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

Violence in Yemen

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

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

Health and Nutrition During Crisis

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

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

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

Yemen Mental Health Studies

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

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

Consequences of the Crisis in Yemen

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

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

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

Aid from Afar

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

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

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

– Hannah Carroll
Photo: Flickr

Elderly Poverty in South Korea

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

How Elderly Poverty in South Korea Came to Be

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

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

South Korea’s Welfare Programs

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

Creating Jobs for Seniors

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

– Karina Wong
Photo: Needpix

The Africa Mental Health Research and Training Foundation
The need for physical necessities such as medical care and food security often overshadows discussions of mental health care in developing countries. However, stress, trauma, violence and poverty exacerbate the need for sufficient mental health services. This makes a lack of these resources even more problematic. The Africa Mental Health Research and Training Foundation is working to fill this unmet need.

The Africa Mental Health Research and Training Foundation (AMHRTF)

Professor of Psychiatry David Ndetei founded AMHRTF in 2004. In addition to teaching at the University of Nairobi, Ndetei has written more than 250 journal articles and six books on mental health. This NGO is based in Nairobi, Kenya. It aims to provide affordable and accessible mental health care to Kenyans who might ordinarily struggle to access services. The organization’s network of researchers and mental health professionals tackle a range of mental health concerns, including suicide prevention, substance abuse and PTSD. In addition to providing clinical services, AMHRTF conducts research to inform public policy and enact innovative, larger-scale projects to provide Kenyans with mental health care regardless of income level.

Services

Resources for mental health care in developing countries, like Kenya, are notoriously scarce. In higher-income countries, 5% of total health expenditures correspond to mental health services. In contrast, in lower-income countries, the expenditure is just 0.5%. However, deficits in mental health services have harsh fiscal consequences for nations already struggling with poverty. Low and middle-income countries lose approximately $870 billion each year, compensating for the effects of untreated mental health disorders, such as productivity loss.

One of the organization’s primary functions is providing Kenyans with affordable counseling services. Clients can book appointments with a network of mental health professionals for individual, couple, group and family therapy. These professionals provide services for anxiety, depression, family violence, personality disorders and PTSD. In addition, AMHRTF offers workshops and presentations to educate other companies and organizations.

Larger Projects

One of the primary challenges of providing mental health care in developing countries is a low concentration of professionals. As of 2016, there were a mere 100 psychiatrists in Kenya. Rural populations outside of Nairobi are especially underserved, with only one psychiatrist per 1 million Kenyans.

AMHRTF has facilitated other innovative, evidence-based solutions to broaden the reach of their organization. To combat a lack of accessible care, AMHRTF has partnered with the Columbia University Global Mental Health Program to form the TEAM initiative. Additionally, the innovative 2015 initiative was awarded nearly $1 million CAD in aid from the Canadian government. This bridges the influence of traditional healers with modern mental health car. Moreover, it works within preexisting structures as a way of reaching rural and underserved patients through trusted community leaders. Many Kenyans turn to traditional healers for help in times of distress. A referral program allows healers to identify and direct individuals to professional care.

Final Thoughts

Developing nations have a pressing demand for mental health services. However, these countries rarely have the resources to deliver sufficient care. To meet this demand, the Africa Mental Health Research and Training Foundation provides affordable mental health services for those in need, conducts research and initiates innovative projects that maximize Kenyans’ existing resources.

Stefanie Grodman
Photo: Flickr

Kerala's Response to COVID-19The South Indian coastal state of Kerala has a population of over 35 million people and a large expatriate population. The state reported its first COVID-19 case in January 2020. Kerala’s response to COVID-19 included quickly implemented response measures drawn from its recent experiences with other crises and emergencies, such as the NIPAH virus outbreak in 2018 and the Kerala floods that caused massive damage and mass evacuations.

Early contact tracing and quarantining of people infected with the virus, along with continued testing for community transmission, has helped control overcrowding in hospitals. As the numbers continue to rise, Kerala’s government has put measures in place to mitigate the economic and social crises that may arise from the pandemic. In addition, Kerala’s response focuses on providing key resources for its people and protecting vulnerable groups. The relevance of these initiatives becomes more pronounced as the pandemic carries on.

