Mental Health for Syrian Refugees
Since the Syrian crisis in 2011, the displaced population has migrated to neighboring countries such as Turkey, Lebanon and Jordan. Currently, 50 percent of the population are children without parents. Mental health issues have risen in the Syrian refugee community since then and the world has stepped up in treating the debilitating aspects of suffering traumatic events. This article highlights the improvements in the mental health of Syrian refugees.

Challenge and Impacts

Refugees that have to leave their homes and migrate elsewhere face many obstacles and challenges. Post-migration challenges often include cultural integration issues, loss of family and community support. Refugees also experience discrimination, loneliness, boredom and fear, and children can also experience disruption. Circumstances uproot them from friends and family and cut their education short. Refugees experience barriers in gaining meaningful employment and they face adverse political climates.

Depression, anxiety and post-traumatic stress disorders (PTSD) are all effects of exposure to traumatic events. Traumatic events for Syrian refugees include war terrorist attacks, kidnapping, torture and rape. Meta-analysis all show a positive association between war trauma and the effects of certain mental health disorders. For example, a study examining the mental health of post-war survivors from Bosnia, Croatia and Kosovo showed PTSD as the most common psychological complication.

Post-Traumatic Stress Disorder is a debilitating disorder that intrudes on the patient’s mind. It also intrudes on relationships and the patient’s ability to live a quality life. Thoughts of suicide and/or avoidance are also symptoms of PTSD.

A study of Syrian trauma and PTSD participants found that those between the age of 18 and 65 have experienced zero to nine traumatic events. Of those, 33.5 percent experienced PTSD and 43.9 percent depression. Another study in Lebanon showed that 35.4 percent of Syrian refugees will experience a lifetime prevalence of PTSD.

According to the United Nations High Commissions, 65.6 million people worldwide are “persons of concern.” That total includes 22.5 million termed “refugees” and several other millions termed “asylum seekers” or “internally displaced persons.” Survivors of torture account for 35 percent.

Health Care and Integrated Care

The National Institute of Mental Health identifies integrated care as primary care and mental health care; cohesive and practical. Primary care practitioners recommend conducting a thorough history check of any exposure to or experience of traumatic events. Health care professionals must be able to effectively address mental health issues. Barriers have long been the cause of mental health issues left untreated. Such barriers include communication, lack of health practitioners to patients in need, the physical distance patients must travel and the stigma of having the classification of “crazy.”

Treatments and Evidence-Based Interventions for Refugees

There have been several test instruments that provided significant results in the treatment of mental health as well as scalable interventions. Currently, the only FDA-approved drug both abroad and in the U.S. are paroxetine and sertraline; both selective serotonin reuptake inhibitors (SSRI). Other instruments include the Narrative Exposure Therapy, Eye Movement Desensitization and Reprocessing. Many found EMDR to be successful in reducing episodes of PTSD and depression in a study with Kilis refugees.

In 2008, the World Health Organization launched the Mental Health Gap Action Programme (mhGAP). This endeavor focused on assisting low and middle-income countries in providing effective mental health treatments. Inventions such as Task-shifting, E-Mental Health and PM+ fall under the mhGAP umbrella. First, the task-shifting initiative aims at alleviating the pressure on a limited number of specialized practitioners. Task-shifting shifts duties and tasks to other medical practitioners which otherwise highly-trained specialists would perform. This initiative is cost-effective and proves to be a promising alternative. Refugees can receive treatment in primary and community care locations instead of specialized facilities. Meanwhile, E-Mental Health and PM+ aim to address multiple mental health symptoms at once, while allowing treatment to remain private and within reach to Syrian refugees. Finally, the EU STRENGTHS, also created under the mhGAP umbrella, strives to improve responsiveness in times of refugees affected by disaster and conflict.

Many Syrian refugees continue to face obstacles and barriers, however, there is hope. Initiatives such as those mentioned in this article provide a promising outlook for the continued mental health improvements of Syrian refugees.

Michelle White
Photo: Flickr

5 Mental Health Effects of the Yazidi Genocide
In the past few years, the Yazidi populations of northern Iraq and northern Syria have faced forced migration, war, the enslavement of women and girls and genocide. These traumatic events have resulted in several, severe psychological problems among Yazidis. A lack of adequate treatment and a prolonged sense of threat compounds the five mental health effects of the Yazidi genocide.

