Showing papers in "Intervention in 2011"
TL;DR: When young mothers, formerly associated with armed groups, return to communities, they are typically social isolated, stigmatised, and marginalised as discussed by the authors, which creates reintegration challenges for themselves, and their communities.
Abstract: When young mothers, formerly associated with armed groups, return to communities, they are typically social isolated, stigmatised, and marginalised. This creates reintegration challenges for themselves, and their communities. Their children face child protection problems such as neglect, rejection a
82 citations
TL;DR: Guereda, Chad, Friday 9 July 2004 The man from ‘Help theWorld’ told me this was the most inhospitable landscape he had ever experienced, and he was glad he was on his way out, and I have to say I like it.
Abstract: Guereda, Chad, Friday 9 July 2004 Theman from‘Help theWorld’toldme thiswas the most inhospitable landscape he had ever experienced, and he was glad he was on his way out. He had done his bit, set up his programme. Hewas gettingmarried next week, and nothing would induce him to stay. Yet, I have to say I like it. An irregular plane of scrub and thorn stretched beneath a vast sky, the horizon broken by small isolated treeless mountains of earth and rock, giving the feeling that a giant mole has burrowed through the terrain. There has been no rain for a few days, but a gloss of green covers everything. There is the sweetest smell in the air when we stop to take a break, and birds everywhere: small ¢nch like ones, ibis, egrets, herons and storks, bright blue birds
44 citations
TL;DR: The project provided assistance to ‘patient support groups’ that then provided support to patients with mental disorders, and the capacities of health workers and Village Health Teams to provide mental health services were strengthened.
Abstract: In 2008, the local nongovernmental organisation TPOUganda and the UgandaMinistry of Health began a project aimed of improving the availability of mental health services in three districts in Northern Uganda.The project consisted of:1) training of general health workers in the primary health care system in mental health; 2) strengthening the capacity of the specialised mental health workers to deliver and supervise mental health outreach services; and 3) increasing the capacity of community members to respond eiectively to mental health and psychosocial needs of people within their communities.Theproject provided assistance to ‘patient support groups’ that then provided support to patients with mental disorders. At the end of the 22 month project, the capacities of health workers andVillage HealthTeams to provide mental health services were strengthened. Major gaps, that still need to be addressed, were attrition of government health workers and a lack of drugs. Lessons learnt also include: the importance of coordination and joint planning between nongovernmental organisations and the government; the importance of support supervision; the important role of village health team members in community mobilisation and sensitisation; and the roles of patient support groups in complementing medical/clinical activities.
28 citations
TL;DR: The findings of this article support the viewpoint of the World Health Organization that mental health training for primary health care workers is just one of the factors necessary for the successful integration of mental health care intoPrimary health care.
Abstract: Evidence suggests that providingsupport to primary health carewith training, assistance and supervision by available mental health professionals is the best way to extend mental health care to the population. Three cases of mental health training programmes for primary health care workers were implemented in diierent countries, and are described in this article.The objective was to share the lessons learnt in diierent settings. Relevant primary and secondary data were used to present the cases.The mental health trainings generally improved the mental health knowledge of primary health care workers. More sustainable changes in theirmental health care practices were achieved only as a result ofseveralfactors combined together: a) professionally designed and implemented mental health training; b) motivation by all key players to develop community mental health services; c) political will by the government followed by formulation of mental health policy promoting integration of mental health into primary care; d) good timingof the programme; and e) in£ux of funding and professional expertise.The ¢ndings of this article support the viewpoint of the World Health Organization that mental health training for primary health care workers is just one of the factors necessary for the successful integration of mental health care into primary health care.
20 citations
TL;DR: Following the 2010 Haiti earthquake, there was a need for specialist services for severely mentally ill people who were presenting to the emergency medical clinics set up for displaced people, but only a relatively small proportion of the displaced population could access help.
Abstract: Following the 2010 Haiti earthquake, there was a need for specialist services for severely mentally ill people whowere presenting to the emergency medical clinics set up for displaced people. That need was unmet. Using guidelines drawn up by the InterAgency Standing Committee (IASC), and piloting theHealth Information System(HIS) ofdiagnostic categories in mental health, weekly mental health clinics were begun in eight mobile clinics. A psychiatric liaison service was also started in the main casualty hospital. Haitian general practitioners and psychosocial workers, who received on-the-job training and supervision from the authors, ran these services. This integrated mental health/primary health care modelwas successful in engagingseverely mentally ill patients in treatment; however, the scale of the disaster meant that only a relatively small proportion of the displaced population could access help. This limitation raised a number of questions about the practicality and sustainability of the IASC model in resource poor countries, with poorly developed community services, hit by large scale emergencies, which the authors address.