Using Technology to Spread Awareness

Kudumbashree is a poverty eradication and women’s empowerment program. In response to the pandemic, the organization has created three groups on WhatsApp, a popular messaging platform, to educate members and spread awareness about COVID-19. Its campaigns, such as Break the Chain, emphasize the importance of washing hands. Kudumbashree’s motivation campaign focuses on encouraging wholesome, healthy choices and activities for citizens to engage in during lockdowns.

Community Kitchens and Shelter

Another key part of Kerala’s response to COVID-19 are kitchens organized by panchayats, or village councils. These kitchens offered free meals to those affected by the pandemic. Kudumbashree also organized free shelter and meals for migrant workers from other states, as well as those in quarantine or isolation. In addition, budget hotels have offered low-cost meals, which are packed and distributed at canteens or kitchens and delivered to homes. Free childcare centers for young children, called anganwadis, ensure free groceries and meals are delivered to the homes of children enrolled in their programs.

Psychosocial and Employment Support

During the pandemic, Direct Intervention System For Health Awareness (DISHA), a 24/7-telehealth helpline, has contributed to Kerala’s response to COVID-19. The organization has reported receiving several thousand calls from citizens each day, many about mental health concerns. DISHA refers these callers to the District Mental Health Program (DMHP), which consists of psychologists, psychiatrists, social workers and nurses in each district of Kerala. DMHP supports citizens under psychological stresses that arise from the pandemic, including substance abuse and withdrawal symptoms. In addition, DMHP checks on quarantined citizens  to ensure their mental well-being. The helpline, mental health services and medication provided by DMHP are free of cost.

To help citizens find work, the National Rural Employment Generation Scheme (NREGS) guarantees 100 days of employment for people above the age of 18. Usually, women over the age of 40 are the main demographic that makes use of the program. With the onset of the pandemic and resulting unemployment, however, the NREGS program has reported high enrollment even among youth.

Reverse Quarantine for Senior Citizens

More than 17% of people living in Kerala are senior citizens. Intending to protect this population, the state government implemented reverse quarantine, a strict stay-at-home requirement to keep those above 65 away from people who may be infected. Also, the government moved vulnerable senior citizens residing in highly affected areas to institutional quarantine centers to ensure better care. Additional measures for Kerala’s older adults include regular check-ins for senior citizens who live alone.

As the number of COVID-19 cases continues to rise worldwide, Kerala’s response to COVID-19 may ensure safety, care and recovery, both in citizens’ personal health and in the economy. This is especially true for the state’s more vulnerable citizens. If these methods succeed, Kerala may provide a model for other communities around the world.

Amy Olassa
Photo: Flickr

Homelessness in Iceland
Homelessness in Iceland has been on the rise, as the country continues to experience aftershocks of the 2008 economic crisis. Iceland has a population of 364,134 (about half the size of Seattle). Between 2009 and 2017, the city of Reykjavík experienced a 168% increase in the number of homeless citizens. Iceland’s current national homeless rate remains unknown, but the last data set released in 2011 showed that 761 people experienced homelessness in Iceland.

Why is Homelessness in Iceland Increasing?

Between high rates of job loss and a lack of affordable housing, most sources credit the 2008 financial crisis as the root cause of Iceland’s increasing rate of homelessness. With too many expensive houses and too few affordable living options, many Icelanders became unable to support themselves or their families and had to move out of their homes and into shelters. Several other factors also figure into homelessness in Iceland. These include:

  1. Gender: More women seem to be experiencing homelessness in Iceland than before. One particular shelter in Reykjavík saw an increase of 35 to 41 women in a month, and 27 of those women had never used the shelter service before. This indicates a need for more shelters, with staff attuned to the needs of women who experienced trauma from domestic abuse and sexual violence. Women also tend to stay at shelters longer than men — sometimes for months or years.
  2. Drug and alcohol addiction: Some Icelanders argue that a more long-term goal is to address the underlying problem of drug and alcohol addiction, which can often lead to homelessness. This would help break the vicious cycle of dependency and lack of reliable shelter.
  3. Age: A large number of Icelanders who homelessness affects are elderly. The 2017 report showed that only 47% of Iceland’s homeless are between ages 21 and 40. This aging demographic often requires more care and medical attention, in which case the general shelter may not be sufficient.
  4. Mental health: Although Iceland ranked third in the World Happiness Report, some argue that the mental healthcare system in the country is not sufficient. Poor mental health is yet another risk factor for homelessness.