The Yazidis, a Kurdish religious minority, practice a non-Abrahamic, monotheistic religion called Yazidism. When the so-called Islamic State declared a caliphate in Iraq and Syria, it specifically targeted the Yazidis as non-Arab, non-Sunni Muslims. ISIS has committed atrocities against the Yazidis to the level of genocide, according to the United Nations Human Rights Council (UNHRC); these crimes included the enslavement of women and girls, torture and mass killings. This violence caused many Yazidis to suffer from severe mental health disorders.

5 Mental Health Effects of the Yazidi Genocide

  1. Disturbed Sleep: According to a study by Neuropsychiatrie, 71.1 percent of Yazidi refugee children and adolescents have reported difficulty sleeping due to the trauma they have experienced. These sleeping problems include trouble falling asleep, trouble staying asleep and nightmares. Children are afraid that if they fall asleep they will not wake up again. Importantly, disturbed sleep will worsen other problems, such as anxiety.
  2. Post Traumatic Stress Disorder: PTSD is one common mental illness that the Yazidi genocide caused. According to the European Journal of Psychotraumatology, 42.9 percent of those studied met the criteria for a PTSD diagnosis. Women and men experienced traumatic stress differently. Women with PTSD were more likely to show symptoms such as “flashbacks, hypervigilance, and intense psychological distress.” Men with PTSD more frequently expressed “feelings of detachment or estrangement from others.” Additionally, more women than men reported having PTSD. According to a study that BMC Medicine conducted, 80 percent of Yazidi women and girls who ISIS forced into sex slavery had PTSD.
  3. (Perceived) Social Rejection: Perpetrators of genocide have often employed systematic sexual violence against women to traumatize the persecuted population. In addition to the devastating injuries women experience, they also suffer from several psychological disorders, including PTSD, anxiety, depression and social rejection. Families and communities frequently reject survivors; Yazidi women who suffered enslavement perceive social rejection and exclusion from their communities at high rates. For instance, 40 percent of Yazidi women that BMC interviewed avoid social situations for fear of stigmatization, and 44.6 percent of women feel “extremely excluded” by their community. Social support is a crucial way to alleviate some of the pain from sexual violence and enslavement since rejection from their community magnifies the likelihood that girls will experience depression. Thus, social support, such as community activities organized by schools, can help by decreasing the factors that worsen psychological disorders like depression and by increasing the rate at which girls report instances of sexual violence.
  4. Depression: The Neuropsychiatrie researchers also found that one-third of the children they studied had a depressive disorder. In another study by Tekin et al., researchers found that 40 percent of Yazidi refugees in Turkey suffered from severe depression. Similarly, a 2018 Médecins Sans Frontières (MSF/Doctors without Borders) study in Sinuni found that every family surveyed had at least one member who suffered from a mental illness. The most common problem was depression. As a response to the growing mental health problems among Yazidis, MSF has been providing emergency and maternity services to people at the Sinuni General Hospital since December 2018. MSF has set up mobile mental health clinics for those displaced on Sinjar mountain and provides services such as group sessions for patients. In 2019, MSF health care officials conducted 9,770 emergency room consultations, declared 6,390 people in need of further treatment in the inpatient wards and have helped 475 pregnant women give birth safely. While MSF has increased its health care activities in the region, there are still people on the waiting list to receive treatment.
  5. Suicide: Since the ISIS takeover of the Sinjar region of Northern Iraq, the Yazidis’ historical homeland, the incidents of suicide and suicide attempts among Yazidis have increased substantially according to Médecins Sans Frontières. The methods of suicide or attempted suicide include drinking poison, hanging oneself and drug overdose. Many Yazidis, particularly women, have set themselves on fire. To alleviate this uptick in suicide and other negative mental health effects, MSF increased its presence in the area and offered psychiatric and psychological health care. Since the start of this initiative in late 2018, MSF has treated 286 people, 200 of whom still receive treatment today.

In the aftermath of ISIS’ genocide against the Yazidis of northern Iraq and northern Syria, many survivors have experienced mental health problems stemming from the trauma. These genocidal atrocities will have long-term psychological effects on the Yazidis, but such issues can be mitigated by psychological care. The five mental health effects of the Yazidi genocide outlined above prove the necessity of such health care for populations that have endured genocide and extreme violence.

– Sarah Frazer
Photo: Flickr

 

mental illness and poverty in India
There is a web of denial that people weave around the issue of mental health in India. Most families and communities refuse to see mental health as a serious concern. Adding on to the stigma, there is also a lack of physicians available to treat mental illnesses and those affected often go unchecked. While mental health can affect individuals of all income levels, there is a significant link between mental health and poverty in India.

