Mental health in Sierra LeoneSierra Leone is a West African country bordered by the North Atlantic Ocean. It is an impoverished country with almost half of the working-age population involved in subsistence agriculture. Between 1991 and 2002, Sierra Leone was subject to a civil war that resulted in more than 50,000 deaths. Sierra Leone also experienced a harsh Ebola outbreak in 2014 that outclassed all others. Its citizens are still recovering from these events, which have resulted in years of physical and emotional pain. This has left hundreds of thousands of people plagued with mental health issues in Sierra Leone.

Mental Health in Sierra Leone

The World Health Organization approximates that 10 percent of Sierra Leone citizens are facing mental health problems. This number may be even higher when taking into account cases that have not been officially reported. “[D]aily hardships and misery can turn into what scientists call “toxic stress” and trigger or amplify mental health problems” as a result of living in extreme poverty. For a long time, there was a lack of political support for mental health in Sierra Leone.

Resources are a big problem when tackling the issue of mental health in Sierra Leone. There are only “two psychiatrists, two Clinical Psychologists and 19 Mental Health Nurses” in a country of seven million people. Furthermore, only four nurses are trained to work with children with mental health issues. Due to the absence of support, many citizens seek out help from the traditional healers available.

Many individuals and organizations are working together with the goal of improving mental health in Sierra Leone. Two organizations that have made significant efforts and progress in raising awareness or providing direct aid to mental health services are the Ministry of Health and Sanitation (MOHS) and the World Health Organization (WHO). Both WHO and MOHS have worked together on projects that have greatly improved support for mental health in Sierra Leone.

The Ministry of Health and Sanitation

Most of those infected or family to those infected during the Ebola virus disease (EVD) outbreak experienced trauma. Patients were often isolated from loved ones and surrounded by strangers. People had to cope with the death of family members and friends. Survivors of EVD beat the virus, but they still experienced toxic stress, depression, insomnia and anxiety. MOHS developed a plan for providing mental health services by improving community awareness, building demand for services and improving access to specialized healthcare workers at all levels of care.

The MOHS worked with the Advancing Partners program on a two-year project funded and managed by USAID’s Office of Population and Reproductive Health and implemented by JSI. In Sierra Leone specifically, MOHS’s framework is being used to aid Sierra Leone’s government with the implementation of health service in post-Ebola recovery. The program is improving mental health awareness in the community, training healthcare workers with the skills to provide high-quality care and reinforcing mental health governance.

So far, MOHS and Advancing Partners have created community healing dialogue (CHD) groups. The groups help communities by providing coping mechanisms, finding resources and offering support for those with psychosocial issues. These groups are placed in areas with a large amount of EVD survivors and trained mental health staff. The CHD groups have “reached almost 700 people in 40 communities across the six districts most affected by the Ebola outbreak (Bombali, Port Loko, Kailahun, Kenema, and Western Areas Rural and Urban).”

The World Health Organization

The World Health Organization is focused on training healthcare workers in Psychological First Aid and the identification of distress. WHO developed the mental health gap action programme (mhGAP) to train community health workers and medical doctors in Sierra Leone. This way, healthcare workers will be able to more easily identify mental disorders and discover treatment options. WHO wanted to create an approach that aims to support mid-level and higher level healthcare workers to provide better tailored services.

Sierra Leone was previously a country where mental health needs were not addressed. The country continues to be impoverished since a large part of its population is unemployed. It experienced devastating losses in its 11-year-long civil war and was further distressed by the severe Ebola outbreak in 2014. The country has a large amount of people still suffering from past issues. That suffering went untreated for a long time. However, organizations like the WHO and MOHS have made considerable progress in addressing the mental health in Sierra Leone.

Jade Thompson
Photo: Flickr

Disabilities in LiberiaLiberia is a West African country comprised of 4.98 million people. Exact statistics about disability in Liberia are out of date but according to a UNICEF study from 1997, 16 percent of the population has a disability. Of that 16 percent, 61 percent struggle with mobility, 24 percent are visually impaired, seven percent are deaf and eight percent have an intellectual or psychosocial disability. The Swedish International Development Cooperation Agency (SIDA), estimated in 2014 that due to the devastating civil war that ended in 2003 and the Ebola outbreak in 2014, the population of people with disabilities in Liberia is likely closer to 20 percent.

Background

People with disabilities tend to be marginalized, stigmatized and excluded from education, skills training and income-generating opportunities. Because they have a limited voice in politics and society, their issues are not included in national policies, especially in poverty reduction initiatives causing their living conditions to continue to deteriorate in a “vicious cycle”. According to SIDA, 99 percent of people with disabilities in Liberia live in extreme poverty.

