Mental Health in South Africa
While a 2019 report from the South African College of Applied Psychology painted a bleak portrait of mental health in South Africa, the country has recently seen promising innovations in telehealth, offering South Africans struggling with mental health new avenues for accessing vital resources and support.

Telehealth is Expanding Access to Mental Health Care

A severe shortage of mental health professionals creates a bottleneck to receiving care and aiding mental health in South Africa – currently, the country has only one psychiatrist for every 100,000 people. Where South Africa is experiencing a shortage of mental health workers, a report by the U.S. Health Resources and Services administration (NHRS) outlines the ability of telehealth services to increase patient access to healthcare professionals. By allowing providers the ability to deliver care from anywhere, the report said, telemental health is able to significantly expand the capacity of existing staff.

In South Africa’s rural areas, the large obstacles to care that patients currently face include the cost of transport and long distances. According to the NHRS’s report, telemental health addresses both of these obstacles, promising to reduce the cost of delivery both for the provider and the patient, both of whom stand to benefit financially from time saved and from no longer needing to pay for travel.

The South Africa Depression Anxiety Group (SADAG)

One telehealth technology, implemented by the country’s largest mental health support and advocacy group – the South Africa Depression Anxiety Group (SADAG) –  allows patients to speak or instant message directly with mental health professionals via a mobile phone or landline. When South Africa’s COVID-19 lockdown first began, SADAG saw calls to its helpline double. In September 2020, the organization was still receiving around 1,400 calls a day, an increase in the volume of 53% from the previous year.

To handle this influx of patients, SADAG has set up WhatsApp support groups, moderated by the organization’s counselors, and moved all of its day-to-day operations online. With 96% of South Africans now able to access either a landline or mobile phone, SADAG’s decision to shift its services to the digital sphere not only offers an alternative to in-person care for South Africans coping with mental illness.

SADAG has also recently launched a toll-free mental health hotline that gives nonprofit workers 24-hour access to mental health services, citing the need to provide “psychological first aid” to nonprofit workers who have experienced  “unprecedented strain and burden” during the pandemic.

The MEGA Project

The MEGA Project, a consortium of nine universities spread across Europe and Africa, is another organization focused on using technology and the internet to expand access to mental health services in South Africa. Through a mobile application, the project aims to offer primary care providers a screening tool to monitor children and adolescents for early warning signs of mental illness, hoping to increase the mental health literacy of these providers in the process. This technology, though still in its early stages of development, is one of the many innovations offering the potential to increase the capacity of South Africa’s overburdened mental health care sector.

Breaking Down Barriers of Geography and Stigma

Telepsychiatry not only helps patients overcome geographical barriers to receiving care but also breaks down the barriers that stigma creates. In South Africa, family, friends and health care workers often perpetuate stigma and misunderstandings around mental health. By giving access to mental health resources outside of a socioculturally insulated community, one study suggests that telepsychiatry can also overcome these stigma-related barriers in offering South Africans the possibility to interact with non-stigmatizing perspectives. According to the same study, telemental health services also mitigate stigmas that exist around older adults attending in-person sessions.

Professors Call for Increased Government Attention

In an op-ed penned alongside two University of Ghana public health professors and published in eNCA, one of the most popular news networks in South Africa, professor of global mental health and development at the University of Cape Town Crick Lund has called for increased attention by governments to the issue of mental health in African countries, and particularly in South Africa.

Pointing out that only 15% of South Africans with mental health conditions ever receive treatment, Lund called on governments to invest in mental health surveys as well as treatment and argued that this investment in mental health not only would improve health outcomes but would pay economic dividends.

Technology “must… be used to deliver mental health services in times of public health emergencies,” the op-ed argues. The professors added that investment in these technological innovations offers governments the opportunity to make “training for and practice of mental healthcare attractive and relevant.

“Underpinning all our recommendations is sufficient and timely mental health financing,” the professors wrote. “This requires a multi-sectoral strategy that shows the health and economic benefits of investing in mental health in Africa.”

– Coalter Palmer
Photo: Wikipedia Commons

Mental Health in Turkey
Turkey is a country with a population of 82 million that is situated in both the continents of Europe and Asia. Turkey has held eight elections in the last five years, endured a failed coup attempt, transitioned to an executive presidential system and has a struggling economy. Inflation has risen as well as unemployment in recent years. Turkish psychologist Ahmet Özcan has said that people have suffered from social isolation and shown symptoms of post-traumatic stress disorder and anxiety due to political polarization and violence. Despite the need, mental health in Turkey has lacked resources and care options.

Statistics Regarding Mental Health Care in Turkey

The World Health Organization (WHO) stated that in 2011:

  • About 2.13 psychiatrists per 100,000 people were available.
  • About 1.62 psychologists per 100,000 people were available.
  • Approximately 0.76 social workers per 100,000 people were available.

