Introduction

Human rights concepts have traditionally been discussed under the purview of politics, economics, and/or sociology. Human rights abuses, however, are always human behaviors inflicted upon being who suffer physically and psychologically. Despite this obvious fact, human rights groups, conference, and symposia rarely consider human rights in their wider social context, including norms, values and historical background. Many ask about the relation between mental health and human rights. To find the answer, we have to revert to the definition of mental health itself and to health in a general sense. This involves a wide-ranging health perspective that encompasses environmental, family, and community health factors, not just an inflexible medical perspective. We must consider mental health as the interaction between a person's self-mechanism and the surrounding environment (human and non-human). When they have mental health, people will be able to enjoy the environment around them, so that they can feel happy and satisfied, and hope for a bright and positive future. An important first step in understanding and intervening to prevent and overcome -term the psychologically degenerative effects of human rights abuses is the training of mental health specialists in regions where human rights lack respect. The post-Graduate Diploma in Community Mental Health at the Gaza Community Mental Health Program is one such training project, designed to train professionals in Palestine to manage and intervene in order to address the chronic effect of human rights abuses. Arguing that interaction between different cultural backgrounds will highlight the marks of behavioral abuse; we will describe an international effort to train local professionals in community mental health and the long -term objectives of that effort. In the context of community mental health training, the emphasis is given to combining social, psychological and biomedical knowledge in training and education of mental health professionals. Behind community mental health education lie important new concepts that provide an effective mental health services and encourage development. These concepts involve real changes in the thinking of health professionals, transforming their role form providers of mental health care to facilitators of care. The most significant change in thinking is recognizing the rights of individuals and communities to express their needs. If such change in thinking is not available, mental health will continue to be viewed as a narrow scientific and political slogan.

Mental health profile of Palestine.

The concept of mental health is not well understood in our society. It fact, mental disorder are perceived as extremely negative of illness. As in most Middle Eastern countries, Palestinian culture retains a traditional explanation of mentally disordered people. The common belief is that mental disorders are mainly attributed to one of two explanatory models. The first is based on the work of supernatural forces known as "evil spirits" or "the evil eye," and in Arabic as "djinn" or "a-fa-reet." The traditional healer is seen as the only person able to extract the "a-fa-reet" from the human body. The second explanatory model is that mental disorders are neuro-biological disturbances that need chemical treatment. Because mental ill- health is highly stigmatized, sufferers usually seek the help of traditional healers or present their psychological complaints in the form of physical symptoms. These attitudes may not be expressed freely, but they constitute a major obstacle to the development of rational mental health services. Mental health is one of the least developed areas in the Palestinian health system. Previously, psychiatric ailments were ignored and patients were neglected and/or held responsible for their illness. Health professionals considered mental ill health simply as madness. Its care had no prestige. Priority was given to organic and infectious diseases, which spread amongst the population and caused many deaths, especially among children. When the intifada erupted in 1987, the mounting psychological problems passed undetected by primary health care professionals. Consequently, the question of mental health was brought up and received increasing attention after the intifada. There are two psychiatric hospitals in Palestine: one in the Gaza Strip and the other in the West Bank. Both have limited staff and together have a capacity of 370 beds. The two hospitals offer bedside care without any community mental health services. The majority of the working staff has gained its knowledge of mental health through work experience. The severe restrictions imposed by the Israelis and the fact that mental health is a quite development in Palestine have had a great impact on the declining quality of services provided. The Gaza psychiatric hospital is located in Gaza City and consists of 50 beds. In 1997, average bed occupancy of the Gaza psychiatric hospital was 95%. The average stay in the hospital as between 3-5 weeks. The majority of patients suffer from stay psychotic disorders and the majority of discharged mental health patients faces a sense of stigmatization and are not reintegrated into the community. Although recently a medical school was initiated in the West Bank, currently no such school exists in Gaza. Palestinian universities do not offer clinical psychology or psychiatric social work. The existing faculties train educational psychologist and social workers. The curriculum is knowledge based and gives little attention to clinical skills. The existing nursing schools give little attention to mental health. In their curriculum, the knowledge of mental health issues are biomedical in orientation and lack comprehensive coverage. In the Gaza Strip, there are no community mental health services offered by the non- governmental sector apart from the Gaza Community Mental Health Program (GCMHP). Only recently, in1996, the Palestinian Ministry of health opened two community mental health units manned by a psychiatrist.