The Relationship Between Mental Health and Poverty

Specifically, there is a cyclical link between mental health and poverty in India. A case-control study conducted in Delhi from November 2011 to June 2012 found that the intensity of multidimensional poverty increases for persons with severe mental illnesses (PSMI) compared to the rest of the population.

As people receive diagnoses of mental illness, their work performance and social status decrease. Without much treatment available, these individuals continue to suffer in silence, slowly falling back from their jobs, families and friends. These individuals lose employment, which means they have a lack of income, ending up without a support system and resulting in poverty. In particular, women with severe mental illness (SMI) or those who are a part of the lower castes (Untouchables or Shudras) suffering from SMI are more likely to face multidimensional poverty. Because society often looks down on women and individuals of the lower caste system, they are the least likely to receive treatment or assistance when they receive a diagnosis of mental illnesses.

On the other side of this relationship, poverty, which many describe as a lack of employment and income, aggravates mental illness. When individuals do not have the necessities for survival, mental disorders such as depression or anxiety can develop and intensify. Without treatment, these disorders build up, eventually leading medical professionals to diagnose individuals with SMIs. Out of those in poverty, women, individuals of the lower castes and individuals with SMIs suffer the most, as they have the hardest time finding work or receiving external help.

In short, untreated mental illnesses can lead to or further exacerbate poverty, but unchecked poverty can cause mental illnesses as well, creating this link between mental health and poverty.

In an attempt to fix the cyclical link between mental health and poverty in India, the government, doctors and businesses have taken action which aims to increase treatment and guarantee more rights to persons with mental illnesses.

Past Actions by the Government

In 2016, the Parliament in India passed the Mental Health Care Bill. This law replaced the older Act which stigmatized mental health and prevented people from receiving treatment. The new legislation provides state health care facilities, claiming that anyone with mental illness in India has a right to good quality, affordable health care. Individuals with mental health now have a guarantee of informed consent, the power to make decisions, the right to live in a community and the right to confidentiality.

The hope is that the act will help people from all levels of income because if an individual cannot afford care, the government must provide treatment. Even in rural or urban areas, mental health care is a requirement and the government is working to build access to such facilities. Anyone who violates or infringes on the rights of those with mental illnesses is punishable by law.  The government is hoping that by taking legal action for individuals with mental illnesses, society will slowly stigmatize the issue less, increasing overall acceptance.

Individuals and Organizations Taking On Mental Health

As the issue of mental health persists, doctors in India have attempted to integrate their services of mental health within the primary health care system. Since 1999, trained medical officers have an obligation to diagnose and treat mental disorders during their general primary care routines. Furthermore, district-level mental health teams have increased outreach clinical services. The results have shown that if people receive treatment in primary health care facilities, the number of successful health outcomes increases. In the future, doctors are looking to expand services into more rural areas, hoping to offer more affordable care to those in severe poverty because there is such a significant link between mental health and poverty.

Alongside medical professionals, businesses are using the shortage of mental health care treatments in India to expand their consumer outreach; these companies rely on technology to bring together a global community of psychologists, life coaches and psychiatrists to help individuals through their journey. Using AI, companies like Wysa can use empathetic and anonymous conversations to understand the roots of people’s problems. Companies, such as Trustcircle, rely on clinically validated tests to allow individuals to determine their depression, anxiety or stress levels, enabling them to understand when to seek help. These companies are all providing free or drastically low-costing help, giving people feasible access to the treatment they need. The hope is that with quicker and cheaper access to treatment, people can address mental health on a wider scale.

Further Action Necessary

Despite the increasing support for mental health, there is a great deal of change that needs to take place. Currently, only 10 percent of patients suffering from mental illnesses receive treatment in India; while all patients do have the right to treatment, the shortage of money and psychiatrists hinders the accessibility. India spends as little as 0.06 percent of its budget on mental health, and there are only 0.3 psychiatrists per 100,000 people in the country. India needs to primarily focus on changing the societal culture regarding mental health. By educating children from a young age about the importance of mental health and acknowledging that mental illness is real and valid, the overall acceptance of mental health can increase. Changing the stigma surrounding mental health will enable more people to pursue jobs in treating mental health, increasing access. The cyclical link between mental health and poverty in India can only be broken by giving people, regardless of income, social status or gender and equal access to mental health treatment.

If India does not take a more aggressive stance on the issue of mental health, the country could face serious problems in the future. The World Health Organization predicts that if mental health remains unchecked, 20 percent of the Indian population will suffer from some form of mental illness by 2020; additionally, it determines that mental illness could reduce India’s economic growth by $11 trillion in 2030. Essentially, the cyclical link between mental health and poverty in India must break to enable optimal growth in the future.