Liberia is taking steps to improve the lives of those living with disabilities. In 2012, the nation signed and ratified the U.N. Conventions on the Rights of Persons with Disabilities as well as other treaties that reference the rights of people with disabilities like the U.N. Convention on the Rights of the Child, the African Charter on Human and People’s Rights, the Convention on the Elimination of All Forms of Discrimination against Women. It also formed a national commission on disability and is reviewing its constitution to address the rights of people with disabilities. While the country is working to improve their rights and conditions, there is still much to be done. The lives and health of people with disabilities in Liberia can be improved in three key-ways: education, mental health and job opportunities.

Education

One important tool for lifting people out of poverty is education. The Liberian government has free and compulsory education for children but students with disabilities are often left behind. In 2009, even though an estimated 92,000 of 600,000 school-age children have disabilities, only four percent was allocated for children with disabilities. While there are schools for the visually impaired and the hearing impaired, they mostly reach a small urban population. Rural areas are lacking in resources for their students with disabilities.

There are, however, organizations working to improve access to education. AIFO-Liberia, for example, is working to ensure that people affected by leprosy can receive their educations, largely through a Community Based Rehabilitation strategy.

Mental Health

The Liberian people have been through much in the past 50 years. Approximately 40 percent of its citizens suffer from post-traumatic disorder from the civil war and there is only one practicing psychiatrist in the country. While not all people with disabilities have a mental illness, mental illness itself can become a disability. Those who have mental illnesses such as schizophrenia and depression are often stigmatized as witches.

The Carter Foundation is working to train 450 mental health professionals and create an anti-stigma campaign to improve understanding of mental illnesses. Meanwhile, AIFO-Liberia implemented a program that provides psychosocial support for those affected by the Ebola virus in addition to a destigmatizing campaign to improve mental health.

Job Opportunities

People with disabilities in Liberia are often excluded from job skills training, work, and income-generating opportunities. While the Liberian government and activists are working to put accommodation and anti-discrimination laws on the books, disability is often seen as divine retribution for a person’s misdeeds. Organizations like AIFO-Liberia have implemented a startup project that will increase job opportunities and improve social inclusiveness. Ending the social stigma, working to improve health care access and workplace accommodations, will help lift people with disabilities in Liberia out of poverty.

While the country has made great legislative strides in signing on to international commitments and in creating legislation, it still has a long way to go in improving the state of people with disabilities in Liberia. The stigma around these conditions prevents people with disabilities from having a voice and escaping extreme poverty. With the help of activists, NGO’s, and the Liberian government, the lives of people with disabilities can be improved.

– Katharine Hanifen
Photo: Flickr

Victims of Boko HaramSince 2002, the Islamic militant group, Boko Haram, has killed more than 27,000 people and displaced nearly two million from their homes in the northeast regions of Nigeria. For victims of Boko Haram, recovery will be a lifelong process. Although it has been estimated that nearly 4.5 million people remain food insecure since the insurgency, it is the psychological toll that remains most difficult to measure and treat. With the help of organizations such as the U.N., the Neem Foundation and Tender Arts Nigeria, victims of Boko Haram in refugee camps are offered much-needed psychological treatment, including art therapy and training on how to reintegrate into society.

The Role of Therapy in Combating Trauma

Many victims of Boko Haram are taken as children and forced to both witness and commit acts of unspeakable violence, even to members of their own families. Girls as young as 11 are forced to marry and undergo rape. These girls are frequently used as suicide bombers, while the boys are trained as soldiers. The victims of Boko Haram are indoctrinated and occasionally radicalized themselves. For this reason, they are often shamed or feared upon their return, being referred to as epidemics.

The Neem Foundation highlights the importance of therapy to help victims recover from psychological trauma. After being kidnapped, witnessing their villages being attacked and their loved ones being killed, many people suffer severe Post-Traumatic Stress Disorder (PTSD). Children also frequently suffer from cognitive delays and a proclivity towards violent outbursts.

The Neem Foundation brings individual and group therapy to refugee camps, visiting the camps on motorized tricycles called kekes around the country. Terna Abege, a clinical psychologist with the Neem Foundation, uses various methods of therapy, including visualization techniques called “thought-stoppers” to help victims of PTSD deal with disturbing flashbacks. The Neem Foundation and other nonprofits, such as MANI, seek to fill the gap in mental health care in any way they can, including offering therapy to suicidal victims over Twitter and WhatsApp.

How Art Therapy is Used in Nigerian Refugee Camps

Art therapy is also being integrated in refugee camps to help people sort through their mental trauma. The use of drawing and painting, among other art forms, can divert attention from negative thoughts and help people communicate in alternative ways. Art therapy can also help victims preserve their broken cultures and identities and express feelings that they cannot put into words.