More Homes, Fewer Homeless

In 2018, Icelanders received hopeful news when their government made homelessness a top priority. The city council of Reykjavík passed legislation calling for the building of 25 homes for the homeless population. These homes, with a minimum rent of 40,000 ISK or $363, emerged as a more financially accessible option than the typical Reykjavík home, while also being longer-term solutions in comparison to shelters. To many, this was a heartening call to action in the fight against homelessness in Iceland, as well as a moving example of a community coming together to protect their fellow citizens.

Today, reports say that while people are still utilizing shelters for short-term housing, few are sleeping on the streets in Iceland. Sleeping outside can be lethal in frigid temperatures, and access to affordable housing is key to providing safety and security for Icelanders in need.

Aradia Webb
Photo: Pixabay

Homelessness in BhutanThe small kingdom of Bhutan dedicates itself to maintaining the happiness of its people. It created the Gross National Happiness Index, a tool for measuring the comfort of the population. With this tool, Bhutan’s government aims to provide a particular quality of life for the population. In order to do so, the country remains isolated in the modern age. It allows only a select few tourists to enter the country annually and monitors what kind of technology makes it past the borders. In a country that dedicates itself to ensuring the wellbeing of its people, what is the homeless population like? Many view Bhutan as a beacon of admirability, believing that there are practically no homeless people. International reporting often focuses on how homelessness in Bhutan is virtually nonexistent.

The Hidden Issue

There is another side to the topic of homelessness in Bhutan though. Kuensel is the national newspaper of Bhutan and has published multiple articles covering cases of homelessness within the country. The newspaper has continuously attempted to source the reasons behind why some people in a country so focused on happiness find themselves on the streets. Kuensel uses its inside perspective to try to shift focus away from shining solely on Bhutan’s successful numbers. Instead, he shifts it toward what still needs to be done.

Environmental Disasters and Accidents

One reason that Kuensel found has to do with environmental disasters and accidents. In 2013, a landslide destroyed the home of a family of five and subsequently forced them to live in a small shed. Three years following the incident, the family claimed that Bhutan’s Department of Roads helped to restore some of their land. However, it did not restore their home despite contacting them multiple times. Their story highlighted the lack of congruence between the disenfranchised population and the government’s actions.

Some do not own any land though and find themselves unable to acquire any. Elderly residents that did not inherit land from their parents work trying to scrape by enough money for rations. Often times, they have to beg when they aren’t able to make enough. A 70-year-old man reported to Kuensel that his parents died when he was young with no land to pass down to him. He lives in a rundown makeshift hut, scrounging up firewood and doing what he can to make money for food. He worries that one day, he will lose the few resources he has and have nothing left.

Mental Illness and Unemployment

Mental illness has also become an issue regarding homelessness in Bhutan. Many of the homeless people in Thimphu, the capital of Bhutan, are mentally ill. Abandoned by their families, they subsequently end up in the streets. One case details the suffering of a woman with schizophrenia. Her family supported her as she was a child, but could no longer care for her as an adult. As a result, she ended up living in an abandoned hut in dismal conditions with little to no food. With few mental health resources in the country, mentally ill homeless people often end up neglected and alienated by society.

There is also an issue with rising unemployment rates, particularly among the female population of Bhutan. The overall rate is approximately 2.7% but rises to 7.3% when specifically looking at youths and women. Only 55% of women are literate. When paired with the unemployment numbers, the women of Bhutan are forced to face the threat of poverty and potential homelessness.