Shvetali Thatte
Photo: Pixabay

Mental Health in Puerto Rico
Mental health is at the forefront with many other illnesses and disabilities. It can in many ways be just as dangerous if not more dangerous than physical disabilities or illnesses if it does not receive treatment. Mental health issues do not only affect the individual suffering from the illness but also the family and loved ones around. Many countries experience high levels of mental illness in all of its extremities. Mental health in Puerto Rico has become a serious conversation among the island’s people.

Mental Health in Puerto Rico

A study published in April 2019, determined the ongoing mental health impact that Hurricane Maria had on the island’s children. Much of the talk about mental health on the island is closely related to the storm. Researchers from the Puerto Rico Department of Education and the Medical University of South Carolina collaborated to study and examine the storm’s effects on the people’s well-being. A significant amount of public school students ranging from third grade to twelfth grade and lived through the storm participated in the study. About 7.2 percent of them showed clinical symptoms of PTSD.

Many regard the mental state of a country’s youth as crucial. For this reason, a group of volunteers from Fundacion Pro Ayuda de Puerto Rico or the Puerto Rico Help Foundation allied with Departamento de la Familia (Family Department) and started a project in 1997. The project’s name was Hogar Santa Maria de Los Angeles or Santa Maria de Los Angeles House.

Fundacion Santa Maria de Los Angeles (FSMA)

The Foundation’s original purpose was to give housing to young pregnant girls who lacked family support and socioeconomic resources. The name of the organization later changed to Fundacion Santa Maria de Los Angeles (FSMA). It reflects that the organization intends to provide help and care as a nonprofit organization and not just by providing housing.

FSMA benefits from donations that private organizations and the government of Puerto Rico make. It also receives individual or personal donations. Throughout the years, FSMA has adjusted to the times and necessities of youth. It offers new services to new communities with at-risk kids. It is one of the most trusted centers with the most complete help, prevention, training and therapy programs on the island.

FSMA’s Success

One of the greatest achievements that the Foundation has had is the decrease of teenage pregnancies at three schools in San Juan. Executive Director, Jose A Benitez-Gorbea states that “these three schools had an average of six pregnancies per year.” The organization made a module for every school semester centered on safe sex.

FSMA taught about protection, the risks and consequences of actions. The three schools began to have positive results and attained the goal of complete eradication of teenage pregnancies. The seminars also encouraged pregnant adolescents and motivated many away from depression. Today, none of the schools that participated in the Foundation’s program have a single occurrence of teenage pregnancy.

In the year 2018, FSMA helped 9,800 people that hurricanes Irma and Maria affected. It also provided aid to 500 people a month through its seminars. Its goal is to create a better standard of life for all and awareness of mental health throughout Puerto Rico.

FSMA’s Services

There is a necessity to create awareness regarding mental health in Puerto Rico. Some communities are vulnerable to mental illnesses because they do not have the resources to pay for medical services and psychological therapy. FSMA’s mission is to help and offer a safe place with room and board. It provides “food, objects of primary necessity, medical and psychological assistance and love,” said Jose A Benitez Gorbea.

Schools, public housing and other communities hold seminars on prevention and education on subjects that affect today’s youth. The subject matters that the seminars cover include bullying, suicide, depression, anxiety, self-esteem, self-care, responsible sex, management of emotions and how to maintain a healthy social life among others.

FSMA’s Team

The team includes a group of professionals dedicated to mental health. Two psychologists are responsible for clinical supervision and the coordination of the other positions. There is also one social worker in charge of the records who also helps with crisis intervention. FSMA collaborates with the Universidades Interamericana and Carlos Albizu of San Juan. There is a training clinic center where 15 students from these universities do their clinical practice to obtain their doctorates. Theses students offer seminars and work every day with patients in therapy.

In the administrative sector, there is an executive director, an assistant administrator and a service helper. “There is also a huge help which also comes from fifteen volunteers. Eleven belong to the union of directors and four are individual volunteers. These volunteers are in charge of making fundraising activities possible,” said Jose A Benitez-Gorbea.

The Future

FSMA is one of many organizations that is aware of the importance of mental health in Puerto Rico. It began assisting the physical, emotional and psychological needs of pregnant adolescents over 20 years ago. Today, it continues to provide support and care. FSMA eradicates teenage pregnancies in lower-income public schools in San Juan. It also facilitates the improvement of the emotional and psychological conditions of many kids. FSMA puts a stop to suicide, mutilation and risky behavior. The Foundation supports encourages and influences the island’s youth. FSMA believes that the youth of the country relies on the future.