In an emergency school set up by UNICEF in Cameroon, children gather in groups to draw as a form of art therapy. The trauma is evident in the scenes of violence and bloodshed that seem to flow naturally from the reservoirs of their memories. Under Boko Haram, children are beaten for crying at the violence they witness and not allowed to play with toys or make noise. When they return, they are often desensitized to violence and either act out violently or withdraw entirely. The art therapy helps the children to express what they have been suppressing and helps therapists identify those in most need of treatment.

Since 2013, Tender Arts Nigeria, created by Kunle Adewale, has used art therapy to help children suffering from physical and mental illnesses and impairments, such as cancer, Down Syndrome and behavioral problems. Since the war with Boko Haram, Tender Arts has reached out to victims of violence and radicalization. They use art therapy to assist in deradicalization efforts and to heal those traumatized from the violence.

Like the Neem Foundation, Tender Arts believes its efforts are not only important avenues of healing but important in helping people avoid radicalization or other areas of crime. More than 10,000 victims have already benefited from the art therapy offered by Tender Arts Nigeria. Because Boko Haram preys on the poor, young and uneducated, Adewale believes that valuing the arts and education is the best way to fight Boko Haram, whose name means “Western education is forbidden.”

The Importance of Greater Access to Mental Health Care in Nigeria

The Neem foundation highlights the importance of increasing the availability of psychological treatment for refugees in Nigeria. There is a major deficit in mental health care in Nigeria, with only one mental health facility available in the northeast and only one therapist per 375,000 people. The Neem Foundation is working to implement programs that will train more people to offer therapy. They now offer an intensive nine-month program in Maiduguri to train lay counselors who can work more immediately as therapists for the traumatized population.

Although the road to recovery is a long one for victims of Boko Haram’s violence, the Neem Foundation believes in the need to act quickly to prevent more severe mental illnesses from developing. They are working to spread awareness about mental health and want to gain more governmental support for the mental health crisis in the coming years. In the meantime, as more therapists become available throughout Nigeria, it is their hope that these victims can recover and start to live normal lives again.

– Christina Laucello
Photo: Flickr

Mental Health in Guyana

Guyana, an English-speaking country situated on the northern coast of South America, has one of the highest suicide rates in the world. The country tallies about 29.2 suicides for every 100,000 deaths, a number surpassed only by Lithuania and Russia. This unsavory statistic can be an important indicator of a country’s relationship with mental health. The seven facts about mental health in Guyana show the variety of complex and interconnected factors that contribute to its high suicide rate.