To put these statistics in perspective, European countries have a significantly higher ratio of mental health care professionals.

  • Finland has 47 psychologists per 100,000 people.
  • The Netherlands has 30 psychologists per 100,000 people.
  • Greece has 14 psychologists per 100,000 people.
  • Denmark has 10 psychologists per 100,000 people.

Mental Health Services Decline Worldwide During COVID-19

Since the outbreak of COVID-19, the world has seen a decline in mental health. The effects of bereavement, isolation, rising poverty and fear are causing an increase in substance use, insomnia and anxiety as well as triggering mental health conditions. A World Health Organization survey from June to August 2020 evaluated how mental, neurological and substance use services have changed throughout COVID-19, which services the pandemic has disrupted and how countries are adapting to these adverse challenges. The results showed an overwhelmingly high disruption of mental health services in the 130 countries that participated in the survey including:

  • Reports of 67% disruptions to counseling services.
  • Reports determining 65% disruptions to critical harm reduction services.
  • Statements of 60% disruptions to mental health services for vulnerable people.
  • About 78% partial disruptions to school mental health services.

Fighting the Toll on Mental Health in Turkey with Hotlines and Online Counselling

A study determining depression and related factors in a society that COVID-19 affects found that in Turkey, the pandemic has caused mild-level depression across all socio-demographic groups. However, the results of the study also concluded that depression levels were significantly higher in the 18-29 year age group, women, single people and those living in poverty.

While many high-income countries have tried to mitigate the reduction in mental health services and increasing mental health problems with telemedicine or teletherapy, less than 50% of low-income countries have reported deploying these tactics.

Turkey is one low-income country that stands out in its effort to provide easy access to teletherapy from the increased anxiety, fear and negative feelings due to COVID-19. After March 2020, the government launched psycho-social support programs in every province. Turkey set up hotlines to address the various emotional impacts of COVID-19, as well as psychiatric guides for health care workers under risk of infection. There are more than 2,200 volunteers for the hotline, including psychiatry experts, social workers and health professionals from non-governmental organizations. The hotline has served more than 2,000 people according to professor Ejder Yıldırım, a director of the program. The system is set up so hotline workers make three calls to applicants at the first stage of therapy. In the second stage, hotline workers make around five calls over a period of five weeks to follow-up with patients.

The Coronavirus Online Mental Support Program

In Istanbul, Turkey’s most populated city, the local health authority has launched a Coronavirus Online Mental Support Program in addition to the hotline. As of August 2020, more than 1,100 people have used the online support system during the pandemic for issues related to COVID-19, natural disasters and crises.

While the world struggles to deal with the emotional and psychological impact of COVID-19, mental health in Turkey has highlighted the importance of having readily available resources in mental health care, especially in low-income countries.

– Charlotte Severns
Photo: Flickr

Mental Health in Indonesia
In Indonesia, institutions have shackled and chained as many as 57,000 mentally ill patients, according to a Human Rights Watch report. The underfunded and understaffed medical sector, as well as mental health stigma, have led to this inhumane practice known as “shackling” or pasung in Indonesia. Indonesia’s shackling problem is improving, but the country has not entirely eradicated it yet. Additionally, the country is progressing toward improving mental health in Indonesia through its mental health sector.

Here is some information about the initiatives contributing to the improvement of mental health services and the reduction of stigma in Indonesia. The ultimate goal of these initiatives is to prevent mental health patients from experiencing cruel and insufficient treatments.

Indonesia Free from Pasung

The Indonesian government officially banned shackling in 1977 but has been working to formally end the process to this day. In 2010, the Indonesia Ministry of Health started a program called Indonesia Free from Pasung. It asked the government to collaborate with communities to address shackling.

The program provided mental health medications and training to community centers, and made mental health a primary mental health service. It also created community health teams intended to directly release and identify people with mental illnesses.

These teams include Tim Penggerak Kesehatan Jiwa Masyarakat (TPKJM) and the PIS-PK program. TPKJM works to monitor and facilitate the release of people from shackles. The PIS-PK program sends representatives from community health centers to identify families’ mental health statuses through home visits. The program was necessary because people were not frequently visiting medical posts, so were not receiving treatment. The program helped to identify Indonesians with mental health issues and direct them to resources.

The frequency of shackling has improved in the 10 years since the implementation of the program. Additionally, people do not stigmatize mental illness as much in Indonesia anymore. Moreover, community centers are more equipped to identify and treat people with mental health disorders. More groups are arising to address mental health issues and end the practice of shackling as well. However, only 20 out of the 34 provinces in Indonesia have successfully implemented programs to free people from shackling. Without full implementation, these programs are unable to free as many people as they aim to.

