Mental health nursing in Palestine

Mohammad Marie  –  mental health nurse academic at An-Najah University

Mental health services vary from country to another. This variation depends on many factors, including those related to culture, politics, and resources. In the case of Palestine, with its history of conflict, mental health services are underdeveloped and face many challenges.

In the West Bank, the total number of community mental health nurses (CMHNs) is fewer than 20, offering care for a population of nearly three million (Marie et al., 2017a). Amongst these three million are large numbers with significant mental health need. Despite this, stigma and limited knowledge make mental health difficulties amongst the least acknowledged of all health problems.

The theme for World Mental Health Day 2017 has been mental health in the workplace. In a rare example of Palestinian nurse-led health services research, completed for my PhD in the School of Healthcare Sciences at Cardiff University, I conducted an in-depth qualitative study of community mental health nurses in the West Bank (Marie, 2015). Underpinning this work was the social ecological idea of ‘Sumud’. This is an important concept for Palestinians, and relates to personal and collective resilience in the face of adversity (Marie et al., in press). ‘Samud’ was used to help frame the challenges faced by West Bank nurses, and particularly to help understand their sources of resilience.

I interviewed fifteen CMHNs which produced rich and detailed information about the workplace difficulties each experienced. These were brought together under four themes: context of unrest, stigma, lack of resources and organisational or mental health system challenges. One nurse, for example, spoke of the day-to-day challenges of living in (and having to travel to work from) a village surrounded by a separation wall segregating their community. Another spoke of lacking training and supervision to support them to provide high-quality care, and during observational fieldwork nurses were seen to be unable to administer prescribed medication because of a lack of equipment.

Nurses also spoke of what sustained them in their working and home lives, and gave examples of what Samud meant in practice. One said that, for them, Samud meant ‘facing the external challenges whether at the personal or at the general level; and being steadfast all the time’. Faith was also important, along with having awareness of the collective, cross-generational, experience of collective suffering. Interviewees talked to me of their commitments to the nursing profession, and of the support given and received from family, community and colleagues. At a more individual level personal tenacity and the capacity to cope were cited.

Overall this study has developed new understanding of the working and living conditions of mental health nurses in the West Bank, and has produced knowledge of workplace mental health in a part of the world which many people in the UK know relatively little about. Research is now needed across other parts of Palestine and, critically, action is needed to develop mental health nursing practice and services.

Marie, M. (2015) Resilience of nurses who work in community mental health workplaces in West Bank, Palestine [unpublished PhD thesis], Cardiff, Cardiff University.

Marie, M., Hannigan, B. and Jones, A. (in press) ‘Social ecology of resilience and Sumud of Palestinians’, Health: an Interdisciplinary Journal for the Social Study of Health, Illness and Medicine.