7 Facts About Mental Health in Guyana

  1. Poverty in rural areas and alcohol abuse are major risk factors for poor mental health. While anybody can struggle with mental health, there are certain social patterns in Guyana that put some communities at greater risk for developing mental health issues like depression. Health workers have cited poverty in rural areas and the prevalence of alcohol abuse as possible factors that increase the risk of depression in Guyana.Rural poverty: About three-quarters of Guyana’s population lives in rural areas, both along the coast and in the interior. Of the 12 percent of people living in the rural interior, about 73.5 percent live in poverty and of the 60 percent of people living in rural communities along the coast, about 37 percent live in poverty. The poverty levels in these more remote communities are much higher than in urban areas, and they represent more dire situations as access to resources is more limited. About 70 percent of the country’s suicides take place in these rural areas.Alcohol abuse: Some health experts have suggested a link between alcohol abuse and poverty in rural regions of the country. An article by NPR cited Guyanese government psychologist Caitlin Vieira in saying, “In these rural communities, there is nothing to do but drink.” Alcohol abuse can have detrimental effects on mental health, especially if the consumer is already struggling. In the long-term, experts have suggested that dependence on alcohol can worsen mood disorders such as depression. In the short-term, excessive drinking lowers inhibitions and can result in impulsive suicide.
  2. There is a severe lack of trained mental health professionals. With very few healthcare professionals trained in mental health treatment and those who are trained working primarily in urban centers, Guyana’s most at-risk populations often cannot receive the care they need. Part of the reason there is so few people trained in this field is because Guyana has an extremely high emigration rate. With over 55 percent of the country’s citizens living abroad, there are typically not enough professionals in medicine generally to meet the population’s needs. Luckily, the government is mobilizing to address this issue. In 2015, Guyana pledged to a National Suicide Prevention Plan that aims to increase the number of trained mental healthcare workers. Over the past two years, about 120 medical doctors have received training for depression and suicide intervention and are now scattered across the country. The number of psychologists and psychiatrists in the country remains low, at around 27, but has increased from just seven in 2014.
  3. Access to treatment facilities is extremely limited. Along with the lack of healthcare professionals, access to adequate mental health treatment facilities in Guyana is very limited. There are only two inpatient rehabilitation facilities in the country, and only one allows women. While some people find it easier and more effective for trained healthcare workers to visit their communities, others benefit from and require the immersive atmosphere of inpatient care. More health workers are being trained, but presently there does not seem to be any plans to expand care and rehabilitation facilities.
  4. The stigma surrounding mental health stops many struggling citizens from seeking help. The stigma around mental health in Guyana is stubborn and pervasive. Especially in the rural communities where people are most at risk, talk spreads quickly and citizens avoid getting the help they need for fear of backlash from their neighbors. Part of the reason for this stigma involves the Mental Health Ordinance of 1930, which continues to serve as the legislative framework for mental health services. The document refers to people suffering from psychological disorders as “idiots” and “deranged,” language that establishes those seeking help for mental health issues as unwelcome outcasts. Some areas even attribute mental illness to witchcraft, further ostracizing those struggling. Fortunately, researchers at the University of Guyana are working to address the problem. To promote wellness, they plan to study and share “local practices for building community mental health resilience” among certain Guyanese neighborhoods. Because these stories and solutions are community-based and not focused on the individual, the study is expected to decrease the stigma around mental illness and promote collective acceptance.
  5. Fear of prosecution also acts as a deterrent for seeking help. Aside from stigma, fear of prosecution and mandatory enrollment in a treatment facility are other reasons why people do not get treated for mental illness. According to the NPR article, 85 percent of patients seeking treatment end up spending more than five years in psychiatric facilities with no legal protections outlining their right to leave or refuse treatment. People are scared that if they seek help, they will be sent away with no way to protest. Additionally, because suicide is illegal in Guyana, those considering taking their lives are sometimes fearful that a report will get them in legal trouble. The police operate the country’s suicide prevention hotline, a fact that intimidates many people, even though very few have been prosecuted. Many citizens suffer in silence for fear that there will be consequences if they seek help.
  6. East Indians have the highest suicide rate among ethnic groups in Guyana. According to the National Suicide Prevention Plan, East Indians made up about 80 percent of Guyana’s suicides between 2010 and 2013, even though East Indians make up just about 40 percent of the population. Some have considered the history of East Indians in Guyana an important indicator of why suicide rates are so high. When slavery was abolished in the 1800s, landowners enlisted indentured servants from India as the new form of cheap labor. Therefore, despite being the largest ethnic group, East Indians have always been associated with poverty and low status in Guyana.
  7. Progress is ongoing. In addition to the various aforementioned steps being taken to address mental health in Guyana, a non-profit organization called The Guyana Foundation has been instrumental in developing “sunrise centers” in communities with high suicide rates. These centers focus less on psychiatric treatment and more on community-based wellness programs to reshape suicide-prone areas from the ground up. Sunrise centers offer courses that teach valuable life skills, such as IT training, photography and music lessons, in order to increase economic opportunities and provide stress relief.

As a result of the efforts from non-profits and legislation like the National Suicide Prevention Plan, Guyana’s suicide rate has dropped from 44.2 percent in 2014 to just under 30 today. While it is clear that improvements are being made, the country still has a long way to go in holistically addressing mental health. An overhaul of the outdated legislative framework surrounding mental illness may be the next step towards improving mental health in Guyana.

– Morgan Johnson
Photo: Pixabay

 

Mental Health In Ukraine

Since gaining independence from the Soviet Union in 1991, Ukraine has faced many troubles. As of early 2014, Ukraine has been in nearly continual conflict with Russia and Eastern Ukraine’s pro-Russian separatists. Ukraine is also home to almost 45 million people. In July 2018, over 1.5 million people were internally displaced, meaning that they had to leave their homes as a result of the fighting. Mental health in Ukraine is affected by the enduring strife in their country.

Issues Impacting Mental Health in Ukraine

Many of those living in Ukraine deal with problems like anxiety and depression, that negatively influence their mental health. These conditions are exacerbated by turmoil. Citizens of Ukraine have dealt with the consequences and brutalities of war, including casualties of friends and family members. Some have had to leave behind the places they call home.

In addition, physical threats are also often an issue. Those living in war zones or even partial cease-fire zones, such as the line of contact through Donetsk and Luhansk, are in constant danger. Roughly 3,300 civilians were killed from 2014 to 2018.

Mental health care is also taboo in Ukraine. During the Soviet era, mental health issues were used as an excuse to imprison in asylums those with differing political beliefs from those in power. The ramifications of this injustice persist today, with many skeptical of psychiatry.

This taboo worsens the effects of anxiety and depression. One survey of 1,000 internally displaced individuals found that 20 percent of those internally displaced suffer from moderately severe to severe anxiety. Also, 25 percent suffered from moderately severe to severe depression. These numbers are significantly higher than the percentage of people suffering from anxiety or depression in the United Kingdom.

The stigma surrounding mental health deters some from voicing their struggles. The matter is further complicated as people who prefer to speak with Church leaders are now unable to do so because many leaders have also fled out of necessity. Those living in separatist territories are denied access to a psychological help hotline. Also, up to 77 percent of the internally displaced are completely deprived of any and all forms of professional help.

