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People have migrated from one place to another since the start of human existence, for all kinds of reasons and varying durations. The process of migration can be divided into three stages: pre-migration, migration and post-migration. The impact of migration on an individual's mental health is multifaceted and affects different aspects of the individual, whether it is biological, social or psychological. Migration involves a series of losses, such as the family and the familiar society; both emotional and structural losses are experienced. The relationship between social inequalities and mental health is well known and it is inevitable that if migrants suffer from social and economic inequalities they are also likely to suffer from mental ill-health, though the mediating factors may well vary. In cultures where Cartesian mind-body dualism is not a prevalent model, the interaction between somatic symptoms and psychological distress will be significant.
Psychiatry in North Africa and the Middle East, from Morocco to Iraq (excepting Israel), is a burgeoning specialty in an evolving medical field within developing countries. Currently it is beset by two main problems: insufficient numbers of physicians and trained staff and insufficient funding:
Staff. A country like Morocco, with 27 million inhabitants, has no more than 200 psychiatrists, a few dozen clinical psychologists, and about 400 nurses specialized in psychiatry. However, in almost all of these countries, remarkable training efforts are under way and are steadily improving the situation.
Funding. The number of beds available and the budget allocations for psychotropic medications are far behind the actual needs in these countries.
One of the consequences of this inadequate medical provision is that considerable proportions of the patients seen by psychiatrists in North Africa and the Middle East are psychotic, especially those seen in the public sector, for they represent most of the emergency cases. For example, in Casablanca, the second largest city in Africa, more than 80% of the hospitalized patients in psychiatric wards and about 60% of the patients seen in psychiatric outpatient clinics (representing more than 35,000 patients) are psychotic and are treated with neuroleptics. Nevertheless, in North Africa and the Middle East, there have been only a few studies of tardive dyskinesia, one of the most important iatrogenic effects of neuroleptics.
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