20 citations
TL;DR: Findings indicate that there are many challenges, both in repairing an already weakened health sector, and in maintaining mental health as a health priority, in dealing with the overall mental health burden in post invasion Iraq.
Abstract: The Iraq war, and the subsequent involvement of various stakeholders in the post con£ict reconstruction of the health sector, presented an opportunity to learn about mental health policy development, challengesand obstacleswithin apost con£ict context in 2003.This paper documents and explores mental health policy in post invasion Iraq, using qualitative methodsand a health policyframework that analyses context, content and process. Findings indicate that there are many challenges, both in repairing an already weakened health sector, and in maintaining mental health as a health priority. In addition to security issues, fragmentation of power, change of leadership and lack of funding pose signi¢cant problems. Achievements are evident, though insu⁄cient to address the overall mental health burden. The policy process is examined over a four-year period. Lessons learned are presented as best practice guidelines for post con£ict mental health reconstruction.
20 citations
TL;DR: The strategy developed by Cordaid aimed to address mental health and psychosocial needs in the early recovery and reconsolidation phases, and to build mental health capacity of community level and primary health care providers, to result in the establishment of a referral system between the community and health care sectors.
Abstract: The recent earthquake in Haiti exposed all the weaknesses in the mental health care system existing prior to the earthquake. This paper describes the strategy developed by the Dutch nongovernmental organisation Cordaid for providing integrated mental health and psychosocial support in Haiti after the earthquake.Thestrategyaimed toaddressmental health and psychosocial needs in the early recovery and reconsolidation phases, and to build mental health capacity of community level and primary health care providers.This would result in the establishment of a referral system between the community and health care sectors. The results of the implementation showed that mental health trainings were a feasible intervention for Haiti, but so far they have not yet resulted in change of practice of primary health care workers, and the goal of a referral system is still in an embryonic phase.
16 citations
TL;DR: The author concludes that money is spent on programmes that are not aimed at restoring trust between the Tamil population and the Sri Lankan state, but at reconciling ex-combatants with local communities.
Abstract: This paper describes the lives of young, female former Tamil Tiger ¢ghters, in Batticaloa, after the civilwar in Sri Lanka. It shows how the kinship and solidarity found in female networks, in a matrilineal society, has helped them survive the con£ict. In Batticaloa, female-headed households bear the main burden for caring for the traumatised, and sometimes injured, returning female, formersoldiers. This is done in the absence of social welfare services or speci¢c medical or psychosocial care. Disabled female ex-combatants ¢nd it especially di⁄cult to build a future within the community. Although Sri Lanka’s National Action Plan for the Re-Integration of Ex-Combatants does include disabled ¢ghters, in reality, disabled female ex-combatants receive hardly any support. The author concludes that money is spent on programmes that are not aimed at restoring trust between the Tamil population and the Sri Lankan state, but at reconciling ex-combatants with local communities. This is unnecessary, as communities already accept and help them, especially in the female-headed households. Households that have extra mouths to feed, because they provide care to returning female soldiers, should at least receive economic support.
12 citations
TL;DR: The Haitian Red Cross started psychosocial interventions to tackle the psychological and social dimensions of the cholera outbreak, which caused tension in the communities and negatively impacted the public health response to the outbreak.
Abstract: In October 2010, an outbreak of cholera was confirmed in Haiti. The country had not seen cholera for many decades, so it was a ‘new’ disease to the population. The outbreak of cholera also leads to high levels of fear and suspicion due to beliefs and perceptions. This field report presents some of those beliefs and perceptions around the outbreak, in four Haitian communities. As many Haitians did not perceive cholera as a ‘natural’ or preventable disease, suspicions that the disease was deliberately spread for political reasons by foreign agencies or national authorities, or was related to religious factors such as vodou practices, caused tension in the communities and negatively impacted the public health response to the outbreak. The Haitian Red Cross started psychosocial interventions to tackle the psychological and social dimensions of the cholera outbreak. These included participatory group discussions, facilitation of community acceptance of cholera treatment centres, conflict mediation, individual psychosocial support to people with cholera and facilitation of mourning.
