Zimbabwe experienced a drought in 2019 and livestock farmers were hit hard. Cattle crossing a dry river in Nkayi District, Nov. 2019. Credit: Busani Bafana/IPS

By Busani Bafana
BULAWAYO, Zimbabwe, Aug 20 2025 (IPS)

My family lost six herds of cattle during the devastating El Niño-driven drought that swept Zimbabwe in 2024. The loss was as emotional as it was financial. Guilt gnawed at me.

Drought was nothing new—the past three years had made it painfully clear that I needed to supplement the cows’ feed and ferry water from kilometers away just to keep them alive. But I was fighting a losing battle, desperately trying to sustain emaciated, skeletal animals. Eventually, I had to accept the inevitable: climate change had killed our cattle, and I had been complicit in their suffering.

Have I moved on? Not really. At first, I told myself my distress was an overreaction. After all, countless farmers lost hundreds of livestock and watched their crops wither to nothing. They had suffered more and lost more than I was crying over. Stress, I reasoned, was simply part of the job.

Journalists report on climate change without being personally affected—or so I thought. I was wrong.

Climate change doesn’t just destroy landscapes and livelihoods; it takes a psychological toll on journalists who highlight its horrors.

A groundbreaking study by Dr. Antony Feinstein, a psychologist at the University of Toronto, reveals a hidden crisis: journalists covering the climate crisis are suffering profound emotional and mental health consequences. The research presented during a discussion organized by the Oxford Climate Journalists Network (OCJN) surveyed 268 journalists across 90 countries, spanning Africa, Asia, Europe, and the Americas.

The findings are staggering and spoke to me. Forty percent of journalists reported experiencing depression, while one in five exhibited symptoms of post-traumatic stress disorder (PTSD), often linked to the “moral injury” of bearing witness to environmental destruction. More than half (55 percent) of the journalists said they lacked access to psychological support, and 16 percent had taken time off work for mental health reasons as a result of covering climate change stories.

The numbers grow even grimmer: nearly half of the journalists surveyed reported moderate to severe anxiety (48%) and depression (42%). Around 22% showed prominent PTSD symptoms. Worse still, 30% had been directly impacted by climate change—losing family, friends, or homes to the crisis. I counted myself in that statistic. I may not have lost a family member, a friend or a home but if cattle count as part of my life, I was affected.

As a journalist reporting on climate change in Zimbabwe—one of the world’s most vulnerable nations—these findings hit close to home. They exposed a fragility I had long dismissed as just part of the job.

Journalists need psychological support. Stigma about mental health runs deep and how do I tell friends and family that I am not okay reporting a story on the impacts of droughts, worse that I have witnessed the loss of six cattle because I could not save them when the drought decimated pastures and dried water supplies? So what? negative events are normal and feeling bad is, I guess, normal too? I have had a lingering question. Surely I can be unsettled by the deaths of cattle and listening to the desperate narratives of farmers about how climate change has upended their lives?

I was depressed, sad, and guilty. I could not do anything to stop cattle dying nor could I pacify farmers in pain. The trauma in covering catastrophe after catastrophe is numbing. Journalists who report on climate change are witnessing a global crisis of our time, and they need support to deliver the news without sacrificing their mental health.

Witnessing tragic events carries a heavy burden for journalists who report on them. I recall covering a story about the impact of drought on livestock farmers in Matabeleland, Zimbabwe’s northern province, where farmers were sharing their staple maize with their cows to keep them alive. Many lost more, some three, five and six cattle between them, but they did give up, though despair was scrawled on their faces. I was shocked and numbed by listening to their sad narrations, but I had to get the story out. I felt hopeless.

Getting a “good” story out of bad experiences means I have to make a tough choice of putting my feelings aside and getting the job done. I have not acknowledged the mental load of witnessing the trauma of covering disasters, yet journalists are supposedly resilient to disturbing news and they soldier on. But no. I have experienced depression at the thought of how people bounce back from personal loss when climate change hits. It is a horror movie that continuously plays in my mind as I go about reporting.

Journalists would benefit from a comprehensive support programme to help them step away from the pressure of being witnesses to catastrophic events. The trauma is beyond comprehension; there is no justification to suffer in silence, especially when mental stress is not talked about in public but endured in private. As a journalist, I have been a victim.

How do I separate myself, my mind and my emotions from the sad stories I cover? I do not have an answer. I am convinced that journalists should tell climate change stories but not be forced to live the reality, although that is almost impossible. Many like me are living the stories they tell with deep scars of mental fatigue and regret.

I believe that newsrooms can offer support in terms of preparing journalists to have the mental agility to report on crises without taking strain from reporting them. Moreover, the impacts of climate change, which is a defining story of the century, affect everyone. Those who say so are at the forefront of agitation, anguish, and hopelessness.

The climate crisis is breaking more than just ecosystems—it’s breaking the journalists who tell its story.

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Since the Taliban's return to Afghanistan in 2021, numerous women grapple with profound mental health challenges, often in silence, fearing repercussions for speaking out. Credit: Learning Together

By External Source
May 16 2024 (IPS)

Afghanistan is grappling with a growing crisis of mental illness, particularly among its women, as highlighted in a United Nations report. Officials from the mental health department at Herat regional hospital have observed a concerning uptick in the number of women afflicted by psychological disorders in the province.

According to these officials, nearly eighty percent of individuals seeking treatment for depression are women and girls. The medical center witnesses a daily influx of one hundred patients seeking assistance.

“Every day, 100 people come for treatment, and more than two-thirds of them are women”, according to one of the doctors of the Association of Clinical Psychologists in Herat, who did not want to be named in the report due to security issues.

Nearly 400 people have been sent to further treatment within one month and the numbers continue to increase daily. Most patients are given psychological counseling but those with severe illness are referred to the regional mental hospital in Herat.

Several factors contribute to the surge in mental illness among women. Economic hardships have intensified, while the oppressive rule of the Taliban has cast a shadow over their future prospects. Additionally, a widespread increase in domestic violence against women, coupled with restrictions on female education and employment, compounds the issue.

“I often experience sudden panic attacks,” shared Marjan, a patient at the hospital. “My heart feels weak, and I constantly battle lethargy. The ban on my education has plunged me into depression,” she lamented.

With tears in her eyes and pain in her voice, she complained how long she and other women would continue to be imprisoned within the four walls of their homes and live with uncertainty of the future.

Marjan continues, “I am the third wife of my husband, and I am always subjected to violence and beatings by my husband or my husband’s wives.”

In some regions, such as Herat, polygamous marriages are common, leading to intra-family conflicts where women bear the brunt of the repercussions.

Marjan, a victim of such a marriage, disclosed her failed suicide attempts and attributed her plight to the Taliban. Forced into marriage by her father during the Taliban regime, she was compelled to relinquish her role as a civil activist and former employee of a human rights organization under the previous government.

“Now, I am left with mere memories of a life that no longer exists,” she lamented bitterly.

Nafas Gul, a mother of five also in Herat Province narrates her story. Her daughter, sixteen-year-old Shirin Gul, is severely depressed, judging from her regular cries and calling her home prison, her mother explains. Shirin no longer attends school.

Memories have made most girls and women depressed. A large number of them have stayed at home, unable to work or acquire education.

In Afghanistan, many victims of domestic violence struggle to find assistance in overstretched healthcare systems. Credit: Learning Together

With the return of the Taliban in Afghanistan in 2021, women have been deprived of their rights, especially the right to work and education. The majority of women in Herat are against recognizing the legitimacy of the Taliban government, rather they say that recognition should be given in return for improving the status of women. 

Doctors caution that without intervention, the number of individuals suffering from depression, particularly in Herat province, will continue to escalate.

Excerpt:

Yasmine Sherif, Director of Education Cannot Wait and Jan Egeland, Secretary General of the Norwegian Refugee Council meet students at the Souza Gare school in the Littoral region, Cameroon. The school hosts displaced children who have fled the violence in the North-West and South-West regions. Credit: ECW/Daniel Beloumou

By Joyce Chimbi
Copenhagen, Aug 30 2022 (IPS)

Hiding in basements during bombings, fleeing their homes, going hungry, and facing the devastating and life-transformative traumas of losing their loved ones as their childhoods go up in flames of war. These are the lived experiences of crisis-impacted children and adolescents.

“They have also seen militia, army and may have been subjected to war crimes, violations of international law, sexual violence and torture. When you go through such experiences, without a doubt, you are going to suffer some form of trauma,” says Yasmine Sherif, Executive Director of Education Cannot Wait (ECW), the United Nations global fund for education in emergencies and protracted crises

She tells IPS that this is the reality for many of the 222 million crisis-impacted children. At the forefront of extreme, unrelenting violence and brutality, but left furthest behind in accessing a most critical human right, mental health services.

“It is imperative that for every child, every adolescent that lives in this complex humanitarian crisis, that their mental health is safeguarded and supported that they receive psychosocial services working with their resilience. For they indeed have a resilience that took them that far and enabled them to survive,” she says.

Sherif stressed that acknowledging and addressing the need for student and teacher mental health and psychosocial support (MHPSS) is fundamental for children and adolescents to be able to learn. That if they are going to resume education, it is critically important that they receive psychosocial support.

“We must ensure that education investments always entail a strong component of mental health and psychosocial support. ECW has integrated mental health and psychosocial services into all our investments. There is no investment in any of the 44 countries where we have invested which does not have a component of mental health and psychosocial services,” Sherif tells IPS.

“Crisis-impacted children and adolescents receive psychosocial support through the education that we have invested in. It is therefore very important that financing for education through ECW dramatically increases so that we can provide even better context-specific mental health services and psychosocial support.”

Speaking against the backdrop of the Nordic Conference on MHPSS in Fragile and Humanitarian Settings, Sherif unpacked safe, inclusive, and quality education as child-centered, holistic education that includes, amongst others, school feeding, teachers, water and sanitation as well as mental health and psychosocial support.

“ECW has reached 7 million children and adolescents in less than five years, and MHPSS is at the core of our work with our partners. To have an impact on MHPSS, we need funding, long-term investments, and working across organizations and disciplines,” Sherif remarked during the conference’s opening panel.

Over 13,800 learning spaces now feature mental health and/or psychosocial support activities, and the number of teachers trained on mental health and psychosocial support topics doubled in 2021, reaching 54,000.

“It costs money to save the world. To give a holistic education centered on MHPSS requires a minimum of 150 dollars per child, and we are speaking about 222 million crisis-impacted children. We have the greatest dream and science on earth, but if we cannot pay for that, it is not going to happen,” Sherif emphasizes.

Co-hosted by the Danish Ministry of Foreign Affairs and Danish Red Cross, the inaugural conference “A Human Right Left Behind: A Nordic Conference on MHPSS in Fragile and Humanitarian Settings” was held on August 29 and 30, 2022, in Copenhagen.

The conference aimed to solidify Mental Health and Psychosocial Support (MHPSS) as a priority concern in all humanitarian responses and address urgent needs to increase access to quality MHPSS.

Recognizing the need for meaningful, collaborative approaches and solidarity in MHPSS, the conference’s Steering Committee includes the IFRC PS Centre for Psychosocial Support, Danish Red Cross, International Children’s Development Program Norway, MHPSS Collaborative, Save the Children Denmark and War Child Sweden.

The conference marks the beginning of a process and movement of joint strategies and collaborative action between multilevel MHPSS stakeholders.

Conference themes include localizing and strengthening MHPSS systems, direct MHPSS interventions, child-, youth-, and caregiver-focused MHPSS, cross-sectoral integration/coordination mechanisms, and innovative approaches.

Conference outcomes include a Nordic Network on MHPSS Launch, 2022-2030 Joint Nordic Roadmap on MHPSS in Humanitarian Settings, and a Copenhagen Declaration on Prioritizing MHPSS in Humanitarian Action.

ECW’s most recent estimates released in June 2022 show 222 million school-aged children and adolescents are caught in crises globally, 78.2 million who are out of school. An estimated 65.7 million of these out-of-school children, 84 percent, lived in protracted crises.

Approximately two-thirds of them, or 65 percent, are in just ten countries, including Afghanistan, Ethiopia, the Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Sudan, and Yemen.

The difficulties they face from sustained conflict and forced displacement are now multiplied by climate-induced disasters and the long-term effects of COVID-19.

Within this context, Sherif urges the global community to respond with an education package centered on healing the brutalized minds of the affected children.

ECW’s landmark Technical Guidance Note on Mental Health and Psychosocial Support (MHPSS) in Education in Emergencies, and Protracted Crises (EiEPC) provides practical guidance to grantees to ensure children and adolescents receive a holistic education that protects and promotes student wellbeing.

