Date de publication:
Dimanche 05 Avril 2015 - 16:06
Publié ici :
05 Avril 2015Mis à jour le :
24 Juin 2017Mots-clefs:
- santé mentale
- mental health
- billet
- Farzyat
- santé
- blog
- Maroc
- CJB
Zone géographique:
- Moyen-Orient
The economy of mental health : Inequalities in access to care in Morocco
In 2005, Morocco's Ministère de la Santé carried out its first-ever epidemiological survey of mental illness in the country. As a Bulletin de Santé later reported, the study found that about 50% of the population had suffered from at least one minor psychiatric ailment over the course of their lives:
"... one in two Moroccans presents with at least one significant sign of impaired mental health, regardless of its degree of severity, ranging from a simple nervous tic or occasional insomnia to more serious manifestations of anxiety or depression."
This number lies within range of the global average, and is not terribly surprising in and of itself. But nearly ten years after publication of this bulletin, a majority of Moroccans who suffer from mental illness still do not receive adequate care – and many never get to see a psychiatrist at all.
Mechanisms of Inequality: Why Access to Care is More Difficult for Some than Others
Several reasons might be cited for this lack of therapeutic intervention. One probable factor, for example, is a lack of willingness to seek out mental health treatment. Within a public health system already associated with a poor standard of care and unavoidable corruption, psychiatry suffers from an especially negative reputation; it still has not fully managed to shed a problematic colonial legacy of severe treatments, racism, and long, involuntary hospitalizations.[2] Another factor likely to keep people away from psychiatrists' offices is a lack of public knowledge about mental illness. Among a large percentage of the population, the nature of major psychiatric diagnoses such as schizophrenia or bipolar disorder is poorly understood at best; at worst, individuals afflicted by one of these illnesses suffer the significant stigma of being labeled as hmeq, or 'crazy'.
However, one of the most acute impediments to receiving good quality psychiatric care – and one that tends to exacerbate the impact of the other factors just mentioned – is a lack of availability and a marked inequality of access to the resources that do exist. Despite recent efforts by the Ministère de la Santé to improve both the quality and quantity of psychiatric services, good mental healthcare in Morocco generally remains difficult to obtain for any but those who belong to the country's upper socio-economic classes. This uneven access not only reflects, but also has the potential to further entrench, fundamental inequalities present in Moroccan society.
Morocco's historic division into bled el makhzen and bled as-siba continues to leave its mark on the nationwide distribution of healthcare resources – just as it still impacts the reach of other government services and social goods. The anchoring points of the public healthcare system are a network of regional Etablissements de Soins de Santé de Base (ESSBs), or small primary health clinics. As of 2010, 2626 such clinics were in operation around the country, in addition to about 140 larger government hospitals and clinics concentrated in urban areas. The ESSBs are specifically meant to constitute a decentralized system that makes basic care accessible to everyone. In practice, however, the distribution of these ESSBs across the country remains uneven: as much as 70% of Morocco's rural population must travel more than five kilometers to reach the nearest healthcare facility, often little more than a dispensary that may not always have a doctor on site.
The distribution of mental healthcare facilities is even more sparse and uneven. The total number of practicing psychiatrists in Morocco is estimated at 350 – which translates into a ratio of about one specialist per 100,000 people – and the vast majority of these doctors practice in the larger Rabat-Casablanca metropolitan corridor. Some of them run private practices, while others are connected to one of the Ministère's 27 public institutions for mental healthcare; a combination of psychiatric wards within general hospitals, specialized mental health facilities, and psychiatric teaching hospitals. In efforts, once again, to decentralize the nation's network of mental health resources and favor regional community treatment over large urban institutions, the number of beds available at each of these institutions has been deliberately limited, or even scaled back.[4] However, the Ministère de la Santé has not had the resources to couple this with an expansion of mental healthcare facilities around the country. As a result, these 27 institutions together offer no more than about 1900 beds for mental healthcare nationwide – which amounts to less than one per 17,000 people. Most of these beds are concentrated in Morocco's larger cities, leaving the country's rural regions without local access to any mental health resources.
(...)
Le 30 mars 2015
par Charlotte Hajer
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