mental health and psychosocial support (mhpss) · organiza on also conducted psychological first...

• The Mental Health and Psychosocial Support Sub working Group (MHPSS SWG) supported a CCCM training on Psychological First Aid (PFA) for IOM staff, Na�onal Emergency Management Agency (NEMA) and State Emergency Management Agency (SEMA) officials, on 28 February 2018. The PFA session captured essen�al knowledge and ac�ons principles.

• The Borno State Ministry Health (SMoH), represented by Director of Emergency Response (as the chair of MHPSS SWG), provided regular support on issues related to the mental health and psychosocial services in various hard-to reach areas.

• MHPSS Partners and Services profile from the first-round mapping exercise has been circulated to the MHPSS SWG members, IASC MHPSS RG co-chairs, donors and Presiden�al Commi�ee on North East Ini�a�ve (PCNI). The profile comprises of organiza�onal details, service loca�ons, type of beneficiaries, project type and status, MHPSS interven�ons and ac�vi�es, and contact person(s) of the organiza�ons. The document updated on a quarterly basis to ensure that relevant informa�on is consistently shared.

• The MHPSS SWG communicated with IASC MHPSS RG co-chairs are developing the work plan and capacity building plan for 2018. Communica�on with both co-chairs will con�nue, to share updates on ac�vi�es and seek technical recommenda�ons.

• The MHPSS SWG par�cipated on the MHPSS.net Webinar series on “MHPSS Coordina�on in Humanitarian Response”. The webinars captured issues on coordina�on and engagement with diverse stakeholders, coordina�on and response structures, and donor funding of MHPSS coordina�on. Useful prac�ces/lessons learned from the Syrian crisis were also shared.

• A joint organized training with the MHPSS SWG, IOM Capacity Building Unit and Humanitarian Hub Staff Counsellor, “Staff Care and Support for Humanitarian Actors” was held on 21 March 20018. The training was a�ended by 30 par�cipants from IOM, UNICEF, Plan Interna�onal, Save the Children and Translators without Borders. Several methodologies have been used to enhance ac�ve partner par�cipa�on and to increase learning processes, including on prac�cal self-help techniques on deep-breathing and progressive muscle relaxa�on.

• The MHPSS SWG par�cipated in the first round of the “Humanitarian Informa�on Management Train-ing for Partners” conducted by iMMAP in collabora�on with UNOCHA, on 26 - 30 March 2018. The training modules comprised of an introduc�on to humanitarian informa�on management (IM), IM in sector management, responsibili�es of sectors’ lead and UNOCHA in IM, source of humanitarian data and informa�on, IM needs assessments, introducing Kobo Tool Box in data collec�on and analysis, report wri�ng, as well as response monitoring and GIS applica�ons.

Mental Health and Psychosocial Support (MHPSS)Sub Working Group - North East Nigeria

QUARTERLY UPDATE Q1 | January – March 2018

Key Highlights

© IOM 2018/Muse MOHAMMED

Enter its ninth year, the humanitarian crisis in north-east Nigeria has compounded pre-exis�ng vulnerabili�es. An es�mated 7.7 million people in the three most affected states of Borno, Adamawa and Yobe are depending on humanitarian assistance for their survival. In 2018, humanitarian partners across sectors targeted 6.1 million people for humanitarian assistance¹.

Several main priori�es captured by partners across sectors targeted quality protec�on services, including psychosocial care, life-skills and livelihood to enhance resilience to cope with protracted crisis; strengthen mental health services and referral to specialized services; strengthen GBV response and preven�ons through capacity building, mainstreaming and coordina�on; enhance rou�ne monitoring of the emergency nutri�on situa�on; improve the ability of school-aged children, teachers and educa�on personnel to cope with the psychosocial and environmental impact of the conflict and rebuild individual and communal psychosocial well-being; strengthen the coordina�on and enhance informa�on systems to improve the life-saving response by partners.