ECW’s MHPSS in EiEPC Technical Guidance Note aims to be used as a reference in partners’ guidance and standards, such as in UNICEF/WHO/UNHCR’s Minimum Service Package for MHPSS in education in emergencies.

An education that is blind to the special mental health needs of children and adolescents in fragile and humanitarian settings, she says, will simply not keep the promise of a safe, inclusive, and quality education for the world’s most vulnerable children.

To keep the promise of holistic education, ECW’s High-Level Financing Conference will take place in Geneva in February 2023. Hosted by Switzerland and Education Cannot Wait – and co-convened by Germany, Niger, Norway, and South Sudan – through the 222 Million Dreams campaign, the conference calls on government donors, private sector, foundations, and high-net-worth individuals to turn commitments into action by making substantive funding contributions to ECW.

Through these contributions, targeted crisis-impacted children and adolescents will be reached with mental health and psychosocial services that include counseling, social group work, online counseling, training of teachers, and other means of providing mental health support.

“We really appeal to all governments, private sector, and high net individuals to make pledges at the upcoming conference to enable us to expand mental health support and education at large,” Sherif concludes.

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Refugee tents in a camp in Greece. UN report shows refugees may be affected by poor health outcomes. CREDIT: Julie Ricard/Unsplash)

By Juliet Morrison
United Nations, Aug 16 2022 (IPS)

While refugees globally face insecurity and uncertainty, a new World Health Organization (WHO) report highlights that they also face poorer health outcomes.

The World report on the health of refugees and migrants, published on July 20, 2022, was the first to survey studies of various refugee health outcomes, including mental health.

The report highlighted that refugees are not inherently less healthy than host populations but that various social factors, including changes in income, substandard living conditions, and barriers to other services, can result in poorer health and well-being.

Refugees from conflict-affect areas are also at a higher risk of developing mental disorders like PTSD, anxiety, and depression. While rates vary by population and region, one study cited by the WHO estimated the burden of conditions to be 22.1 percent.

But experts caution that estimates of PTSD in the field may be overstated because of the difficulty of discerning a post-traumatic stress disorder (PTSD) response from a normal behavioral response to trauma.

The WHO report also dove into the importance of mental health, which Dr Timothy Mackey, a global health professor at the University of California San Diego, told IPS is often neglected.

According to one report, only 0.3% of international assistance for health went to mental health care between 2006-2016. Refugees can also be excluded from accessing health services in certain countries based on their migratory status.

The neglect of mental health care is often because of limited resources and capacity, added Mackey. Healthcare issues that are more visible and studied extensively tend to be more significant priorities.

“[Mental health] is harder to advocate for than a lot of the more quantifiable diseases like an infectious disease outbreak, or diabetes, or heart disease or cancer, where you may have more compelling global disease burden statistics.”

Despite this, Mackey added that addressing mental health can be a real benefit for countries as treating mental health leads to many positive effects.

“Because there can be such clear acute trauma, and especially in the early stages of the lifecycle with children, [mental health issues] can have very lasting impacts for economic productivity or long-term health outcomes. […] Addressing mental health is a preventative component. It can save health systems money, and it can lead to better long-term outcomes.”

But disorders are only one aspect of mental health. Some academics advocate for treating refugees holistically – taking into account the overall well-being of refugees in addition to visible health problems.

This means examining the social factors affecting a person’s mental state, like living and working conditions. The WHO report revealed that both could play a big role in overall refugee well-being.

According to one study, Palestinian refugees from occupied territories had a reduced risk of mental disorders when they were in secure housing in Lebanon. Another study on Southeast Asian refugees in Canada showed a significant improvement in mental health once refugees had access to the labor market and could generate income.

Hussein Alzribi, a former refugee from Syria, is familiar with how a lack of security can affect well-being. He fled Syria in February 2016 and underwent a brief transitory period in Greece before settling in the Netherlands.

Unable to practice law as a refugee, Alzribi told IPS that his stretch of unemployment felt hopeless.

“I couldn’t practice my profession, I didn’t know who to ask, and I had no money. There was nobody to give me guidance and help.”

He has since co-founded a non-profit that provides coaching to help refugees find employment. His co-founder, Bev Weise, told IPS that their non-profit, Refugee JumpStart, is a great support to refugees.

She said that being employed and generating income makes them feel part of society.

Dr Michaela Hynie, a psychology professor at York University in Canada, echoes this claim. In her research, she’s found many of these problems around refugee well-being to be rooted in social exclusion and systemic problems, rather than individual issues.

She stressed to IPS that many of the concerns of refugees she’s encountered center around a lack of stability and security.

“We default to mental health, which allows us to then say it’s about the individual and they have a mental health problem, and we need to teach them to be resilient as opposed to they’re in a system that is preventing them from establishing the things that we need for mental health.”

She argued that to improve refugee well-being, governments should focus on finding ways for people to thrive and find opportunities.

Most countries do not have policies on refugee well-being. Many are also far from considering refugee health in a comprehensive way that takes well-being into account, Mackey told IPS.

Getting to that place requires prioritizing refugee health. The WHO has stressed this requires focusing on data collection. Refugees are largely invisible from health data because large-scale surveys tend not to disaggregate their results by migratory status. This can make public officials “oblivious” to health issues within their borders.

The WHO stated that more data could enable better monitoring and strengthen compliance with refugee-related Sustainable Development Goal (SDG) targets.

“It is imperative that we do more on refugees and migrants’ health, but if we want to change the status quo, we need urgent investments to improve the quality, relevance, and completeness of health data on refugees and migrants,” Dr Zsuzsanna Jakab, WHO’s Deputy Director-General noted in the report’s press release.

Data collection is necessary for meaningful policy development, she added.

“We need sound data collection and monitoring systems that truly represent the diversity of the world population and the experience that refugees and migrants face the world over and that can guide more effective policies and interventions.”

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COVID pandemic allowed artists to find expression. Credit: Fuzia.com

By Fairuz Ahmed
New York, Aug 11 2021 (IPS)

Screens, devices, and smartphones replaced the human touch and day-to-day interactions as COVID-19 protocols forced millions of people into harsh lockdowns and prolonged isolation.

According to a report published by UNICEF, even with more than 90 percent of the countries adopting digital and broadcast remote learning policies, more than 1 billion children were at risk of falling behind due to school closures.

With school closures, remote learning and work from home, the world also faced issues with mental health, depression, coping with the loss of loved ones and heightened stress.

Irene Zaman, who has been working with teens and adolescents in New York schools for more than 15 years, told IPS in an interview that the mental health of children, teen and their parents was a significant issue.

Artist Muthulakshmi Anu Narasimhan says art helped with mental health during the COVID-19 pandemic. Credit: Muthulakshmi Anu Narasimhan

“We have got many requests from parents to offer mechanisms to assist the mental and emotional well-being of the children. This was something we never experienced, and the adaptation had to be quick,” Zaman said.

“Children, teens and even parents were facing challenges, severe or prolonged feelings of depression or sadness. As a new routine, the schools started to call homes, offering therapy and support. Among these, of the most engaging of them was art therapy for dealing with stress.”

A pilot study published in Child and Adolescent Psychiatry and Mental Health and completed during the pandemic showed that “emotion-based directed drawing intervention and a mandala drawing intervention may be beneficial to improve mental health in elementary school children.” These interventions could take place both online and via video conferencing.

Artist and entrepreneur Muthulakshmi Anu Narasimhan agrees with the findings. “One thing that is vital about art, especially during COVID, has been how therapeutic it is. Throughout my life, I have leaned on art to get me through difficult times. It helps me stop thinking about everything else and focus on creating something from nothing,” she said in an exclusive interview with IPS.

“When I bring to the world a physical representation of an idea I had, it gives me not just joy but a sense of triumph and accomplishment. Going through a lockdown and caring for two children as a single mom was difficult, but my art helped me rebalance and give a creative outlet to my fears and exhaustion. This not only resulted in a wider clientele and happier mental state but also better art! My art grew leaps and bounds because of how much I relied on it.”

Ironically while artists, performing artists, and musicians suffered financially during the pandemic, it was these things that kept people engaged. The World Economic Forum estimated that a six-month shutdown cost the music industry alone more than $10bn in sponsorships. It noted that innovative platforms were beginning to change this downward trajectory.

Riya Sinha, a co-founder of online platform Fuzia, told IPS that her platform had quickly adapted and had increased its focus on arts and learning.

“Earlier this year, with a focus on skill development and microlearning, we launched a series of webinars, quizzes, e-books and courses. We also provided a free platform and international audience base for upcoming artists to share their work,” Sinha said. “Word of mouth and international engagement has been unprecedented in helping create what we are today.”

Fuzia is an online hub that aims to drive women empowerment and gender equality by providing inspiration, empathy, and creativity, Sinha says. Any user with internet access can share this safe space and express themselves to an audience of about five million users.

Fuzia’s co-founder, Shraddha Varma, agrees: “Freedom of expressing creative personas and learning are the steps towards self-discovery and empowerment. Through us, learning and engagement opportunities are accessible and affordable to every individual worldwide with internet access”.

Fuzia harnessed the need to be creative and to share experiences. It created a safe place where women and others, could meet, and share their art – and at times also build a career.

Humaira Ferdous Shifa, who is currently a full-time student and working as an illustrator at Fuzia, says she started her journey as a user and ended up with a position as a graphic artist.
“I was interested in making friends and having an audience to share my work, and this was the best medium to explore. I found incredible growth in my professional and personal life.”

The platform celebrates its 9th anniversary in August with a Fuzia Creative Summit. The summit will offer a three-day virtual gathering bringing together experts, artists, and industry leaders, all under one remote roof. Here upcoming artists will have an opportunity to showcase their talents and immerse themselves in creative expression.
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Protesters hold up their placards in front of the Lagos State House. Credit: TobiJamesCandids/Wikimedia Commons.

By Ifeanyi Nsofor
ABUJA, Oct 28 2020 (IPS)

On October 20, 2020, young Nigerians who were protesting against police brutality were shot by men in Nigerian military uniforms. Unarmed, peaceful citizens were massacred at the Lekki Toll Gate in Lagos, southwest Nigeria.

The Governor of Lagos state, Jide Sanwo-Olu earlier in the day had announced a 24-hour curfew to curb violence that erupted following the #EndSARS Campaign. SARS is Special Anti-Robbery Squad, established in 1984 to combat armed robbery which was rife then. However, SARS has been on a killing spree of young Nigerians. Protesters are demanding for the disbanding of SARS, prosecution of indicted officers and total reform of the Nigerian Police Force.

I do not know how long this campaign against police brutality will last. However, one thing I am sure of is the mental health consequences of the pre-meditated massacre of young Nigerians at the Lekki Toll Gate will be with us for a long time

Governor Sanwo-Olu’s announcement for curfew to begin at 4pm was made at 11:49am on the same day. This meant that a city of more than 20 million people was somehow supposed to magically beat the notorious Lagos traffic, get off the streets and be at home within 4 hours. I do not live in Lagos. However, I am aware of the confusion that arose as residents scampered home. My sister-in-law drove through the Lagos traffic from Apapa to Ojuelegba to make sure she was home for her three daughters aged 7 years and below.

There were complaints on social media about the short time available for people to get home before the curfew began. Human rights advocates urged residents to do everything possible to obey the directives. However, it is understandable that not all would be able to. Some peaceful protesters stayed back to continue pushing their message of disbanding SARS, at the Lekki Toll Gate, Lagos.

I followed the protest over Twitter while preparing dinner for my wife and daughters. My wife was tracking it too, and soon she called to me in tears that these peaceful protesters were being shot. Coincidentally, one of Nigeria’s celebrity Disc Jockeys (DJ Switch) was a protester at Lekki Toll Gate and live streamed the shooting.

When I viewed it, it was pure chaos hearing the sounds of multiple gunshots and the screams. It was like a war zone. It was also pitch dark because lights were off at the usually well-lit area. Sadly, these young protesters assumed they would be safe if they sat on the ground while singing Nigeria’s national anthem and waving Nigeria’s flag. It was a fatal assumption.

This experience has negatively affected my mental health. I am completely overwhelmed with feelings of helplessness and apathy. I could not sleep that night. I kept turning and tossing. I was edgy and jumpy for days. For instance, not long after daybreak, I heard loud sounds and I thought they were gunshots. It turned out to be sounds made by masons at a construction site next to my house. A week later, I am still trying to make sense of this massacre.

I am not alone in my reaction to the horrible events. Indeed, there is fear and apprehension in the land. All over social media, Nigerians are sharing how depressed they are by this massacre:

Nigerian public health physician, Dr. Chijioke Kaduru tweeted:

For someone who is used to being angry, and channeling that anger, today feels very different. It’s anger. Heartbreak. A sense of helplessness. And for the first time, doubt. This is 2020.