Organizations Working to Improve Mental Health in Ukraine

UNICEF has a mobile outreach program that aims to provide psychosocial support to the people of Ukraine. These individual and group activities are designed to focus on relieving anxiety and fear, issues that are abundant in the turbulent areas. UNICEF’s efforts are near the line of contact and provide help for children and their caregivers; 1,792 people were helped by these efforts during January 2019.

Also, UNICEF established the aforementioned hotline for both legal and psychological relief. In 2017, over 43,000 calls were made to the hotline. This outlet for help provides much-needed support to those in need.

The WHO, in cooperation with Ukrainian health authorities, also created a mobile mental health center to provide psychological services, support and education. The program is community-based. Based on the success of the four mobile units across the conflict areas, this system may be implemented on a larger scale as a measure to reform mental health care in Ukraine.

Johns Hopkins University, along with USAID, recently completed a project that started in March 2015 in Ukraine. The design sought to improve the mental health of community members and research the effects that conflict has had on the population.

With the help of these organizations and more, hopefully, the effects of the Ukrainian struggle on mental health can be alleviated. The programs are working to find workable solutions to mental health stigmas and to provide relief for those facing issues with mental health in Ukraine.

– Carolyn Newsome
Photo: Flickr

Mental Health in South AfricaThe South African Depression and Anxiety Group (SADAG) conducted a study that revealed the shocking state of mental health in the country. In fact, one-third of South Africans have a mental illness. However, 75 percent of them will not get any kind of help.

This is where SADAG comes in. SADAG is Africa’s largest mental health support and advocacy group. It is made up of experts who take calls from South Africans about their mental health questions and concerns. The group has a 16-line “counseling-and-referral” call center and work in “urban, peri-urban and the most rural communities across South Africa.”

SADAG is comprised of a network of over 200 mental health treatment facilities and support groups throughout the country. Its focus is on areas lacking widespread community health resources. The organization believes access to this type of treatment is fundamental to improving mental health in South Africa. Additionally, SADAG believes it can improve the overall quality of life while simultaneously influencing socio-economic issues in a positive way.

SADAG and Language

Since South Africa has 11 different official languages, SADAG offers workshops and training programs tailored to these languages for individual members. In fact, the programs also are tailored to corporate businesses, healers, doctors, care workers, correctional facilities, schools and churches.

Workshops and Campaigns

These workshops focus on how to openly and productively talk about illnesses such as depression, panic disorders, bipolar disorder, PTSD and suicide prevention. Furthermore, the workshop explores healthy ways to deal with stress in an attempt to reduce the stigma surrounding mental health.

SADAG is also working to disseminate mental health awareness beyond just those member organizations within the group. They have created media campaigns with a message of de-stigmatization of mental illness that runs on TV and radio. Additionally, the campaign runs via print and electronic press releases.

Finally, SADAG has been working especially hard with HIV and AIDS patients on coping skills to conquer depression and other mental illnesses that accompany a diagnosis. This is pivotal in the country where the leading cause of death is HIV/AIDS.

There are several other organizations located in the nine different provinces doing important work to improve mental health in South Africa.

  1. Care Haven Psychiatric Centre: This center provides residential accommodation and an arts and crafts area. The main purpose is to provide therapeutic care for those with mental illnesses who have been discharged from psychiatric hospitals, and who struggle to function independently in society.
  2. Port Elizabeth Mental Health: Located in Port Elizabeth, this organization provides social work intervention services, skills training and prevention towards better mental health. It also promotes neighborhood unities for children with disabilities who cannot access special daycare centers. Finally, the organization offers youth skills development centers.
  3. Bloemcare Psychiatric Hospital: This is a private psychiatric hospital in Bloemfontein in the Free State. It offers psychiatric programs and nursing care. Its programs help develop coping skills and group therapy environments to connect with others. Furthermore, the hospital has recreational facilities and dietitians to help promote the balance between physical and mental health.
  4. SA Federation for Mental Health: This is the largest mental health organization in South Africa located in Randburg, South Africa. They work to implement national awareness campaigns, empower mental health care users and organizations, advocate for human rights of mental health care users and conduct mental health research.
  5. Ekupholeni Mental Health and Trauma Centre: Located in Katlehong, South Africa, this center provides HIV/AIDS support and a bereavement program to counsel infected children, youth and adults.
  6. PsySSA: The Psychological Society of South Africa works to negotiate with the government and other legislative bodies to create programs that focus on mental health awareness development. Specifically, these programs focus on the unique circumstances of a post-Apartheid society.
  7. Durban & Coastal Mental Health Society: In addition to standard psychiatric care, this organization offers protective training workshops that promote self-worth, dignity and self-reliance for those with mental illnesses. The organization does this through job creation initiatives that encourage block making projects, gardening projects and supported employment.
  8. NICRO: This organization focuses on social crime prevention, juvenile justice and the reintegration of criminals into society during a tough transition.
  9. Mpumalanga Mental Health Society: Located in Secunda, South Africa, this organization advocates for the rights of the disabled, trains caregivers and provides social work services to those dealing with substance abuse.
  10. Careline Clinic: The goal of this clinic is to provide care while upholding human dignity. It provides psychotherapy and crisis resolution skills to encourage empathy for patients going through emotional trauma.
  11. MSF Rustenburg: This international NGO provides medical services and support, initiated by Doctors Without Borders. It focuses on providing support to domestic violence and sexual assault survivors. It is located in Rustenburg, South Africa.
  12. Bendiga House: Bendiga House is a facility helping those in recovery from trauma and those suffering from mental illness. It teaches independent living through lessons. For example, lessons are offered on budgeting, shopping and chores. It also provides group and music therapy, life skills training, exercise programs and supervised leisure and entertainment.