The coordina�on of Mental Health and Psychosocial Support Sub Working Group (MHPSS SWG) in north-east Nigeria has the representa�on chaired by the State Ministry of Health (SMoH) and co-chaired by IOM. It is within the Health sector coordina�on mechanism and has linkage with relevant sectors and sub working groups (Protec�on sector, Child Protec�on sub working group, GBV sub working group, Displacement Management System (CCCM/Shelter/NFI), Educa�on sector, Nutri�on sector). The work of MHPSS SWG is guided by the core principles in the IASC Guidelines Mental Health and Psychosocial Support in Emergency Se�ngs (2007).

The MHPSS SWG has set of objec�ves to improve the design and delivery of MHPSS interven�ons, serve as the reference body for coordina�on to minimize duplica�on of efforts and comprehend gap, guidelines development and ensure the implementa�on of IASC guidelines, technical advice and oversight of MHPSS in north-east Nigeria.

Working in support of the Government, MHPSS SWG and the humanitarian partners will work together to implement an integrated approach of mental health and psychosocial support to coordinate and ensure effec�ve interven�ons to rebuild resilience of crisis-affected people in north-east Nigeria. Capacity-building among partners and stakeholders will be strengthened, especially in coordina�on, response and monitoring, as well as in more technical topics such as on IASC guidelines on MHPSS in emergency se�ngs, MHPSS need assessment and analysis, MhGAP humanitarian interven�on guide, psychological first aid, and monitoring and evalua�on framework for MHPSS in emergency se�ngs. The well-being of staff is also a top priority, efforts to support through regular training on staff care and support to humanitarian actors with specific session of local context in north-east Nigeria. In Q1 2018, the MHPSS SWG has finalized its first round MHPSS partners and services profile through collec�ng informa�on from 5Ws of relevant sectors and verifying with partners and stakeholders to increase the reliability of informa�on. Currently there are six partners in Adamawa, fourteen partners in Borno, and five partners in Yobe. The profile will be quarterly reviewed to ensure the informa�on is up-to-date.

The improvement on MHPSS informa�on management and mapping will be one of key ac�on plan to support decision making through dissemina�on of relevant and up-to-date informa�on in the form of MHPSS partners and services profile, assessment report, situa�onal updates, dashboards, mee�ng minutes, lessons learned and best prac�ces.


OVERVIEW: MHPSS SWG IN NORTHEAST NIGERIA

2¹ Humanitarian Response Plan Nigeria (2018) www.humanitarianresponse.info/en/opera�ons/nigeria

Inaccessible areas

Less than 3

3 - 6

More than 6

Number of partners

Fune

Tarmua

Gujba

Bursari

Fika

Geidam

Yusufari

Yunusari

Jakusko

Gulani

Damaturu

Karasuwa

Nangere

Bade

Potiskum

Bade

Biu

Bama

Song

Toungo

Fufore

Damboa

Konduga

Kukawa

Mafa

Jada

Marte

Hong

Kaga

Magumeri

Abadam

Gubio

Gwoza

Mobbar

Gombi

Hawul

Ganye

Dikwa

Nganzai

Girei

Ngala

Chibok

Shani

Guzamala

Askira/Uba

Maiha

Demsa

Monguno

Bayo

Kala/Balge

Mayo-Belwa

Shelleng

LamurdeNuman

Michika

Guyuk

Madagali

Yola South

Mubi North

Kwaya Kusar

Mubi South

Jere

Adamawa

Yobe

Maiduguri

Yola North

14

6

5Borno

MHPSS Sub Working Group

MHPSS Sub Working Group 3


Over the course of the three month period, IOM reached 27,328 new beneficiaries with psychosocial support services. The Organiza�on also conducted Psychological First Aid (PFA) trainings to 56 humanitarian actors, and protec�on trainings for all IOM internal units.

A joint effort training on “Staff Care and Support for Humanitarian Actors”, led by the MHPSS Sector Working Group, IOM’s Capacity Building unit and the Humanitarian Hub Counselor, was held in March at the Red Roof Humanitarian Hub in Maiduguri, following an a�ack in Rann (one of the hard-to-reach areas in Kala/Balge Local Government Area (LGA) of Borno State), in which three humanitarians were killed.

IOM’s MHPSS team also par�cipated in verifica�on exercises as part of Monitoring and Repor�ng Mechanism missions to assess viola�ons of child rights and child abuse, and supported the deployment of Na�onal Agency for the Prohibi�on of Trafficking in Persons (NAPTIP) officials to hard to reach areas (such as Ngala, Dikwa, Bama and others) to conduct counter trafficking sensi�za�on campaigns.