Bringing Awareness

There are groups that aim to bring awareness to homelessness in Bhutan though. All for One and One for All (A11A) is a group that assists those who find themselves on the streets by linking them with healthcare workers. Lhak-Sam, an organization originally meant to aid those with HIV in Bhutan, has also opened a care house for the homeless population. It hopes to develop the center so that it can provide mental, physical and emotional aid to those who rely on its services.

However, these efforts are not sustainable in the long-run without assistance. Bhutan may not have a large homeless population, but the suffering of those who find themselves with nowhere to go is generally unheard. With more international awareness, groups such as A11A and Lhak-sam may be able to receive the aid from both the Bhutanese government that they need.

Nicolette Schneiderman
Photo: Pixabay

Beirut Explosion
Though there is still uncertainty about the massive explosion that occurred on August 4, 2020, near the port of Beirut, the capital of Lebanon, there are some facts and predictions about the health outcomes that it has and will cause. NGOs mobilized humanitarian aid teams immediately after the tragedy in an effort to provide aid. The recent explosion could impact much of the population’s health, considering the mass amounts of ammonium nitrate and other toxins in the air, the falling infrastructure and destroyed hospitals, an increasing lack of access to healthcare and the rising demand for emergency response teams. The following four points are a few of the health outcomes and predictions regarding the Beirut explosion, as well as what organizations on the ground are doing to help those the explosion impacted the most.

4 Facts About How the Beirut Explosion Could Impact Health

  1. The toxins in the air could result in detrimental health impacts for much of the population. The Beirut explosion has a link to the storage of about 2,750 tons of ammonium nitrate. As a result, when the explosion occurred, it released multiple toxins into the air. The ammonia in the air is a corrosive gas that may cause cell damage, resulting in a burning feeling in a person’s eyes, nose, throat and respiratory tract. Furthermore, it can cause lung damage, blindness and death. Additionally, the nitrogen oxides in the air are especially dangerous for those with respiratory issues. These toxins are also dangerous to newborns and pregnant women, and could likely cause premature death. The Lebanese Red Cross called for an immediate dispatch of all members in order to help those the explosion impacted. To date, millions of people around the world have donated to this organization.
  2. The explosion resulted in many casualties and some are still unknown. As of August 5, 2020, the death toll from the explosion was around 135, with many people still missing. There were over 5,000 people injured and four hospitals damaged in the blast. These numbers will likely increase in the coming weeks due to the impact of the blast. Additionally, at least 300,000 homes experienced damage and became uninhabitable, with estimates of around a quarter-million people now homeless, leading to further issues in health outcomes and disparities within the population. However, many volunteers, NGOs and the Lebanese Red Cross have set up base camps near the scene of the explosion and have been offering food, shelter and collecting donations and medical supplies to those who lost their homes. There have been other groups that have set up shelter for those who were homeless previous to the explosion and for those who have lost their homes due to the tragedy.
  3. COVID-19 cases are likely to increase. Due to the number of injured people, as well as the ever-increasing amount of hospital patients from the toxins in the air, there is a possibility that swarms of incoming patients will overwhelm hospitals. Additionally, because the Beirut explosion destroyed four hospitals, the loss of personal protection equipment supplies will likely impact the number of coronavirus patients in the coming weeks. According to the WHO, the tragedy reduced the number of hospital beds by 500-600. Due to the strained healthcare system from COVID-19, many organizations have set up camps and clinics near the scene for those who need medical assistance.
  4. The blast could trigger PTSD, depression and health status deterioration. A 2003 study of survivors of a church explosion in Lebanon found that one year after the explosion, 39% of victims had PTSD, 51% were depressed and 45% reported a deterioration in their health status. These percentages were significantly higher than those who did not experience the explosion. Currently, there are many groups on the ground that are working to support survivors of this explosion through medical assistance, offering shelter and food and giving financial support. The Lebanese Red Cross is working to meet emotional support needs and has trained team members who are providing crisis counseling to the community.

