Mental Health Research in Palestine: what is undermining it and how we strengthening

The importance of mental health research as an instrument for informing decision-makers is increasing particularly in developing countries. As a consequence of this growing awareness also within the World Health Organization (WHO), there are many new approaches and initiatives to ensure the national health research be strengthened to address the countries' health challenges particularly in fragile and resources constraint countries. Assessing the perceptions of health system performers is an essential part of comprehensive analysis, which seeks to recognize a mental health research’s strengths and limitations. The present study is part of larger research project focused on investigating the health research system in Palestine. First, it assessed the health research concept and its importance among systems performers. Second, it evaluated their satisfaction with overall research performance and the political attention towards health research. Third, it examined the stewardship functions, governance, policy, and priorities, as a central pillar. Fourth, it analyzed stakeholders’ roles and the status of research capacity. Based on these four axes of analysis, key gaps and avenues of solutions are imperative towards not only achieving the overall health research strengthening in Palestine but also the mental health research in particular. The study targeted three sectors, namely relevant government institutions, schools of public health and major local and international health agencies. A qualitative analytic approach was used where data was collected through 52 in-depth interviews and 6 focus group discussions (FGDs) with 104 policymakers, academics, directors, and experts. The evidence shows that western models are informing the mental health system in Palestine, promoting interventions and policies oriented to empirical bases and less interested to the community implications of social suffering. Lack of funds due to the Israeli occupation are making the mental health emergency a crucial challenge in the Palestinian Health System. Cultural barriers, environmental and political constrains are contributing in disrupting the mental health system in Palestine along with lack of instruments, personnels, and models that can ensure the community well-being through robust mental health research. The results of the study were classified into different themes: firstly, the study found inadequancy of understanding on health research concepts and application among health experts in Palestine. Secodnly, health research in Palestine is underdevelopment due to a significant lack of political support and engagement. Thirdly, lack of coordination caused by absence of stewardship functions and missing of structural and regulatory framework and dispersed research work. The third theme revleals a clear weakness in the Ethical Review and Clearance (ERC) and lack of policy or strategy dedicated to health research is lacking, and low levels of knowledge and experience in research prioritization amid of lack of consensus. Fourthly, key outcomes found: low involvement of society, private, local and the international sectors; a substantial weakness in the role of international agencies in supporting health research; and significant deficit in its capacity. This deficit is due to the fact that research in Palestine is externally and individually-funded, limited and unsustainable, and importantly, moderate research quality, as well as knowledge transfer and translation are not well-conceptualized and inappropriately performed. The study also identified main further common gaps as follows: lack of health research culture, systems values and principles; structure; policy; resources; defined roles; connection and network; evidence-informed concepts; and politic impacts. The study has recommended further empirical research to investigate pertinent pitfalls of mental health research in Palestine and could be so in the region is a priority. The study offered crucial actions to be translated into policy-making levels. First, launching a strategic dialogue to strengthen health research with a focus on mental health research among actors to ensure a solid commitment, a collective involvement, and a national consensus. This move should pave the ways towards two substantial actions, building a unified national health research body and formulating a national strategy, both are integrated into the structure of Palestinian HCS, that has to include conceptual, regulatory, legal, technical and ethical aspects. Under this body and through this strategy, actions to improve health research prioritization, ERC, awareness, performance, resources and capacity e.g. research quality, knowledge transfer, and translation, are fundamental components must be integrated and improved. In doing so, operational policies for health research resources and capacity have to be established, along with guidelines, indicators, and mechanisms for prioritizing the health research in general and mental health research specifically, performance, quality, knowledge diffusion and utilization that essentially required to be formulated and adhered. Also, effective networks communications, dynamic coordination, and systematic education and training programs are further feasible actions towards achieving a comprehensive health research strengthening that should lead to promoting the mental health research. This study proofed very worthwhile because it met a longer-standing local demand, as well as was aligned with regional and global strategic directions. Consequently, strengthening and promoting mental health research and the overall health research is possible and yields meaningful benefits to the health system and other development sectors in Palestine. This research attempt opened up new avenues for any future endeavors and for the new generation of health research, mental health research, and health system strengthening in Palestine and in the region in general.