The Center for Indonesia Medical Students’ Activities (CISMA)

UNICEF partnered with the Center for Indonesian Medical Students’ Activities (CISMA) to promote mental health support for young people through online sessions on health on Zoom and YouTube. The sessions cover a range of mental health topics such as “Coping with stress during the COVID-19 pandemic.” Their partnership’s aim is to provide awareness and information about mental health.

CISMA’s sessions are an amazing resource because they are accessible and provide psychological support for people who may not be able to see a therapist. CISMA’s initiative is also beneficial to Indonesia’s mental health sector because it raises awareness and tackles mental health stigma. The type of awareness it is spreading can keep people with mental illnesses out of shackles.

The WHO QualityRights Initiative

The WHO QualityRights initiative supports countries in implementing policies and services to improve the conditions of mental health services globally. It developed a toolkit of information to provide guidance on how to improve mental health services. This includes information on assessing mental health services and quality standard goals. It also provides e-training and other materials for mental health professionals, NGOs and people with mental illness and disabilities. This program is encouraging a human rights-based approach to mental health issues.

Indonesia has been improving in awareness and identification of mental health issues. The next steps are for the implementation of policies and programs to improve resources, as well as the quantity and quality of community centers.

International aid can assist in building community centers and medical schools. However, more is necessary, such as quality training and funds to hire nurses, therapists and psychiatrists. The country must also address the availability of medications and adequate facilities by providing more funding for mental health programs.

The country is moving in the right direction to improve its mental health in Indonesia. With increased development and a continued focus on the mental health sector, Indonesia may be able to eradicate the practice of shackling.

– Stephanie Jackson
Photo: Flickr

Mental Health in India
The COVID-19 pandemic has brought the crisis regarding mental health in India to the forefront. COVID-19 has led to various versions of isolation and insecurities for many Indian citizens.

Amid this crisis, the Indian Psychiatric Society’s survey has noted a significant increase in reported mental illness since the lockdown. This is an opportunity for the country to rework its mental healthcare system for its diverse population. The pandemic has affected the poor the most. The World Health Organization (WHO) has stated that mental health illness and poverty have a cyclical relationship in that extreme poverty triggers mental illness, which leads to further financial crises.

Government Initiatives

The government of India launched the National Mental Health Programme (NMHP) in 1982 and the Mental Health Care Act in 2017. The National Mental Health Programme focused mainly on increasing the reach of minimum mental health services for the poor. This encourages social development in general healthcare. After a gap of more than 20 years, the Mental Health Care Act mandated affordable mental health care, the right to make decisions and informed consent, the right to live in a community and the right to confidentiality. This Act more importantly decriminalized suicide.

The Mental Health Care Act is a step in the right direction with the aim of bringing mental healthcare to those who cannot afford it. Yet, almost 14% of the population still suffers from mental health disorders. While stigma and social stereotypes play a major role in the aggravation of these numbers, the nation’s budget invests very little into mental health. India as a developing country, spends only 0.05% of its subtotal health care budget on mental health.

De-stigmatizing Awareness

A study from 2017 suggested that 87% of the population was aware of mental illness and that 71% inculcated terms that propagate stigma. In 2015, Bollywood and Hollywood actress Deepika Padukone talked about her battle with depression on Indian television. By speaking about her struggles, she started a conversation about mental health in the nation. She also founded the Live Love Laugh Foundation which facilitates research and outreach on various levels. The Live Love Laugh Foundation provides free mental health care to the rural poor, educates caregivers and creates a community of awareness in rural Karnataka and Orissa. As of now, close to 3,000 direct beneficiaries have received treatment through the Foundation.

Organizations like The MINDS Foundation, Manas Foundation, The Banyan and Aasra along with many others are key in de-stigmatizing mental health in India. They often work as gap-fillers in a system that is out of reach for many. The World Health Organization (WHO) noted in a report in 2017 that there are less than two mental health professionals for every 100,000 people in the country. The Banyan, with its branches in Kerala, Tami Nadu and Maharashtra is an NGO that focuses on holistic mental health solutions for those who live in poverty in these states. It has over 16 centers and has reached a population of over 100,000.

Tele-health Initiatives

Universities, nonprofits and several hospitals have facilitated workshops, online counseling sessions and helplines. Tele-health calls have helped to bridge the gap between those who would normally shy away from in-person visits. However, it has been detrimental to those who lack access to these online facilities. The rural poor in India do not own the technology to be able to access facilities like e-prescriptions or telehealth calls. The transition of online healthcare into rural areas in India is a promising developmental venture.

