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

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

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

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

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

The Link Between Communal Traditions and Well-Being

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

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

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

Community Outreach, Mental Health Services in India and Medicalization

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

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

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

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

– Tamara Kamis
Photo: Flickr

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

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

mental health in nigeriaThe West African country of Nigeria is home to about 200 million people. Of these, 20 to 30 percent suffer from a mental illness. The World Health Organization (WHO) ranks Nigeria 15th in the world for suicides. One of the biggest challenges facing mental health in Nigeria is the inadequate number of practitioners and clinics. The WHO estimates that less than 10 percent of those who need help have access to psychiatrists. Additionally, while the global average is nine mental health workers per 100,000 people, the ratio in Nigeria is one mental health worker for every one million people. This could partly be caused by the fact that only around 3.3 percent of the national health budget goes to mental health.

Despite the mental health crisis that is looming there are several organizations working to improve mental health in Nigeria.

4 Organizations Improving Mental Health in Nigeria

  1. Neem Foundation: This nonprofit, nongovernmental organization is doing important work in Borno State to help those who have suffered trauma as a result of attacks by the Boko Haram islamic militant group. In 2017 alone, the organization provided psychological services to over 7000 people in Borno. In order to reach their target of getting to 16,000 more clients by 2019, the foundation began a Counseling on Wheels program which has counselors use motorcycles or motor tricycles to take counseling services to people’s doorsteps. By doing this, they have managed to raise the number of their client reach 12,000 people so far. Besides providing mental health support to individuals, the Neem Foundation also offers training in counseling, trauma care and child-centered therapy.

  2. Mentally Aware Nigeria Initiative (MANI): Launched in June 2016, this Lagos-based nonprofit focuses on creating awareness on mental health and illnesses as well as helping its clients connect to mental health professionals. MANI has a suicide/distress hotline and is planning on launching a mobile app to connect mental health professionals to people in need of help. The organization promotes its advocacy campaigns online using channels such as Twitter, Facebook, Instagram, Youtube and its website to draw attention to different mental health illnesses or other related topics each month. Since 2016, MANI has managed to expand its work to four Nigerian states and provide support to more than 5,000 people.

  3. She Writes Woman: This organization has made great strides since its inception in April 2016. The organization launched the first privately-held, 24-hour mental health line in July 2016 and in April 2018 added a helpline chat service that has received 6,000 messages to date. The organization also founded and curates Safe Place – a support group where women in Nigeria can meet, discuss mental health issues and get the help they need. So far, more than 800 women have benefitted. In partnership with Airtel Nigeria, they have grown and founded Safe Place Nigeria – a walk-in clinic where young people can seek mental health care.

  4. Love, Peace and Mental Health Foundation (LPM): Launched in 2012 in Lagos, LPM carries out advocacy and awareness campaigns to the youth in Nigeria. LPM also founded and curates Umbrella, a men’s-only support group which meets monthly. During the support group meetings, mental health professionals are on hand for observation and consultancy. The foundation also partners with various psychologists and consultants to provide free therapy sessions during these meetings. LPM also ran the #SAVE campaign in 2017 which encouraged creatives to embrace photography, music, art and fashion to raise awareness of mental health in Nigeria.

By creating awareness and challenging the misconceptions and stigma held by the public, these four organizations are helping create an environment in which those suffering from mental health illnesses do not need to isolate themselves or shy away from seeking help. Mental health in Nigeria is sure to improve because of these and other organizations and initiatives.

Sophia Wanyony
Photo: Flickr

Hurricane ResilienceHurricane Dorian is the latest in a long series of hurricanes that have hit the Caribbean — impacting the Bahamas the worst. Initial reports from the U.N. estimated that nearly 70,000 people were in need of food, water and shelter in the archipelago and that around 30 people had died as a result of the hurricane.

For the estimated 10 percent of the population of the Bahamas who live below the poverty line, recovering from natural disasters such as this is a particular challenge. As a result, there is a massive need for programs that not only address the short-term impacts of hurricanes but also focus on the importance of long-term hurricane resilience.

The Caribbean Development Bank (CDB), based in Barbados, has pledged to provide $1 million in aid to the Bahamas, with $700,000 in the form of a loan and the remaining $300,000 as a grant. While disaster relief helps improve recovery for local economies and minimize the impact for impoverished communities, there are also other avenues of aid that the CDB could pursue which take the form of mental health programs and debt repayment plans.

