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This guest blog post was written by Cemile Ceren Sönmez, a doctoral student and research assistant in Dr. Verdeli’s Global Mental Health Lab.
Mental health problems are highly prevalent, debilitating, closely linked to physical health problems, and consequently, critical contributors to the global burden of disease. The impact of mental health problems is even more pronounced in complex emergencies and other humanitarian settings. The suffering is immense and the impact of compromised functioning can be catastrophic when the circumstances call for desperate fight for survival. Thus, use of effective mental health interventions embedded in comprehensive approaches to health are urgently needed.
To that effect, the Global Mental Health Lab at Teachers College, Columbia University has launched several initiatives focusing on training and knowledge-sharing of evidence-based practices for Common Mental Disorders around the globe. These initiatives intend to provide mental health specialists and non-specialists with practical, feasible and locally acceptable tools while maintaining a vision to gradually develop regional hubs where professionals can continue supporting each other’s work through self-sustaining “learning collaboratives”. During these programs, basic principles and strategies of the Group Interpersonal Psychotherapy (IPT-G, an evidence-based, WHO recommended intervention for distress and depression) are typically covered in an immersive 6-day training that also includes a workshop on WHO first line assessment and management tools in response to humanitarian crises. These tools are provided during an annual Global Mental Health Summer Institute (GMHSI) held every July by the Teachers College Global Mental Health Lab at Columbia University. Two similar training workshops are taking place in Middle East region; one in Dubai focusing on Arab women’s mental health, and the other in Amman, targeting priority mental health conditions in persons affected by the Syrian crisis.
One theme that emerged during the July 2016 GMHSI was about the balance between what is feasible in humanitarian settings and what meets the minimum rigor to maintain quality service delivery. Research is often overlooked in humanitarian settings since it is considered costly, time-consuming, and not a priority during a time when provision of services is critical. Nevertheless, interventions that are not culturally valid may result with little or no participation and loss of trust towards the organization by the target population.
Another area of focus was the way in which humanitarian services should be delivered; culturally appropriate delivery is crucial and conducive to the individual’s mental health. The general approach of UNHCR advocates for a culturally sensitive and supportive provision of mental health resources for displaced populations. Community-based approaches are put in place to build on affected populations’ skills, capacities, and resources, thus enhancing community capacities for self-protection and recovery. Providing money/vouchers instead of food, letting refugees build their own shelters the way they would do back home, having play areas for children, organizing same-gender support groups are some of the strategies used by the UNHCR to enable and empower refugees, and strengthen their social support systems.
While such services foster resilience among those who are affected, under extreme circumstances a number of people (twice or three time as many as in non-emergency conditions, depending on the type of surveys used) may stop being able to carry out their daily activities, work or care of themselves and their families. For those with impaired functioning, access to and uptake of goods and services provided by the humanitarian communities will be significantly compromised. The ensuing lack of resources combined with consistent exposure to environmental stressors will cause further worsening in mental and physical health.
To break this vicious cycle, impairment in functioning needs to be identified and addressed in a sensitive, supportive and timely manner. The encouraging news is that there are short-term, active, symptom/functioning-focused, and evidence-based or -informed strategies that could be delivered by trained counselors, nurses, midwives, social workers, and community health workers (CHWs), under rigorous training and supervision. A team from Columbia and Johns Hopkins Universities and World vision Uganda showed that groups led by a local person who had received intensive training and supervision in IPT adapted for Uganda were efficacious in significantly reducing depression and dysfunction. The same team showed strong results with displaced teenagers in northern Ugandan camps. Since then, this and a number of other teams around the world showed strong results with other populations.
An important take home message is that, when done right, bringing dedicated non-specialists on board can be a feasible and highly effective solution to help alleviate the increased burden of mental illnesses in undersourced settings. It can also improve the quality of services that are already being provided by humanitarian agents. At the same time, this can open up a new career path for the psychologists, where they can spend more time in training future providers and providing ongoing supervision. A number of high-income regions have been adopting these methods for their low mental health access/high need communities.