Community-based Approaches

India’s allocated mental healthcare budget and prevalent social stigma surrounding it have emerged as the two major problem areas. Encouraging studies have paved the way for a community-oriented approach to practicing psychosocial therapy in the country. This will entail training community-based healthcare workers to serve as supervised non-specialist mental healthcare workers by following standard protocols. Sangath, an NGO based in Goa, New Delhi and Bhopal, is implementing this model through its programs. Sangath provides affordable mental healthcare by strengthening state and private sector services by training the community. Sangath is also working with policymakers to further develop as well as implement this model of care.

Resources During COVID-19

The India Research Center of the Harvard T.H. Chan School of Public Health has recounted a few tips for mental well-being during the pandemic. Mindfulness, breathing exercises, meditation, limiting news consumption, generosity and empathy are practices that are effective along with other useful resources that the school emphasizes. Here is a list of numbers one can contact during a mental health emergency in India.

In a country as plural as India, innovative approaches are essential factors of growth. The nation has a long way to go in order to climb up on the mental health and well-being ladder. However, NGOs and foundations are paving the way toward improved mental health in India.

– Anuja Mukherjee
Photo: Flickr

mental health in haitiLocated on the island of Hispaniola is the Caribbean nation of Haiti. The country gained independence in 1804, becoming the first country led by formerly enslaved peoples. A long history of political instability and corruption accompanied by catastrophic natural disasters has devastated Haiti’s population and economy. Additionally, a lack of infrastructure and access to basic resources ranks Haiti as one of the world’s least developed countries. This has created a crisis for mental health in Haiti, which has only worsened during the COVID-19 pandemic.

The Humanitarian Crisis in Haiti

Haiti is now home to over 11.4 million people, and nearly 60% of the population lives below the poverty line. Income inequality and unemployment rates are high, while the country does not meet its citizens’ basic needs. In fact, nearly 90% of people in rural areas lack access to electricity and plumbing.

Several natural disasters have also damaged Haiti in the past decade. The 7.0-magnitude earthquake of January 2010 devastated the nation’s capital city of Port-au-Prince. Indeed, the earthquake was one of the worst natural disasters to strike an urban area. An estimated 250,000 people died, while 300,000 people got injured and over 5 million became displaced. Six years later, Hurricane Matthew wiped out trade roads and coastal infrastructure. Conversely, lengthy periods of drought have paralyzed local agricultural markets. This has resulted in the inflation of even the most basic foods and necessities.

Though Haiti has focused on efforts to recover from natural disasters, longstanding economic and sociopolitical crises remain. One often overlooked problem lies in how these humanitarian crises affect mental health in Haiti.

Mental Health in Haiti: Existing Services

The ongoing humanitarian crises in Haiti create an extraordinary psychological toll on people. In particular, poverty and socioeconomic disadvantage increase the crisis of mental health in Haiti. Following the earthquake, 25% of the population reported experiencing PTSD. Additionally, 50% experienced a major depressive disorder. Disasters have also caused many Haitians to experience trauma and the loss of loved ones and livelihoods.

Despite these negative psychological outcomes, mental health in Haiti remains neglected. This is largely due to the majority of Haitians attributing mental health problems to supernatural forces. Specifically, many Haitians rely on inner religious and spiritual strength to overcome mental health issues. This culturally important Haitian belief, in tandem with the country’s inadequate mental healthcare services, leaves vast numbers of the population neglected.

Many people in Haiti simply go without mental healthcare. For a nation of around 11 million people, Haiti has a mere 23 psychiatrists and 124 psychologists. Haiti’s investment in healthcare services has even declined from 16.6% to 4.4% since 2017. Additionally, even if Haitians could find mental health services, they may not be able to afford or access them. Available services are often costly and inaccessible for those who do seek care.

The Implications of COVID-19

During the pandemic, Haiti has seen a rise in the cost of mental health services and medication. The country’s two running psychiatric hospitals have stopped accepting patients. Other hospitals, many now at full capacity due to the pandemic, have become testing facilities for COVID-19.

The pandemic has further exacerbated mental health in Haiti. General anxiety and concerns relating to the coronavirus and its effects have skyrocketed. Additionally, quarantine mandates have increased rates of domestic violence and abuse. Fatigued health professionals and medical staff also suffer from increased rates of depression. In short, medical professionals as well as the general population are experiencing the devastating mental impacts of COVID-19.

Moving Forward

Humanitarian crises and the coronavirus pandemic persist in the small island nation of Haiti. The aftermath of natural disasters, trauma and continuing political and economic instability lead to a crisis of mental health in Haiti. The country needs attention to the mental health needs of its citizens, in the midst of current and past crises.

Thankfully, nonprofit organizations like Partners in Health are striving to improve mental health in Haiti. Based out of Boston, Partners in Health is dedicated to establishing long-term relationships with organizations in the world’s poorest developing countries. Through its partnerships with local governments and other organizations in Haiti, Partners in Health has helped to innovate mental healthcare delivery models that integrate cultural beliefs about health and current biopsychosocial knowledge. Mobile health clinics also help ensure ensure that patients living in even the most remote regions of Haiti have access to necessary mental health services.