Beirut has a population of nearly 2.5 million people, all of whom may be at risk of detrimental health outcomes from the explosion. When considering the impacts of the toxins in the air, destroyed housing and other vital infrastructure and mental health impacts from the Beirut explosion, it is critical for experts to account for and properly assess present and future health outcomes in order to aid the affected civilians. The most reliable and effective place to donate is through the Lebanese Red Cross. Thirty teams mobilized to work on the ground in Beirut; they worked on rescuing and searching for the wounded, and treating them on-site and/or transporting them to hospitals. Additionally, Lebanese Red Cross teams have provided emergency shelter for thousands of families, with goals to shelter over 10,000 families in the coming months, as well as offer food, water, hygiene kits and PPE to families.

– Naomi Schmeck
Photo: Wikipedia

Childhood Mental Health in YemenYemen is currently enduring one of the greatest humanitarian crises in history. War, poverty and disease run rampant throughout the country. Around 1.8 million children suffer from acute malnutrition in Yemen, 400,000 of which are life-threatening cases. The Yemeni people face daily exposure to stress and violence in the form of Saudi-led airstrikes, Houthi detention camps, closed airports, poverty, starvation and cholera. This can impact childhood mental health in Yemen.

5 Things to Know about Childhood Mental Health in Yemen

  1. Lack of mental healthcare – There is a dire lack of mental healthcare providers in Yemen. Mental health services are only available in 21% of Yemen’s health facilities. As of February 2019, there are about 0.17 psychologists per 100,000 Yemenis. Save the Children reported that only two child psychiatrists are available for the whole of Yemen and only one mental health nurse is available for every 300,000 people.
  2. Safety and childhood mental health – A recent survey from Save the Children shows that 52% of children in Yemen never feel safe when they are away from their parents. The survey also showed that 56% of children never feel safe when walking alone and 36% of children never feel like they can talk to someone in their community if they are sad or upset. In addition, around 38% of caregivers report a recent increase in children’s nightmares.
  3. Malnourishment and brain development – Half of Yemeni children under 5 experience chronic malnourishment. This has a direct negative impact on brain development and will impact generations of Yemenis. Stunted brain development and the neglect of childhood mental health in Yemen will, according to Columbia Law School, “affect family structures, social cohesion, physical and emotional health, educational outcomes and reduce the ability to find peaceful solutions to conflict.”
  4. Since December 2017, violence from the Yemeni conflict has maimed or killed 2,047 children. Children throughout Yemen grieve family and friends killed by airstrikes every day. Living in these violent and stressful situations will not only have longterm effects on mental health but on physical health as well. High levels of prolonged stress can increase blood cholesterol, blood sugar and blood pressure. Consequently, children growing up in this environment are more vulnerable to chronic diseases like heart conditions in later life.
  5. People are doing something about it. The Sana’a Center for Strategic Studies’ objective is to foster change through spreading knowledge–focusing specifically on Yemen and the surrounding area. The Sana’a Center partnered with the Columbia Law School Human Rights Clinic to bring attention to the mental health crisis in Yemen at the 2018 United Nations convention in Geneva. The two organizations pushed for an international response and also laid out a suggested plan for the Yemeni government. The plan called for the government to create a national mental health policy, ensure budget allocation for mental health services, reopen the Sana’a airport and pay salaries for public health sectors. Unfortunately, the crisis in Yemen led to the suspension of any government efforts to implement national mental health policies and no changes have yet been made.

The first step to a brighter future in Yemen is understanding the problems the Yemeni people face daily. Childhood mental health in Yemen is easy to overlook, but today’s children are tomorrow’s negotiators of peace. They are tomorrow’s doctors, nurses, teachers and politicians. The sooner the government can begin efforts to create a national mental health policy, the sooner the community can come together to ensure healthier and happier lives for the children of Yemen.

– Caroline Warrick-Schkolnik
Photo: Flickr

Mental Health in Africa
Africa still has a long way to go in terms of mental health awareness and care. Mental health is highly stigmatized and there are not enough mental health facilities or resources for the people. In Africa, the average number of psychiatrists is 0.05/100,000 population, while in Europe it is 9/100,000 population. Here are five challenges to mental health in Africa.

