serious human rights violations. The project builds on the network of CMHWs that Heartland Alliance has established in ten of Iraq's eighteen Governorates, concentrating on torture treatment but also providing basic primary mental health care. In consultation with JHSPH, Heartland Alliance is working to strengthen the Iraqi and Kurdistan Regional Government Ministries of Health in their management of the CMHW network.

Activities

Heartland Alliance is working to provide mental health care for Iraqis in rural areas by:

• Supporting a network of Community Mental Health Workers (CMHWs) and physicians in Iraq's primary health care system;
• Providing basic medical and mental health services to torture survivors through existing Ministry of Health facilities, and monitoring their well being;
• Training of Ministry of Health primary healthcare supervisory staff to independently supervise the CMHW network;
• Increasing the population’s awareness of CMHWs’ available services in communities where they exist.