12 citations
TL;DR: In this article, the potential of posttraumatic growth (PTG) among youths formerly associated with the Lords Resistance Army (LRA) in Northern Uganda was investigated through investigating life narratives of 12 such youths.
Abstract: This article presents the potential of posttraumatic growth (PTG) among youths formerly associated with the Lords Resistance Army (LRA) in Northern Uganda. Through investigating life narratives of 12 such youths, this study aims to discover the potential of PTG as a consequence of a forced time peri
11 citations
TL;DR: This article discusses the training of mental health workers whose basic job is with clients that have been seriously affected by armed conflict and/or natural disasters by using ‘helping through talking’, and who have had little education that is relevant to this work.
Abstract: This article discusses the training of mental health workers whose basic job is with clients that have been seriously affected by armed conflict and/or natural disasters by using ‘helping through talking’, and who have had little education that is relevant to this work. It sums up the characteristics required of the workers, their learning needs, the messages that the training needs to convey, and the characteristics and potential contents of a tailor made, participants-oriented 1 In earlier publications (e.g. van der Veer, 2003; 2006) referring to the same approach the first author has used the term person-oriented or contact-focussed. programme. This approach is illustrated with a few key points from such a training programme.
TL;DR: In this article, the authors argue that blurring the line between psychosocial support and "spiritual support" could lead to promoting speci c religious values to distressed populations, and may even be seen as proselytising of vulnerable groups.
Abstract: The commentaries on the next few pages relate to the article ‘Spirituality and mental health in humanitarian contexts: an exploration based on World Vision’s Haiti earthquake response’ by Alison Schafer on page 121^130 of issue 8.2 of Intervention (2010). The author uses the experiences in the aftermath of the Haiti earthquake to substantiate her argument that nongovernmental organisations do not have a clear set of interventions to address the spiritual needs of an aiected population, in conjunction with their mental health and psychosocial support needs. The author considers this a gap, given the evidence that spirituality can have bene¢cial eiects on mental wellbeing, and is often an important resource for both coping and coming to terms with the consequences of events. However, as mentioned in the editorial of issue 8.2, blurring the line between psychosocial support and ‘spiritual support’could lead to promoting speci¢c religious values to distressed populations, and may even be seen as proselytising of vulnerable groups. The dilemma surrounding this uneasy relationship between religion and psychosocial work de¢nitely warrants further exploration and discussion. This issue, therefore, contains four commentaries responding to the issues raised in Schafer’s article. Grace Onyango, an experienced psychosocial specialist from Uganda, believes that spiritual approaches are not necessarily at odds with more standardised mental health and psychosocial support interventions. In her experience, providing spiritual nurture is not the same as evangelism
TL;DR: There has been widespread advancement in awareness of integrated psychosocial and mental health approaches, multi-professional teamwork and training methodology among practitioners, and this has translated into practical projects improving the quality of care for beneficiaries.
Abstract: The massive in£ux of Iraqi refugees into Syria in 2006 put an immense strain on the already underresourced mental health sector.This prompted a consortium of international agencies to create an Interagency Working Group (IAWG) in 2008, with the goal of national capacity building.This Interagency Working group merged into a National Advisory Board that included the Syrian government. An integrated one-year master training programme for mental health professionals was designed.The ¢rst cohort of master trainers successfully completed the programme, and started to train frontline worker with very good results.There has been widespread advancement in awareness of integrated psychosocial and mental health approaches, multi-professional teamwork and training methodology among practitioners.This has translated into practical projects improving the quality of care for bene¢ciaries. In addition, comprehensive training curricula and a bilingual handbook have been draftedwith thegoal of integratingand streamlining psychosocial, mental health and training methodology. Initial steps have also been taken to create a uni¢ed National Mental Health and Psychosocial Council.
TL;DR: A programme in a rural area of the West Bank (occupied Palestinian territory) developed in 2005 by Médicos del Mundo Spain, in coordination with the World Health Organization and the Ministry of Health, provides the opportunity of addressing severe and common disorders in their current situation.