5 Challenges to Mental Health in Africa

  1. Poverty: There is a strong correlation between different mental illnesses and the socioeconomic status of patients. According to The Conversation, when people are stressed about searching for basic resources for survival like food and stable sources of income, this stress affects their mental health. Furthermore, the healthcare expenses are high, making them inaccessible to some. People with mental health problems may also have more trouble with functioning effectively which can harm their financial resources as well.
  2. War and Conflict: Various African countries endure tribal wars and terrorist groups. These wars affect the population’s mental health — especially the victims. Commonwealth Health reported that more than half “of refugees have mental health problems from post-traumatic stress disorder to chronic mental illness.”
  3. Insufficient Resources: Most African countries spend less than 1% of their budget on mental health. Additionally, mental health is not a popular subject; therefore, there are few higher education facilities teaching about it. The stigma around it prevents graduates from enrolling in mental health-related programs. As a result of this shortage, the Mental Health Innovation Network states that “90% of people with mental illnesses have no access to treatment, especially in poor and in rural areas.”
  4. Lack of Awareness: Mental illness is a taboo topic in some African cultures. A study done by BioMed Central in Northern Nigeria found that at least 34.3% of respondents believed that drug and alcohol abuse was “a major cause of mental illness.” Commonwealth Health reports that the widespread stigma makes families hide their members who are suffering from mental illness because of the discrimination they have to endure.
  5. Other Diseases: Many African countries are still fighting a number of deadly communicable diseases such as HIV/AIDS, cholera, malaria and tuberculosis. As a result, the governments of these nations prioritize helping people survive these illnesses. A mere 3% of Nigeria’s health budget is invested in mental health: the other 97% goes to other health departments. This means that people with functional mental disorders are usually unnoticed and have difficulties accessing appropriate professional help.

Despite all the issues, progress is steadily being made. In Burundi, lay community counselors started screening people and encouraging dialogue about mental health. They emphasized educating parents about better ways to discipline children without causing trauma. Additionally, cognitive behavioral therapy has been helping people in Sub-Saharan Africa to deal with depression. Crisis assistance hotlines were also put in place to help those struggling with suicidal thoughts and other urgent crises. All these intervention alternatives highly depend on the community counselors to integrate the strategies with their respective cultures in order to provide relevant solutions.

Many African nations are trying to invest more in mental health and encourage people to seek professional help. Moving forward, countries must continue to support mental health research and intervention measures, prioritizing both the mental and physical health of Africans.

Renova Uwingabire
Photo: Flickr

Mental Health in AfghanistanDecades of violent civil war and political unrest have debilitated Afghanistan’s healthcare system and led to the populations’ exceedingly high rates of mental illness. In 2004, Afganistan’s Ministry of Public Health (MOPH) declared mental health in Afghanistan a top priority. Today, the National Strategy for Mental Health (NSMH) is taking a multifaceted approach to improving the mental health of Afgan citizens.

The National Strategy for Mental Health aims to provide a “community-based, comprehensive” system with “access to treatment and follow up of mental illness and related conditions.” One of the primary goals of this system is to integrate mental health services into Afghanistan’s Basic Package of Healthcare Services (BPHS). Within the first 10 years of mental health integration into the BPHS, 70% of patients utilizing mental health services reported “significant improvement.” Other developing countries may wish to follow Afghanistan’s lead and to begin implementing their own mental health initiatives.

Women in Taliban-controlled Areas

Mental health surveys of Afgan women in Taliban-controlled areas exemplify the link between stress and mental illness. Women living in these areas report experiencing gender segregation and violent treatment. This includes restricted employment and education as well as domestic abuse and lack of health resources.

A survey of 160 Afghan women during the 1996-2001 Taliban regime showed many Afgan women suffer from mental illness. The survey results displayed that out of the 160 women,

  • 42% had PTSD symptoms

  • 97% had major depression

  • 86% had severe anxiety

Additionally, Afgan women living in Taliban-controlled areas suffered from depression at almost three times the rate of women living in non-Taliban-controlled areas (78 % versus 28 %).

