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