In the years to come, continued funding and support of programs like Partners in Health and its partnership organizations will be vital to improving the mental health and overall well-being of Haitians. Only then can the country truly overcome its current crises and past history.

Alana Castle
Photo: Flickr 

Left-Behind ChildrenChina has undergone swift urbanization and development in recent years. However, reaping the rewards of this progress has not been easy for everyone. In search of better job opportunities, millions of Chinese parents in poverty have left their communities in hopes of creating a better future for their children. However, these parents must leave their children behind to do so. These left-behind children (LBC) may remain with a caregiver, family member, friend or institution, or they can be left entirely on their own.

There are about 70 million left-behind children in China, and they experience many effects of poverty. The average ages of LBC range from 6 to 17. While LBC are more prominent in rural China, the number of LBC has risen in urban areas as well. As a result, many children in China are mentally and physically ill, don’t receive a proper education and are essentially stuck in the cycle of poverty. Parental absence contributes to all of these factors.

Poor Quality of Education

While their parents seek more money in the city, left-behind children are left in inadequate school buildings with limited supplies and ill-prepared teachers. In an interview with The Borgen Project, Lijiah Zhang, an author and journalist who examines China’s left-behind children, stressed that education is the largest problem these children face. “Without their parents, the children are more likely to lose interest in their studies and sometimes drop out of school, the opposite of what their parents hope for,” she said. Indeed, over 13% of left-behind children drop out by the eighth grade. Another reason for dropouts is the household responsibilities some left-behind children must take on, such as agricultural work, which leaves them with no time for academics.

For those who do continue their education, the quality is waning. With teachers lacking incentives and resources, education is a large obstacle for LBC. Educators hired for rural teaching positions are often fresh out of training and possess little teaching experience to offer a proper education. But because they are cheaper to pay, schools that lack funding hire them constantly. The staff is overworked and tremendously underpaid, with some rural educators working over 12 hours a day. This poor teaching quality combined with cramped classrooms and a lack of technology sets rural children up for failure.

High Dropout Rates

Left-behind children dropping out of school perpetuates cyclical poverty. China’s economic expansion over the past 40 years has brought about 800 million people out of poverty, but it has also widened the gap between rural and urban communities. Families in poverty continue to struggle with money, and the number of parents deciding to leave children behind is rising. These children are stuck living with the effects of poverty, and with no parental guidance, they have little means of digging their way out.

Zhang stated that many LBC feel powerless in their situations, which leads to them losing interest in their schooling and dropping out, thus reducing their chances of climbing the employment ladder. Because of the difference in economic opportunities between rural and urban communities, poor children remain poor while the rich stay rich.

Lack of Safety and Health

Because left-behind children do not have parents to protect or guide them, they are more vulnerable to abuse. Forms of abuse include harassment from peers and guardians, sexual abuse and criminality. For example, in 2015 a teacher was sentenced to life in prison for raping 12 of his students, 11 of whom were left-behind children. Many children also experience extremely long walks to and from their schools, some of which take multiple hours. This leaves them alone and vulnerable to anyone passing by.

Living without parental guidance also takes a mental and physical toll on children. Left-behind children are much more likely than non-LBC to have depression, anxiety and behavioral issues due to parental absence. They are also more likely to suffer from chronic loneliness. In a survey of six Chinese provinces, 25% of LBC reported high levels of loneliness, which can worsen mental and physical health. While parental migration offers a chance at economic improvement, child development often deteriorates.

The diets of left-behind children are often also insufficient. According to a 2015 study, left-behind boys consumed more fat and less protein in their diets. This puts them at an increased risk for obesity and stunted growth. Zhang said: “I think the LBC’s diet is worse than non-LBC. Their guardians, usually their grandparents, are mostly very frugal. They also don’t have any idea about healthy diet or nutrition.” Limited nutrition can lead to poor school performance in addition to long-term health risks.

Helping Left-Behind Children

This crisis is well-known, and many organizations are working to aid these millions of children. Save the Children, OneSky and Humanium advocate for and offer direct assistance to left-behind children. So far, Save the Children has helped 310,000 vulnerable Chinese children. Specifically, it provides educational improvements and services to keep them from harm. UNICEF also offers services to LBC in multiple Chinese provinces, including social and emotional development and health administration. UNICEF continues to initiate projects to help these children.

Each year, millions of Chinese children suffer without their parents. The mental and physical health consequences along with the inadequate education they face make their everyday lives an uphill battle. Humanitarian assistance helps thousands of these children, but the causes underlying the crisis continue challenge poverty eradication. 