For someone who is used to being angry, and channeling that anger, today feels very different. It’s anger. Heart break. A sense of helplessness. And for the first time, doubt.

This is 2020.

— Chijioke Kaduru, MD (@cj_kaduru) October 21, 2020

In response to his tweet, my friend and laboratory scientist Celestina Obiekea responded:

Today, I can’t even channel any anger… I’m just numb… and when I think my heart can’t break any more than it has already, it breaks all over again.

For someone who is used to being angry, and channeling that anger, today feels very different. It’s anger. Heart break. A sense of helplessness. And for the first time, doubt.

This is 2020.

— Chijioke Kaduru, MD (@cj_kaduru) October 21, 2020

With such strong emotions, Nigerians are searching for answers and mental health support. I am not surprised that Nigeria’s top mental health advocacy organization, Mentally Aware Nigeria Initiative (MANI) is inundated by calls and have now extended their usual service hours.

With these increased requests for mental health therapy by Nigerians, my friend and MANI founder, Dr. Victor Ugo sent out this this message for international mental health support volunteers. 

Reaching out for help to all my friends in the international #mentalhealth community. We’ve just had the most overwhelming day since Mentally Aware Nigeria Initiative (MANI) started providing crisis support services in Nigeria, way beyond what we experienced during the months of #COVID19 lockdown. We are very much overwhelmed and need your help. If you have Mental Health and Psychosocial Support experience and can provide remote support, please fill this form. If you aren’t able to help, please do share across your networks.

The mental health services provided by MANI are very important in a country like Nigeria with poor knowledge of mental health and inadequate human resources for mental health. In 2019, EpiAFRIC and Africa Polling Institute conducted the mental health in Nigeria survey that found most people know little about it or how to help.

For instance, 54% say it is caused by evil spirits, and when someone has a mental health illness, 18% say they will take the person to a prayer house. For a country of about 200 million people, Nigeria has only 250 psychiatrists, according to the Association of Psychiatrists of Nigeria. This means that approximately one psychiatrist provides mental health services to 800,000 Nigerians.

Nigerians currently feel like sheep under attack without a shepherd. President Buhari made a national broadcast without acknowledging the massacre at Lekki Toll Gate. Initially, the Lagos State Governor had alluded that those responsible were forces beyond his control. However, at a recent interview, he mentioned that it was indeed the Nigerian military that is responsible for the massacre.

I do not know how long this campaign against police brutality will last. However, one thing I am sure of is the mental health consequences of the pre-meditated massacre of young Nigerians at the Lekki Toll Gate will be with us for a long time.

Dr. Ifeanyi M. Nsofor, is a medical doctor, a graduate of the Liverpool School of Tropical Medicine, the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. He is a Senior Atlantic Fellow for Health Equity at George Washington University, a Senior New Voices Fellow at the Aspen Institute and a 2006 International Ford Fellow. 

Ismaila Badji. Credit: IOM/Amanda Nero.

By Marilena Crosato
DAKAR, Oct 9 2020 (IPS)

Ismaila Badji could not bring himself to leave his house for weeks after returning to Senegal. “I failed twice; at school and on the road,” he said. “What’s wrong with me? I’m still looking for the answer.” After spending time in a Libyan detention centre, Badji returned to where he came from. He did not feel like himself, he lacked motivation and he suffered from stigma from the local community.

It was thanks to two friends who took walks with him in the neighborhood that he was able to overcome these challenges. “That’s how I was able to integrate again within my community.” he recalled.

Badji is one of many young people in West and Central Africa who undertake dangerous journeys to Europe, do not reach their destination and struggle to return and re-establish their lives. For them, peer support is an essential part of the return process.

Shame, guilt, low self-esteem, and a sense of loss are common reactions among returnees. Psychosocial care is vital for people returning. A supported reintegration process is an essential element of the return journey

Badji joined the International Organization for Migration’s Migrants as Messengers (MaM) programme, which supports a peer-led approach to awareness-raising in communities to help people make informed migration decisions.

He recently started a poultry business and is now an active advocate for safe migration. The programme also seeks to develop strong social networks to improve the health and wellbeing of returned migrants and has brought together more than 260 returnees, MaM Volunteers, across seven countries in West Africa. The volunteers share accurate and balanced information about migration routes and processes and, more recently, about COVID-19.

“During our journey, we gained a lot of experience, we faced lots of things and it is often in moments like this that we measure the importance of solidarity between people… since we returned, when we see people in need, we say to ourselves that it is our duty to help others,” said Diarra Kourouma from Guinea, a MaM volunteer and returnee.

Many young people in West and Central Africa hope to find a better life for themselves and their families and risk their lives by undertaking some of the most dangerous migration journeys every year to Europe. According to IOM data (June 2020), 92 per cent of migrants attempting to reach Europe from West and Central Africa are young men under the age of 30.

Lack of jobs and other opportunities for personal and financial growth and strong pressure from families, drives large numbers of young people to migrate. When they set out, it is with the expectation that they will make it to their destination, find a job, and send money home.

The reality is that many do not reach their desired destination and are stranded, abandoned and sometimes abused and imprisoned. These harrowing experiences, often combined with stigma faced from returning home empty-handed, make reintegration in their communities of origin a challenge.

Shame, guilt, low self-esteem, and a sense of loss are common reactions among returnees. Psychosocial care is vital for people returning. A supported reintegration process is an essential element of the return journey.

Elhadji Mohamed Diallo. Credit: IOM Guinea.

“I returned to Guinea completely devastated by everything I had just experienced during my journey. I didn’t want anyone to know my story, no one to know that I am a returnee. I simply wanted to hide in silence,” said Elhadj Mohamed Diallo, a 32-year-old from Guinea.

Diallo is now the president of the OGLMI, a Guinean organization raising awareness about the dangers of irregular migration. He explains how he benefited for his role leading awareness raising activities and the importance of challenging the stigma that migrant returnees face when they go back to their communities of origin.

“It was an opportunity to regain confidence in my abilities, but also to become aware of the role I can play by sharing my story with the Guinean populations; I understood that I could help save lives. And this boosted my energy,” said Diallo. “When we return home, we want more than anything else to fight the stigma we were subjected to. For me, this means contributing to the development of my country.”

MaM Volunteers report that belonging to these peer groups and playing an active role in the community help with the process of re-establishing their lives. People involved in these peer groups have gone on to create civil society associations, start small businesses, pursue studies and work on other initiatives.

Discussions in markets, churches and schools, community theatre, music and dance, collaboration with media are just a few examples of the activities led by the MaM Volunteers to breakdown stigma and social and economic barriers returnees often face.

“When I returned from Libya, I had a hard time being accepted by my family,” said Mariama Conté, a 23-year-old business law student in Guinea and MaM Volunteer.

“In the eyes of my parents, I was just the one who had stolen money from them to leave and fail on the shores of the Mediterranean. It was thanks to my involvement as a volunteer that I managed to reconnect with them. When they saw me engaging in awareness-raising activities, fighting to prevent other young girls to fall into the same trap as me, they understood that I could be useful.”

In the past few months in the seven countries where MaM is being implemented, more than 288 creative, community outreach activities have been carried out to help communities and youth face the COVID-19 pandemic.

This includes videos, songs, billboards, posters, comics strips, radio shows and other community-based activities – all of which has been widely shared across on air, online and by word-of-mouth, reaching more than seven million people this year.

The “Stay Home and Dance” challenge, a series of videos encouraged people to stay home during the pandemic lockdown and addressed issues of social isolation through song and dance. Guinean Volunteers welcomed returning migrants in transit centers and a group of five returnees in Sierra Leone created the song ‘Together We Can Cope’ to build support and solidarity in the pandemic.

“Firstly, I feel proud to be a part of a network that is helping in the fight against COVID-19,” said Abdul Sankoh, a MaM Volunteer from Sierra Leone. “Secondly, the experience has given me a sense of wanting to do more to help other people in time of crisis or emergencies.”

Marilena Crosato is Community Engagement Officer, IOM Regional Office for West and Central Africa, mcrosato@iom.int.

Mental health concerns for Bangladeshi garment workers — especially females — has always been of concern, even before the collapse of Rana Plaza. Credit: Obaidul Arif/IPS

By Samira Sadeque
UNITED NATIONS, Dec 19 2019 (IPS)

Nearly seven years ago, garment workers in Bangladesh were victims of one of the gravest man-made disasters in history — a factory collapse that left more than 1,100 workers dead, and rendered thousands with injuries — in many cases lifelong ones. 

For many of the workers from Rana Plaza, the trauma remains real even to this day.

Bangladesh relies heavily on its garment industry for its rising status in the global economy, with textile being its biggest export revenue. Yet its garment workers remain often poorly treated, and continue working in unsafe conditions for minimum pay. Many survivors of Rana Plaza are still reeling from the physical and mental health trauma they suffered in the incident and the aftermath. According to ActionAid, a locally-based NGO, a large number of workers say they can’t return to work owing to their physical and mental health conditions. 

But mental health concerns for Bangladeshi garment workers — especially females — has always been of concern, even before the collapse. 2017 research shows that female garment workers, often driven to the workforce owing to their financial status, have thoughts of suicide and suffer from “stress, anxiety, restlessness” because of their long hours at work while being away from their family, especially their children. 

A recent initiative might change that. The Bangladesh Garment Manufacturers and Exports Association (BGMEA) recently launched the “first ever” mental health initiative in the country for the workers. The project recently held a session with workers of one factory, and will be piloted across 50 factories. It’s working with Moner Bondhu, a mental health service provider in Bangladesh. Tawhida Shiropa, founder and CEO of Moner Bondhu, shared her thoughts with IPS. 

Inter Press Service: What is Moner Bondhu’s role in this initiative? 

Tawhida Shiropa: Moner Bondhu is providing mental health group counselling to garment factory workers. Our counsellors conduct sessions at the factories to address the emotional well-being of the workers so that they can be more peaceful in their personal and professional lives. We work on mind healing, stress management, empathy, being respectful towards others, how to get relief from fatigue and be more productive at the workplace and also on how to be happy at work and in their family life. Our sessions include breathing exercises, stress relief exercises and mindfulness meditation.

What do you hope will be achieved through this initiative?

Through this initiative we aim to help the workers lead a happier and peaceful life so that they can achieve a better work-life balance, be more productive at work while playing a more involved role in their families. In this way they can contribute more to their and as a result the economy of the country will advance.

How do you believe mental health of RMG workers is related to their livelihood, if at all?

We believe mental health is related to everyone’s livelihood. By taking care of their mental health, workers will become more resilient to all the challenges of life. At work, they can be more mindful of their co-workers and together they can create a more harmonious work environment.   

What kind of response did you get from your first session?

Our first session was very lively and exciting for all participants. The event was a huge success. All the workers and the factory administration said that they felt very relaxed and calm after the session, especially after the exercises and meditation. They also said that they have never had a session like ours. Many of them came up to our counsellors to thank them personally. They also asked how to stay in touch with us and we share our contact details with them, so that they can access our help in future if they need to.

What’s ahead for the initiative? 

We see this initiative as a milestone for mental healthcare. Before now, there was no big scale initiative for mental healthcare of factory workers, so BGMEA’s concern for their workers is highly admirable as they are concerned for the overall well-being of the workers.  

Tropical Cyclone Idai made landfall on Mar. 14 and 15, destroying some 90 percent of Beria, the capital of Sofala province, Mozambique, according to reports. A majority of those affected are living in makeshift camps as they try to rebuild. A Global Humanitarian Overview (GHO) 2020 report claimed climate change, “unexpected spread of infectious disease” and regional conflicts were the main reasons pushing millions of people into spaces for humanitarian needs, and why the numbers of those in need was “unprecedented”.  Credit: Andre Catuera/IPS

By Samira Sadeque
UNITED NATIONS, Dec 10 2019 (IPS)

The world had an unexpected number of people in crisis this year, which exceeded projected numbers the United Nations had expected, with climate change being one of the key crises that led to “needs to unprecedented levels” according to a new report. 

The observations were made in Global Humanitarian Overview (GHO) 2020, which was released last week by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). According to the report, at the time of the GHO 2019 launch, 93.6 million people were targeted for assistance, despite 131.7 million being in need. By November 2019, the 117.4 million were targeted as opposed to the 166.5 million in need.   

The report claimed climate change, “unexpected spread of infectious disease” and regional conflicts were the main reasons pushing millions of people into spaces for humanitarian needs, and why the numbers of those in need was “unprecedented”.  

“Climatic shocks, the unexpected spread of infectious disease, and the impact of protracted and often intensifying conflicts have combined to drive needs to unprecedented levels this year,” Zoe Paxton, with the Humanitarian Affairs and Emergency Relief Coordinator, told IPS. 