Through the intergra�ons of psychosocial ac�vi�es with the small component on livelihood support, IOM has developed vulnerability selec�on criteria that includes gender considera�ons. These forums have been used to strengthen the social fabric through various community ac�vi�es, including preven�ons of SGBV.

109,605 MHPSS Services per person provided, reaching 27,328 new beneficiaries

INTERNATIONAL ORGANIZATION FOR MIGRATION

© IOM 2018

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Func�onal psychosocial support with emphasis on early childhood play-based s�mula�on ac�vi�es for children admi�ed in the stabiliza�on centers is an ongoing care and support for children to meet their age-appropriate and iden�fied emo�onal, cogni�ve, social and physical needs. These aspects of support were carried out to encourage children’s interac�on with their surroundings focused on improving maternal child s�mula�on that reinforce mother-child bonding. Actually the impact of this interven�on was clearly observed in recovery rate because of the significant propor�on of cured beneficiaries at the stabiliza�on centers.

The IRC has been integra�ng psychosocial support in management of severe acute malnutri�on both in MMC and Jere stabiliza�on centers. A total of 355 children with severe acute malnutri�on (SAM) aged 6-59 months have been admi�ed into the therapeu�c feeding program, of which 290 children were managed and discharged home. The IRC stabiliza�on centers have sustained their tempo in their strides to improve quality and efficient service delivery for inpa�ent management of pa�ent with severe acute malnutri�on (SAM) with medical complica�ons. Also serves as a training and referral center for UNICEF, WHO, INGOs and their implemen�ng partners. The child friendly spaces (play rooms) are well equipped with enough toys that are cogni�ve sensi�ve which are tailored on improving the children’s cogni�ve domain during their concrete opera�onal stage. A total of 355 care givers/mothers of children admi�ed with severe acute malnutri�on with

complica�ons have been reached with psychosocial support (individual psychotherapy and group psychotherapy) in an effort to reduce the incidence of maternal psycho trauma in the IDPs camp and host communi�es. A total of 82 community outreach workers from nutri�on sector and stabiliza�on centers, had three days psychosocial support capacity building on how to iden�fy and counsel trauma�zed mothers of infant with severe acute malnutri�on.

All children can be affected by sensory processing issues, so exposing children to varie�es of sensory ac�vi�es in a playful manner can alleviate some of their problems

Nyali Ali, a 2 years old child was brought from Baga road community to Umaru Shehu Stabilization Centre on account of severe acute malnutrition with complication.

Few days after Nyali’s admission she was moved to transition phase and then later to rehabilitation phase, she seems to have remarkably improved. Had early childhood play based stimulation activities in the child friendly space IRC stabilization center Umaru Shehu M.M.C

A- Before admission B – After admission

IRC stabilization centre child friendly space Mashamari Jere.

Summary of PSS Program Response from January – March 2018

INTERNATIONAL RESCUE COMMITTEE


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MANDATE HEALTH EMPOWERMENT INITIATIVE

The Mandate Health Empowerment Ini�a�ve (MHEI) is a Not-For-Profit, Non-Governmental Organiza�on founded and duly registered in Nigeria. Our core mandate centers on mental health in-terven�onist programs and projects, advocacy outreaches, free-from-drugs-and-substance dependency campaigns and providing psycho-social support for vic�ms of communal and religious clash-es (Internally Displaced Persons). Available sta�s�cs paint a gory picture of millions of Nigerians suffering under a form of mental condi�on. We also work with nursing mothers and the aged in ru-ral communi�es where we address issues of malnutri�on among school age children and depression in pregnant and nursing women, and the ugly culture of s�gma�za�on.

The Mandate Health Empowerment Ini�a�ve is centred on mental health promo�on, care and psychosocial support through sensi�za�on, advocacy and early interven�on with a par�cular interest in school-age children and pregnant and nursing women in Africa.