These great initiatives are tackling inter-sectional and systemic barriers that prevent adequate care for many marginalized communities. Overall, mental health in South Africa is improving via these organizations and initiatives.

– Meredith Breda
Photo: Flickr

Mental Health in NigeriaNigeria, Africa’s most populated country, is having a mental health crisis. Many developing nations fall prey to mental health traps, and this West African country is no different. Developing nations spend too little, if any, resources on mental healthcare, and their nation’s population suffers because of it. Healthcare in Nigeria, especially for those with mental health issues, is poorly managed, underfunded and outdated. Here are five facts about mental health in Nigeria.

Five Facts about Mental Health in Nigeria

  1. With a population of 181 million, it is estimated that as much as 30 percent of the population suffers from a mental illness. This means that more than 54 million people are dealing with mental illness with little to no help. In comparison, the Center for Disease Control estimates that 54 million is the same number of people who are diagnosed with arthritis in the United States.
  2. In Nigeria, fewer than 10 percent of those battling mental illness have access to mental healthcare. Access is mainly limited to cities, leaving the rural areas without resources for psychiatric care. Since half of the population of Nigeria live in rural areas, those people do not have access to mental healthcare. Those people are turning to self-medication, self-diagnosis and misunderstanding or denial of their symptoms. Many of those without help are children and adolescents.
  3. There has not been an update to the laws regarding mental health in Nigeria since 1958. These laws are outdated and contradict decades of mental health research. This is how it is possible for the Nigerian government to spend only 4 percent of its annual budget on healthcare.
  4. Depression is the most common illness that affects mental health. In a global survey, Nigeria ranked 15 in the number of suicides per year. In another survey, Nigeria was ranked the most depressed country in Africa. Despite the government’s inability to manage mental health in Nigeria, there is hope.
  5. MANI, or the Mentally Aware Nigeria Initiative, is the largest and most successful NGO fighting mental illness in Nigeria. This group focuses on ending the negative stigma surrounding mental health in order to increase the demand and the resources for psychiatric care. MANI has been successful since its inception in 2016 by using the internet and social media to spread awareness as well as providing a suicide and distress hotline.

MANI has grown its following from 500 to more than 20,000 Nigerians, spreading the word across the country about the free mental health services that it offers. MANI is providing an important resource for mental health in Nigeria, but until NGOs like MANI gain more traction, those struggling with a mental illness will continue to find a lack of support and continued opposition to changing laws surround mental healthcare.

Kathryn Moffet
Photo: Flickr

Mental Health in South Sudan

After years of violent conflict and civil war, many South Sudanese are suffering from mental health problems caused by trauma. With little to no government funding and cultural stigma attached to psychological health issues, thousands of people struggle to cope and heal from decades of war. USAID’s program Viable Support to Transition and Stability (VISTAS) is working to bring healing and restoration to the war-torn people by conducting trauma awareness workshops.

A History of Conflict

South Sudan, the youngest nation in the world, declared its independence from Sudan in 2011 after years of civil war and fighting. Only two years after gaining independence, conflict once again erupted in South Sudan, this time between the infant nation’s president and vice president, leading to a civil war that lasted for five years. Around 400,000 South Sudanese people lost their lives during the war, including women and children, while many more suffered unthinkable traumas and hardships. According to UNICEF, three-quarters of South Sudanese children have never known anything but war, and as many as 19,000 of them were kidnapped or recruited to join armed groups. Numerous accounts of South Sudanese women being sexually abused and raped by opposition forces circulated throughout the war.