GCMHP

It was established response to the increasing number of mental of the intifada, the GCMHP in 1990 to meet the immediate needs of the health problems among Palestinian as a result of the violence and trauma population of Gaza. The program has adopted a community-based approach to address mental health problems. It offers mental health services at three community mental health centers. These centers are located in Jabalia (north), Khan Younis (south) and Gaza City. Each center has its own multidisciplinary team consisting of nurses, psychiatrists, psychologists, and social workers. Each team collaborates with the existing health and non-health organizations in Gaza. In addition to the implementation of community education campaigns, the program offers therapeutic services to more than 9500 people, primarily traumatized children, female victims of domestic violence, and victims of torture and drug abuse. Simultaneously, the Program has established a broad network of friends, supporters and professionals in Palestine and elsewhere. The GCMHP established a Research Unit in April 1990. The goal of this Unit is to investigate and analyze effects of violence, considered the most important psychological phenomena affecting individuals and families. One of the most important target groups of the unit has been Palestinian children. When the Program was establish in 1990, its primary staff recognized the absence of training institutes in Gaza that could adequately prepare mental health professionals. To overcome this difficulty, the Program on an ambitious training program and attracted trainers from prestigious institutes from around the world. The trainers offered in-house training to the GCMHP staff to provide them with the knowledge and skills necessary to provide quality services to the Palestinian population. Several selected members of the staff went abroad to further their professional skills and have returned with an increased capacity to assist in the training of local staff. The capacity of the Palestinian staff to conduct culturally sensitive training has also increased. In 1995, a one year "training of trainers" course was conducted for 5 mental health professionals working for the GCMHP. The course aimed to improve the local trainers' skills and enable them to properly train others. In addition to the GCMHP staff, the Program has increasingly been called upon to train other Palestinian health care providers in the various mental heath skills. For example, in 1993 the program successfully completed a three-month comprehensive course in community mental health nursing. Twelve nurses attended the course. All of them are now working in the Palestinian health system. In 1994, a one-year course in community mental health was conducted. Twelve social workers, psychologists, nurses and doctors completed the course. All of them are employed in governmental and non-governmental organizations. These promising results encouraged the Training Department to organize other projects. In 1995, another fifteen professionals were trained in community mental health. Upon completion of this course, the Palestinian of Education employed all of the graduates as mental health professionals in health institutions and as school counselors. In 1996, twelve-community women leader completed a six-month training course. They are now running their own community women's center in the southern part of Gaza. Another such course was conducted for twelve community women leaders during 1997. The graduates have opened their own community women's center in the Beach Camp in Gaza City. To improve the communication skills of kindergarten teachers and enable them to detect mental disorders in children, two six-month training courses for providers were organized in 1997. Forty teachers from different kindergartens in the Gaza Strip participated in these courses. In 1994, planes were developed to introduce a post -Gradate Diploma in Community Mental Health for professionals in all fields of health care in an attempt to address the total lack of psychiatric in Palestine. Such training must ensure that candidates receive adequate Knowledge of state of the art theories, principles and strategies of treatment and prevention used in addressing mental health concerns. The training must also be based on a spirit of active participation and self- learning.

Broad Aims and Objectives of the Diploma The post-graduate Diploma in Community Mental Health Is a two year course run jointly by the Gaza Community Mental Health Program and the Islamic University of Gaza. Candidates who successfully complete the course will be awarded a Diploma in Community Mental Health. The program combines both theoretical and clinical aspects of community mental health and provides candidates with a broad base of knowledge. The curriculum is culturally sensitive and community oriented. It demands a critical analysis of the concepts of human rights and mental health. Seven international universities contribute to the diploma, including Edinburgh University-Uk, Flinders University-Austria, Oslo University-Norway, San Francisco University-Israel, Tunis University-Tunisia, and Utrecht University-the Netherlands. The diploma is designed to encourage candidates to explore theoretical concepts and practical applications of community mental health and rights, Wide exposure to clinical experience enables the students to discover their particular interest in mental health, while learning about many different areas and how to integrate them in clinical practice and social interventions. The course attempts to beak away from the medical model and its tendency to focus on microscopic aspects of mental health. Instead, it hopes to place the study of mental health within the wider social, environment al, and biological context. The course further seeks ways to shift psychiatric therapy away from traditional Freudian concentration on the individual and his unconscious motivational conflicts to move closer towards an emphasis on the social, interpersonal, and environmental factors. The course is placed firmly within the philosophy of the community based approach which emphasizes the shift from segregated, self-contained based approach which emphasizes the shift from segregated, self -contained mental health care system within institutions to community based therapy and community involvement in health related issues. It also emphasizes a change in the role of mental health professionals from being providers of mental health care to facilitators of care, thus enabling individuals to solve their problems using available family and community resources, such as schools, mosques, etc. The course aims to equip students with real skills, helping the transition from theoretical class-based study to skilled and practical application within the community. No course in mental health would be complete without an analysis of human rights and role they play within the community. The course therefore hopes to expose students to notions of human rights and to highlight the links between mental health and human rights. Candidates are expected to combine knowledge gained from their clinical work with information obtained from the Diploma. They will have access to the GCMHP library and computers in addition to the Islamic University Library. Key reference articles will be copied and distributed prior to lectures. A general reading list will be available at the end of each module. Future outlook

This is an on-going project and needs to be evaluated and improved. Therefore, we have established an ongoing system of corrective evaluation through an academic board. Since such community mental health training does not exists in the middle East, the Diploma will be the first step towards the formation of an Arab Institute for community Mental Health that will attract international students and researches. Well-qualified local professionals will take over teaching responsibilities from the international teachers and will run the institute. In order to prepare the local trainers for this mission, we are organizing their continuing education towards PhDs and Masters degrees by distance learning.