– Radley Tan
Photo: Flickr

Mental Illness in EthiopiaEthiopia is the second most populated country in Africa, with a population of over 100 million. With such a large population comes a prevalence of poverty as well as disease. In an estimate from 2014, around 30% of Ethiopia’s population was below the poverty line. According to statistics from this year, Ethiopia also makes it onto the list of the world’s poorest countries, ranking 7th poorest in the world in both GDP growth and GDP per capita. Along with this poverty comes a myriad of diseases. The top four causes of death in Ethiopia are, in order, neonatal diseases, diarrheal diseases, lower respiratory infections and tuberculosis. While these diseases are quite well-known, Ethiopia is also plagued by another type of disease: mental illness. Mental illness in Ethiopia may not be as recognized as the other diseases that plague Ethiopian citizens but mental illness can impact overall general health and the ability to provide for one’s family.

A Troubled Past

Despite the fact that an estimated 15% of Ethiopians suffer from mental illness and substance abuse disorders, for decades almost nothing was done to address or treat these issues. In the 1980s, there was only one psychiatric hospital in the entire country and such an insignificant number of psychiatrists, that it was almost impossible to find treatment. Moreover, the psychiatrists who did practice at the time were often not interested in developing new research and treatment techniques. Because of this, most cases of mental illness went untreated, leaving mental health sufferers to face both isolation and discrimination.

A Passionate Doctor

When Dr. Atalay Alem started his medical work, there was only one psychiatric hospital in the country. After his decades of work, spanning from the 1980s until modern day, his efforts to improve the psychiatric treatment of Ethiopians have had a massive payoff. He started as a medical doctor before receiving his degree in psychiatry. After that, he became a psychiatric professor at Addis Ababa University, where his research and his passion for better mental health services were instrumental in the expansion of Ethiopia’s mental health care. Alem was also a key founder of the graduate psychiatry program at Addis Ababa University, giving more Ethiopians a chance to make a difference in the field. Today, there are almost 90 psychiatrists practicing in Ethiopia. Apart from these psychiatrists, there are hundreds of psychiatric nurses as well. These nurses are part of what has made such widespread psychiatric care possible and their presence has aided in the addition of mental health services at most Ethiopian hospitals. For his efforts, Alem was awarded the Harvard Award in Psychiatric Epidemiology and Biostatistics in 2019.

A Positive Future

Though Ethiopia has a total of under 100 psychiatrists, the current number is a great improvement from just a few decades ago. Moreover, with the help of Alem and other passionate psychiatrists, research efforts continue to grow. Alem is currently working on a study that looks at the way severe mental illness impacts rural Ethiopian communities in order to evaluate how to improve treatment and maximize impact. The Ethiopian government is also invested in improving the diagnosis and treatment of mental illness. The government, starting seven years ago, created a mental health strategy to aid the country’s mentally ill and allocated government funds to the overall improvement of mental healthcare. These funds have gone toward improving health services, such as more adequate healthcare training and increased access to psychiatric medications. Part of the reason Ethiopia’s mental health treatment has improved so much is due to the partnership between the Ethiopian government and the World Health Organization. WHO was absolutely key in providing guidelines for how to implement these new mental health care strategies.

Though progress always takes time, with the help of doctors like Alem and partnerships with organizations like WHO, Ethiopian mental health care has better days ahead.

Lucia Kenig-Ziesler
Photo: Flickr

Mental Health Services In IndiaThe vicious cycle of poverty and mental illness is a problem worldwide. According to the World Health Organization, mental illness is twice as prevalent among the poor than among the rich. Not only does mental illness put someone more at risk for poverty, but the insecurity of day to day life in poverty can also exacerbate mental health concerns. Indigenous communities, routinely separated from their land, traditions and support networks by discriminatory government policies, struggle with both poverty and mental health concerns at particularly high rates, according to the United Nations.

Mental Health Services In India: A Holistic Model for Indigenous Communities

One way of addressing the cycle of poverty and mental health concerns in indigenous communities is a holistic model that draws both from community traditions as well as biomedical and psychological care paradigms. Such an approach is most effective when it treats the community members as experts on their own needs.

Hailey Shapiro ‘22, a Cornell student, spent a semester abroad in Kotagari, India, learning about public health. While she had to leave India early due to the COVID-19 pandemic, she completed her literature review about holistic mental healthcare for indigenous communities in the Nilgiris Biosphere Reserve region of Southern India from her home in California. Shapiro spoke to The Borgen Project about her research on the mental health and well-being issues faced by the indigenous Adivasi people in India, as well as the strengths and limitations of different strategies developed to address these issues.

“Learning from local scholars and community members was vital research. Programs to support community wellness are never a one-size-fits all, because all communities have unique resources and challenges,” Shapiro said.