End of the War Brings New Battles

Although the fighting has officially ceased, South Sudan’s restoration is just beginning. Years of violence and trauma have left their mark on the mental health of many in the nation. Although data is limited, several studies show that the conflict has had a severe effect on the mental health of South Sudanese civilians and soldiers alike. Nearly 41 percent of respondents in a survey conducted by the South Sudan Law Society and the United Nations Development Program (UNDP) showed symptoms of post-traumatic stress disorder (PTSD). The South Sudan Medical Journal reported that PTSD, depression, anxiety and substance abuse are major health issues impacting the country. However, the conflict-riddled nation not only lacks the resources to bring healing and help to those suffering from trauma, but it also struggles to remove cultural stigma and shame from mental health problems.

Mental Health Care Lacking in South Sudan

In 2012, South Sudan’s Deputy Minister of Health, stated, “The situation is very rudimentary in terms of mental health,” and “There are so many people suffering because of post-war trauma.” Today, mental health in South Sudan is still severely under-resourced, with its 2017-18 budget allocating only two percent to the health sector, none of which was appropriated towards mental health care.

In 2019, only three psychiatrists reported practicing in the whole country. Atong Ayuel, one of South Sudan’s three psychiatrists, said that “mental illness is a huge problem in South Sudan,” blaming the problem on both the country’s underfunded health program and that mental health in South Sudan is a culturally taboo subject.

VISTAS Workshops

USAID’s program VISTAS is conducting trauma awareness workshops throughout South Sudan with two primary goals:

  1. Create a space where those suffering from trauma-induced mental health issues can open up about their experiences and begin to address them
  2. Provide communities with practical tools to collectively address mental health issues and promote reconciliation and healing

“We define trauma as a wound. It is when something shocking or abnormal happens in your life, and it overwhelms you and you don’t know how to respond,” said Thor Riek, a 32-year-old South Sudanese man who struggled to cope with trauma from his days as a child soldier. Now as a trainer for VISTAS trauma awareness workshops, Thor not only has gained the tools he needs to respond and recover from past trauma, he now shares these practical tools of healing with other South Sudanese who are also suffering from trauma-induced mental health issues. Thor hopes the workshops will give participants “a narrative that can move them forward from the cycle of violence and begin to walk on the healing journey.”

In 2018, VISTAS workshops engaged 6,452 community members in different types of trauma awareness sessions. As South Sudan works to put years of violence and war behind them, programs like VISTAS’ trauma awareness workshops bring restoration and healing to a once war-torn people, inspiring a hopeful future.

– Sarah Musick
Photo: Flickr

Improving Mental Health in CambodiaThere are two main factors that have lead to the need for improving mental health issues in Cambodia today.

First, is the Khmer Rouge. The Khmer Rouge was a genocide in the late 1970s that ultimately killed four million Cambodians. The ruthless regime of the Khmer Rouge left many survivors with PTSD (post-traumatic stress disorder) from witnessing such horrific crimes against humanity.

Second, is the high rates of poverty that plague Cambodia. The mass destruction of Cambodia’s infrastructure during the Khmer Rouge left the country poverty stricken, losing decades of development in a just few years. As a result, living in poverty poses itself as a large risk factor for mental illnesses, causing many Cambodians without PTSD from the genocide to still be at a high risk of struggling with mental health.

Specifically targeting educated people and those unable to work, the Khmer Rouge left the country with only a few dozen medical professionals by the genocide’s end. Moreover, it has taken decades for Cambodia to develop the organizations necessary to combat such deeply-rooted mental health struggles. Here are four organizations improving mental health in Cambodia today.

4 Organizations Improving Mental Health in Cambodia

  1. Transcultural Psychological Organization (TPO Cambodia)
    TPO Cambodia recognizes the gap between mental health services needed and the mental health services provided in Cambodia. Through recognizing this gap, TPO Cambodia has developed an extensive array of mental health services. For instance, services are aimed at community building, raising awareness and providing psychological treatment. By focusing on the cultural context of Cambodia, TPO Cambodia aims to develop culturally aware treatment options for patients. Some of the many services available at TPO Cambodia are:

    • Offering the training of already-established community leaders to be key mental health resources for the community
    • Trauma treatment
    • Counseling and therapy
    • Self-help groups for victims of sexual assault and of the Khmer Rouge
    • Protection of children
  2. Cambodian National Program for Mental Health
    Secondly, training mental health professionals are just the beginning for the Cambodian National Program for Mental Health. With its primary goal being to support the Cambodian Ministry of Health, this program continues to help increase the number of properly-trained mental health professionals in Cambodia. This is so foundational as Cambodia needs more trained mental health professionals to properly address the mental health needs of the country. In addition to training mental health professionals, the Cambodian National Program for Mental Health:

    1. Provides mental health services to 23 out of 24 Cambodian provinces
    2. Introduced computerized documentation for client’s files
    3. Supports the primary psychiatric facility in Phnom Penh
    4. Develops the Psychosocial Rehabilitation Centre
  3. Center for Child and Adolescent Mental Health (CCAMH)
    Also dedicated to supporting the mental health struggles of children and their families, CCAMH strives to help children in the community, at school and at their center. So, by providing counseling and awareness-building services at school and in the community, CCAMH’s primary resources are at their center. For example, some of the services available at the center are:

    • Play therapy
    • Behavior therapy
    • Psychosocial Education
    • Multi-Model Therapeutic Intervention
    • Individual and family counseling
  4. Social Services of Cambodia (SSC)
    Finally, the primary focus of SSC is to dismantle the negative stigmas associated with mental health professionals in Cambodia. For example, SSC aims to change the negative public opinions by spreading messages busting stigma-centric myths about mental health professionals to schools, government officials and the public. Additionally, SSC encourages future university students to get involved in social work and recognize the value of social work professionals.

Overall, with very little allocated to mental health services in Cambodia’s public health budget, government-run mental health programs are severely underfunded. Therefore, compiled with the severe stigma against psychiatric help in Cambodia, the discouraging of many health professionals to go into the mental health field leave Cambodia with a monetary and human resource deficit to properly manage nationwide mental health struggles. Fortunately, there are these four organizations improving mental health in Cambodia to help pave the way towards a solution.

– Amy Dickens
Photo: Flickr

TPO CambodiaThe Khmer Rouge was a genocide in Cambodia that resulted from a civil war, leaving 4 million dead and millions more traumatized. The destruction of Cambodia’s infrastructure during the Khmer Rouge has greatly contributed to poverty levels in the country and the struggle to rebuild the country. Since the Khmer Rouge specifically targeted doctors and educated people (leaving the country devoid of healthcare professionals), it took decades for mental health treatment to be available. Thankfully, organizations like the Transcultural Psychological Organization (TPO Cambodia) have emerged to help combat the negative mental health impacts of the Khmer Rouge and poverty. Here are 4 ways TPO Cambodia provides mental health aid.

4 Ways TPO Cambodia Provides Mental Health Aid

  1. Raising Awareness of Mental Health Among Locals: TPO Cambodia builds upon already established relationships to develop new mental health leaders in communities. It does this by training already established leaders in Cambodian communities in the basics of psychosocial education and how to refer those in need. This strategy is respectful of Cambodian social structures while, at the same time, raises awareness of mental health. TPO Cambodia conducts various mental health awareness programs in schools, pagodas and on the radio. These programs have been proven to increase understanding of psychosocial issues in families and leave people empowered to know how to take action to aid their mental health.Raising awareness of the importance of mental health also helps prevent mental health issues by increasing mental wellness practices. One story highlighted a man who was traumatized when attacked by robbers. The event left the man incredibly violent and, eventually, his family had to chain him up in fear of their own lives. Once the family learned of TPO Cambodia, they were able to provide him the treatment he needed, allowing him to heal and be free from chains.
  2. Building Communities: One positive impact TPO Cambodia sees from increased mental health awareness has been stronger communities. These two aspects build upon one another, the larger community raises more awareness and raised awareness strengthens the community. Trained individuals facilitate self-help groups, providing a community space for people to problem solve on shared struggles, share personal experiences and feel more socially connected. Some community programs currently available through TPO Cambodia are healing for victims of the Khmer Rouge, mental health for sexual assault victims, promoting gender equality and working for the protection of children.
  3. Providing Psychological Treatment Services: TPO Cambodia is staffed with experienced clinical professionals that offer a variety of mental health services for psychosocial, psychological and psychiatric conditions. Services available are decided based on an individual’s needs. Some of the services available at TPO Cambodia are trauma treatment, psychiatric assessment and treatment and counseling and therapy. It also provides help for issues such as insomnia, alcoholism and depression.
  4. Research Projects: All research projects TPO Cambodia conducts specifically focus on the cultural context of Cambodia. Through research projects, TPO Cambodia has developed a culturally aware version of “Testimonial Therapy” for traumatized victims of the Khmer Rouge. This therapy aids in helping victims find closure and to associate traumas with a more positive state of mind.  The various research projects TPO Cambodia is involved in aims to gain a better understanding of how traumatic events have impacted its people as well as understand better how this information can improve TPO Cambodia’s current therapeutic practices.

With a majority of mental health issues worldwide residing in impoverished communities, mental health issues need to be actively considered in the eradication of poverty. Living in poverty presents itself as a huge risk factor for many mental health struggles. TPO Cambodia’s method of incorporating the Cambodian cultural context into every part of their work has shown to positively impact communities while maintaining a crucial understanding and respect of cultural norms. These 4 ways TPO Cambodia provides mental health aid show how organizations can work to end the vicious cycle of poverty and mental health in their own communities.

Amy Dickens

Photo: Flickr