Molai-Maiduguri, Nigeria, 7-13 January 2018. We received an invita�on from Pro Health Int’l via the execu�ve director Dr Iko Ibaga to par�cipate in their Health Outreach at Molai, Maiduguri Ni-geria. We were invited to work in their mental and trauma counseling unit thereby educa�ng the target audience on mental health.

The mental and trauma counseling unit was headed by Dr. Akuwuyi. The event which lasted for five days had catalogs of ac�vi�es in the General Hospital Molai, the rehabilita�on center in Bolumkutu Maiduguri, an orphanage home owned by the vice president and also Bakassi IDP camp in Jere MMC.

In Molai, intensive health promo�on and educa�on covering personal health care hygiene, nutri�on, sanita�on even sex gender based violence were largely discussed, several focus group session were held to further discuss health promo�on among the peer groups.

A session of mental health, trauma & counseling by Mr. Zion Abba Ameh was held also in Molai to enlighten individuals on mental health and mental disorders also, par�cipants were educated on various psychosocial support interven�ons.

In Bolumkutu rehabilita�on center, some members of staff of the women affairs and social devel-opment ministry were present to monitor the proper care of the internally displaced persons (IDPs), we met about twenty-five (25) IDPs in which some of them had cases of mental illnesses ranging from depression to psychosis. We were told that over 700 of the IDPs that have been rehabilitated have been reconnected back to their families.

In Bakassi camp in Jere, we were able to go to the schools and IOM centers were we interacted with a group of adult men to sensi�ze them on the place of mental health and how to manage trauma. We also had extensive talk on gender based violence with emphasis on sexual abuse, the place of the s�gma and effec�ve solu�on also informing that the prac�cal applica�on of the solu�ons as taught will not only have a posi�ve effect on the vic�m, but also the family, community and society at large. Some members of the community were also trained to iden�fy some of the signs and symptoms of mental disorder, substances use and abuse and gender based violence within their re-spec�ve communi�es.

We had a play session with primary and secondary school students. We met with the women during the livelihood session. There was a focus group session with the widows, in all we had a great expe-rience, mee�ng people’s psychosocial needs.


6

MEDECINS DU MONDE


Psychoeducation at kawar maila Camp, with the MHPSS counsellors and beneficiaries.

Meeting with female community leaders at Damboa on to improve MHPSS sensitization

What MdM Does:Médecins du Monde or Doctors of the World, is an Interna�onal Humanitarian Non-profit Organiza�on that provides emergency quality Primary Health Care services to vulnerable popula�ons while advoca�ng for equal access to healthcare worldwide. Mdm offers Primary Health Care services (Nutri�on services, Sexual and Reproduc�ve Health services, and Primary Health Care Consulta�on Services, Integrated GBV response team, and Mental Health and Psychosocial Support Services) at El-Miskin Camp (Jere L.G.C.), Garba Buzu (MMC), Kawar-Maila (MMC) Hussari Camp (Damboa L.G.C.) and Mainok (Kaga L.G.A) serving both IDPs and Host Communi�es.

The MHPSS component offers individual counselling, group counselling, psycho-educa�on psychotherapy.

Our most common cases seen are; Psychological/Psychiatric cases such as ASD and PTSD, Major Depressive Episodes, Anxiety Disorders, Stress induced hypertension, and then Psychoses; Lifestyle adjustment problems, GBV cases, psychological distress, Epilepsy/Seizure disorders, psychosocial cases such as livelihoods concerns, etc.

Capacity Building: Working closely to mainstream MHPSS into all MdM’s components. MHPSS team has trained most staff, both medical and non-medical on some relevant MHPSS topics, these topics are; Self-care for humanitarian workers, Effec�ve and Respec�ul Communica�on in clinical se�ng, Psychological First Aid, Stress management model via the Stress Inocula�on sessions. Furthermore, the team has been trained from other partners offering specialized services, this include the recently completed MhGap Interven�on Guide Training for the team. On our referrals, MdM enjoys a good referral network with other mental health actors such as the IOM and the WHO, and recently, MdM has strengthened rela�onship with IRC and Save the Children for protec�on concerns; and Chris�an Aid most recently for other forms of services not provided by MdM.

