Al Rawiya

Mental Health & Economic Performance in a Crisis-marred Lebanon

I turn on my laptop to write, blank head, I turn it off. Turn it on again, I forget what I want to write about, I turn it off. Third time’s a charm, right? Not in Lebanon. Third time, there’s no electricity, no Wi-Fi, no patience anymore. Deadline is approaching, anxiety kicks in.


While the whole world gears up to battle different crises, Lebanon, yet again, finds itself against multiple opponents. The dire economic conditions along with the previous restrictions of the Coronavirus, took up the lion’s share of every Lebanese person’s burden. However, a silent mental health epidemic is just around the corner of every household, forming an unnoticed bubble that is on the breaking point of  bursting.


Today, Lebanon has the lowest wage (OCHA, 2021) in the world with 82% (UNESCWA, 2021)  of the population living in multidimensional poverty as of 2021. A person is considered multidimensionally poor when he/she suffers from poverty in several dimensions at the same time. A prominent example of such dimensions in the Lebanese experiment includes a less than optimal access to healthcare and education facilities.  Yet, the cherry on top, remains  the supply shortages the country continues to face. All families are suffering from shortages in food, electricity, fuel and medicine(Farran N. 2021) (Maatouk I. et al 2021). The prevailing struggles fall heavier on the less fortunate families, as the rich find it easier to rely and access substitutes from abroad. However, it is important to note that financially “well-off” people do face liquidity limitations as well, particularly once looking at yet another dimension, the banking crisis. Even the most well-off families are struggling to access their financial assets being held by the local banks, with an almost null access to their savings. While the media sheds light on the damages of the scarcities on the physical well-being of an individual, the topic of mental health still hovers behind the spotlight.


Analyzing the mental well-being of the average Lebanese person is very complex, as almost all generations have suffered wars, political instabilities and economic downturns. Though there isn’t enough evidence in Lebanon, studies in other countries prove that accumulated adverse events have a greater impact on a person’s health than a single event. Thus, scholars  emphasize on the fact that Lebanese people are more prone to poor mental well-being, given the events that have occurred from the 90s till now. Research done in 2011(Maatouk I. et al. 2021) shows that Lebanese who have experienced two war events were three times more at risk of developing mental health disorders.  Most recently, researchers(Salameh P. et al. 2020)  also explained how the effect of the pandemic and the economic recession combined exacerbate stress and anxiety, more so should each of the following hardships have taken place on their own timeframe.  As such, it is important to divide the statistics into two categories: people who were dealing with mental health issues before the (Habib R. et al. 2020) pandemic and the August 4 explosion, and people who developed mental health issues after these events.

Credits: Photo Courtesy of Nuno Alberto

Just before the Beirut port explosion, 60% (Grey I. et al. 2020) of self-isolated people reported experiencing a deterioration in their mental well-being. Also, a large sample of low-income Lebanese bakery workers were interviewed regarding their mental health status, which  resulted in 45% of them reporting (Grey I. et al. 2020) poor mental well-being as the economic situation was worsening and instability was creeping in their daily lives.

Hiba Dandachli, communications director of Embrace, an NGO providing free mental health hotline services, explains how the number of calls increased by threefold between 2019 and 2020. The NGO surveyed (Embrace, 2022) a sample of 903 people after the port explosion. The statistics gathered were alarming, with  83% of interviewees  reporting  daily sadness and lack of pleasure, and 78% reporting  high anxiety levels. A month later, the numbers decreased to 55% and 46% respectively, however the percentages remain disturbingly high.


Despite all the power constraints in 2021, the number of calls received by Embrace has immensely increased. “Man-made” disasters evoke feelings of guilt. Erikson (1995) explains that “wrongs, however perpetrated, are never settled unless there is genuine apology and reparation; to the extent possible, for what has been lost”. Lebanese people blame the government for the explosion, yet have  not received  any form of compensation or apology. This leaves the Lebanese people in  more despair as justice remains unserved, exacerbating the time needed for the nation to commence healing from their experienced trauma.


So why are we talking about mental health? According to the latest data provided by Embrace, every 2.1 days and 6 hours, Lebanon recorded both a suicide and a suicide attempt respectively between 2018 and 2021. In all suicide cases reported to the Internal Security Forces (ISF), the percentage of men committing or attempting to commit suicide has shown to be more prominent  than that of women,  between the ages of 18 and 39 (Beirut Today, 2021).


Though mental illness is not a topic of interest to many people, the total number of individuals  who suffer from any  kind of mental  disorder can be estimated to amount to around 1 billion people globally, as reported by the United Nations in June 2022 (United Nations, 2022). Thus, I believe looking at the issue of mental health from the economic lens would be prudent to better understand the rising numbers of individuals affected by mental health disorders. 

Credits: Photo Courtesy of Gadiel Lazcano

Since the core of capitalism is profit, let’s analyze mental disorders in terms of numbers. Depression and anxiety alone cost the global economy $1 trillion every year in lost productivity. Other mental disorders cost the economy an additional $2.5 trillion as found in 2010. This number is projected to increase to $6 trillion by 2030 (The Lancet Global Health , 2020). Studies in the United States have also shown that mental health related sick days cost the economy $53 billion every year. In other words, with every extra sick day taken for mental health reasons, the real per capita growth rate decreases by 1.84% (Science Daily, 2018) (Embrace, 2022). 