Mental Health

As a part of the Stronger Together campaign, in collaboration with the Pan-American Health Organization, the CDB has also placed an increased focus on addressing the negative mental health impacts of hurricanes — which traditionally get little attention. However, this type of support is key to help uplift those who experience the trauma of losing their homes or worse, their loved ones.

The campaign, launched in July 2019, aims to train 16 new mental health service professionals, ranging from psychologists to social workers to promote resilience in the face of natural disasters. This program could have a major impact on helping people in the Bahamas recover, while also offering a path towards future mental resilience in the event of another damaging hurricane. This is especially valuable for communities living in poverty.

Debt Repayment

High levels of debt are a substantial impediment to the massive discretionary spending needed to successfully recover from a hurricane, as nations are often forced to choose between allocating resources towards serving the immediate needs of their citizens or maintaining their current repayment plans. As such, a debt relief program could prove incredibly beneficial in the Bahamas, as the country had a debt burden of $8.2 billion prior to the events of Hurricane Dorian.

There is already precedent for the CDB to offer debt restructuring opportunities. For instance, following Hurricane Ivan, Grenada was able to re-negotiate its debt repayment plan to cease repayment following a natural disaster. Some have argued that this program should be extended to all nations in the event of a natural disaster.

This would help to reduce an unsustainable reliance on foreign aid, as nations find themselves falling deeper into debt and failing to provide adequate assistance to their own citizens. Not only do such increases in debt leave countries less prepared for another similar natural disaster, but they also limit the amount of aid which governments can extend to the citizens facing the most significant damages as a result of the disasters.

Conclusion

While the recent pledge of $1 million in aid to the Bahamas by the CDB is a useful step in mitigating the impact of Hurricane Dorian, the CDB also has several other methods of improving not only hurricane recovery but also hurricane resilience. With investment in the mental health field, the CDB is working to train mental health services professionals who can provide psychological support to citizens. This could be supplemented by a re-negotiated debt repayment plan for the Bahamas, with many arguing that such a program would reduce the financial burden placed on the Bahamas by the need to take more loans.

Alexander Sherman
Photo: Flickr

5 Ways Uganda is Improving Mental Health Care
Following Uganda’s independence in 1964, the nation went through devastating periods of unrest that significantly impacted its population of 42.8 million people. While Uganda has seen major improvements in recent years due to reaching their millennium development goals, such as lowering poverty from 33.8 percent in 1998 to 19.5 percent in 2012, the nation is still struggling with an epidemic of mental illness. As much as 35 percent of the population suffers from mental illness, 15 percent of which require treatment.

Changing Precedents

Major improvements have been made to Uganda’s healthcare system, raising the average life expectancy from 44 to 59-years-old. However, less then 1 percent of the 9.8 percent of GDP Uganda dedicates to healthcare goes towards mental health. The majority of this funding goes towards the national mental health hospital in Butabika, which holds 500 beds and is still almost always overcrowded.

Mental Health Still Neglected

The rest of Uganda’s mental health budget is spread out over a network of 28 out-patient facilities that specialize in follow-up care. These services are starved of the funding needed for proper medication. According to a study conducted by the World Health Organization in 2006, only 57 percent of clinics had at least one psychotropic medication in each class, meaning medication someone needs is highly unlikely to be available in Uganda.

The stigma around mental illness in the nation comes in particular from traditional beliefs that associate illnesses of the mind with spirits and witchcraft. Due to religious culture in the area, mental illness is viewed as a spiritual curse.

While mental health care in Uganda is struggling, many improvements have been made in recent years to help those who are affected by it.

