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

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

Ways to Treat Mental Health

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

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

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

Effects of Improving Mental Health

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

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

Paige Regan
Photo: Flickr

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

What is Friendship Bench?

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

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

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

Why the Friendship Bench is so Successful?

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

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

Friendship Bench as a Blueprint for Other Countries

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

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

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

Navjot Buttar
Photo: Flickr

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

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

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

Four Microlending Organizations that Empower the Poor

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

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

– Meredith Charney
Photo: Flickr


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

Mental Health Awareness in Honduras

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

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

Visit to a Mental Health Facility in Honduras

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

Doctors Without Borders

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

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

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

Julia King
Photo: Pixabay

Community Healing Dialogues in Sierra Leone
There are historical misunderstandings and underinvestments in social care for people with mental health problems. This is even more prevalent among people living in poor countries like Sierra Leone. People in Sierra Leone do not treat mental health as seriously as other physical health disabilities. Sierra Leone has a population of more than 7 million people and there are only two psychiatrists, two clinical psychologists and 19 mental health nurses. There are also only four nurses that have specialization in child and adolescent mental health. With a clear need for psychological professional help, there has been a rise in community healing dialogues in Sierra Leone.

Mental Health in Koindu

Like many towns in Sierra Leone, Koindu struggled after the Ebola epidemic. Some say that mental disorders and anxiety affected many citizens even after the virus outbreak. Koindu citizens go through similar psychological effects as war veterans.

After experiencing stigmatization and discrimination from within their communities, many survivors of the Ebola outbreak became stressed which increased mental health problems. Koindu’s community suffered distress with only a few mental health providers and little information about psychological pain. The USAID Advancing Partners & Communities project initiated community healing dialogues (CHDs) to provide care to the people.

Community Healing Dialogues (CHDs)

Trained facilitators lead the community healing dialogues. They unite the community members together to vent their concerns and come up with ways to solve them. The success of community healing dialogues in Sierra Leone is raising awareness about serious problems affecting group members. Community members are discussing economic and livelihood challenges as a group, and creating solutions. People, who formerly discriminated against Ebola survivors, are now accepting them back into their communities.

Once a week, the CHDs gather between 15 to 18 community members to talk about and promote the mental health issues in their communities. There are at least two social workers and two nurses per district to organize and facilitate Community Healing Dialogues. More than 705 community members in 45 communities benefit from this psychosocial care. Depending on the situation, people refer some members to higher-level mental health services.

Higher-Level Program Aid

The World Health Organization (WHO) developed the mental health gap action program (mhGAP) to provide more specialized services. The program trains higher-level health care workers and medical doctors around the country. The workers and professionals use procedures within the program to identify and diagnose possible treatment options for mental disorders.

The African region is widely using mhGAP. It is pursuing professionals who may provide more specialized care at the local recommended hospitals; Kissy Psychiatric National Referral Hospital, Connaught Hospital and Ola During Children’s Hospital. The WHO is collaborating with other partners within the Ministry of Health and Sanitation to provide technical support to continue strengthening mental health services.

There is now a better understanding and acceptance of how to treat mental health within the country. Advanced care solutions along with the community healing dialogues in Sierra Leone are improving the quality of care for the people in need of help.

– Francisco Benitez
Photo: Flickr

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

Mental Health in IndiaIndia is home to more than one billion citizens. According to a 2015 World Health Organization (WHO) report, of that billion, 56 million suffer from depression and 38 million have anxiety disorders. When adjusted for population size, India is the country with the greatest burden of mental and behavioral disorders, leading some to call the lack of mental health care in India a burgeoning crisis.

Although India is working to improve the mental health of its citizens, initiatives have been slow going. Some roadblocks to improving mental health are the social stigma, its low priority in the healthcare budget and a shortage of mental health professionals.

Stigma

One major barrier to improving mental health in India is the social stigma around mental illness. According to a survey by the Live Laugh Love Foundation, of the 3,556 respondents, 47 percent could be considered judgmental of people with mental illnesses while 26 percent were categorized as being afraid of the mentally ill. This study looked at people between the ages of 18 and 45 from different socio-economic backgrounds. Surprisingly, most of the respondents in those categories were well educated and from higher social classes. When asked to describe the mentally ill, many used derogatory terms or harmful stereotypes.

However, 26 percent of the respondents were categorized as supportive of people with mental illnesses. These respondents tended to be younger—between the ages of 18 and 24—and from a relatively lower educational and socio-economic background.

Advocates and activists are also working to destigmatize mental health in India. Recently, India passed the Mental Health Care Act of 2017, which protects the rights of people with mental illnesses so that they are treated without discrimination.

Low Priority

According to a 2015-16 survey by the Bengaluru-based National Institute of Mental Health and Neuroscience, 150 million Indians are in need of mental health care, but only 30 million have access to the care they need. Although India began implementing its National Mental Health Program in 1982 with the goal of integrating mental health care with general care, the rollout has been slow. As of 2015, only 27 percent of the 630 districts intended to have a mental health program had created one. The District Mental Health programs have also struggled with inaccessible funding and administrative issues like an inability to fulfill the required number of professionals for each district.

While this program has struggled, the government has been working on other means of improving mental health in India. In 2014, it began implementing its first National Mental Health Policy, which aims to increase funding for training mental health professionals and universal access to mental healthcare.

A Need for Mental Health Professionals

Perhaps one of the biggest roadblocks to improving mental health, though, is the extreme shortage of mental health professionals. In 2014, the WHO found that there is on average only one mental health professional for every 100,000 citizens. These doctors, psychiatrists and psychologists tend to be overworked leading to misdiagnoses in too many cases.

One way the government of Karnataka in southwest India has been trying to fill in the gap is with community health workers called accredited social health activists or ASHA workers. Though they usually are women who council other women in their communities on pregnancy, breastfeeding and parenting, in 2016, they began training these workers to identify and deal with mental health issues. While ASHA workers can help fill some of the gaps, there remains a need for more specialized care. India’s National Mental Healthcare Policy and District Mental Healthcare Policy is a good start, but for it to be successful, the Indian Government has to be proactive in training mental health professionals.

While people with mental illnesses are still struggling, the topic of mental health in India is gaining traction. Activists are working to destigmatize and protect people with mental illness while the government is working to increase accessibility to mental health professionals.

– Katharine Hanifen
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