Abstract: The authors describe a programme in a rural area of the West Bank (occupied Palestinian territory) developed in 2005 by Me¤ dicos del Mundo Spain, in coordinationwith theWorldHealthOrganization and the Ministry of Health. The main features include:1) working with the Palestinian Authority in order to reinforce the existing public health system, rather than developing a parallel one; 2) providing a building, and other long lastingmaterial resources, to the Community Mental Health Centre and the public health system;3) supportingthe incorporation of human resources in mental health teams in the public system; and 4) providing capacity building for mental health and primary care teams, through intensive on the job training, and providing didactic material for mental health and primary care professionals.The integration ofmental health care into primary health care structures in con£ict settings provides the opportunity of addressing severe and common disorders in their current situation.
TL;DR: The Spanish Cooperation, through the nongovernmental organisation Sanitary Religious Federation and the financing of the Spanish Agency for International Development Cooperation conducted an assessment of the mental health care system in Equatorial Guinea in 2009, focusing on integration of mental health into primary care, through capacity building and sensitisation.
Abstract: The Spanish Cooperation, through the nongovernmental organisation Sanitary Religious Federation and the financing of the Spanish Agency for International Development Cooperation conducted an assessment of the mental health care system in Equatorial Guinea in 2009. There was no specific mental health policy in place, and no formalised mental health care system. A National Mental Health Policy has recently been approved, and an implementation plan was made by the government and nongovernmental organisations. The plan focuses on integration of mental health into primary care, through capacity building and sensitisation. The implementation is still in the initial phase, and the scaling up process is expected to be slow.
TL;DR: The development of the Inter-Agency Standing Committee Guidelines heralded an international achievement by gathering mental health and psychosocial professionals to evolve common minimum responses during emergencies as mentioned in this paper, but one continuing contentious issue has been the definitions of mental health.
Abstract: The development of the Inter-Agency Standing Committee Guidelines heralded an international achievement by gathering mental health and psychosocial professionals to evolve common minimum responses during emergencies. However, one continuing contentious issue has been the definitions of mental health
TL;DR: It is argued that emergencies and disasters can be an opportunity for fundamental changes in the mental health care that would be very difficult to implement at other times.
Abstract: The paper describes the development of a community oriented mental health care system in the Region of Huancavelica (Peru), after a devastating earthquake in 2007.The area is also one of the most inaccessible and disadvantaged areas of Peru. Collaborative eiorts by health personnel in the area, the Regional Directorate of Health and the international organization Me¤ dicos del Mundo ^ Espan‹ a, led to a wide range of activities such as: 1) the revitalisation of a dysfunctional Community Mental Health Centre; 2) the development of a Regional Mental Health Plan, through an participatory process; 3) a pilot action research project in the community to identify people with severe mental health disorders who did not receive psychiatric care; 4) the training of general health personnel in mental health and 5) support a mental health reparations programme for survivors of political violence. The authors argue that emergencies and disasters can be an opportunity for fundamental changes in the mental health care that would be very di⁄cult to implement at other times.The ¢rst six months of reconstruction after a disaster represent a privileged time for nongovernmental organisations to assess the local mental health care systems, and work hand in hand with survivors and the authorities to elaborate longer term projects and mobilise the necessary support.
TL;DR: The results and implications of this project are presented: the contribution of the child-soldiers to the healing process of many of the direct victims of the war, as well as implications of the project for former child-Soldiers, other victims ofThe war, and all other community members involved.
Abstract: ‘ Agape’ is a reconciliation project among victims of the armed con£ict in Colombia and child-soldiers who, legally, are also victims of the armed con£ict. The project was realised fully by volunteers, who are kidnap victims, refugees, students and other members of the Colombian community inMontreal, Canada. The paper presents the results of this project: the contribution of the child-soldiers to the healing process of many of the direct victims of the war, as well as implications of the project for former child-soldiers, other victims of the war, and all other community members involved.The paper concludes by asserting the importance of the participation of the community in the search for solutions to armed con£ict.
TL;DR: While refugee children seem slightly more concerned by the political situation, children in the north of the West Bank region and in rural areas display less personal aspiration and more interest in material wealth.