5 Ways Uganda is Improving Mental Health Care

  1. Ending the stigma around mental illness is the first step that must be taken to tackle the problem. According to the Community Development Officer of the rural district, “…most people think that [mental illness] is bewitching. Others associate it with disagreements with their elders.” Bringing awareness about the true cause of mental illness is allowing the healthcare system to grow and make room for mental health care. This may be the most important of the 5 ways Uganda is improving mental health care.
  2. Increased aid would drastically improve the living conditions in Uganda. For every dollar invested in mental health, the economy sees a return of $4 due to an improved ability to work. In Uganda, the mentally ill often have trouble finding employment, however, increased aid would allow them to become contributing members of society. Organizations such as Basic Needs are working to tackle both poverty and mental illness by supporting locals to create small businesses. By helping the mentally ill and their families, organizations such as this are increasing peoples means and helping them afford the care that can save them.
  3. The Mental Health Action Plan for 2013-2020 was released by the World Health Organization (WHO) in the spring of 2012. The plan cites its goal “is to promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders.” In order to accomplish this, the WHO has set out to achieve four goals: strengthen government leadership, provide integrated mental health care in community-based areas, strategize prevention techniques, and strengthen information and research for mental illness.
  4. Grand Challenges Canada, an organization that supports “Bold Ideas with Big Impact,” has trained nearly 500 faith healers, otherwise known as witch doctors, to recognize symptoms of mental illness and refer them to physiatrists. This unlikely tactic takes advantage of the abundant number of traditional healers in Uganda. While there are only 32 western-trained, psychiatrists in the country, there is a ratio of one witch doctor for every 290 Ugandans. As a result, most suffers of mental illness go to faith healers for their symptoms. This new technique is building a bridge between traditional healing and western health care.
  5. New Legislation in Uganda such as the Mental Health Act of 2018 is improving health care conditions. The Act provides mental health treatment at primary health centers, along with emergency treatment and involuntary admission and treatment for those who need it.

Mental health care is a complicated system and as Uganda improves life expectancy and poverty reduction, improvements and funding for mental health will become more available. There is a long way to go for the Ugandans suffering from mental illness, but enhancements are present as indicated by these 5 ways Uganda is improving mental health care.

Maura Byrne
Photo: Pixabay

 

Art for Refugees
Throughout history, art has been a respite for many who lived through trauma. Refugees live their lives in an almost constant state of precarity. Refugee children typically have a higher rate of experiencing many mental health problems such as depression, anxiety and post-traumatic stress disorder.

Art for refugees can help them express their feelings, grow in self-confidence, and develop problem-solving skills. There are a number of art initiatives which aim to help refugees cope with psychological stressors. Some are located in refugee camps, while others are located in resettlement cities, but they all have the same goal of providing an outlet for expression. Some such initiatives are listed below.

The Za’atari Project

The Za’atari Project is an art therapy program started by Joel Artista in the Za’atari refugee camp in Jordan. Za’atari is composed of Syrian refugees. This project serves as a bridge between the Jordanian and the Syrian communities and serves as a way to foster further understanding.

Adult artists and educators team up to create programs to enhance the lives of children living in refugee camps. These programs are both expressive and educational. They teach children about topics such as health and hygiene all while fostering healthy ways of articulating feelings. These projects include painting murals, wheelbarrows, tents and kites that allow the children to play.

The Exile Voices Project

Exile Voices is a project started by renowned photographer, Reza. This project offers a photography program to refugees in the age group of 11 to 15 in the Kawergosk camp in Iraqi Kurdistan. Exile Voices aims to tell refugee stories through the voices of refugees themselves.

Partnered with the UNHCR, Reza set out to empower these children on how to use the most powerful tool that they have–their own voice. Photographs from many children in the Kawergosk camp were lined along the Seine River in Paris, France in 2015 to show people the importance of art for refugees.

Art for Refugees in Lebanon

In 2017, 1 out of every 6 people in Lebanon was a Syrian refugee. This put significant pressure on schools to make the resources available for education. To tackle rising tensions in schools, the Skoun Association started an art therapy program within schools to help refugee and Lebanese students express themselves in healthy ways.

The art therapy program allows the students to overcome the trauma they experienced and helps to strengthen social bonds. It allows students to see themselves as children first. It also helps them forget the places of disconnect.

The Amsterdam Painting Project

In Amsterdam, refugees are housed in the Bijlmerbajes prison. The Amsterdam Painting Project aims to turn the prison space into something more welcoming, one that is full of renewed hope and life. This project aspires to serve as a bridge within the community and empower refugees to become more involved with one another.