“The current state of geopolitics means conflicts are becoming more protracted and intense. Combatants display growing disregard for international humanitarian law,” said Paxton, adding that a combination of issues affecting those caught in conflict situations: displacement, hunger, psychosocial trauma, and loss of their livelihoods, education facilities and health services. 

“That’s in addition to the direct impact of fighting, bombing and other violence affecting their physical safety and security,” she said. 

Perhaps one of the crucial ones remains the issue of climate change, with more frequent drought, floods, and tropical cyclones. Paxton says these concerns disproportionately affect already poor and vulnerable populations.

“Eleven of the 20 countries most vulnerable to climate change have appealed for humanitarian aid in each of the past seven years,” she told IPS. “We need to do better in prioritising climate change adaptation as part of humanitarian response.”

Paxton added that other factors that contribute to climate concerns are slow economic growth and debts of countries.  In 2019, she said, almost 60 million people in need of humanitarian assistance were from 12 of the 33 countries “in, or at risk of, debt distress,” she said. 

Mental health concerns 

One of the other pressing issues that appeared in the report is the mental health concern of those in need. The report says one in five people in conflict areas have some kind of a mental health condition. 

An increase in “highly violent conflicts” — from 36 last year to 41 this year — is leading to humanitarian concerns such as loss of livelihoods, sexual violence, hunger, while exacerbating mental health concerns.  According to a World Health Organisation report from June, of people who have lived in conflict for the past 10 years, about 11% are expected to have moderate or severe mental conditions. 

While mental health is mentioned in the report, it remains underreported or under-documented in some regions. For example, in Afghanistan, the report noted that “at least 11 percent of the population is estimated to have a physical disability, while an unknown number of people are suffering from mental health issues as a result of their constant exposure to conflict”.

Meanwhile, children are likely to bear the brunt of it the most. The report estimates that 24 million children currently living in some kind of conflict will experience some variation of a mental health condition which would require support. However, challenges remain in addressing this need. 

“Though there is increasing focus on mental health, the vast majority of survivors do not have access to care,” Dr. Mark van Ommeren, who authored an analysis of mental disorders in conflict settings, told IPS. “Whether or not support is made available is often dependent on the interest of individuals within donor agencies or individuals within agencies on the ground.”

In his foreword, United Nations Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Mark Lowcock acknowledged the importance of addressing mental trauma as an issue. “We increasingly understand the need to deal with mental trauma as well as people’s physical health,” he wrote. “We are getting ahead of more crises by taking anticipatory action.”

Credit: SEWA BHATTARAI

By Sewa Bhattarai
Oct 29 2019 (IPS)

Children sit in a circle experimenting with different colours on palettes at a shelter in Godavari one morning this week. Some design flowers in bright colours, others draw homes nestled below mountains. Many of the children are survivors of rape or domestic violence, from rural parts of Nepal. The one thing they have in common is mental trauma.

For Colombian painter Dairo Vargas (pictured with students of Kitini College) who is coaching these and other Nepali children, the situation is very familiar to that of his own country. Vargas himself suffered depression as a teenager, and believes art can be a great healer in a country wracked by war.

“Traumatised people often cannot express their suffering to other people, and art is a space where they can free themselves. Completing a piece of art also helps the brain make connections, and gives a sense of achievement and confidence.”

“When I was depressed, I could not focus on anything. But when I start painting, I am able to concentrate on what I am creating. That gives me a sense of calm, and slowly helped me overcome depression,” says Vargas, who now helps others like him around the world.

Nepal and Colombia share the common burden of war trauma — people in both countries today struggle with the violence of their past, and seek closure. Nepal signed a peace accord with the Maoists in 2006, and Colombia made peace with the FARC rebel group 10 years later, ending a conflict that killed over 220,000 people and displaced 7 million.

While many victims and their families have received compensation for physical wounds or loss in Nepal, mental trauma has been largely ignored. Likewise, various studies indicate that up to 40% of the population in Colombia suffer from mental illness at some point, and lifetime prevalence may be up to 20%. There too, the Ministry of Health has recognised that the issue is under-reported and inadequately addressed.

Vargas works with former FARC guerrillas and others in Colombia who suffer post-traumatic stress, but finds it hard.

“Of course the guerrillas have many mental health issues, but they are not happy to do anything about it at the moment. Also, they have made so many enemies in society that reintegrating them is very difficult,” he says.

Vargas is attempting to bring his own experience in Colombia to fill this gap in Nepal. His mission is to spread awareness about mental illness, and make painting more accessible to traumatised people through his movement #TheArtListens. He is using the technique with children at a shelter for rescued children in Godavari, where they paint, sketch and draw.

Credit: SEWA BHATTARAI

As in Colombia, mental health is still a stigma in Nepal, especially for families of the disappeared, children who witnessed violence and victims of war rape.

These survivors rarely seek help, even though a 2012 study showed 80% of conflict-affected people suffer anxiety and depression, 50% have PTSD (post-traumatic stress disorder), and former child soldiers are far more likely (45-50%) to suffer from these symptoms than children never conscripted (20-37%). Social reintegration continues to be a challenge, and many former combatants and relatives suffer stigma.

Suraj Koirala of TPO (Transcultural Psychosocial Organisation) has surveyed and counselled many conflict-affected Nepalis, and says the most common problems are depression, anxiety and PTSD.

“Children and women have suffered the most, and it is prolonged for victims of sexual abuse and family members of the disappeared,” says Koirala.

One of them is Bhagiram Chaudhary of the Conflict Victims’ Common Platform, whose brother and sister-in-law were disappeared during the conflict but who has never sought counselling or therapy.

“If I see anyone who looks like my brother, I still take a second look, wondering if it is him,” he says. “We are unable to perform his last rites, because we don’t know if he is still out there. Not having closure means that we are still undecided about how to take our life forward.”

Gita Rasaili of the Conflict Victims’ National Network was 13 when she saw soldiers taking away her sister. Her family later found the decomposed remains of her body. After that, Rasaili’s mother used to faint often and was unable to perform household chores. After years of therapy, she did get better.

Credit: SEWA BHATTARAI

“There are many war victims like me who suffer from mental health crises, but we do not recognise it and never seek help,” says Rasaili. “If you go to a mental hospital people think you are mad. A lot more needs to be done for the nation to heal.”

Like Rasaili, other war survivors suffer from symptoms like lack of sleep and concentration, inability to focus, disruptive memories and depression. The bigger concern is that these problems could transcend generations.

“If parents are unable to deal with trauma and express their mental state in unhealthy ways, their children could be impacted as well,” says Koirala of TPO. “Social reintegration is already difficult for combatants, and this could create another generation of outcasts.”

As in Colombia, some victims of the conflict and the 2015 earthquake in Nepal have found ways to express themselves through art. Rasaili keeps a journal, saying it helps her find relief from stress, and she knows others who paint and sketch. But they all found these outlets through personal effort — there is no systematic approach to artistic therapy in Nepal.

Says Vargas: “Traumatised people often cannot express their suffering to other people, and art is a space where they can free themselves. Completing a piece of art also helps the brain make connections, and gives a sense of achievement and confidence.”

This story was originally published by The Nepali Times

By Jo Baker
LONDON, Jan 7 2016 (IPS)

It is a grim fact that prisoners in most countries suffer from poorer health than non-prisoners, and that their right to health is not always protected. But for certain groups these rights can be even more elusive. Such is the case for women.

Jo Baker

For me, this was starkly illustrated during a visit to the clinic of a large women’s jail in the southern Philippines. Here, a very thin woman lay curled and still on a narrow wooden bench. Her hands were cradling her taut, bloated stomach, her eyes tightly closed. The nurse explained that she was an addict, arrested while heavily pregnant for drug possession (a sentence that keeps the country’s women’s jails lamentably stocked), and that her baby had died days earlier in a government hospital because of a condition related to her drug use, after a complicated labour. Being understaffed and short on medicine and beds in the prison, the best treatment she could offer the woman on her return, as she faced her withdrawal, post-labour pain, grief, separation from family, and possible years awaiting trial, were paracetamol, kind words and a bench. Hers would be a particular and gendered kind of purgatory.

In speaking with imprisoned women and healthcare practitioners across five countries, our research team commonly found harmful responses and barriers to healthcare that existed because the inmates were women. These included women who were imprisoned in Jordan while recovering from brutal gender-based violence (including honour crimes and rape), without adequate treatment or rehabilitation; women who prepared for and recovered from childbirth in dirty rooms with little more than substandard prison rations, water and soap; and women who were isolated and punished because of attempts to self-harm or commit suicide. “One girl used the edge of a seafood shell on her wrists,” recounted an inmate in the Philippines. “They scolded her. If you want to die, go ahead, do it now!”

These responses are of course unlikely to be particular only to these countries.

International standards (including the Bangkok Rules) now recognize that because women commonly face certain risk factors and backgrounds, they require a gender-specific framework for healthcare. More women than men suffer from particular diseases, including HIV, hepatitis and some cancers. They have differing sexual and reproductive health (SRH) needs, including those relating for example, to birth, abortion and the menopause. They are more susceptible to particular mental health problems. Studies have found self-harm in prison to be up to ten times higher among women than among men, and suicide to also be proportionally higher. This list goes on.

Women (especially those in conflict with the law) are also, crucially, more likely to have been victims of sustained gender-based violence and sexual abuse. Yet prisons, which are increasingly taking in women, are rarely equipped to respond to these forms of trauma. As I was told quietly by one prison healthcare worker, gesturing to a courtyard of around 20 women. “Almost all the women here are mothers, and a lot have maltreatment and molestation in their histories. I can look around and count more than ten women who have been raped. Some have been prostituted by their families. Then drug use comes in and makes it a vicious cycle.”

These and other cultural factors lead to a different sense of shame, which can also work as a barrier to healthcare. For example inmates in Jordan, Zambia and the Philippines told me that they often avoided reporting urinary tract infections and SRH problems to male health staff. Yet some prisons for women don’t employ female doctors, and these issues remain unrecognized, and sometimes debilitating.

My research findings with DIGNITY (see our comparative study here) therefore stress the urgent need for every prison and place of detention to follow a framework for healthcare that is gender-responsive and trauma-informed – one that treats women’s specific health needs, and trains staff accordingly. In just a few facilities did we find gestures towards this.

But not all gender-sensitive health responses are medical. The traditional prison model – designed as a harsh criminal justice response to violent men – remains the basis for many institutions detaining groups that are neither violent, nor male. In the facilities where women told me of harsh disciplinary structures, negative relationships between staff and inmates, and their isolation from caring relationships, they tended to report very low morale, forms of depression, and other signs of serious struggle, such as self harm and hunger strike. This was markedly different in facilities (such the one described here in Albania) that connected the women with the outside community – particularly their children – and gave them tools to cope, learn, communicate and prepare for the future.

Meanwhile, exercise is known to be important to health and morale, and is a right of prisoners under international law (see the Mandela Rules). Yet only in one of five countries, the Philippines, were detained women encouraged and able to exercise every day. In the other countries, exercise and sports facilities of some kind were common only in prisons for men.

Many of our findings on health fell in line with those observed by the former UN Special Rapporteur on Violence Against Women in her 2013 report on women’s incarceration, and they indicated clear and harmful examples of discrimination. Yet in reviewing issues raised by UN treaty body reports, we found women’s health to largely be a gap: UN experts are not giving this area consideration.

The human rights of these women entitle them to better, and must be championed, internationally and in their own countries. As once said by Dostoevsky, society must be judged by the way that it treats its prisoners. Or rather, and as told to me by one mother and survivor of domestic violence, sentenced to life in a Zambian prison: “If you’ve offended, certain things you must accept. But I don’t deserve to pass through some of these things. I came to prison healthy. I’m not intending to leave sick.”

(End)

Excerpt:

A young resident of Tacloban in the Philippines walks through some of the damage and debris left by the Typhoon Yolanda, Dec. 21, 2013. Credit: UN Photo/Evan Schneider

By Jed Alegado and Angeli Guadalupe
MANILA, Sep 8 2015 (IPS)

Jun* is in chains, tied to a post in the small house that resembles a fragile nipa hut. His brother did this to prevent him from hurting their neighbours or other strangers he meets when he’s in a ballistic mood. Jun has been like this for three years now, but since Typhoon Haiyan hit the Philippines two years ago, his symptoms have worsened.

After the disaster, Jun lost his own house, his wife and his children. This psychological distress he went through triggered a relapse of his psychiatric illness. With no one else able to take care of him, Jun was taken by his brother to their family’s house.Climate change’s health impacts are inequitably distributed with the most vulnerable sectors like the elderly, children and pregnant women having the least capacity to adapt.

But since his brother is working and the other people in the house are their old, sickly and frail parents, no one can control Jun during his manic episodes. He has not been able to maintain his medications because his family can’t afford them and the free supply at the local health center doesn’t come consistently. For these reasons, the best option left for Jun’s brother is to put him in chains.

