In the last years, the number of people in Turkey suffering from anxiety and depression has significantly increased due to the factors like repeated natural disasters, migration, economic downturn and COVID-19 pandemic. According to the data of the Ministry of Health of Turkey (MoH), 17 percent of the population face mental health issues, 3.2 million people suffer from depression, and antidepressant consumption has increased by 56 percent in five years. Of a population of about 83 million, some 9 million people seek mental health support in Turkey each year. Add to this the fact that Turkey hosts the highest number of refugees in the world, with over 3.6 million Syrian refugees, and we have a major social problem: mental health. 2020 was also the year when COVID-19 pandemic broke out, scaling up the challenges.

The Social Inclusion of Persons with Mental Disabilities, an EU-funded project, was aimed at addressing the above mentioned mental health challenges. Launched in 2018, the project received technical assistance from the WHO Country Office in Turkey (WCO), with the Ministry of Health and the Ministry of Family, Labour and Social Services (MoFLSS) as beneficiaries. The project aimed to enhance workforce skills in providing healthcare services to people with mental disabilities and to improve community-based healthcare services at a national scale. Another objective was to capacitate those who deliver health services for both refugee and host communities with a strong emphasis on people-centered care.

In line with the WHO Global Mental Health Action Plan, WHO’s Thirteenth General Programme of Work and the European Programme of Work “United Action for Better Health in Europe”, the revision of the National Mental Health Action Plan started. WCO developed technical guidelines for the functioning of local steering committees on mental health that enabled better supporting governance at the provincial level. In addition, WCO delivered training modules for MoH and MoFLSS staff operating in primary health care services, refugee health centres, Community Mental Health Centers (CMHC), and Residential Care institutions. As a result 500 healthcare workers were trained using local steering Committee Guidelines. Additionally, under the Mental Health Gap Action Programme (mhGAP), WCO provided training workshops for Syrian and Turkish general practitioners, community health workers and mental health staff, to equip them with improved knowledge and updated practices of diagnosis, referrals and treatment processes when addressing the mental well-being and psychosocial needs of refugees. Over 3,400 Syrian and Turkish health professionals were trained in dealing with several mental health and psychosocial support issues (mental health GAP, early childhood development, gender-based violence, psychosocial support, and others).

WHO scaled up its support in mental health with a specific focus on improving the quality of services to provide a timely response to COVID-19 related needs. WCO supported MoH and MoFLSS in efforts targeting on public awareness and advocacy, the development of guidelines and algorithms to support psychosocial hotlines, the development of guidelines for the transition period of CMHCs, online training for managers of social care centers of CMHCs. The webinars addressed issues like the provision of mental health services during the pandemic for 175 CMHC. The training sessions and webinars covered all residential care institutions managed by MoFLSS and 85% of CMHCs managed by MoH. The guidelines developed are in use for all psychosocial hotlines and CMHCs staff nationwide.

In order to meet the new restrictions on meetings imposed by the pandemic, WCO adapted and translated into Turkish the QualityRights e-training platform, WHO’s an online  learning tool to improve the provision of mental health services and promote human rights of people with psychosocial, intellectual and cognitive disabilities around the world. 773 people enrolled and 90 completed the training on topics of human rights, mental health, disability and human rights, recovery and the right to health in mental health and social services, legal capacity and the right to decide in mental health and social services, mental health and social services free from coercion, violence and abuse, and others.

Online meetings, webinars and psychosocial support algorithms for COVID-19 hotline took place in 81 provinces of the country. The hotlines provided support to 236 000 people between April and December 2020, to help them cope with stress factors caused by changes stemming from the COVID-19 pandemic. The hotlines also assisted individuals with chronic mental illnesses and provided a referral mechanism for people who require access to social services.

Another important project implemented by WHO is the Refugee Health Programme, that specifically addresses mental health issues of the refugees and migrants hosted in the country. WHO continues today to work closely with Turkey’s Ministry of Health to provide health services to Syrian refugees. The project offered a bridge to linguistic and cultural barriers to serve as patient guides at primary, secondary and tertiary levels of care. Furthermore, WCO coordinated the provision of continuing medical education to Turkish and Syrian health workers in diagnosing and treating mental health conditions like depression, anxiety, and post-traumatic disorders. In addition, WCO advised on guidelines and algorithms for psychosocial support hotlines, which provided 80 000 consultations annually in 7 Refugee Health Training Centers.

With the close relationship between WHO and MoH as a key factor for the successful design and implementation of planned activities, WHO worked closely with a range of Government actors, including related Ministries - specifically MoH and MoLFSS - academics, professional organizations, service user organizations as well as provincial health and social care directorates and staff of health and social care centres.

As part of a coherent, structured, and coordinated effort, these projects form the broadest training initiative related to mental health and psychosocial support in Turkey and in the region in the recent years. Overall, through these projects, Turkey has strengthened its health workforce through in-service training, and by responding rapidly to health emergencies.

Photo caption: Turkish and Syrian family physicians participated in “Training on Strengthening Mental Health Services in Primary Care Program” carried out within the framework of MhGAP to scale up mental health services in non-specialized health settings to achieve universal health coverage.

Photo credit: WHO