2014 annual technical review workshop
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2014 Annual Technical Review
Workshop
MHPSS In DadaabDr Adan/Birongo
March 2014
Background
In the WHO constitution the concept of Health is defined as “not merely the absence of disease or infirmity”, but rather, “a state of complete physical, mental and social well-being’’
Mental health represents a crucial aspect of health and wellbeing of individuals, families, communities as a whole.
It is estimated that around 1-3 % of the population, under normal circumstances is affected by a mental disorder
Background Cont’d
According to WHO 450 million people are estimated to have a mental disorder worldwide and up to 25% of adults will experience a mental disorder at some point during their lifetimes.
Considering the global burden of disease (GBO) methodology WHO underlines that mental disorders account for 13% of the global burden of diseases, and projections show that this figure will rise to nearly 15% by 2030.
MHPSS in Dadaab In Dadaab UNHCR works with a wide range of
implementing and operational partners including several that are involved in mental health and psychosocial support (MHPSS).
However, an explicit strategy for mental health and psychosocial support is not present and
there may be significant differences in the organisation
and quality of service provision between the various camps.
Services provided/components
PSYCHIATRIC SERVICES
-Facility based consultations
-Community based /family support
-Referrals where necessary
CAMPS NGO’S PSYCHIATRIC SERVICES
IFO 1/Host community IRK
DAGAHALEY/Host community
MSF
HAGADERA/KAMBIOS IRC
IFO 2 EAST/WEST KRC
Services provided/components Cont’d
PSYCHOSOCIAL SERVICES
-Psychotherapy-Psychological
Counseling/support-PFA-Home Visits/community
sensitization- play/art therapy
CAMPS NGO’S PSYCHOSOCIAL SERVICES
IFO 1 CVT – HI – SCUK - CARE
DAGAHALEY MSF – SCUK – CARE – NCCK –HI -LWF
HAGADERA/KAMBIOS IRC – SCUK -LWF
IFO EAST/WEST KRC – HI
2013 Psychiatric Consultations
0
2000
4000
6000
8000
10000
12000
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr total
DagHagIfoTotal
2013 Admissions
0
5
10
15
20
25
1st Qtr 2ndQtr
3rd Qtr4th Qtr Total
DagHagIfo
Mental Health Morbidity % 2013
19%
2%
46%
2%
6%
15%
4%
1%
1%4%
1
2
3
4
5
6
7
8
9
10
Key: 1. Depression, 2. Anxiety, 3. Epilepsy, 4. MUPS, 5. Bipolar, 6. Schizophrenia, 7. PTSD, 8. DIP, 9. Intellectual Disability, 10. Others
Comparison (Consultations) 2011/2012/2013
0200400600800
100012001400160018002000
201120122013
Achievements Despite the security conditions, psychiatric
and psychosocial services have continued in all camps
216(98m,f109) children with impairments benefitted at the day care centre and demonstrated improvement as indicated by ICF scoring system
15 children with intellectual impairment were placed at schools after showing marked improvement from day care services
A total of 19,780 consultations, of which 771 were new patients.
Achievements Cont’dDuring the year 2013,CARE MHPSS
interventions reached out to 6459 (3829F) members of the refugee community.
2558 psychosocial sessions conducted in MSF
365 clients benefited from MHPSS in CVT
Child individual therapies and group therapies including play and art therapy in the child friendly spaces have been provided (CFS)
Achievements Cont’d Organizations have adapted alternative ways
to support and capacity build incentive staff to offer some basic quality services despite insecurity.
Agencies through meager funds were able to celebrate important calendar events like World Torture day & World Mental Health Day.
Peter Ventevogel (Senior Mental Health Expert
Public Health Section, DPMS UNHCR Geneva) visited the camp and made several recommendations (See Report)
Achievements Cont’dProvision of Psychological First
training for IRC staff in HagaderaTraining on stress management for
UN staff
Challenges Lack of vocational placement available in the
camps Caregivers shunning away from rehabilitation
services and demanding for NFIs Children with intellectual impairments not
accessing schools due to limited special teachers for them In the camp
Insecurity in the camps and along the roads Uncertainty in-terms of refugee repatriation
process Low funding leading to understaffing
Challenges Cont’d Cultural beliefs and practices that favor
stigma and containment measures are common in the camp often chaining and caging used mostly.
Slow uptake of M/H services since community first seeks other intervention like Quran reading, traditional healers etc
Miraa chewing – culturally accepted and even most of the patients use it as it is readily available.
Challenges Cont’d Extra pyramidal side effects to antipsychotics(
old generation) Dashed hopes of resettlements Burnout of the MHPSS staff as some do not
have any clinical supervision plans in place High rate of relapses due to defaulting and
non compliance Narrow admission gate to MHPSS, hence
many people out there not benefiting from the services.
Way forward MHPSS should be a regular element of UNHCR’s
humanitarian response. MHPSS activities should be rooted in existing key
strategies and policies of UNHCR and other agencies, such as:
• A Community Based Approach in UNHCR operations • Accountability Framework for age, gender, diversity
mainstreaming • Education Strategy 2012-2016 • Working with persons with disabilities in forced
displacement • IASC Guidelines on Gender-Based Violence in
Humanitarian Settings. • Community-based Rehabilitation: CBR Guidelines “Paracetamol consumers “study
Way Forward cont’d Appropriate staffing of the psychiatric
services.• The minimum requirement according to the
new Operational Guideline for MHPSS is to have at least one qualified Mental Health Officer per camp (at this moment this is not the case in Kambioos, Hagadera and in Ifo-2).
Regular training workshops for the MHPSS staff need to be in place as this is currently lacking
Need for more funding to agencies so as to continue providing MHPSS activities
Introduction of physical therapy when funds allow
Way Forward Cont’d Develop concerted efforts by all partners
and stakeholders in refocusing the attention of the caregivers from Dependency on charity.
Employment/training of more teachers with knowledge in handling children with intellectual impairments - SNE
MHPSS training of auxiliary nurses• For the incentive staff in the various mental
health programmes a standardized mental health training can be organized, for about 5 days, using the mhGAP IG - humanitarian version.
Patient with chronic treatment resistant schizophrenia in a cage
Chained patient as generally practiced in the camp
An elderly mentally ill lady chained at home
A post partum mother chained to prevent her harming the child
THE END
THANK YOU
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