Beneficiaries reached: Figure below shows the number of beneficiaries reached for each ac�vity. For the individual PSS, individual counselling is majorly the ac�vity captured, while for the Group PSS, group counselling, support group ac�vi�es, child PSS ac�vi�es are all captured here.

MHPSS ac�vi�es within the last quarter (January – March 2018)


January February MarchMale 16 26 42 84 Female 62 91 69 222 Male 410 695 780 1,885 Female 988 1,780 2,269 5,037

1,476 2,592 3,160 7,228

Total

Total per month

Month

Individual PSS

Group PSS

Ac�vity Gender

The bar chart in figure 1 illustrates that the Boko Haram survivors assessed in these loca�ons manifest symptoms of PTSD including intrusive, avoidance and hypervigilance symptoms. It also shows that a higher number of survivors manifest intrusive symptoms follow by avoidance and hypervigilance symptoms. The survivors were adults and children including CAFAAGs and OVCs.

The bar chart in figure 2 shows that the Boko Haram survivors assessed in these loca�ons manifest depressive, anxiety and stress

symptoms. Concerning symptoms of depression, it shows manifesta�on of higher number of survivors with severe symptoms, then moderate, extremely severe, mild and normal symptoms. For anxiety it indicates higher number of survivors manifest extremely severe symptoms, follow by severe, moderate, mild and normal symptoms. Regarding stress, it entails that a higher number of survivors manifest severe symptoms, next with extremely severe, moderate, mild and normal symptoms. The survivors were adults and children including CAFAAGs and OVCs.

7


The Boko Haram crisis have caused psychological distress among adults and children (CAFAAGs and OVCs) who are experiencing intrusive, avoidance, and hypervigilance symptoms of PTSD. Also there is manifesta�on of normal, mild, moderate, severe, and extremely severe symptoms of depression, anxiety, and stress disorder among the vic�ms (Neem Founda�on MHPSS Assessment, 2018).

A total number of 1,069 clients were assessed within the period using standardized tools by Neem Founda�on trained lay counsellors, protec�on officers and being directly conducted or supervised by clinical psychologists. Their level of psychological distress can be seen as below:

NEEM FOUNDATION

1st QUARTER MHPSS ASSESSMENT CONDUCTED BY NEEM FOUNDATION IN MORAMTI AND DUBAI HOST COMMUNITIES, LAFIA SARARI SCHOOL, AND BAKASSI IDPs CAMP IN MAIDUGURI-BORNO STATE

Note: It is important to note that some client manifested multiple symptoms. This is represented in bar charts as follow:

PTSD0

200

400

600

Post Trauma�c Stress Disorder-PTSD among Boko Haram Survivors in Moran� and Dubai Host

Communi�es and Bakassi IDPs Camp in Maiduguri-Borno State

Intrusivve Symptoms Avoidance Symptoms

Hypervigilance Symptoms

Depression Anxiety Stress0

100

200

300

400

Depression, Anxiety and Stress among Boko Haram survivors in Moram� and Dubai host Communi�es, Lafia Sarari, and Bakassi IDPs Camp in Maiduguri-

Borno State

Normal Mild Moderate Severe Extremely Severe

Figure 1 Figure 2


PTSD

Depression

Anxiety

Stress 91 97 123 240 166

41 52 111 160 353

74 100 199 224 151

577 422 371

Number of Clients with Normal Symptoms

Number of Clients with Mild Symptoms

Number of Clients with Moderate Symptoms

Number of Clients with Severe Symptoms

Number of Clients with Extremely

Severe Symptoms

Number of Clients with Intrusive Symptoms

Number of Clients with Avoidance Symptoms

Number of Clients with Hypervigilance SymptomsPsychological Distress

UNITED NATIONS CHILDREN’S FUND

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In the first quarter of 2018 (January – March), UNICEF and its implemen�ng partners provided cri�cal child protec�on services to 200,160 children and caregivers in the crisis affected states of Borno, Adamawa and Yobe. This represents 35% of the 2018 HAC target. Out of the total number above, 151,266 received PSS ac�vi�es meaning 75% of the case load access PSS services. This number includes 37,519 children (18,202 girls and 19,317 boys) and 2,620 caregivers (1,239 women and 1,381 men) reached in March.