Francisco Benitez
Photo: Flickr

Mental Health in Ecuador
One of the numerous factors spurred by poverty is mental illness. In many developing countries, those who are mentally ill face ostracization and a lack of support from health care providers. Mental illness may cause substance abuse, which can create further mental issues that prevent those who are ill from seeking assistance. Additionally, people who are mentally ill and abuse drugs in countries or areas where gang activity is common are much more likely to join criminal groups and further exacerbate the prevalence of gang-related violence. Ecuador is no exception to these symptoms. 

Government-funded health care provisions have largely overlooked mental health in Ecuador. Policy regarding mental health does exist, but the provisions are outdated and only 10 percent of the policy’s original content was put into action. Additionally, the policy’s provisions receive no regular public funding, even though much of Ecuador’s health care infrastructure is dependent on public funds. 

The Stigma of Mental Illness

The mental health policies do allow health care institutions to treat those who are mentally ill, however, mental health typically receives less attention than other sectors of health care. The lack of attention towards mentally ill people links back to the social perception of mental illness in Ecuador. People in many developing countries often consider seeking medical assistance for mental issues wrong. People who do not have a mental illness may find it difficult to understand what it is like to live with one. Many ill people do not seek treatment due to stigma and explore alternative methods, such as drugs, to cope with their problems instead. 

Many developing countries have only recently established mental health awareness. In the United States, social stigma still exists to an extent. However, the U.S. has established facilities to adequately treat the mentally ill. That is not the case in many developing countries. In numerous Ecuadorian provinces, people do not treat mental health institutions as primary facilities. Mental health is classified as a primary health care concern under Ecuadorian law, but only 25 percent of the population has access to these services. 

Progress In Mental Health

However, Ecuador is making progress. Rather than focusing on directly funding mental health institutions, the Ecuadorian government is beginning to direct attention to community-based solutions. Trained nurses diagnose mental illness and must make a referral to a primary source of care. Even so, a large portion of the mentally ill in Ecuador does not receive diagnosis or treatment. Groups like McLean Hospital are working to educate Ecuadorians at the university level, as well as at the community level. McLean Hospital believes that the most important step is to educate the public on the truth behind mental illness. Education can drive Ecuador’s perception of mental illness from one of stigma to acceptance and treatment.

Crime in Latin America is a dire issue that pushes millions out of their homes and their countries. By improving the mental health situation in Ecuador, there would likely be a large decrease in gang-related and drug activities. As a direct result, those who are mentally ill would receive adequate treatment and experience a much higher quality of life through the support from their community and health care.

– Graham Gordon
Photo: Wikimedia

Mental Health in the Developing World
According to the World Health Organization, the number of people diagnosed with a mental health disease has increased by 40 percent in the last 30 years. Poverty has been well-established as a driving force behind mental illnesses in the developing world. The Mental Health Foundation reports that 23 percent of men and 26 percent of women among the lowest socioeconomic class are at high risk of mental health problems. However, Psychiatric Times reports that many psychiatrists receive little training on intervening and addressing poverty and its relationship to mental disorders. The nonprofit Grand Challenges Canada is improving mental health in the developing world by funding innovations and expanding access to mental health care.

Mental Health in the Developing World By the Numbers

According to Grand Challenges Canada, 75 percent of the global burden from mental disorders is in developing countries. In addition, a World Health Organization report reveals some cogent statistics about the relationship between poverty and mental health:

  1. Depression is 1.5 to 2 times higher among low-income individuals.
  2. Common mental disorders are more prevalent for people living in poor and overcrowded housing.
  3. People with the lowest socioeconomic status have eight times more relative risk for schizophrenia than those of a higher socioeconomic status.
  4. People experiencing hunger or facing debts are more likely to suffer from common mental disorders.
  5. Evidence indicates the relationship between poverty and poor mental health is cyclical. Grand Challenges Canada is committed to ending the poverty-mental illness feedback loop.

Grand Challenges Canada

According to its website, Grand Challenges Canada has given 159,000 individuals access to mental health treatment. The organization’s project portfolio entails 85 projects in 31 countries and estimates that by 2030, the number of individuals impacted will be between 1.1 million to 3.2 million. Global Challenges Canada has influenced 17 mental health policies in various countries.

