Community-wide and one-to-one interventions

In situations where a community as a whole is experiencing a crisis, the need to shift from individualized therapeutic interventions to a more collective approach toward mental health has been suggested as a possible solution (Bosqui, Reference Bosqui2020). While approaches focusing on the individual are useful in the West, the need for community-wide, culturally sensitive interventions becomes critical when an entire population is experiencing a crisis (Bosqui, Reference Bosqui2020). Although not adequate for all individuals with developmental delays and disorders, group-delivered interventions could represent a more affordable and accessible option than one-to-one interventions (e.g. McCrone et al., Reference McCrone, Weeramanthri, Knapp, Rushton, Trowell, Miles and Kolvin2005). As for children who need one-to-one early intervention services, they may benefit from telehealth services by qualified professionals who reside both within and outside Lebanon. While there are a handful of studies discussing telehealth in Lebanon (e.g., Abi Ramia et al., Reference Abi Ramia, Harper Shehadeh, Kheir, Zoghbi, Watts, Heim and El Chammay2018; Shehadeh et al., Reference Shehadeh, Abi Ramia, Cuijpers, El Chammay, Heim, Kheir, Saeed, van Ommeren, van't Hof, Watts and Wenger2020), the majority of the literature focuses on psychiatric disorders among adults and/or refugees, with no empirical work examining early intervention services for children with developmental disabilities. While it is possible for professionals residing abroad to offer such services via telehealth at reduced and affordable costs, the ultimate goal would be to train professionals in Lebanon to support community-wide and one-to-one interventions. This will ensure continuity of care within the country if and when professionals residing abroad can no longer offer such services. Furthermore, training professionals in Lebanon will ensure culturally appropriate practices. One possible avenue is offering certifications in early intervention for individuals who hold bachelors and master's degrees in a related field (e.g. psychology, speech language pathology, social work). It is noteworthy that the logistics of such services may prove complicated given the current state of healthcare systems in Lebanon, which will be discussed next.

The Lebanese health care system and licensure considerations

The Lebanese mental health profession and its organization are still relatively new. The National Mental Health Program (NMHP) was launched in May 2014 within the Ministry of Public Health (MoPH) with the support of the World Health Organization (WHO), UNICEF, and International Medical Corps (IMC; El Chammay and Roberts, Reference El Chammay and Roberts2020). Even though several laws and regulations have since been published attempting to regulate the mental health profession in Lebanon, much work remains to be done. The mental health care system in Lebanon (for adults and children) does not have the required infrastructure nor does it have sufficient human or financial resources to respond to the needs of the Lebanese population adequately (El Chammay and Roberts, Reference El Chammay and Roberts2020). An analysis conducted by the MoPH (2016) sheds light on some of these gaps, including insufficient psychiatric beds, supplies, and a shortage of mental health professionals. It is worth noting that these findings were published in 2016. At the time of this writing, in early 2022, in the midst of what has been dubbed as one of the most severe global crises by the Word Bank (World Bank Group, 2021), the mental health gaps identified in 2016 are likely much worse today.

In a similar vein, most governmental mental health programs and support (when available) seem to be offered to refugees, low-income people, port blast victims, and individuals suffering from alcohol disorders with few or none aimed at children with developmental delays and disorders. In addition to the Lebanese MoPH, the Lebanese Ministry of Social Affairs (MSA) is tasked with providing information and support to individuals with developmental delays and disabilities. A look at the MSA's website highlights the harsh reality Lebanon is currently facing: The information is difficult to locate and what services are available and where to access them is far from clear. For a parent of a child with developmental delays and disorders, navigating Lebanon's health and social systems seems confusing and painful at best.

As for the financial coverage of mental health services, approximately half of the population in Lebanon is insured by private companies (Yehia et al., Reference Yehia, Nahas and Saleh2014; MoPH, 2015). Most of these private health insurance plans (especially the Lebanese ones) do not cover mental health services. Some Lebanese have health insurance through a workplace pension for public sector employees, such as the National Social Security Fund, the Army and Internal Security Forces, and the Public Servants. These workplace pensions cover, to varying degrees, psychiatric visits, psychotropic drugs, and inpatient care (Yehia et al., Reference Yehia, Nahas and Saleh2014; MoPH, 2015). To the best of our knowledge, these health coverages do not extend to early intervention services for children. Parents seeking such services need to cover these costs out of pocket. To make matters worse, charges from service providers keep increasing (in most cases) due to the devaluation of the salaries of mental health professionals. Lastly, to the best of our knowledge, most telehealth services are not covered by either public or private insurance companies in Lebanon, especially the ones pertaining to early intervention services, underscoring the inequitable access to early intervention services in the country.

Another potential problem that may arise is licensing. Attempts to create licensing rules and regulations for practicing psychologists in Lebanon remain relatively new (Lebanese University, 2017). Under the current National Mental Health Programme (NMHP) guidelines, to practice on Lebanese soil, one needs to be a Lebanese citizen. However, exceptions are made when the need for a certain expertise is high and difficult to find. This regulation also does not apply to Applied Behavior Analysis (ABA) therapists, nor does it apply to various professionals (e.g. speech-language pathologists, psychomotor therapists) that are often called to work with children with developmental delays and disorders. To the best of our knowledge, regulations concerning the use of telehealth in Lebanon could use more formalization and guidance. For more information regarding guidelines and considerations when offering telehealth services in Lebanon, please see Naal and et al. (Reference Naal, Whaibeh and Mahmoud2021). As authorities create licensing guidelines, it is imperative for them to take into account the current exodus of professionals in the field and ease the guidelines for foreigners willing to train and support the citizens who remain in the country. Additionally, offering regulations for the efficacious and ethical use of telehealth is an important next step.

In sum, even though some efforts have been made to try to move the field of psychology forward in Lebanon, much work remains to be done. The recent pandemic and socio-economic crisis the country has been grappling with has only exacerbated existing issues and hindered progress. According to Médecins Sans Frontières (MSF, 2021), the Lebanese health care system is disintegrating.