The Link Between Communal Traditions and Well-Being

Adivasi communities in India have long faced disruptions to traditional ways of life. The British colonial government rarely recognized their communal land ownership traditions, which were central to traditional practices of hunting, gathering and practicing shifting cultivation. The Indian government has designated many of the forests they traditionally hunted, gathered and farmed as protected land, which means the Adivasi are still barred from using the land to feed themselves. Most Adivasi now work as day laborers for agricultural plantations and government construction programs.

Community cohesion that provided essential social support for psychological well-being in earlier times has grown weaker as the Adivasi no longer hunt or farm together as frequently and are displaced from their land. The widespread land loss not only prevents the Adivasi from supporting themselves in traditional ways, but it also causes many youths to leave the community in order to find work and has exacerbated the issues of food insecurity and poverty.

These disruptions to community support systems have caused or exacerbated stress for many community members. However, India’s main mental health program, the District Mental Health Policy, does not collaborate with non-clinical agencies to address psycho-social factors.

Community Outreach, Mental Health Services in India and Medicalization

While psychiatric medications have been found to be an effective strategy to assist those struggling with mental health concerns, The Keystone Foundation recognizes that a holistic approach can make psychiatric strategies more effective. The Keystone Foundation trains community health workers to assist with the delivery of mental health services; the organization also works with the family and friends of patients to help patients adhere to medications.

Another organization providing mental health services in India within the context of the community it serves is The Banyan, a mental healthcare nonprofit. The Banyan started as a homeless shelter and became a mental health service provider that focuses on the needs of mentally ill women in Chennai, India. The Banyan uses a variety of strategies including in-patient and outpatient care as well as community outreach and aid to those coping with both mental health struggles and poverty. Through frequent surveys, they identified that their clients wanted to stay in their homes and that facilitating work opportunities and providing healthcare in more remote areas could help make that goal possible.

According to Shapiro’s literature review, learning from the example of The Keystone Foundation, The Banyan and other providers of holistic care could lead to better mental healthcare outcomes for indigenous communities and other marginalized groups.

“We need a holistic approach to community mental health that responds to communities’ unique challenges using communities’ unique resources,” said Shapiro. “According to my research, we can learn what factors are most important to address by incorporating communities’ voices into the intervention decision-making process.”

– Tamara Kamis
Photo: Flickr

crisis in yemenCivil war has taken over Yemen for over five years. As a result, upward of 12 million minors are in desperate need of some form of humanitarian aid, making the crisis in Yemen the largest humanitarian crisis in the world. Experts fear Yemen’s violent and impoverished conditions will have a severe effect on the mental health, and consequent futures, of the country’s children.

Violence in Yemen

As a country of extreme poverty to begin with, Yemen is struggling in this time of war. Violence and fighting remain constant as clashing forces, including the Houthis and the Saudi-led coalition, fight for power.

Although all demographics in Yemen have been strongly affected, children are bearing the brunt of this crisis in Yemen. The Yemen Data project recorded over 17,500 deaths since the beginning of the war in 2015. The deaths of children were a large portion of the casualties, forcing Yemeni children to constantly fear the death of a friend, sibling or even their own death. Additionally, with approximately 12 airstrikes on Yemen each day, the sounds of war are consuming. The war is inescapable for those in Yemen.

Health and Nutrition During Crisis

Many of the systems taken for granted in developed countries collapsed in Yemen as a result of the war. Health services are extremely limited, leaving over 10 million Yemeni children without access to healthcare services, which are of great importance in one’s formative years. High rates of disease and unsanitary conditions due to the overcrowding of millions of displaced families make the lack of these services even more tragic.

Furthermore, the crisis in Yemen has placed over 10 million Yemenis at risk of famine, while double this number are already food insecure. Such malnutrition results in the hindered development of children in Yemen.

Another system that is important to the development of children in general is the education system. Like the systems mentioned before, Yemen’s educational system has also suffered amidst this continuing war. As of June 2020, almost 8 million Yemeni children were unable to attend school, damaging their development and futures.

Yemen Mental Health Studies

A recent study conducted by Save the Children, an organization aiming to better the lives of the world’s children through health, educational and aid services, surveyed over 1,250 Yemeni children and guardians. From this survey, Save the Children found 50% of the children who responded said they experience feelings of depression amidst the crisis in Yemen.

In addition to feelings of sadness, 20% of the children said they live in extreme fear. Parents and caregivers supported this statistic, claiming their children had experienced increased incidents of nightmares and bedwetting. Such common feelings and behaviors indicate a growing prevalence of mental health disorders, including PTSD and depression, in children in Yemen.