Impacts on mental health

A few more cases like Jun exist in Tacloban City and most likely, in other areas of the Philippines as well – both urban and rural. Typhoon Yolanda (also known as Typhoon Haiyan) struck the country on Nov. 8, 2013. It was a Category 5 super-typhoon with wind speeds ranging from 250 to 315 kph, killing at least 6,300 people and costing PhP 89 billion in damages.

Due to extreme loss and survivor guilt, at least one in 10 people here suffers from depression. But two years after the disaster, some survivors remain unaware of available mental health services. Others complain of the poor quality of services and scant supply of medications. Many survivors who are more affluent choose to consult psychiatrists in other cities to avoid the stigma.

As with most disasters, physical rehabilitation is prioritised. This is understandable and perfectly rational, but the mental health of the victims should not be forgotten.

According to the World Health Organization’s report on the Global Burden of Disease, mental disorders follow cardiovascular diseases as the top cause of morbidity and mortality in terms of disability-adjusted life years or the number of years lost due to ill-health, disability or early death.

Yet despite the staggering number of people affected, only an estimated 25 percent of them worldwide have access to mental health services. More than 40 percent of countries have no mental health policy and mental health comprises less than 1 percent of most countries’ total health expenditures.

Nowadays, climate change brings us more frequent and devastating natural disasters. In emergencies such as natural disasters, rates of mental disorders often double. Hence, attention to mental health should be doubled as well, especially in countries highly vulnerable to disasters such as the Philippines.

Being an archipelago and still a developing country, this is not surprising. According to the United Nations University Institute for Environment and Human Security’s World Risk Index Report 2014, out of the 15 countries with the highest disaster risk worldwide, eight are island states, including the Philippines.

Ensuring health impacts in the negotiation text

Health advocates are quick to respond to this alarming issue. Groups led by the International Federation of Medical Students (IFMS) are ensuring that the issue of health and its impacts to climate change are included in the climate negotiating text.

Beginning from the Conference of the Parties (COP 20) in Lima, Peru last year which continued in Geneva last February, the group has been advocating for health to be back at the center of negotiations and in effect ensuring that parties will forge a strong climate agreement in Paris on December.

Last week’s Bonn climate negotiations – one of the few remaining negotiation days before the actual COP in December – proved to be an exercise in futility as negotiators keep dodging on the issue of a loss and damage mechanism, which, according to health advocates, is crucial for helping people affected by the health-related impacts of climate change.

According to IFMS, “there is a growing involvement of member states to include health in the negotiating text. As a group, we want to ensure that health is included in all parts of the negotiating document – preamble, research, capacity building, adaptation and finance.”

Indeed, the impacts of climate change go beyond environment, food security, land rights and even indigenous peoples’ rights. More importantly, climate change has both direct and indirect effects on health. Climate change’s health impacts are inequitably distributed with the most vulnerable sectors like the elderly, children and pregnant women having the least capacity to adapt.

Parties to the UNFCCC must see this alarming issue towards forging a fair and binding climate deal in December which will limit keep global warming below 2 degrees C and ensure adaptation mechanisms to the most vulnerable nations.

In the future, it is foreseen that wars will be fought over water not oil. Disasters nowadays may give us a glimpse of the worst to come when the staggering impacts climate change worsen and affect us in ways beyond what we can handle.

Yet, with the rapid turn of extreme weather events, what we are doing is not just for future generations. It is for us, who are living now on this planet. We are going to be the victims if we do not take responsibility as much as we can, as soon as we can.

*Name has been changed to protect his identity.

Edited by Kitty Stapp

Excerpt:

About 10 percent of the Indian population of 1.2 billion people experiences a form of mental illness - that is about 200 million people. Credit: IPS

By Minto Felix
NEW DELHI, Mar 4 2015 (IPS)

India is not only poised for greatness, some say it is already on its way. The events that have shaped the nation’s dialogue over the past month showcase an India with a bold vision – to transform industry, to close the gap on inequality and ultimately, to redefine its place as a leader among the world.

Yet, it is a baffling reality that political leaders from across the spectrum have failed to adequately respond to one of the most pressing human challenges facing India today. A challenge that not only comes attached with significant consequences to the most important asset of the country – it’s people – but also, if not taken seriously, is likely to impede upon the continued progress achieved by the nation.

India has only one psychiatrist for every 343,000 people, and one of the highest suicide rates in the world.
The challenge of mental illness is an urgent priority for the country, one that requires collective action and constructive reforms.

Imagine this: by the year 2020, depression and anxiety is set to be the biggest illness facing humanity, costing the world about 13 trillion dollars to treat.

In India, conservative measures from the Bangalore-based National Institute of Mental Health and Neurosciences (NIMHANS) estimate that about 10 percent of the population experiences a form of mental illness – that is about 200 million people.

Whether they’re Bollywood celebrities like Deepika Padukone, who recently and poignantly blogged about her struggle with anxiety, or the painful stories of suicide that have emerged in recent years from farmers grappling with the pressures of prolonged drought, mental illness impacts individuals from every walk of life and throughout the lifespan.

It is also well established that mental illness particularly impacts those most vulnerable in our communities, especially those that experience poverty and discrimination.

With the exception of India’s first Mental Health Policy, which was launched to positive public reception in October last year, we have seen little to no action follow suit in driving through core reforms identified.

Further, with mental health expenditure occupying only 0.83 percent of the total health budget, which, in turn, also continues to be a tiny fraction of overall government expenditure, the plausibility of important change occurring in this arena remains grim. So what’s needed to shift the status quo?

1. Start an informed conversation

The essential first step in driving positive change on mental ill-health is to learn about it. Whilst there certainly have been improvements over the past decade, the mental health literacy amongst Indians remains low.

This is problematic for several reasons, as it allows for misinformation to propagate at the community level, and as a natural consequence, stigmatising attitudes that prevent individuals from seeking the appropriate help they require.

Improved understanding of mental illness not only removes stigma, it also builds compassion – of how to adequately care for oneself, as well as for others, when experiencing mental health difficulties.

A population that is mental health literate is also armed with the tool kit to be powerful agents of change, and can confidently hold medical professionals, governments and policy makers to account in improving the status of mental health in India. To have individuals experiencing mental illness labeled as inadequate and deprived of their humanity is simply not acceptable in 2015.

2. Build world-class infrastructure

It is altogether unacceptable that India has only one psychiatrist for every 343,000 people, and it is worrying that India has among the highest suicide rates in the world, particularly within its youth population.

This reflects poorly resourced infrastructure, and also inadequate services to match the deep needs experienced by the population.

In some senses, the answer is simple – increase the amount of funds directed towards tackling mental illness, and in other senses, the solutions are more complex – of determining quality care coordination across states, of making investments in priority areas such as youth mental health, and working to increasing the number of trained mental health professionals.

As is the case with technology and infrastructure, India should aspire to have a word-class mental health system that is efficient, effective, and accessible by its entire population.

3. Age of innovation

One of the genuine achievements of the past year with regards to mental health is the decriminalisation of attempted suicide. The repeal of this legislation is an important step in working towards reducing the number of suicides, but also reflects the broader societal factors that need to be addressed in strengthening the mental health of Indians.

Economic, social and political factors all play a vital role in strengthening or damaging a person’s level of health, and this is no different with mental illness.

Countless NGOs and government agencies around the country are implementing exciting projects that seek to alleviate mental illness, as well as surrounding factors of gender based violence, homelessness, and drug abuse. However, in order for these projects to make a lasting difference, they need be implemented on a larger scale.

The Banyan, a Chennai based mental health NGO, is leading the way in this space, with both its innovative service delivery in working with vulnerable women experiencing mental illness but equally, in its commitment to scale through establishing partnerships with universities in other parts of India and government agencies to increase the organisation’s reach.

By the very same token, it is indeed the role of the government to evaluate, to encourage, and extend the full potential of these initiatives. There is a pressing need to build a bank of evidence-based solutions for tackling this health issue.

There is no health without mental health, and the call for reform is crystal clear. If we are able to promote the full mental health of each and every person living in this country, India can only be stronger, richer, and indeed a more fulfilled nation.

Edited by Kanya D’Almeida

Excerpt:

Kids work side by side at a temporary school for those displaced by floods in eastern Nepal. Many children experience trauma, fear or other psychological impacts of natural disasters, but few receive the necessary treatment. Credit: Mallika Aryal/IPS

By Mallika Aryal
SURKHET, Nepal, Feb 13 2015 (IPS)

On the night of Aug. 14, 2014, 10-year-old Hari Karki woke up to his grandfather’s loud yelling in the family’s home in Paagma, a small village in east Nepal.

He was warning Hari’s family to move out of the house immediately because they were getting flooded. It had been raining non-stop for a couple of days. Hari could hear the water gushing. He grabbed his sister’s and grandfather’s hands, waded through knee-deep water in his living room, and ran as fast as he could.

“Advocating for mental health itself is such a big challenge in Nepal. We are not even close to getting specialised services such as mental health programmes that focus entirely on children." -- Shristee Lamichhane, mental health advisor with the United Mission to Nepal (UMN)
On the other side of the village, on much higher ground, is a primary school. They took shelter there for the night as heavy rains devastated the village, washed away Hari’s school and his neighbours, and inundated his house.

“Life changed forever for us that night,” says Hari’s father, Dhan Bahadur Karki. The floods and landslides that took place in Surkhet district in mid August last year affected more than 24,000 people, according to the District Disaster Relief Committee, a Nepal government-led coalition of international aid organisations and local NGOs.

The disaster displaced 12,000 people and killed 24; 90 still remain missing. More than 40 percent of those affected were children. For them, experts say, the horror of surviving such a disaster does not simply fade away; often, it lingers for a lifetime.

“Children lose their homes, school, friends and family members,” says Manoj Bist, a child protection officer with Save the Children, Nepal, which has been working in the flood affected areas of mid-west Nepal. “When their support system is lost, children become vulnerable to violence, disease and abuse.”

Five months since the disaster, those displaced by floods are still living in tents. Karki’s family has pitched their tent across the river from where their home used to be. “I see what used to be my house from my tent everyday, but I can’t get myself to go back there and try to rebuild,” says Dhan Bahadur Karki.

Along with their belongings, the flood washed away the little saving they had in the house. So money is tight for the Karki family and Dhan Bahadur is planning to leave for Malaysia to work in a mobile phone factory as soon as he gets a visa.

Even as Dhan Bahadur plans his departure, he is most worried about his two children and the state of their mental health.

Hari complains about not being able to concentrate at school. A good student before the floods, his grades have slipped. “I can’t fall asleep at night and when I do, I have nightmares,” says Hari as he comes out of his temporary classroom in a bamboo trailer. Last month, Hari could not be found on his bed at night. When his relatives went looking for him, they found him near the woods, sleepwalking.

“The kind of psychological stress a child goes through after a natural disaster is profound, and has to be dealt with early on in life so it doesn’t have a long-term consequence ” Saroj Prasad Ojha, associate professor in the department of psychiatry at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, tells IPS.

In Nepal, there is a near-total absence of official data on the number of children in need of mental health care, from young victims of sexual abuse and domestic violence, to children affected by natural disasters, to kids suffering from conflict-related stress and trauma.

Still, health professionals and social activists here say it is a major issue that calls for swift government action.

Stigma scuppers progress on mental health

The World Health Organisation estimates that 450 million people worldwide have a mental disorder, and mental illnesses account for 13 percent of the global disease burden.

There are no official numbers for the 28 million in Nepal, but the Christian charity United Mission to Nepal (UMN) that works on mental health issues estimates that approximately 20-25 percent of all out-patients attending primary health care services show some kind mental or behavioral disorder often presented with multiple physical complaints.

“The problem lies in the fact that mental illness is not seen as a health issue,” says Sailu Rajbhandari, clinical psychologist with Transcultural Psychosocial Organisation (TPO)-Nepal.

Nepal spends less than two percent of its 334-million-dollar health budget on mental health services. The 50-bed, Kathmandu-based Mental Hospital is the only one in the country that exclusively provides mental health and psychiatric services. There are 70 psychiatrists in Nepal, one for every 380,000 people, and only one child psychiatrist.

Other mental health-care providers such as clinical psychologists, social workers and nurses are even more scarce.

“Advocating for mental health itself is such a big challenge in Nepal. We are not even close to getting specialised services such as mental health programmes that focus entirely on children,” says Shristee Lamichhane, mental health advisor with UMN.

Arun Raj Kunwar, Nepal’s only child psychiatrist, faces this challenge every day at work.

“Our society and health system cannot even grasp the concept that children can have mental health issues,” says Kunwar. He says children’s trauma may be disguised and could manifest in the form of physical ailments because children cannot clearly express grief or fear.

