In 2003 Late Prof Dr Adel Sadek wrote this article to the debate started by  the Lancet on the election of the Director General of the World Health Organization:


Dear Sir

Ismail Sallam

Minister of Health, Population and Mental Health

My consideration and appreciation for the debate already started on the election of the Director General of the World Health Organization. Please allow me as an independent witness to give my contribution which highlights the achievement made by the National Egyptian Mental Health Reform lead by Dr. Ismail Sallam.

Much like in any developing country, mental health was hardly a priority inside the Egyptian healthcare agenda due to the preoccupation of policymakers with other challenges like Bilharziasis, Tuberculosis, and poliomyelitis. Thus it is of no surprise Egypt suffered a considerable shortage in mental health facilities. Even the few mental healthcare providers were inaccessible to poor patients. The so-called mental hospitals were evidently the worst government facilities in Egypt. Put simply, the mental healthcare establishment consisted of old buildings with filthy facilities and hardly any qualified psychiatrists. Given the above facts, psychiatry was an extremely unpopular field for medical graduates. In consequence, doctors fell short of the skills and enthusiasm that could allow psychiatry in Egypt to keep up with the continuing progress on the academic track of the field.

Child psychiatry, forensic psychiatry, liaison psychiatry and substance abuse disorders were almost unknown to healthcare providers. More importantly, there was absolutely no interrelation between psychiatry and other branches of medicine unless psychiatrists were faced with cases involving suicides and violence. Moreover, there were no exclusive specializations in psychological stress, physiological responses and liaison psychiatry. Unlike in other branches of medicine, continued education was rare in the field of mental health.

On the political front, the government was not willing to invest in mental health. The right of mental patients to adequate health services was clearly outside the scope of human rights. Personally, I believe the root of this problem did not originate from the lack of financial resources given the considerable level of foreign aid that could have been utilized to improve the quality of mental health services. The tragedy of Egyptian mental healthcare stemmed from the lack of appreciation on the part of healthcare policymakers of the essentiality of mental health.

Today health is defined in terms of well-being, adaptation, and happiness. Such a condition remains unattainable under an environment filled with psychological instability, fear, worries, and depression. Put simply, psychological stability comprises the core of societal well-being.

In our capacity university faculty members, we were unable and disallowed to offer much outside the scope of teaching. This was no longer the case beginning 1996 when Dr. Ismail Sallam assumed the leadership of Egypt’s national health establishment. Initially, my colleagues and I had little hopes for new renovations in mental healthcare given our perception that Sallam had no familiarity with psychiatry, coupled with almost no prior exposure to the problems we faced as veterans in that specific field. To our surprise, he began addressing the shortcomings of Egypt’s mental healthcare institutions as if it was his principal priority. Upon his appointment he brought together leaders of mental healthcare, whether in the public or private sector, in a daring attempt to investigate the mental health crisis in Egypt. Dr. Sallam managed to get a clear view of the deteriorating situations by inspecting hospitals in unannounced visits. It was not long before we all came to the realization that mental health in Egypt was undergoing a revolutionary change; a long awaited change.

Dr. Sallam instituted the basic philosophy that mental health is a key element in the process of development. In terms of policy, this notion was translated into a national mental health reform project. The main tenets of this project are:

1-      ‘Prevention before cure’, or in other words the  of preventive measures in mental health.essentiality

2-      Setting mental health as a main priority in primary health care.

3-      The introduction of training programs that allowed mental health personnel to acquire the essential skills in addition to academic degrees. Human resources development program included subdivisions pertain