Consequences of the Crisis in Yemen

Dr. Carol Donnelly, a psychotherapist and professor of psychology at Northwestern University, told The Borgen Project about her concern for children experiencing the conditions of the crisis in Yemen. “If the trauma lasts for too long, which apparently it is, the kids could have all sorts of dissociative experiences (related to PTSD), just extreme mental health issues,” Donnelly said.

With constant fears of attack and altered living conditions in Yemen, Donnelly stated that there may be potential consequences of changing parent-child relationships during this crisis. “[Children] need to be in a relationship with an adult, not only for attachment emotionally, but just for learning so many things,” she said. “This relationship helps to wire the brain up properly, and if kids are not getting that because the parents are overwhelmed as well, we’re just going to have a whole generation of severely traumatized children. Children that will just be a burden on the entire society.”

She also referenced Maslow’s hierarchy of needs, explaining that we need to provide the most basic needs of these children, such as water and food, as a priority. Then we must provide these Yemeni children safety and shelter before ensuring they have loving relationships. By following this psychological theory, she hopes children will be able to mentally progress despite the crisis in Yemen.

Aid from Afar

Several global organizations are working to provide assistance to this generation of suffering Yemeni children in order to help them become successful regardless of their conditions. One such organization, Save the Children, has made efforts to make these children feel safe amidst the crisis in Yemen by creating engaging, peaceful spaces for children in Yemen to play and spend time with friends while consequently promoting further cognitive development. Here, these children can act without fear, as normal children would. Since the initiation of this project, almost a quarter of a million Yemeni children have visited these spaces.

Additionally, Save the Children is working to promote awareness around childhood mental health and rights in Yemen while also training mental specialists in the country. With only a couple of child psychiatrists servicing the entirety of Yemen, there is little education for the general population of Yemen surrounding this area of healthcare.

“Psychology is just … not recognized as a formal science in some countries yet. It is still very much stigmatized,” Donnelly agreed. “I think what would be a good solution is to have a psychologist train the people there how to simply be present and to exude unconditional love and empathy and to listen. That’s something anyone can do.”

– Hannah Carroll
Photo: Flickr

Elderly Poverty in South Korea

While South Korea is home to great technological developments and world-famous rising trends, it also has one of the highest numbers of impoverished elderly in a single developed country. Around half of the senior citizens are living in poverty with little to no support from relatives or the government. The Organization for Economic Cooperation and Development, or OECD, consists of over 30 countries that work with one another to encourage economic development. Unfortunately, despite all the economic progress it has made, South Korea has the highest elderly poverty rate of all OECD countries.

How Elderly Poverty in South Korea Came to Be

In the 1970s, a financial crisis hit South Korea that caused around 2 million people to be unemployed, many of these workers being senior citizens today. When the country began building its economy back up, many companies decided to replace the older generation of workers with younger ones. While the younger workers did not cost as much, the newly jobless population was left with no other choice but to retire earlier than expected.

In the present day, the now elderly population who was affected by the financial crisis have to support themselves by working non-conventional jobs. These jobs include picking trash off the street, cleaning or in the most extreme cases, elderly prostitution. Since this way of living is detrimental to the mental wellbeing of the older population, senior suicide rates have risen over time. Just three years ago, for senior citizens around 70 years old, nearly 50 people out of 100,000 committed suicide. For senior citizens around 80 years old, that number went up to 70 people per 100,000.

South Korea’s Welfare Programs

  • Comprehensive Welfare Program: In 2012, South Korea began the Comprehensive Welfare Program to benefit the impoverished elderly population. Senior citizens who are physically compromised were given assistance in everyday routines, such as housework or laundry. Meals are provided at senior citizen dining halls and even delivered for those who cannot make it to a meal service location. Social service and activity programs were implemented as well, which helps boost the mood of the elderly who would not have otherwise gotten a form of entertainment anywhere else.
  • Community Care Program: In 2019, South Korea announced the Community Care Program to aid senior citizens as well as other vulnerable groups. This program is spread all throughout South Korea, with application booths in plenty of local areas. Similar to the Comprehensive Welfare Program, the Community Care Program also provides in-home care services for physically compromised seniors, as well as food deliveries. This program also provides public housing and elderly daycare for those in need of special assistance and care. Additionally, 12 million won (nearly $12,000) will be provided as subsidies for senior citizens who continue to reside in the Community Care Program.

Creating Jobs for Seniors

In late 2019, South Korea’s employment rate continued to grow over 300,000 new jobs every month. Employment in late 2019 was around 27.5 million jobs, which is over 330,000 more jobs from the previous year. This hiring growth was because of the Ministry of Health and Welfare’s plans to increase senior jobs using the over 1.5 trillion won (nearly $1.5 billion) from their budget. Those who were out of a job previously were able to get a chance at improving their lives and livelihoods through becoming employed again.

– Karina Wong
Photo: Needpix