Kunwar says that children need extra attention and trained specialists to deal with mental trauma.

A crucial link in the developmental chain

Experts say that mental health should be prioritised along with the other developmental goals of the country.

“It is surprising that children’s mental health is often left out from our development plans, considering children are the future, the next productive generation of the country,” explains Ojha of the Tribhuvan University Teaching Hospital.

Ojha says there’s a need to properly train professionals so that they know how to deal with various types of mental health issues. “Counseling children who have gone through the trauma of natural disasters is different from those who have gone through the trauma of war – we need specialised focus.”

Official data on the number of children affected by Nepal’s decade-long ‘People’s War’ that ended in 2006 is missing. However, a 2008 National Human Rights Commission report states the war orphaned over 8,000 children and displaced over 40,000 children.

Few, if any, of them are receiving necessary mental health services.

There is also an urgent need to prioritise mental health at the local level. Lamichane of UMN recommends stationing trained mental health professionals at the 30 public hospitals across Nepal.

“But mental health has to be integrated at the primary health care level because that is where patients first come with their problems,” says Lamichhane.

Nepal is a party to the United Nation’s global commitment to prevention and control of non-communicable diseases. In 2014, the country formulated the Multi Sectoral Action Plan for Prevention of Non-Communicable Diseases 2014-2020, which positioned mental health as one of the country’s priority areas.

Psychiatrists and mental health professionals are hopeful that this move will encourage the government to pay attention.

“It may be slow, but mental health issues are getting a little more attention than they were a few years ago,” says Lamichhane “This is the time to make a case for children, really hammer the issue home so that the issue of children’s mental health is not forgotten,” adds Lamichhane.

In Paagma village, local psychosocial counselor Santoshi Singh has begun working with Hari and his sister. “Depending on what his case is like, there are a few things I can do to help Hari as a counselor,” says Singh, “But if the case is severe, I am really unsure where I can send him so he can get the kind of help that he needs.”

Edited by Kanya D’Almeida

Women in India’s mental health institutions often face systematic abuse that includes detention, neglect and violence. Credit: Shazia Yousuf/IPS

By Shai Venkatraman
MUMBAI, Jan 30 2015 (IPS)

Following the birth of her third child, Delhi-based entrepreneur Smita* found herself feeling “disconnected and depressed”, often for days at a stretch. “Much later I was told it was severe post-partum depression but at the time it wasn’t properly diagnosed,” she told IPS.

“My marriage was in trouble and after my symptoms showed no signs of going away, my husband was keen on a divorce, which I was resisting.”

“The nurses were unkind and cruel. I remember one time when my entire body was hurting the nurse jabbed me with an injection without even checking what the problem was.” -- Smita, a former resident of an Indian mental health institution
After a therapy session, Smita was diagnosed as bi-polar, a mental disorder characterised by periods of elevated highs and lows. “No one suggested seeking a second opinion and my parents and husband stuck to that label.”

One day after she suffered a particularly severe panic attack, Smita found 10 policemen outside her door. “I was taken to a prominent mental hospital in Delhi where doctors sedated me without examination. When I surfaced after a week I found that my wallet and phone had been taken away.”

All pleas to speak to her husband and parents went unheeded.

It was the beginning of a nightmare that lasted nearly two months, much of it spent in solitary confinement. “The nurses were unkind and cruel. I remember one time when my entire body was hurting the nurse jabbed me with an injection without even checking what the problem was.”

On one occasion, when she stopped eating in protest after she was refused a phone call, she was dragged around the ward. “There were women there who told me they had been abused and molested by the staff.”

Not all the women languishing in these institutions even qualified as having mental health problems; some had simply been put there because they were having affairs, or were embroiled in property disputes with their families.

Days after she was discharged her husband filed for a divorce on the grounds that Smita was mentally unstable.

“I realised then that my husband was building up his case so he would get custody of the kids.”

Isolated and afraid, Smita did not find the strength or support to fight back. Her husband won full custody and left India with the children soon after. “My doctor says I am fine and I am not on any medication but I still carry the stigma. I have no access to my kids and I no longer trust my parents,” she told IPS.

Smita’s story points to the extent of violence women face inside mental health institutions in India. The scale was highlighted in a recent Human Rights Watch (HRW) report, ‘Treated Worse than Animals’, which said women often face systematic abuse that includes detention, neglect and violence.

Ratnaboli Ray, who has been active in the field of mental health rights in the state of West Bengal for nearly 20 years, says on average one in three women are admitted into such institutions for no reason at all. Ray is the founder of Anjali, a group that is active in three mental institutions in the state.

“Under the law all you need is a psychiatrist who is willing to certify someone as mentally ill for the person to be institutionalised,” Ray told IPS. “Many families use this as a ploy to deprive women of money, property or family life. Once they are inside those walls they become citizen-less, they lose their rights.“

Ray points to the story of Neeti who was in her early 20s when she was admitted because she said she heard voices. “When we met her she was close to 40 and fully recovered, but her family did not want her back because there were property interests involved.”

With the help of the NGO Anjali, Neeti fought for and won access to her share of family property and was able to leave the institution.

Those on the inside endure conditions that are inhumane.

“There is hardly any air or light. Unlike the male patients who are allowed some mobility within the premises, women are herded together like cattle,” says Ray. In many hospitals women are not given underclothes or sanitary pads.

Sexual abuse is rampant. “Because it is away from public space and there is an assumed lack of legitimacy in what they say, such complaints are nullified as they are ‘mad’,” adds Ray.

Unwanted pregnancies and forced abortions impact their mental or physical health. They languish for years, uncared for and unattended.

“One can’t help but notice the stark contrast between the male and female wards,” points out Vaishnavi Jaikumar, founder of The Banyan, an NGO that offers support services to the mentally ill in Chennai, capital of the south Indian state of Tamil Nadu.

“You will find wives and mothers coming to visit male patients with food and fresh sets of clothes, while the women’s wards are empty.” Experts also say discharge rates are much lower when it comes to women.

The indifference towards patients is evident not just in institutions, but also at the policy level, with mental health occupying a low rung on the ladder of India’s public health system.

According to a WHO report the government spends just 0.06 percent of its health budget on mental health. Health ministry figures claim that six to seven percent of Indians suffer from psychosocial disabilities, but there is just one psychiatrist for every 343,000 people.

That ratio falls even further for psychologists, with just one trained professional for every million people in India.

Furthermore, the country has just 43 state-run mental hospitals, representing a massive deficit for a population of 1.2 billion people. With the District Mental Health Programme (DMHP) present in just 123 of India’s 650 districts, according to HRW, the forecast for those living with mental conditions is bleak.

“Behind that lack of priority is the story of how policymakers themselves stigmatise,” contends Ray. “The government itself thinks [the cause] is not worthy enough to invest money in. Unless mental health is mainstreamed with the public health system it will remain in a ghetto.”

Depression is twice as common in woman as compared to men and experts say that factors like poverty, gender discrimination and sexual violence make women far more vulnerable to mental health issues and subsequent ill-treatment in poorly run institutions.

Gopikumar of The Banyan advocates for creative solutions that are scientific and humane like Housing First in Canada, which reaches out to both the homeless and mentally ill. The Banyan is presently experimenting with community-based care models funded by the Bill and Melinda Gates Foundation and the Canadian government.

“Our model looks at housing and inclusivity as a tool for community integration,” says Gopikumar. “The poorest in the world are people with disabilities and most of them are women. They are victims of poverty on account of both caste and gender discrimination and its time we open our eyes to the problem.”

*Name changed upon request

Edited by Kanya D’Almeida

Following an Israeli airstrike, Palestinian youth inspect the building their families lived in. Credit: Khaled Alashqar/IPS

By Khaled Alashqar
GAZA CITY, Jul 22 2014 (IPS)

As a result of over two weeks of Israeli bombardment, thousands of Palestinian civilians have fled their homes in the north of Gaza and sought refuge in schools run by the UNRWA, the U.N. agency for Palestinian refugees.

Among the worst affected are Gazan children who have been forced to live in constant fear and danger, according to Dr. Sami Awaida, a specialised child psychiatrist for the Gaza Mental Health Programme – a local civil society and humanitarian organization that focuses on war trauma and mental health issues concerning children and adults in Gaza.“Children in Gaza have already suffered from two recent violent and shocking experiences in 2009 and 2012 … This trauma now re-generates previous pain and shock and also leads to a mental state of permanent fear and insecurity among children here” – Dr. Sami Awaida, a specialised child psychiatrist for the Gaza Mental Health Programme

Describing the impact of the current trauma, Awaida told IPS:  “Children in Gaza are suffering from anxiety, fear and insecurity because of this war situation.  The challenge we now face as mental health practitioners is ‘post-traumatic disorder’.”

“This means that children in Gaza have already suffered from two recent violent and shocking experiences in 2009 and 2012,” he continued. “This trauma now re-generates previous pain and shock and also leads to a mental state of permanent fear and insecurity among children here.”

Since Monday July 7, Israel has subjected the Gaza Strip to a severe military assault and engaged with the Palestinian factions in a new round of violence.

The Palestinian Ministry of Health has so far reported 230 Palestinians killed; most of them are entire families who were killed in direct shelling of Palestinian houses. Meanwhile, the number of injured has risen to 2,500. Many of the injured and the dead are children.

Hospitals in Gaza are currently suffering from a severe shortage of medical supplies and medicines. Ashraf Al-Qedra, spokesperson for the Gaza Ministry of Health, has called on the international community “to support hospitals in Gaza with urgent medical supplies, as Israel continues its military attacks, leaving more than 800 houses completely destroyed and 800 families without shelter.”

Since Israel began its current offensive against Gaza, its military forces have been accused of pursuing a policy of destroying Palestinian houses and killing civilians. Adnan Abu Hasna, media advisor and spokesperson for UNRWA in Gaza, told IPS that “UNRWA has officially demanded from Israel to respect international humanitarian law and the neutrality of civilians in the military operation.”

He added: “UNRWA stresses the need to fulfill the obligations of the U.N. Secretary-General Ban Ki-Moon to immediately stop violence, due to the increasing number of children and women killed in the Israeli striking and bombardment of Gaza.”

Assam Yunis, director of the Al-Mezan Centre for Human Rights in Gaza, spoke to IPS about the stark violations of human rights and the urgent need for justice and accountability. “The current situation is catastrophic in every aspect,” he said.

“Human rights abuses are unbelievable and these include targeting medical teams and journalists, in addition to targeting children and women by Israel.  This points to clear violations of international law as well as war crimes.  Israel must be held legally accountable at the international level.”

Analysing the situation, Gaza-based political analyst and intellectual Ibrahim Ibrash says he believes that “Israel will never manage to end and uproot both Hamas movement and the Palestinian resistance from Gaza. On the other hand, the Palestinian militant groups will never manage to destroy and defeat Israel.”

He told IPS that the consequences for the Palestinians at the internal level after this military aggression ends will be critical, including “a split between the Palestinian people and the Palestinian Authority; many people will be outraged with the Palestinian leadership, and this of course will leave Gaza in a deplorable state.”

This critical crisis in Gaza comes against a backdrop of a continued blockade imposed on the territory by Israel, widespread unemployment, severe poverty, electricity cuts, closure of borders and crossings since 2006, destroyed infrastructure and a stagnant Gazan economy, combined with a lack of political progress at the Israeli-Palestinian political level.

The real truth that no one can deny is that the civilian population, including women and children, in Gaza are the real victims of this dangerous conflict.

Kayla Moore, in photo with her infant niece, suffered a mental health crisis and died in police custody. She is remembered in a community birthday celebration by her sister, Maria Moore. Credit: Doug Oakley/IPS

By Judith Scherr
BERKELEY, California, U.S., Nov 26 2013 (IPS)

Just before midnight on Feb. 12, Kayla Xavier Moore’s roommate dialed 911. Moore, 41, a paranoid schizophrenic, was off her prescription meds and highly agitated. The roommate thought he knew the drill – Moore would be taken to a psychiatric hospital, stabilised with medication and allowed to go home in 72 hours.

That’s not what happened. Finding Moore had an outstanding warrant, Berkeley police decided to take her to jail. When they tried to handcuff her, Moore, who was also African American and transgender, resisted – and died."All of a sudden there would be these invisible people in the apartment coming after her and she’d have to move again.” -- Elysee Paige-Moore

The coroner said Moore died from obesity, drugs and cardiovascular disease. Moore’s family blames the police.

Moore was not creating a disturbance and presented no threat, her sister Maria Moore told the community at a meeting on the incident.

“When you put your hands on someone who is a paranoid schizophrenic, who does not trust police, they are going to fight that,” she said. “If [police] had just stopped for a minute instead of trying to be enforcers, had listened and found out what the situation was about, Kayla would be alive.”