This result is a�ributed in parts to improved capaci�es of implemen�ng partners and UNICEF LGA Consultants and community volunteers in �mely and accurate repor�ng and monitoring of results and also the scale-up of psychosocial, life skills, risk educa�on, case management and reintegra�on services to children. In Borno, 38 child protec�on workers (20 males,18 females) from MMC, Jere and Konduga LGAs received addi�onal skills in reinforcing the coping mechanism, psychosocial wellbeing and enrichment of the life skills of children and adolescent through a three-day refresher training.

Girls participating in the MAFA in PSS activities in the Mafa IDP camp

A master trainer working with community volunteers on how to use the UNICEF Adolescent kits when running an adolescent group section.

Girls participating in the Potiskum PSS- Life Skills adolescent kits activities


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WORLD HEALTH ORGANIZATION

WHO in collabora�on with Ministry of Health, State Primary Health Care Development Agency (SPHCDA) and Federal Neuro-Psychiatric Hospital (FNPH) Maiduguri integrate treatment of men-tal health condi�ons at Primary Health Care level through Mental Health Outreach sessions at some Primary Health Care facili�es and some clinics within IDP camps in Borno State to address unmet top layer of IASC interven�on pyramid for MHPSS (Provision of Specialized Services).

There were 251 MH Outreach sessions between January to March 2018, conducted by 10 MH specialist. 4,290 mental health pa�ents were a�ended to (Epilepsy/seizure disorders, alcohol or other substance use disorders, mental retarda�on/intellectual disability, psycho�c disorders, severe emo�onal disorders, other psychological disorders and medically unexplained soma�c complaints), out of which 1,028 were referred to FNPH for further management and 124 of them were admi�ed.

70 primary health workers (53 females, and 17 males) were trained on mhGAP-IG from 26th to 30th March, 2018 at Federal Neuro-Psychiatric Hospital, Maiduguri who will be mentored on the treatment of mental health conditions at primary health care levels. 12 of the trainees came from 11 new addi-tional health facilities in Borno State.

On 15th March, 2018. Giving motivational interview to a psycho-active substance abuser at CAN Center Camp Clinic Maiduguri during routine MH outreach supervisory visits.


On 16th February, 2018. Attending to a beneficiary referred to FNPH to re-enforce motivation to overcome drug dependence.

MHPSS SUB WORKING GROUP (MHPSS SWG) PARTNERS

Deborah Gayatri Magdalena

Working Group Coordinator (MHPSS)

+234 (0) 8124515325

Email: [email protected]

Government Agencies:

Adamawa State Ministry of Women Affairs and Social Development, Borno State Ministry of Health, Borno State Ministry of Women Affairs

and Social Development, Federal Neuro-Psychiatric Hospital, Presiden�al Commi�ee on the North-East Ini�a�ve, Yobe State Ministry of

Youth, Sports and Social Development.

Community Based Organizations, National and International NGOs, UN Agencies:

Bri�sh Council, Care for Life, Care Interna�onal, Center for Community Health and Development Interna�onal, Community Development

and Reproduc�ve Health Ini�a�ve, Family Health Interna�onal-360, Heartland Alliance Interna�onal, Interna�onal Commi�ee of the Red

Cross, INTERSOS, Interna�onal Medical Corps, Interna�onal Organiza�on for Migra�on, Interna�onal Rescue Commi�ee, Life at Best

Development Ini�a�ve, Mandate Health Empowerment Ini�a�ve, Médecins du Monde, Neem Founda�on, North East Youth Ini�a�ve for

Development, Plan Interna�onal, Premiere Urgence Interna�onale, Save the Children, Street Child, Translators without Borders, United

Na�ons Children’s Fund, United Na�ons High Commissioner for Refugees, United Na�ons Popula�on Fund, World Health Organiza�on.

Acknowledgment to partners for their contribution to the MHPSS SWG Quarterly Update(Q1 January – March 2018)

Dr. Muhammad A. Ghuluze

Director of Emergency Response

Borno State Ministry of Health

+234 (0) 8036176866

Email: [email protected]

For further informa�on, please contact

mental health and psychosocial support (mhpss) · organiza on also conducted psychological first...

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