One example of Grand Challenges Canada improving mental health in the developing world is The Friendship Bench project in Zimbabwe. In 2012, Grand Challenges Canada funded a controlled study of more than 500 individuals with depression in the country. The patients involved received six 45-minute cognitive behavioral therapy sessions with a lay health worker, one of which took place in the individual’s home. The study found the prevalence of depression throughout program participants after treatment was less than 10 percent versus the approximate 33 percent of non-participants. The program has now spread to more than 70 clinics in Zimbabwe’s three largest cities.

In Vietnam, Grand Challenges Canada partnered with the Center for Creative Initiatives in Health and Population to develop the Smart Care project. The focus of the campaign centers around early diagnosis of autism spectrum disorder (ASD) to enable the best circumstances for children with the disorder. The program is based on a mobile platform, which includes apps to support screening and home-based intervention, a model of pilot screening development and health checkups for children with ASD.

Grand Challenges Canada is improving mental health in the developing world through the funding of technologies that vastly expand access to care. In 2016 and 2017, the organization invested over CA$42 million in projects to mitigate mental disorders. By 2030, Grand Challenges Canada expects to have seen symptomatic improvement in 297,000 to 844,000 individuals involved in projects.

– Zach Brown
Photo: Flickr

Mental Health and Poverty
Although mental health and poverty are two things that one might not always group together, there is a serious link between people living below the poverty line and mental health disorders. According to a Substance Abuse and Mental Health Services Administration SAMHSA report, around 9.8 million people living in the United States had mental health disorders in 2015, and 25 percent of those people were living below the poverty line.

Both poverty and mental health can bring about the other. For instance, a Gallup poll found that about 15.8 percent of people not living in poverty reported having diagnosed depression, while 31 percent of people living in poverty reported depression. In addition, a McSilver Institute for Poverty Policy and Research study based on data from the National Center for Education Statistics found that a household is likely to experience a 50 to 80 percent increase in food insecurity if the mother has diagnosed depression. While it is not clear whether the depression leads to living in poverty or living in poverty results in depression, the link between the two issues is clearly prevalent. Therefore, it is crucial that others address and treat the mental health of people living in poverty.

Ways to Treat Mental Health

One large issue with impoverished people having mental health disorders is that they often do not have the insurance and money to seek therapy and get medical help. This can be especially harmful to children living in poverty. The Official Journal of the American Academy of Pediatrics has three main recommendations for low-income families to seek help for mental health disorders, including education and training, establishing relationships with providers and creating multidisciplinary teams.

The best way to help and treat mental health in low-income families and communities is education. By integrating mental health education in schools and free programs that schools offer to families and communities, more people can learn about how to cope with mental health disorders and keep themselves and their families healthy and happy. In addition, integrating mental health services into school health services allows children to seek help for any mental health disorders right at school.

Further, establishing relationships with school health providers and counselors allows children to feel comfortable enough to seek the help that they need, in a safe space that they are used to. Communication between children/families and health care providers also allows the providers to be available more quickly and could result in more effective treatment.

Effects of Improving Mental Health

Poverty can strain a person’s mental health due to stress and instability. Therefore, public mental health has a huge impact on communities and the mental health of the people. People do not widely recognize public health, which is why is it crucial that communities are actively working to prevent mental health problems and to educate the community on how to cope with mental health strains.

Mental health problems and poverty have a serious link and it is vital that people are aware of the strains of poverty and understand their community and who is at risk. Only by monitoring and evaluating impacts of mental health, creating educational programs and addressing both physical and mental health, both mental health and poverty can improve together.

Paige Regan
Photo: Flickr

the Friendship Bench

The Republic of Zimbabwe is a landlocked country located in the southern parts of Africa. Zimbabwe has a population of around 17 million. Estimates show that one in four Zimbabweans have anxiety and depression, yet there are only 12 psychiatrists in the country. Roughly two years ago, the idea of the Friendship Bench in Zimbabwe was introduced as an answer to this deficiency in mental health care. Now, the success of the program might be able to help other countries.

What is Friendship Bench?

In 2016, Dr. Dixon Chibanda came up with the idea of a friendship bench to treat the enormous problem of depression and inaccessibility to mental health treatment for the people of Zimbabwe. This was in response to the lack of resources and healthcare professionals. He decided to train 14 grandmothers as mental health counselors for a pilot project.

The government of Zimbabwe expanded the program following its success and has trained more than 700 grandmothers since. The mission of the Friendship bench is to boost mental well-being by bridging the gap created by poverty, distance and lack of resources. Friendship benches are wooden benches placed in open areas of health facilities where patients and their counselors have conversations based on problem-solving therapy.