Police involvement in the death of people with mental health emergencies is not uncommon. In fact, an investigation by the Portland Press Herald/Maine Sunday Telegram one year ago estimated that at least half of the 375 to 500 people shot and killed by police in the United States annually suffer from mental health issues.

“Always a happy child”

Arthur Moore remembers the day he brought his first-born child home from the hospital and the joy Xavier brought the family. (This article refers to Xavier, the child, in the masculine and to Kayla, the adult, in the feminine.)

“Xavier was always a happy child. Whatever he focused on, he would focus on it with a lot of joy and a lot of intensity,” Arthur Moore said in an interview at the family home. “He was very bubbly and curious about everything.”

As he grew older, Xavier was found hiding twice for extended periods, something the family would come to see as an early sign of his illness.

As an adult, Kayla Moore was haunted by voices and often chose street drugs over prescribed medicines. Known by friends and family as a poet, talented cook and hilarious impersonator, Moore lived in shelters, the streets, cheap hotels, the family home and finally in a subsidised apartment.

She’d settle in a new place, “then all of a sudden there would be these invisible people in the apartment coming after her and she’d have to move again,” said Elysee Paige-Moore, Kayla’s stepmother.

Police reports indicate that Kayla Moore initially cooperated with police on the night she died, stepping outside the apartment to speak with officers. But when they told Moore she was going to jail, she rushed inside, demanding to speak with the FBI for confirmation.

Police called for backup. Officers struggled with the 347-pound Moore until she lay on her stomach on a mattress on the floor, with several officers straddling her to place her in handcuffs and ankle restraints. When she stopped struggling, officers rolled Moore to her side. Police say she was breathing then, but soon stopped breathing and could not be revived.

Some Berkeley police have completed 40 hours of specialised Crisis Intervention Training, but no CIT officer was available when Moore was in crisis, and Berkeley’s Mobile Crisis Team of mental health clinicians clocked out at 11 p.m.

“If you’re going to be in a mental health episode in Berkeley, make sure you’re going into it during business hours,” Berkeley Mental Health Commissioner Paul Kealoha Blake quipped at a community meeting.

Shifting out of “cop mode”

Crisis Intervention Training is premised on the principle that people experiencing mental health distress need compassion and treatment, not jail.

“The tactics we are taught in the academy often are not the best tactics for dealing with someone in crisis,” Philadelphia Police Captain Fran Healy says in “An Integrated Approach to De-escalation and Minimizing Use of Force,” published by the Police Executive Research Forum.

“We reiterate to our officers that they need to shift out of ‘cop mode’ in these situations…[CIT] gives the officers an awareness of when they have to change their approach and shift more to ‘social worker mode,’” Healy writes.

Initiated in Memphis, Tennessee in 1988, Crisis Intervention Training teaches officers recognition of mental illnesses, de-escalation techniques, and the principle of “diverting people that have serious mental illnesses away from the criminal justice system and back into the community system of care,” said Officer Jeffrey Shannon, Berkeley’s CIT coordinator.

Just eight percent of Berkeley police are CIT trained, though Shannon hopes that will grow to 20 percent. Most of the 2,000 communities with CIT programmes train a fraction of the force; Portland, Oregon trains the entire department.

Partnership with the mental health community is the heart of CIT training, said Laura Usher, CIT programme manager with the National Alliance on Mental Illness, which co-founded the Memphis CIT.

“There’s usually a component of the training where individuals just tell their stories – what it’s like to have a mental illness, what it’s like to be in crisis and what it’s like to be in recovery,” Usher said. “Officers say it’s the first time they’ve ever seen someone with a mental illness who is not in crisis. They realise, ‘This is a person just like me.’”

Many communities have Mobile Crisis Teams of mental health professionals who respond to people experiencing mental health distress. The downtown Oakland, California MCT partners with police and is available weekdays for about nine hours each day.

Stephanie Lewis, who heads the team, explains that when police get a call saying, for example, that a loved one is agitated, pacing or yelling, the MCT will respond. First police make sure the situation is safe, then clinicians try to connect with the individual, calling the person by a name they prefer, modulating their tone of voice, and, especially, showing respect, Lewis said.

Collaboration with police has been built over 10 years, said George Karabakakis, head of Health Care & Rehabilitation Services, the nonprofit that employs the embedded mental health staff.

“It’s not something you just say – ‘We’re going to embed someone in the police department,’” Karabakakis told IPS. “There has to be a lot of preparatory work to build those connections.”

In Berkeley, a coalition led by the local NAACP, the nation’s oldest civil rights group, is responding to Kayla Moore’s death and related issues by pressing city officials for around-the-clock mobile crisis teams, restricting police response to mental health calls to dangerous situations, increasing mental health services and hiring more Black and Latino clinicians.

“We have to make some sense out of Kayla’s death,” said Maria Moore. “We have to make some change from this.”

A fisherman and other Gulf Coast residents at a community meeting in New Orleans in 2010. Experts say that trauma related to the record-breaking BP oil spill in the region could last for decades. Credit: Erika Blumenfeld/IPS

By Lucy Westcott
NEW YORK, Aug 15 2013 (IPS)

Although Hurricane Sandy made her final sweep through the Northeastern United States nearly 10 months ago, for many people the stress caused by the storm lingers.

(See Part One and Part Three of the series)

In Lower Manhattan, two hotlines, the Disaster Distress Helpline (DDH) and Project Hope, which is part of the New York City-wide helpline Lifenet, and specifically for those affected by Sandy, are at the frontline of disaster counselling, listening to myriad concerns ranging from queries about post-storm open hours of drug rehabilitation programmes to anxious parents reluctantly sending their children back to school in the days after the Newtown, Connecticut school shooting last December. Both programmes are administered by the Mental Health Association of New York City.

“Typically the kind of disasters that result in a spike of calls at the national level are those that are larger in scale. The impacts tend to be greater in terms of loss of life, loss of property or the potential for psychological distress on a sizeable population,” Christian Burgess, director of the DDH, told IPS.

Following the Sep. 11, 2001 attacks on New York City, there was a need for a nationwide, phone-based crisis counselling service, Burgess says. The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the Department of Health and Human Services (DHHS) established the National Suicide Prevention Lifeline in 2005, but created an entirely separate hotline for disaster counselling after the 2010 BP oil spill.

Transitioning from the Oil Spill Distress Helpline, the DDH went live in February 2012, receiving its first major spike in calls following Hurricane Isaac, which tore through the Gulf Coast on the seven-year anniversary of Hurricane Katrina.

“It’s not therapy, it’s not a substitute for therapy. Really, it involves listening,” Burgess says, comparing the helpline to triage for mental health.

Counsellors are trained to listen for symptoms of distress that may indicate the need for crisis intervention, like suicidal or homicidal intent, and callers may also be at risk of depression or substance abuse.

The DDH saw spikes in calls after the Newtown shootings, in which a lone gunman killed 20 elementary school students and six staffers, and the Boston Marathon bombing in April, as well as the Oklahoma tornadoes in May.

“School shootings in particular tend to trigger stronger feelings of distress, simply because it’s easier for a large part of the population to identify with the sadness and grief,” Burgess says. “It shakes our foundation of what is supposed to happen, the order of things… especially if you were already feeling vulnerable before the event.”

Burgess says that the majority of calls following the Newtown shooting didn’t come from Connecticut, but from all over the country.

After a major disaster, repeated coverage on the 24-hour news cycle, sensationalised headlines and the easy accessibility of Internet allow for the vicarious trauma of rewatching distressing events, which adds to anxiety, Burgess says.

“The event in and of itself is traumatic… but it’s heightened by the constant media exposure, particularly for those who would have been at risk before the event,” Burgess said.

Trigger events still loom, like the State Department’s closure of 19 U.S. embassies across North Africa and the Middle East in early August. The DDH have received calls from people concerned about what the terror alert means, Burgess says.

Calls related to Hurricane Sandy marked the first time the DDH received sustained levels of calls over a period of time, Burgess says. At its peak, Sandy resulted in a 2,000 percent increase in calls from two weeks prior, before the forecasts began to take shape. Texts increased by 600 percent.

“In December we were starting to get longer calls from people, and mental health concerns were coming to the surface,” Burgess says, due to fewer resources and the emotional fatigue of still-displaced people.

Melany Avrut, programme manager for Project Hope, which has received nearly 4,000 calls since the hurricane, told IPS that the needs of callers have changed. In the weeks following the storm, callers wanted to know about filing FEMA applications, but six months later, there were more concerns about anxiety, mood and children having trouble sleeping.

“A big component of Project Hope is using your strength… recognising what [people] have used in the past to get them through a hard time,” Avrut says. “They want to talk about what it was like to go through this traumatic experience.”

The World Health Organization (WHO) recently released new guidelines on how to care for those with mental health issues following trauma. The guidelines emphasise the use of behavioural therapies, such as cognitive-behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) rather than relying on medications.

Although unusual, EMDR can be effective, Dr. Mark van Ommeren, a scientist in the WHO’s department of mental health and substance abuse, told IPS.

It likely works when a patient, focusing on the traumatic event, follows a therapist’s hand with their eyes. The working memory is taxed as the patient thinks about both the event and their eyes working to track the hand. The painful memory becomes less prominent, and upon revisiting the memory, it is less vivid and emotional in the long-term memory, van Ommeren says.

For people living in disaster areas who are vulnerable to mental health issues, van Ommeren suggests that stress management is a good way to prepare, as it makes going through difficult moments a slightly easier, adding that there are no concrete studies about this.

To contact the Disaster Distress Helpline, call 1-800-985-5990, or text “TalkWithUs” to 66746. To contact Project Hope, call 1-800-LIFENET (1-800-543-3638). 

Excerpt:

President Barack Obama tried Monday to jumpstart a new national discussion on mental health, sponsoring a conference with Vice-President Joe Biden aimed at reducing social stigma around the issue.

The event took place five months after two-dozen schoolchildren were killed in a shooting spree in the state of Connecticut by a killer who allegedly suffered from psychological problems. Since then bipartisan supporters have urged greater government focus on overhauling the country’s creaky mental health infrastructure.“If someone had cancer in your family or diabetes, you wouldn’t be afraid to seek help or talk about it." -- Dennis Wharton of the National Association of Broadcasters

“For the first time in a really long history, we have a president who is actually doing something tangible on this issue,” Mike Fitzpatrick, executive director the National Alliance on Mental Health, an advocacy group, told IPS. “President Obama is actually moving into the community and bringing together groups that haven’t worked together before to develop new partnerships. It’s exciting.”

Fitzpatrick called the United States’ current system of care for young adults dealing with mental health issues “abysmal”.

According to President Obama, speaking Monday at the opening of the conference, one in five adults in the United States experiences some form of mental illness. In addition, some 22 veterans of war commit suicide each day.

“The main goal of this conference is not to start a conversation, so many of you have spent decades waging long and lonely battles to be heard,” the president stated. “Instead, it’s about elevating that conversation to a national level and bringing mental illness out of the shadows.”

President Obama announced the launch of the new website, mentalhealth.gov, a clearinghouse of information for those seeking mental health services. The site will also host stories of those who have overcome mental health-related problems.

“We also need a change of hearts and minds,” Kathleen Sebelius, the secretary of health and human services, said at Monday’s conference. “We need to break down social barriers and help people understand that recovery is very real.”

Alongside the website, U.S. media outlets across the country are set to start a coordinated national campaign aimed at destigmatising mental health. According to organisers, the campaign will start by focusing simply on getting those suffering from mental health problems to feel comfortable talking about their experiences.

“If someone had cancer in your family or diabetes, you wouldn’t be afraid to seek help or talk about it,” Dennis Wharton, a communications executive for the National Association of Broadcasters, told IPS.

“So this new ad campaign will include television, radio and online advertisements targeted at 13- to 24-year-olds with the message that is it okay to talk about mental illness.”

Wharton says the new ads will not star celebrities, but instead feature a cross-section of U.S. society. “Because mental health knows no gender or race boundaries – this affects all walks of life,” he says.

Years of cost-cutting

Significant resources will be aimed at people who have served in the U.S. military.

For instance, Blue Star Families, an advocacy group for military families, will be producing a series of ads featuring country music stars urging veterans with mental health problems to seek help.

According to Barbara Van Dahlen, president of Give an Hour, a mental health advocacy group for veterans, says it’s unsurprising that many veterans suffer from mental illness, given their wartime experiences.

“It doesn’t mean that they are broken,” she said Monday. “It doesn’t mean that they can’t be great parents, great partners and great co-workers.”

Van Dahlen stresses the need for trauma and substance abuse to be included in the category of mental illnesses. Advocates emphasise that substance abuse is an indicator of deeper problems, often mental health issues – and that dealing with those problems often helps with the substance abuse, as well.