Integration of Mental Health Services

In many countries, mental health support falls under general health funding, which results in very little direct funds for necessary mental health resources. However, as a result of successful integration by the Afghan government and restructuring of its healthcare system, resources for mental health in Afghanistan are available within the national healthcare infrastructure. The critical decision to absorb mental health in Afghanistan into general health has allowed mental health training to become a priority among all general physicians in addition to specialists.

The National Institute of Mental Health reports that people suffering from mental illness can potentially die anywhere from 13 to 30 years before their counterparts with no mental health problems. The integration of mental illness into general health equips primary physicians with the resources and training to diagnose and treat conditions. Transferring training and resources to primary health caregivers makes mental health services more accessible to the general public.

Afghanistan’s NSMH recognized that medication alone cannot fix mental health problems in Afghanistan. Medication treats the symptoms of trauma, not the source. This can lead to social isolation. This research led the NSMH to switch from a strictly medical treatment plan to a biopsychosocial treatment plan. This provides patients with counseling services, including stress management and domestic violence training for community health workers and teachers.

Impact of Mental Health Services

Before 2004, there were no psychiatrists working for the government. Furthermore, mental health receives less than 1% of physician training. After the integration of mental health services into the BPHS, each district hospital in Afghanistan has a full-time mental health physician who has received a two-month training in psychiatric care.

In regions that previously had no access to mental health services, there are now health facilities with health workers trained in identifying mental health disorders and creating treatment plans. These facilities can provide services for up to 60,000 people. Between 2002 and 2012, when mental health service programs were implemented, more than 900 community health workers and hundreds of doctors, nurses and midwives received training in mental health services.

Furthermore, in 2001, only 10% of the Afghan population lived within a one hour walk from a health facility. The BPHS increased the presence and accessibility of health facilities serving mental health in Afghanistan. Afterward, the overall patient visits to health facilities grew from two million to more than 44 million per year, which shows that the facilities were utilized frequently. In 2004, 22% of the health facilities served a minimum of 750 new patients per month. In 2008, 85% did.

Economic Incentive

Especially in developing countries, prioritizing mental health creates a more sustainable economy. According to the World Health Organization, depression and anxiety account for $1 trillion per year of lost or diminished output in the global economy. Additionally, when workplaces do not provide mental health resources, they lose the equivalent of 45 years of work per year. Mental health consequences on the economy and a population’s health are even greater in low-income countries due to the increased prevalence of stigmatization, superstition and treatment inaccessibility.

In addition to ethical incentives, governments have economic incentives to provide mental health services and resources because there is an economic advantage to having a healthy workforce. A failure to recognize and support populations suffering from mental health problems leads to a loss in economic productivity. Globally, every $1 that is invested in mental health disorder treatment translates to $4 in productivity and well-being.

Global Investment

Afghanistan’s next goal is to increase access to the BPHS for the remaining quarter of the population who still struggle to acquire health care. The growth of the BPHS and the Afghan government’s promise to expand its services to reach every citizen requires some economic input from international donors; however, the BPHS does not intend to rely on international donors forever. The World Bank, European Union and United States Agency for International Development (USAID) have been the largest donors to Afghanistan’s BPHS since the creation of the BPHS. However, each has diminished their contributions over the years.

Between 2003 and 2009, each of their individual financial contributions funded about one-third of the BPHS resources for mental health in Afghanistan. These contributions also supported technical and infrastructural support by funding construction and renovation of health facilities as well as road work projects to increase accessibility for rural populations. Between 2010 and 2012, USAID cut its contributions from $4.5 billion to $1.8 billion. Until the MOPH finds permanent funding for mental health in Afghanistan, the funding will come from donors, taxation, public spending and out of pocket pay for patients.

To fully universalize accessible and affordable mental health resources, the world, and particularly global leaders such as the United States, must continue to invest in mental health and commit to fighting poverty worldwide. Reducing global poverty reduces civil unrest, which decreases the rate of mental health problems. The World Bank, European Union and United States Agency for International Development (USAID) are the largest donors to Afghanistan’s BPHS. Continuing global support for mental health strategies helps not only poverty-stricken countries address mental health needs, but supports the global economy by increasing each populations’ well-being and productivity.

Nye Day
Photo: Flickr