Thus, one may ask where exactly do those costs arise from? How does an individual battling their own mental health issues cost the economy this much? The answer lies in both: direct and indirect costs. People with mental health struggles frequently experience physical symptoms and pains. For example, people diagnosed with crippling anxiety often suffer from shortness of breath, fatigue and muscle aches. This means that they will also have to pay for physical illness treatments, which in many countries is paid for by the government. Individuals who fail to receive treatment might result in an overwhelming amount of symptoms, leading to reduced functionality and productivity in the workforce. This will cost the economy output, lost taxes and welfare payments in advanced countries. Thus, the government as well as the taxpayers’ burdens will increase. As for the indirect costs, individuals facing mental health struggles  are more prone to take all their legal sick days (Beirut Today, 2021)  as well as use the paid vacation days as sick ones (The Lancet Global Health, 2020).  This means colleagues have to cover for them, deadlines might be missed and work might be delayed.  This, in return, costs the businesses millions of dollars.


Now, let’s put profit aside and view situations of mental health  from a humane point of view. Sick days are limited and medical reports are required, but how do you explain to your employer that your anxiety spiked today and you are unable to drive yourself to work? The answer is simple. Individuals find it difficult to explain these cases to their employers, fearing the receiving end. Because mental disorders are not taken seriously in most corporations, individuals battling mental health struggles usually resort to two options: lie and say they’re physically sick, or “toughen” up and go to work. If they are lucky, they’ll get a third option: tell the truth to an understanding employer. Unfortunately, options 1 and 2 are most likely to occur, and each has its own consequences. Lying about having to take a break due to a mental  health episode makes an employee feel guilty for skipping work. Some might feel naïve or even worthless.  Option 2 might be worse, as toughening up usually leads to worse downturns in terms of health and well-being in the future. Thus, options 1 and 2 eventually lead to exceeding sick days, leaving jobs or turning down further opportunities. On a personal level, I have turned down so many opportunities in fear of being mentally overwhelmed and not being able to express my illness and taking the time to rest without being misjudged. However, I quietly wondered how organizations   claim to take on social responsibility as a top priority, when they cannot even give employees the proper environment to help overcome their mental health battles. 

Credits: Photo Courtesy of Rex Pickar

So, where does Lebanon stand in the midst of all this chaos? Studies are still premature in the country and empirical evidence is scarce. Taking a random sample of 49 individuals (sd11) living in Lebanon, I conducted a small survey. Out of 49 people surveyed, 60% were females. 16% of the individuals are aged between 18 and 22, 59% are aged between 23 and 26, 16% are aged between 27 and 31 and 8% are aged above 31. Unsurprisingly, 55% of the respondents suffered from some form of mental illness, 50% of them were diagnosed before the pandemic/economic crisis and 50% after. Also, 56% of the diagnosed claimed that the pandemic and the economic situation made their illness worse. 23% of the diagnosed do take medications. Finally, and most importantly, 70% of the diagnosed have claimed that their illness has affected their school/job performance. Out of the mental illnesses, the most common were depression and anxiety.


The following are some of the responses on how the disorder affected these individuals:


It made me worry about perfecting everything, what would happen if I lost my job, overworking myself to burnout so I wouldn’t think…”


“Lagged performance/demotivated/paranoid”


“Didn’t have the energy. Nothing made me happy. Irritated. Always scared and worried about everything. I put my partner above everything else because he was my comfort zone. Too much thinking made me slower. Low to zero focus”

“I don’t feel like working”


“At first, it wasn’t affecting my academic performance, but with things getting worse, I feel like I’ve wasted my years of education for a future I won’t be able to choose.”


“I lost all motivation to get anything done so naturally I wasn’t getting good grades and couldn’t focus in class and some days I couldn’t even get out of bed so I would often skip classes.”


“Unable to go to work, unable to do my daily routine such as getting out of bed, cooking, going out or socializing.”


“High Anxiety about the actual work. Leading to being afraid of actually working. Leading to not wanting to work and not searching for a job.”

Credits: Photo Courtesy of Tim Marshall

The above are only a drop in the ocean of sorrow the Lebanese encounter. According to Dr. Joseph El Khoury, assistant professor of psychiatry at the American University of Beirut, around one million (National News MENA, 2021) people in Lebanon are receiving some kind of mental health medication. Yet, the problem is not the number of people who are mentally ill, but the lack of treatment. Even though the import of the medication has not changed (L’Orient Today, 2021) , the demand has drastically increased. People who were already on medications are now forced to ration or to skip their medications. This poses a huge threat on their lives as they may relapse. Not only is their work at risk, but relapsing individuals might need hospitalization which in turn increases the pressure on the already broken medical system, scarce medical staff and equipment.

Studies showed that for every $1 invested for anxiety and depression treatment, there is $4 return in productivity (The Lancet Global Health, 2020), however, unsurprisingly, worldwide government expenditure on mental health is still low. Corporations and governments tend to forget that a healthy workforce is the main source of profit, and that health is not limited to the physical aspect only.

Though studies in Lebanon are still scarce , it doesn’t take a genius to know that this epidemic is silently costing the economy millions of dollars (Science Daily, 2018).  Dr. Joseph El Khoury says that “we have not witnessed the peak of the crisis yet”. With all the ongoing crises in Lebanon, can the country withstand another one? In the absence of government interference, private corporations can take the initiative to reduce CSR advertising and increase its actual implementation. Businesses can acknowledge the validity of mental illnesses and the fact that some employees do need extra time to recharge. In this case, corporations can provide sick days for the sole reason of mental wellbeing. They can also provide free therapy sessions to their workers. Most importantly, businesses need to create  a supportive environment and start treating mental illnesses with the same importance as physical ones.

Stephanie Doumit is an economist, yet has found herself swimming across the tide of the corporate world. Driven by research and academia, Stephanie is mainly invested in the teaching and writing world where awareness could be spread through communication rather than excel sheets. In parallel to obtaining her master's degree in Financial Risk Management, Stephanie teaches business, economics and sociology for high school students.



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