Abstract: In this study, the body of drawings and written wishes chosen from a drawing contest for Palestinian schoolchildren, provided data revealing a world of hopes, wishes and desires of Palestinian teenagers. Irrespective of the measure of regional exposure to the violent con£ict, the political situation ¢gures prominently in their wishes. Peace and statehood are dominant themes. While refugee children seem slightly more concerned by the political situation, children in the north of the West Bank region and in rural areas display less personal aspiration and more interest in material wealth.
TL;DR: In this paper, the authors describe a "minimal budget project" aimed at developing the expertise of a mixed group of workers, which included nurses, community workers, counsellors and psychosocial workers attached to, or connected with, the mental health units in four hospitals in east Sri Lanka.
Abstract: This¢eld report describes a ‘minimal budget project’ aimed at developing the expertise of a mixed group of workers.This project included nurses, community workers, counsellors and psychosocial workers attached to, or connected with, the mental health units in four hospitals in east Sri Lanka. In order to develop expertise, the project included a series of basic counselling training, as well as ongoing guidance during monthly peer supervision meetings. The peer supervision was done according to a strict procedure, and creates an ongoing opportunity for learning, both from the practical experience of oneself, and one’s colleagues.
TL;DR: In this article, four respondents made contributions to the discussion of spirituality and psychosocial support in emergencies, and the issue of the con£uence of religion and spirituality was raised several times by respondents.
Abstract: I would like to thank the four respondents for their positive and helpful contributions to the discussion of spirituality and psychosocial support in emergencies. I hope that a further response will oier clarity where needed and continue promoting the discussion and progress in this most important area. It is estimated that 90% of the world’s population are involved in religious or spiritual custom (Koenig, 2009). Additionally, as many humanitarian disasters and crises occur in the non western world where such practices are widespread, and many of the mental health and psychosocial support (MHPSS) interventions are planned and implemented from a background that is overwhelmingly secular in nature, it would seem this is both an important and urgent topic. The issue of the con£uence of religion and spirituality in the original article was raised several times by respondents. It is well documented and accepted that spirituality and religion does not refer to the same constructs, however, it is clear they are closely related. The faith constructs onwhich religious practice sits are the pillars of a worldview that provide existential meaning to that religion’s active participants in that cultural group. A change in religion will certainly aiect a
TL;DR: In this paper, the author describes in a personal report how oppression and violent con£ict in Kosovo eiected a change in his career, and how he became the founder and director ofa local nongovernmental organisation in the field of education and psychosocial support for children.
Abstract: The author of this ¢eld report, originally a professor in mathematics, describes in a personal report how oppression and violent con£ict in Kosovo eiected a change in his career, and how he became the founder and director ofa local nongovernmental organisation in the ¢eld of education and psychosocial support for children. After the con£ict, many psychosocial activities were organised. Unfortunately, local experience was often ignored in these projects. After more than a decade of experience, the author stresses the pivotal role of teachers as the key agents in improving psychosocial support to children. Further, he emphasises the importance of strengthening local capacity, rather than international agencies implementing projects with expatriate stai.
TL;DR: In this article, the authors examined the use of the IASC guidelines in an academic setting, and discussed a case example of how the guidelines were utilised by MAIDP students working in Panama.
Abstract: There is a growing recognition of the signi¢cant psychological and psychosocial damage caused by natural and manmade disasters.This phenomenon has increased the demand for trained professionals with the necessary skills to address these problems, in diverse populations around the world. The Masters of Arts International Disaster Psychology (MAIPD) programme in the Graduate School of Professional Psychology was developed in order to help to meet this increased demand for professionals, required to work in the ¢eld of disaster psychology and emergency management within the United States, and around the world. The Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007) are extensively utilised in this programme. The guidelines provide practical approaches for addressing psychosocial problems in (post)disaster settings, and provide a framework for developing plans and intervention strategies. This article examines the use of the IASCguidelines in an academic setting, and discusses a case example of how the IASC guidelines were utilised by MAIDP students working in Panama. This critical evaluation aims to provide practical information in order to assist faculty, students and practitioners preparing to work in (post)disaster settings.
TL;DR: The steps to create a capacity building programme in an unstable and fragile context are described, with the aim of mainstreaming psychosocial support in public services.
Abstract: Since the collapse of the central government of Somalia in 1991, large parts of the country have been in turmoil. Fighting, poverty, hunger and gender based violence have all contributed to high levels of mental and psychosocial problems. Excessive consumption of khat may also be a major contributor