Addressing Mental Health in Conflict Zones
This is part of a series highlighting innovations and possibilities for action for the famine in Somalia. Most news stories frame the famine and political conflict as near unsolvable; we’re examining the on-the-ground measures that can help – from the large scale and political to the local and preventative.
Compared with other forms of illness, mental health disorders tend to be an overlooked health issue. This is especially true in a place like Somalia. In a conflict-prone area vulnerable to the kind of drought and famine that is occurring right now, mental illness drops far down the list of public policy priorities.
According to the World Health Organization, an estimated 10 percent of the world population is affected by mental health disorders. That rate jumps to 20 percent in conflict-prone areas, and even further in Somalia in particular. One in three Somalis are said to be affected by some kind of mental illness. But until earlier this year–and similarly to practices in other resource-poor countries–most individuals being treated for mental illness were literally kept in chains, either to a bed (or some other object, perhaps a large rock or the floor) or with chains around both legs, with little attention to the real problem at hand.
That’s starting to change, according to Pieter Desloovere, communications officer for the WHO’s Somalia office in Nairobi who has been in Somalia working on the organization’s mental health initiative.
The WHO published a situational analysis of mental health in Somalia in October that maps out an emerging (or full-level, depending on your perspective) crisis in the country. At the time of publication, the country had a total of five functional health centers with mental health services, and only 19 social workers and three psychiatrists–no psychologists–to attend to the entire nation’s mental health needs. The total number of cases in Mogadishu’s Habeeb Hospital alone nearly tripled in five years, from 903 in 2006 to 2468 in 2010. The WHO has a team in Somalia that has been focusing specifically on this issue and starting to see positive results, starting with its Chain-Free Initiative.
It’s a program that the WHO is piloting in Somalia and Afghanistan, and involves working with hospitals to abandon the practice of using chains as well as helping families and communities to improve conditions for people with mental illness (step one: chain-free homes) and developing community programs to increase societal understanding of mental health issues. The ultimate goal is to create a chain-free environment, literally and figuratively. The social stigma and discrimination toward mental illness is not a small hurdle, and it’s an important one to overcome.
“Mental health is still seen as an isolated sector but should be integrated into primary health care. Interventions are not too difficult or costly, but the area is rather lacking resources and infrastructure,” said Dr. Marthe Everard, WHO Representative for Somalia.
The WHO team has been working to educate health facilities in Somalia, and partnering with the Ministries of Health and other players at all levels to try to change public attitudes toward mental illness. Since the launch of the initiative, all five health centers with mental health services have now adopted a chain-free policy, and Desloovere said that other centers are starting to do the same.
After first removing the chains, the WHO has been working to build capacity of mental health workers: 33 workers from three different zones were trained in 2009, and the training continues, although numbers from the last two years are not yet available.
Desloovere said the launch of the analysis last year was able to catch people’s attention, and inspire donors to help the WHO with funding to provide emergency medical supplies for mental health patients. The EU has also provided support to an NGO, Gruppo per le Relazioni Transculturali, to provide mental health services in Somalia.
Desloovere said that as part of the chain-free initiative, health workers receive a special three-month training on how to deal with mental health patients. “Thanks to this, health workers don’t chain patients any longer (at least in the health facilities we supported and a few more),” he wrote in an email.
“After two decades of conflict and fighting, this mental health situation analysis comes at the right time,” said Mark Bowden, UN Resident and Humanitarian Coordinator for Somalia, when the report was released. “The human rights of the persons with mental disorders and of their families cannot be neglected.”
Photo: WHO/Pieter Desloovere