Highlighting successes and challenges of the mental health system in Tunisia: an overview of services, facilities, and human resources

Abstract

Background

Tunisia is a lower-middle-income country located in North Africa with strengths and challenges to its mental health system.

Aims

We present an overview of available services, facilities, and human resources to offer mental health care in Tunisia.

Methods

We conducted a cross-sectional study, where data for the year 2017 was collected between May 2018 and May 2019 by consulting stakeholders involved in the health field in Tunisia. We compare this information with data published in the WHO-AIMS report (2008), which presents mental health data in Tunisia for the year 2004.

Results

Successes of the mental health system in Tunisia include an increase in the ratios of psychiatrists and psychologists, with these ratios being higher than those of other lower-middle-income countries; a flourishing child-psychiatry practice; and an increase in people being treated for mental health conditions. Challenges include psychiatrists being over-represented in large cities along the coastline and in the private sector, and most people receiving treatment in specialized mental health facilities.

Conclusions

The further operationalization of the National Strategy for Mental Health Promotion is envisioned, through the training of non-specialists in mental health care and incentives offered to psychiatrists to work in the country’s interior and the public sector.

Keywords:

• Mental health
• mental health system
• resources
• LMIC
• Tunisia

Acknowledgements

The authors would like to thank the following people for their support and help with data collection to inform this article: Sonia Khayate, Sofiane Manai, and Zeineb Boughdiri (Direction of Public Healthcare Facilities at the Ministry of Health); Sihem Bellalouna (Regional Coordination Unit at the Ministry of Health); Lobna Ghrab (Social Worker, Ministry of Social Affairs, attached to the Ministry of Health); Ahlem Gzara (Direction of School and University Medicine); Hela Ouennich (National Office of Family and Population), Mohamed Turki (National Medical Council), Aslem Lazaar Selimi (Tunisian Association of Psychologists), Samia Chaabène (National Union of Speech Therapists), Amel Salem Mouhli (National Union of Occupational Therapists). The authors also wish to thank Matthew Rettino for his editing services and Slim Achour for drafting the figures.

Disclosure statement

No potential conflict of interest was reported by the author(s).