The project was founded by Jeroen Koolhaas and Dre Urhahn. These two Dutch artists set out to promote community art by improving living conditions. The Project is funded by the Favela Painting Foundation, a group that has also completed projects in Rio de Janeiro, Brazil and Florence, Italy.

Clothes, food, shelter and other basic necessities will always be required in refugee camps or in resettlement cities. There is, however, also a need to ensure the mental wellbeing of refugees and create an outlet for them to share their experiences. Art is an excellent way to create this outlet. It allows refugees to tell their own stories and to express themselves productively. Most importantly, the idea of ‘art for refugees’ is one of the most effective ways to heal those minds that have been traumatized for a long period of time.

– Isabella Niemeyer
Photo: Flickr

Low Income and Climate Change Linked to India's Suicide Epidemic
India is in the midst of a suicide epidemic. Recent studies by the World Health Organization (WHO) and Proceedings of the National Academy of Sciences of the United States of America (PNAS) have linked India’s suicides to academic pressures, financial stresses and climate change.

When last reported in 2015, WHO found that 15 of every 100,000 Indians commit suicide, dwarfing many other nations’ rates. More concerning is that teens and young adults account for nearly half of India’s suicides. These high rates can be attributed to a variety of factors.

Academic Pressures
Societally, failure is not an option for many students in India. Many have a hard time coping with poor grades because they believe that scholastic performance is the deciding factor in gaining employment.

Failure in school leads to frustration. Because India’s schools lack emotional support systems for students, many can fall into cycles of anxiousness, helplessness and in extreme cases, suicide. In 2015, one student committed suicide every hour.

Academic pressures were also found to disproportionately negatively affect lower income and impoverished students. These students feel there is more on the line, and when they struggle are more prone to fall into depression.

Financial Stress and Climate Change
Financial stress and climate change are very much linked in India’s agricultural society. With over half of India’s population involved in agriculture in some way, crops and land viability have a huge impact on the mental well-being of Indians.

A 2017 PNAS report linked changing climates to an increase in suicides, attributing nearly 60,000 deaths to climbing temperatures and crop failures. Researchers found that during the growing season, every degree above 20° Celsius could be linked to roughly 70 deaths.

For farmers living from harvest to harvest, every crop is crucial. Failure not only means that you may go hungry, but that the loan servicer may come to collect and repossess the equipment you need to start another crop. India’s suicide epidemic is not only due to climate change, but also to the financial strain it disproportionately puts on poor farmers.

India’s Response
India currently has a number of suicide prevention hotlines. All are NGO-run and none are government funded. This means limited resources and limited accessibility. In the same vein, India currently has a shortage of mental health professionals and mental health infrastructure to address this epidemic.

When asked, many in India believe that suicide is a personal matter that should be handled privately, and until 2014 was considered an illegal act. Mental health professionals believe the stigma of talking about mental health needs to end. Some, like psychiatrist Satyakant Trivedi, believe that it needs to be addressed early.

“Mental health and wellness should be added to school curriculum. Only when children know about these disorders in their formative years will they be able to seek help,” Trivedi wrote in an India Today article.

Addressing mental health in schools, funding appropriate infrastructure and increasing the number of mental health care professionals in India are all good ideas. The road map is there. Leaders just now need to come forward and address India’s suicide epidemic.

Thomas James Anania

Photo: Flickr

Mental HealthIn sub-Saharan Africa, a poverty-dense region, there is a relative lack of mental health services. This is partly because most healthcare resources in sub-Saharan African countries are allocated to infectious diseases such as HIV/AIDS, malaria and tuberculosis.

Ninety percent of malaria deaths, 70 percent of people with HIV/AIDS and 26 percent of tuberculosis cases are concentrated in sub-Saharan Africa. Against this background, mental health problems do not always raise concern. Mental illness accounts for 10 percent of the disease burden in sub-Saharan Africa.

The most common mental disorders in the region are depression and anxiety. The prevalence rates of depression and major depressive disorder in sub-Saharan African countries range from 40 to 55 percent. Among the child and adolescent populations of Sub-Saharan Africa, mental health issues are common. Fourteen percent have mental health problems and nearly 10 percent have diagnosable psychiatric disorders.

