Algeria is a country with an approximate area of 2382 thousand sq. km. (UNO, 2001). Its population is 32.339 million, and the sex ratio (men per hundred women) is 102 (UNO, 2004). The proportion of population under the age of 15 years is 32% (UNO, 2004), and the proportion of population above the age of 60 years is 6% (WHO, 2004). The literacy rate is 78% for men and 59.6% for women (UNESCO/MoH, 2004).
The country is a lower middle income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 4.1%. The per capita total expenditure on health is 169 international $, and the per capita government expenditure on health is 127 international $ (WHO, 2004).
The main language(s) used in the country is (are) Arabic and French. The largest ethnic group(s) is (are) Arab. The largest religious group(s) is (are) Muslim. The life expectancy at birth is 67.5 years for males and 71.2 years for females (WHO, 2004). The healthy life expectancy at birth is 60 years for males and 62 years for females (WHO, 2004).
An epidemiological study done by the Ministry of Health (2004) showed that chronic mental disorders were diagnosed in 0.7% to 1.9% of subjects of different age groups and epilepsy in 0.2% to 0.8% of subjects in different age groups. Chronic mental disorders and epilepsy were more common in those below 40 years of age and in women. There was no rural-urban difference in prevalence of these conditions. The prevalence of posttraumatic stress disorder (PTSD) assessed using the PTSD module of the Composite International Diagnostic Interview Version 2.1 was found to be 37.4% in a community survey conducted on a sample of 653 subjects (de Jong et al, 2001). Conflict-related trauma after age 12 years, torture, poor quality of camp and daily hassles were associated with the occurrence of PTSD. Brunetti et al (1982) compared depression between French (n=125) and Algerian (n=45) women.
The one-year prevalence of depressive syndrome (structurally similar in both cultures) for the two samples combined (n=170) was 15% for the mildly impaired and 3% for the more markedly impaired, but the severity of depression was greater in Algerian women. Touari et al (1993) reviewed 3984 clinical interviews of criminals over a period of 23 years. In case histories concerning 1007 criminals, who had committed or attempted homicide, psychosis was identified in 19.9%. Psychotic subjects were older, more likely to have a previous psychiatric history, less likely to come from very large families and less likely to have been raised by both parents. A prevalence survey on psychotrauma on 12 000 school children between the ages of 12 to18 years conducted in 10 regions showed that 9.2% to 29.2% of children in different regions had mental health problems related to trauma (MoH, 2002).
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is present. Details about the year of formulation are not available.
The components of the policy are promotion, prevention, treatment and rehabilitation. The components of the current mental health policy were defined more clearly in the 4 axes of the national mental health programme established since 10 October 2001.
Substance Abuse Policy A substance abuse policy is present. The policy was initially formulated in 1990. A National Bureau for Fighting against Substance Abuse has been set up since 2003.
National Mental Health Programme A national mental health programme is present. The programme was formulated in 2001. The national mental health programme prioritizes decentralization, primary health care, community approach, availability of psychotropics, adaptation of the mental health legislation, prevention of mental and neurological disorders, psychosocial rehabilitation of people with psychological problems related to violence, education of the public, formation of community and family associations, human resource development, and mental health research.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1997. A national list (nomenclature) exists, in which psychotropic drugs are included and are defined based on their medical use. Also, a ministerial circulation letter in 1997 defines the drugs to be distributed at no cost for mentally ill whose care is prioritized in the national mental health programme.
Mental Health Legislation The mental health law is included in the Law on Health Protection and Promotion of 1985. The Law no. 98.09 is the most recent legislation related to mental health. Presently, the mental health legislation is being revised. The latest legislation was enacted in 1998.
Mental Health Financing There are no budget allocations for mental health. Details about expenditure on mental health are not available. The primary source of mental health financing is tax based. The country has disability benefits for persons with mental disorders. The mentally ill are assessed for disability and benefits are provided accordingly.
Mental Health Facilities Mental health is a part of primary health care system. Actual treatment of severe mental disorders is available at the primary level. There is availability of treatment in primary health care following the integration of mental health care within primary health care as a part of the national mental health programme. There is an organization of intermediary mental heath centres in the structures of primary health care. Regular training of primary care professionals is carried out in the field of mental health. Training in mental health is provided to doctors and nurses and to the psychologists who provide primary health care. There are no community care facilities for patients with mental disorders.
Psychiatric Beds and Professionals
Total psychiatric beds per 10 000 population
Psychiatric beds in mental hospitals per 10 000 population
Psychiatric beds in general hospitals per 10 000 population
Psychiatric beds in other settings per 10 000 population
Number of psychiatrists per 100 000 population
Number of neurosurgeons per 100 000 population
Number of psychiatric nurses per 100 000 population
Number of neurologists per 100 000 population
Number of psychologists per 100 000 population
Number of social workers per 100 000 population
Some beds have been earmarked for mentally challenged individuals and for children.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in promotion. The APAMM (Association des parents et amis des malades mentaux – Association of parents and friends of the mentally ill) and the AAMMB (Association d’aide aux malades mentaux de Blida – Relief Association for the mentally ill of Bilda) help in the care of the mentally ill. Other associations work in the area of research, such as the Algerian Society of Psychiatry, the Algerian Society for Research in Psychology, the Algerian Society of Psychiatric Epidemiology etc.
Information Gathering System There is mental health reporting system in the country. Presently, several epidemiology studies on different topics related to mental health, such as the psychological consequences of violence, are under development. Furthermore, the Algerian Society of Psychiatric Epidemiology works in the area of epidemiology.
The country has no data collection system or epidemiological study on mental health. There are no national level epidemiological studies, but psychiatric institutions have their own epidemiological data collected through local surveys.
A system exists on mental health data collection since 2002 on various activities such as: care of the victims of violence, mental health activities (till mental health intermediary centre level), hospitalization, distribution of drugs, establishments meant to provide intersectoral care to mentally ill persons with social problems.
Programmes for Special Population The country has specific programmes for mental health for disaster affected population, elderly and children. An information service which deals with psychiatric emergencies has been operating since September 1997.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, ethosuximide, phenobarbital, phenytoin sodium, sodium valproate, amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol, carbidopa, levodopa.