With more than half a million of its inhabitants suffering from depression in 2019, the North African country of Tunisia has seen a rise in mental health conditions in recent years. Based on data compiled between 2018 and 2020, the 2021 World Happiness Report ranked Tunisia 122 out of 149 countries in terms of citizens’ overall happiness. Unfortunately, stigma and discrimination surrounding mental health in Tunisia deter those in need from seeking help and treatment, a problem exacerbated by a lack of mental health services and facilities. However, the Tunisian government and several national and international organizations are taking action to improve mental health in Tunisia and ensure its citizens have the resources necessary to lead happy, fulfilling lives.

Factors Impacting Mental Health in Tunisia

Over the last 10 years, Tunisia has been hit by social, economic and political turmoil that has led to a decline in mental health. Mental disorders are responsible for 98% of extended sick leaves among public service sector employees in the country. Yet, many Tunisians suffering from mental illnesses and disorders do not seek help due to persistent “stigma and discrimination against people with mental disorders,” which the WHO has identified as “a significant public health issue in Tunisia.”

Such stigma is prevalent, not only among the general public but also across the country’s health care systems and among health care providers, who receive limited training in mental health diagnosis, treatment and recovery. Similarly, there are limited public programs in place to raise awareness of mental health disorders and promote intervention, prevention and treatment, causing many to feel shame for seeking help for themselves or their loved ones.

Additionally, there are limited resources for those struggling with mental health issues in Tunisia. For instance, as of 2020, Tunisia had only 2.89 psychiatrists, 3.36 mental health nurses and 0.23 social workers for every 100,000 Tunisian citizens, according to the WHO’s 2020 Mental Health Atlas report. The lack of mental health care workers has been compounded by a lack of mental health care facilities across the country, which has only one mental health hospital and 10 psychiatric units in general hospitals.

Consequently, even those who want to seek help often lack access to it. Untreated mental illness can have detrimental consequences for individuals, families, communities and societies as a whole. It often results in unemployment, homelessness, substance abuse and incarceration, profoundly diminishes the quality of life and increases the risk of suicide.

Current Solutions

Fortunately, there is hope for strengthening mental health care in Tunisia and eradicating the barriers that prevent people struggling with mental illness from obtaining help.

With support from the WHO, a group of psychiatrists from Razi Hospital is now working to implement changes that will advance mental health care in Tunisia to a level consistent with its general health care system.

The only public hospital completely dedicated to mental health in Tunisia, Razi Hospital has launched the country’s first anti-mental-health-stigma training for medical students at Tunis Medical School. Introduced in 2017, the program called Responding to Experienced and Anticipated Discrimination (READ), centers on educating future doctors about mental-health-related stigma in order to reduce it and improve the quality and accessibility of mental health care. The program has already shown positive results. In Tunisia, the number of mental health workers per 100,000 citizens increased from 0.20 in 2017 to 8.77 in 2020. Additionally, there was a 1.31% increase in expenditures on mental health research between 2016 and 2019.

The Tunisian authorities are stepping in to improve mental health in Tunisia, as well. In 2020, at the height of the COVID-19 pandemic, the government implemented a Psychological Assistance Unit to address the growing need for mental health support. It also established a toll-free hotline that allowed people struggling with mental health issues to remotely access the services of 240 mental health professionals.

Looking Ahead

In the face of rising mental health challenges, Tunisia is taking significant steps to improve mental health care and reduce stigma. The implementation of the Responding to Experienced and Anticipated Discrimination (READ) program at Tunis Medical School has shown promising results, increasing the number of mental health workers and research expenditures. Additionally, the government’s establishment of the Psychological Assistance Unit and toll-free hotline during the pandemic demonstrates a commitment to providing accessible mental health support to those in need. These efforts offer hope for a brighter future where mental health resources are readily available to all Tunisian citizens.

–Paige Falk

Photo: Pxfuel