The Randomized Control Studies conducted in 2016 evaluated the success of the Friendship Bench. They found that the benches alleviated symptoms of depression in 86 percent of the patients compared to 50 percent in a control group with standard therapy. These patients were also five times less likely to have suicidal thoughts. Dr. Dixon Chibanda, the founder of Friendship bench Project says that there are also positive effects of this treatment on other health outcomes such as hypertension and diabetes.

Why the Friendship Bench is so Successful?

The Friendship Bench in Zimbabwe has been successful for a number of reasons. By understanding these reasons, other countries could use this method to alleviate their mental health issues. The following are a few reasons that have led to the success of the Friendship Bench.

  1. The use of local terminology by the grandmothers to communicate resonated with the patients. For example, instead of using the word depression, grandmothers use the local word kufungisisa, which means ‘thinking too much.’ The non-use of strict medical terminology prevented stigma and encouraged people to seek help.
  2. The grandmothers involved in the project not only provided a safe space to share the problems but also helped empower their patients through solutions-oriented discussions.
  3. The patients meet with their counselors every week. This higher frequency of meetings leads to effective treatment.
  4. The holding of group sessions for the patients brings in a feeling of community and belonging.
  5. Since grandmothers who deliver the treatment come from the native community, they were able to build a relationship of trust with the patients.

Friendship Bench as a Blueprint for Other Countries

The United States has about 16 psychiatrists per 100,000 people. This number is one of the highest in the world, and yet it is inadequate. To cover this gap, New York City launched the Friendship bench project under the aegis of Dr. Chibanda in 2016. New York City has three permanent, bright orange friendship benches in Bronx, Brooklyn and Harlem. The project got an enormous response. Within the first year of the program, there were already 30,000 visitors. The counselors in New York City are as diverse as people. In fact, many of them have experienced mental health issues and/or substance abuse.

Canadian Universities have an independent but similar program to tackle depression in students. The Lucas Fiorella Friendship Bench is a nonprofit organization in Canada that started in 2015. The program uses #YellowforHello to spread awareness about mental health. The method is the same; person-to-person conversation to solve the problems causing mental health issues in university students. Dr. Shekhar Saxena, the Director of the Department of Mental Health and Substance Abuse (MSD) said, “When it comes to mental health, all countries are developing countries.” Depression is one of the leading causes of disability worldwide and one of the largest contributors to the global burden of disease.

Zimbabwe’s success with the Friendship Bench has provided a blueprint for mental health treatment in both low- and high-income countries. With New York already following the suit and London in consideration, it is safe to say that Zimbabwe, an otherwise resource-deprived country, is leading the globe with an effective and accessible solution to address common mental health disorders.

Navjot Buttar
Photo: Flickr

Microlending Organizations
In the fight against global poverty, one hot-button issue is how to provide aid without the implication of paternalism, the idea that one person or group knows the interests of another group better than that group knows its own interests. Tariq Fancy, the founder of the nonprofit The Rumie Initiative, recalls hearing a Kenyan relative’s view on problems with international aid, saying “don’t walk in assuming that from your perch in North America you figured out all the answers for Africa.” Putting resources and power in the hands of communities both provides aid and acknowledges that they can make decisions about local interests. Microlending organizations have the power to do just that

Microloans are small loans at low-interest rates. Individuals living in poverty often have difficulty securing loans from traditional financial institutions due to a lack of borrowing history and assets to use as collateral. Even when people can get loans, interest rates are often high. People often use microloans to finance small businesses in their early stages, enabling people to overcome barriers and progress toward lifting themselves and their families out of poverty.

Microlending organizations can also issue loans for community projects, like building wells or funding schools. Microlending organizations typically, but not always, issue loans funded by individuals rather than by banks or other financial institutions. Here are four companies and organizations that use microlending in different forms to empower people living in poverty.

