2014 Annual Technical Review Workshop

1. 2014 Annual Technical ReviewWorkshop MHPSS In Dadaab Dr Adan/Birongo March 2014

2. 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

3. 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.

4. 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.

5. Services provided/components • PSYCHIATRIC SERVICES -Facility based consultations -Community based /family support -Referrals where necessary

6. Services provided/components Cont’d • PSYCHOSOCIAL SERVICES -Psychotherapy -Psychological Counseling/support -PFA -Home Visits/community sensitization - play/art therapy

7. 2013 Psychiatric Consultations

8. 2013 Admissions

9. Mental Health Morbidity % 2013 Key:1. Depression, 2. Anxiety, 3. Epilepsy, 4. MUPS, 5. Bipolar, 6. Schizophrenia, 7. PTSD, 8. DIP, 9. Intellectual Disability, 10. Others

10. Comparison (Consultations) 2011/2012/2013

11. 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.

12. Achievements Cont’d • During 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)

13. 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)

14. Achievements Cont’d • Provision of Psychological First training for IRC staff in Hagadera • Training on stress management for UN staff

15. 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

16. 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.

17. 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.

18. 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

19. 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

20. 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.

21. Patient with chronic treatment resistant schizophrenia in a cage

22. Chained patient as generally practiced in the camp

23. An elderly mentally ill lady chained at home

24. A post partum mother chained to prevent her harming the child

25. THE END THANK YOU