Poverty, warfare and disease have all been identified as vulnerabilities and risk factors to child and adolescent mental health in sub-Saharan Africa. In one study conducted in southern Sudan, researchers found that 75 percent of children there suffer from post-traumatic stress disorder. There is a lack of evidence-based research on child and adolescent mental health in sub-Saharan Africa. However, a review of the literature indicates that psychological distress and mood, conduct and anxiety disorders are common among children who have experienced armed conflict.

In 2011 it was estimated that 90 percent of children infected with or directly affected by AIDS reside in sub-Saharan Africa. Rates of anxiety and depression are significantly higher in children who have been orphaned by AIDS than in other children. One study found that 12 percent of children orphaned by AIDS in rural Uganda had suicidal thoughts.

There are several challenges to providing quality mental health services in low- and middle-income countries. Two of these include cost and lack of research and needs-based assessments. Of all medical conditions, mental disorders are some of the most expensive to treat. In most sub-Saharan African countries, treatment facilities are limited in number and often inaccessible to much of the population. But without needs assessments and research demonstrating the value of providing effective treatments and services in the region, improving mental health care and its availability to those who need it remains a relatively low priority.

In recent years, mental health has been getting increased attention in sub-Saharan Africa and new efforts have been developed to improve mental health research and care in the region. In 2011, an association of research institutions and health ministries in Uganda, Ethiopia, India, Nepal and South Africa partnered with Britain and the World Health Organization to research the effect of community-based mental health treatment in low- and middle-income nations and to develop facilities and services in these areas.

Another effort is the Africa Focus on Intervention Research for Mental Health, which is working with several sub-Saharan nations on infrastructure development and has conducted a number of randomized controlled experiments to test affordable, accessible intervention methods for severe mental disorders.

This is only a small sample of the development efforts addressing mental health treatment and services in sub-Saharan Africa. Recognition of mental disorders’ significance in national health and more research on intervention will go a long way toward bettering child and adolescent mental health in sub-Saharan Africa.

Gabrielle Doran

Photo: Google

Mental Health in Poor Communities
While it is proven that poverty leads to cognitive setbacks, similar studies suggest that there are methods to counter poverty and its psychological effects in both the family unit and schools.

Improving mental health in poor communities became a priority in sustainable development over the last decade. Children from low-income families face psychological challenges that are much less common for higher-income children, including developmental delays, mental disabilities, ADHD, anxiety, depression and attention disorders. Parents’ education levels, race and other critical factors are not shown to have as strong a correlation as family income. Scientists trace statistics concerning mental health in poor communities back to inadequate nutrition, obstacles to proper development and chronic stress.

In response to these findings, more promising studies have shown that efforts to improve mental health in disadvantaged populations can be particularly effective during childhood.

For example, nutrition during and for a year after pregnancy is a critical part of cognitive development. Mothers who prioritize nutrition and a high-protein diet during pregnancy and breastfeeding are far more likely to have children free of mental disability.

The parent-child relationship is also crucial. At least one parent or parental figure’s consistent ability to care for a child leads to “secure attachment,” which encourages brain development, feelings of being worthy of love and the development of positive relationships. Professionals today are using attachment theory to understand and assist disadvantaged families.

The takeaway is that prioritizing pregnancy education and support in addition to positive parental relationships can improve mental health in poor communities.

Outside of the family unit, schools are an additional opportunity to promote psychological health in disadvantaged populations. Encouraging students to set goals in the classroom and giving consistent feedback develops student autonomy and intrinsic motivation. Since impoverished individuals are at greater risk of adopting a “victim mindset,” the thought process that external events alone determine their circumstance, drive and independence are crucial to future success.

According to the self-determination theory, surrounding students having material that suggests they can overcome difficult circumstances lead them to believe that they can succeed. Supplementing this school material with similar cultural stories and values at home increases the chances of internalizing positive values.

Organizing students into cooperative learning groups promotes relaxation, high achievement, positive relationships and improved psychological health, according to a 2000 study. Encouraging children to work together may combat the anxiety and stress that results from living in a low-income family and improve socialization.

While the psychological effects of poverty can be discouraging, these studies suggest that simple changes in the home and classroom are highly effective ways of empowering disadvantaged individuals. As research continues in the areas of cognitive development and psychology, further improvement in mental health in poor communities is expected.

Kailey Dubinsky

Photo: Flickr