Four Microlending Organizations that Empower the Poor

  1. Kiva: Kiva crowdfunds loans from people around the world and uses partners to issue them. The nonprofit has enabled the funding of more than $1.33 billion in loans. Kiva emerged in 2005 and has partnerships with financial institutions throughout the world, where it transfers the crowdfunded money. The local field partners then loan money to Kiva’s lenders. Kiva has a 96.8 percent repayment rate and operates in 78 countries. On Kiva’s website, lenders can sort loans by region or category, such as agriculture, women and eco-friendly.
  2. Zidisha: Zidisha is the first direct person-to-person microlending service that focuses on entrepreneurs and job creation. Its name” comes from the Swahili word meaning “grow.” Unlike Kiva, Zidisha does not loan through financial institutions but facilitates direct lending between people. Zidisha’s loans total more than $16 million and have financed more than 240,000 projects.
  3. Building Resources Across Communities: Building Resources Across Communities (BRAC) is the largest non-governmental development organization in the world in terms of number of employees. Hasan founded BRAC in 1972 and it employs more than 120,000 people in 11 countries. BRAC has a microfinance program, primarily in Bangladesh, which has loaned to 5.6 million borrowers, 87 percent of whom are women. Unlike Kiva and Zidisha, which operate person-to-person lending services, BRAC distributes loans to lenders on its own using donations and other funds. BRAC also does work unrelated to microfinance, investing in schools and in water, hygiene and sanitation services.
  4. Women’s Microfinance Initiative (WMI): Women’s Microfinance Initiative (WMI) began issuing loans in 2008 and trains local women in managing loan hubs. WMI has loaned more than $4.5 million to rural women in amounts of $100 to $250 at an interest rate of 10 percent. According to WMI, 99 percent of its borrowers report doubling their income within six months of being involved in the program. WMI reports a 98 percent repayment rate.

The efficacy of microlending in pulling people out of poverty is up for debate, but some cases have shown promising results. A microfinance program in Uzbekistan resulted in 71 percent of participants reporting an increase in food intake quality. One study showed that when a microfinance program was put in place, there was an 18 percent decline in extreme poverty. While different studies report differing results, microlending organizations like Kiva, Zidisha, BRAC and WMI have certainly been a success.

– Meredith Charney
Photo: Flickr


May 2019 marked the 70th anniversary of the first Mental Health Month in the U.S. While 70 years of mental health awareness activism seems like a long time, the Mental Illness Policy Organization estimates that there are 3.5 million adults with untreated schizophrenia or bipolar disorder in the U.S. on any given day. That figure excludes individuals suffering from other mental illnesses such as acute anxiety and depression. Untreated mental illness is a problem at the forefront of the U.S. health care system and improvement seems imminent for suffering Americans. For countries plagued with poverty and violence like Honduras, accessible and affordable health care is scarce. Lack of health care options in Honduras causes more barriers for those living with mental health conditions, which makes raising mental health awareness in Honduras extremely important.

Mental Health Awareness in Honduras

Mental health awareness in Honduras is an uphill battle. In 2006, the government allocated 6.61 percent of the country’s general budget to health care. Less than 2 percent of that amount supported mental health. As social security often lacks resources to treat mental health illnesses, most cannot afford to pay for medication. Unfortunately for those suffering from mental health-related issues, most never receive proper care.

Being one of the poorest and most dangerous countries in the world, Honduras is home to prevalent violence and poverty that specialists point to as key factors in an increase in mental illness in the country. Experts estimate that 10 percent of Hondurans suffer from mental illness or substance abuse.

Visit to a Mental Health Facility in Honduras

In 2018, this author had the opportunity to visit a local mental health treatment facility in a small Honduran town called El Porvenir. The facility was the only public mental health resource within five hours, which meant that many families dropped their relatives off with the prospect of going years before seeing them again. One nurse who came in twice a week monitored the treatment center. Between her visits, however, patients, including some who suffered from severe illnesses like schizophrenia, lived in the three-bedroom house unsupervised. For some patients, it was the only option their families could afford.

Doctors Without Borders

Luckily, change is starting to look imminent and mental health awareness in Honduras is increasing. Since 2011, Doctors Without Borders (DWB) prioritizes treatment for victims of violence and sexual assault, as well as for their family members. “We try to work on the emotions, feelings, and thoughts that people experience as a result of what happened to them,” said DWB mental health supervisor Edgard Boquín. “We use cognitive behavioral therapy to help patients take the detrimental elements and replace them with positive coping tools, such as anxiety control, breathing, and relaxation techniques, or by making small life plans which will allow them to cope with their environment again.”

In 2016, DWB expanded activities in the country’s capital, Tegucigalpa, and its sister city, Comayagüela. The number of patients suffering from mental illness treated by DWB jumped 117 percent from 2015 to 2016. Community Health Partnership Honduras, a nongovernmental organization, also travels to southwestern Honduras twice a year, which is among the poorest regions in the world. The organization partners Honduran and American volunteer medical workers to increase access to mental health care.

With those missions in mind, mental health awareness in Honduras is spreading from the cities to the rural regions. Consequentially, treatment and support are increasing as well.

Julia King
Photo: Pixabay