President Obama announced that in coming months more than 150 “summits”, similar to Monday’s conference, would take place across the country. Hosted by the Department of Veteran Affairs, these will be held between July and September.

“What we ultimately want to do is take the conversations we are having today in the White House, and take them to school auditoriums, community centres, houses of worship, living rooms and kitchen tables across this country,” Health Secretary Sebelius said.

Nonetheless, she also warned of the presence of significant barriers to the new initiative, particularly given years of cost-cutting and the current environment of financial austerity.

“States have cut back on mental health services, and there’s no question that there has been dramatic reduction in state funding,” she said. “We have been trying at the federal level not only to keep federal funding, but also to increase access to services.”

The president’s 2014 budget, for instance, has a request for the training of 5,000 new mental health providers, particularly those who can work with people to transition into university.

According to the National Alliance on Mental Health’s Fitzpatrick, the United States currently requires a massive effort to train practitioners and other medical professionals to be able to offer some form mental health care. Currently, he says, many who are actively seeking help simply cannot find it.

First, however, the new Obama administration push on this issue is focusing on trying to make people comfortable enough to discuss their experiences in the first place. In closing comments Monday, Vice-President Biden drew on personal experiences to urge others seek out mental health-related help if they need it.

“There is nothing, nothing to be ashamed of if you are struggling with mental issues or if your child is or your spouse or your friend,” he said. “It’s okay. It’s okay to talk about it. It’s okay to ask for help.”

Three in four people with mental illness live in developing countries, where treatment options are often limited or nonexistent. Credit: Photostock/IPS

By Stephen Leahy
UXBRIDGE, Canada, Oct 10 2012 (IPS)

About 50 percent of Afghanis over 15 years of age suffer from mental health problems – depression, anxiety or post-traumatic stress disorder. In northern Uganda, nearly every family suffered during the vicious 20-year rebellion during which thousands of children were kidnapped and turned into child soldiers in the Lord’s Resistance Army.

The fighting is over but the mental trauma continues.

Globally, close to 450 million people have mental health disorders, with more than 75 percent living in developing countries. Many are shut away or locked up. Few are ever treated, health experts say.

On World Mental Health Day Wednesday, 15 innovative projects are being launched to improve mental health diagnosis and care in Asia, Africa and the Caribbean. Nearly 20 million dollars will be invested under Grand Challenge Canada grants.

“There is a great deal of misunderstanding and ignorance about mental disorders in Afghanistan, especially outside of Kabul,” says Richard Scott of the University of Calgary, Canada.

There is only one psychiatrist in Badakshan Province where Scott and colleague Shariq Khoja will be working.

“We want to educate community health workers and get them to talk about mental disabilities,” Scott told IPS.

To reach Afghan youth, informative text (SMS) messages sent to their mobile phones will hopefully reduce some of the stigma and get some discussion going, he said.

“The first challenge is working with the Afghan Ministry of Health to change their approach and involve them in recognising mental disorders,” Scott said.

Security is another challenge, said Scott, who has been to Kabul, adding, “I don’t know how people can and live and work in that environment.”

“Everyone knows someone in their extended family with a mental health disorder,” says Peter Singer, CEO of Grand Challenges Canada.

“You’ve probably seen what a difference treatment can make. But if they were living in one of these countries, there was a six in seven chance they’d would receive no treatment,” Singer said in an interview.

“I have seen the health improvement with my own eyes. It makes me very sad about the current situation in most of the developing world.”

A year ago, Grand Challenges Canada launched a call for proposals to tackle the needs of mental illness. The money to fund Grand Challenges Canada comes from Canada’s 228-million-dollar Development Innovation Fund.

“Global mental health is a significant challenge, which left unaddressed could undermine the health, social and economic futures of developing countries,” said Jim Flaherty, minister of finance for Canada, in a statement.

The need for home-grown solutions is paramount, said Singer. There simply isn’t enough money to meet the need in poor countries using the same approaches used in richer countries to treat mental illness, he argues.

The projects were selected through competitive scientific peer review from among 97 ideas submitted to increase access, improve treatment, and address stigma for people with mental health disorders.

“We are looking for treatment innovations by researchers in the developing world who best know the reality in their countries,” he said.

In northern Uganda, that means revitalising the Wayo-Nero (“Auntie-Uncle”) tradition, said Herbert Muyinda of Makerere University, Uganda.

“Traditionally, aunties and uncles play an important role in raising children. We want to create ‘mental health aunties and uncles’,” Muyinda told IPS from Uganda.

The 20-year-long rebellion in northern Uganda displaced more than two million people. More than half suffer from post-traumatic stress disorder (PTSD) and up to 70 percent from clinical depression.

“People here don’t believe mental illness can be cured in hospitals or helped by modern medicine. They rely on traditional healers,” he said.

Those suffering from mental illness are often hidden away. Aunties and uncles will be trained and go into communities to find out about them and help lead them to treatment, he said.

Muyinda wants to get the modern and traditional to work together and avoid conflicts. “We want to engage with traditional healers to help them manage their patients better. We’re not going to take their patients away.”

Mobile phones will also have an important role in reducing the stigma of mental illness. Roads and other infrastructure have been destroyed by the war and many villages are very isolated, but people have access to mobiles, he explained.

Text (SMS) messages can inform people and help those suffering from mental illness to be identified and receive some form of treatment. “We hope to have a number that people can message and then a Wayo-Nero can visit them,” he said.

“We want to have many more innovative projects like these to create a portfolio of treatment options that have been evaluated for their effectiveness,” said Singer. “There is a great deal of talent in the developing world to meet the mental health challenge.”

The economic recession in Spain is taking a toll on mental health. Credit: Photostock/IPS

By Inés Benítez
MÁLAGA, Spain, Aug 29 2012 (IPS)

Rising rates of depression and suicide are among the most obvious signs of the increase in mental illness resulting from the economic crisis in Spain.

“Between December 2011 and March or April 2012, the number of suicides presumably linked to economic problems has increased significantly,” a forensic investigator in the southern Spanish city of Málaga, who asked to remain anonymous, told Tierramérica*.

During the first months of 2012, two well-known businessmen were found burned to death in their own cars in seaside towns in the province of Málaga, and all of the evidence seems to suggest that they took their own lives after their businesses went bankrupt, said the investigator, who did not offer any further details.

Suicide is already the leading cause of violent death in Spain, ahead of motor vehicle accidents. The number of suicides did not grow significantly between 2007, prior to the crisis, and 2010, the last year for which official statistics are available.

In 2007, deaths by suicide numbered 3,263, divided between 2,463 men and 800 women, according to a report on fatalities by cause of death released by the National Statistics Institute (INE). In the following years, slight fluctuations were observed: 3,457 in 2008, 3,429 in 2009 and 3,158 in 2010.

Statistics on suicide are not generally made public, and emergency services do not report them to the media, although deaths from other causes do receive news coverage.

“In 95 percent of cases, journalists do not go to the scenes of suicides, but they do show up at the scenes of homicides or accidents,” the forensic specialist reported.

Journalist Gema Martínez, who works for a local daily newspaper, told Tierramérica that suicides are generally not treated as “news” in order to avoid the potential for “copycats”.

“A great deal of care is taken when it comes to information on suicides and, in fact, when it is known that a death is the result of self-harm, this is not reported. It is almost as if it were part of an unwritten code of ethics,” she said.

But the scope of the health problem represented by an increase in suicides for social and economic reasons should be addressed by the media, said Martínez.

As psychiatrist Concha López told Tierramérica, suicide is generally the end result of a combination of factors. “The crisis and economic problems are one more reason that has been added, but not the only one,” she stressed.

Nevertheless, the crisis is undoubtedly becoming an increasingly powerful factor.

Unemployment currently affects 24.6 percent of the country’s economically active population, and there are 1.5 million households in which every member of the family is out of work, according to the INE. Spain has a population of over 47 million.

In addition, Spaniards have endured successive cuts in basic health care and education services, undertaken by the government to reduce the public deficit to 6.3 percent of GDP by the end of the year, so as to meet its commitment to the European Commission.

López said her psychiatric practice is receiving increasingly more men and women suffering from the symptoms of depression after losing their jobs, as well as others who are still employed but are facing a deterioration in work conditions and enduring considerable hardships to keep their jobs at any cost.

These patients suffer from “sadness, insomnia, anxiety, panic attacks, feelings of guilt and suicidal thoughts,” reported López, who said there has been a sizeable increase in the number of unemployed people who are “seeking answers” in the offices of psychiatrists and psychologists.

“In Málaga, the hospital emergency wards admit two or three people who have attempted to kill themselves every day,” said López, who has worked for eight years at the Community Mental Health Unit in Fuengirola, a town in the province of Málaga.

More than 50 percent of young people in Spain are unemployed and, according to the United Nations Children’s Fund (UNICEF), one in every four children is poor.

The income gap between the rich and poor has grown more in Spain than in any other of the 27 countries of the European Union, according to the report “Exclusión y desarrollo social – Análisis y perspectivas 2012” (Exclusion and social development: Analysis and outlook 2012), published by the Catholic organisation Caritas in February. The report places the poverty rate in Spain at 21.8 percent.

Gaspar Llamazares, a medical doctor and deputy from the opposition Izquierda Unida (United Left) party, spoke in Congress in February about the “upsurge” in suicides and stated that “the only factor that can explain it is the crisis.” Those who take their own lives are “workers made desperate by the lack of social security coverage,” he added.

After visiting a number of pharmacies in Málaga, Tierramérica confirmed that the demand for anti-depressant medications is on the rise.

“Sales of anti-depressants have increased by around 10 percent,” said a pharmacy manager with more than a decade of experience in the field. “It has been very noticeable. More people are coming in with doctors’ prescriptions to purchase psychoactive drugs,” concurred a young pharmacist at another drugstore, where she has worked for a year and a half.

Spain is not alone in this epidemic of despair.

In Italy, the financial and economic crisis has contributed to higher rates of suicide and attempted suicide, according to the article “Excess Suicides and Attempted Suicides in Italy Attributable to the Great Recession”, published in August in the Journal of Epidemiology & Community Health.

The article reports on a grassroots protest movement of “widows of the crisis” in the northern Italian city of Bologna, the wives of businessmen, craftsmen and workers who have been driven to suicide by bankruptcy and overwhelming debts.

In Greece, where the suicide rate has always been low compared to the average in Europe, there has also been an upsurge in cases of people who have taken their own lives for reasons related to the crisis.

* This story was originally published by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme, United Nations Environment Programme and the World Bank.

“Help us find them” reads a sign with photos of victims of forced disappearance, put up by their families. Credit: Daniela Pastrana/IPS

By Emilio Godoy
MEXICO CITY, Jun 7 2012 (IPS)

Since the forced disappearance of his son Jethro in May 2011, Héctor Sánchez has found an outlet for his grief in activism. So far he has turned down psychological support offered by the Mexican Attorney-General’s Office and human rights organisations.

“I cope by keeping very busy with the school project. That’s how we channel our painful feelings,” said the 59-year-old owner of an automobile parts business.

Jethro Sánchez, an electromechanical engineer, was arrested by municipal police in the city of Cuernavaca, 90 km south of Mexico City, on suspicion of belonging to a criminal organisation. Then he was handed over to soldiers, who tortured and killed him.

His body was found in August 2011, and three members of the military are now in custody awaiting trial for the crime.

Experts say post-traumatic stress disorder (PTSD) and acute depression are on the rise in Mexico as a result of the increasing violence seen over the last few years. Scientists have evidence that communities and soldiers involved in armed conflict – among regular or irregular armed groups – are exposed to PTSD, a severe health problem.

“This disorder is spreading rapidly in populations like that of the capital and other cities in Mexico, where PTSD levels associated with violence are already high. We find similar patterns: people’s stress levels are directly proportional to their exposure to the mass media,” which transmit terror and panic, Mauricio Meschoulam, an academic at the Jesuit-run Ibero-American University, told IPS.

Meschoulam, an expert on terrorism, peace-building and mediation, co-authored a study that assessed the prevalence of PTSD in Mexico, which is caught up in a spiral of drug-related violence aggravated by the government’s militarisation of the country.

Based on 333 replies to a questionnaire, from respondents in 15 of the country’s 32 states, the “Estudio sobre efectos psicosociales por violencia en México” (Study on Psychosocial Effects of Violence in Mexico) found that 51 percent of those interviewed said the violence affected their work life, 72 percent their social life and 58 percent their family life.

Moreover, 42 percent of the sample said the violence had an impact on their economic status and 60 percent reported that it had affected their mental health.

The survey recorded symptoms of various disorders, like frequent anxiety attacks, frequent insomnia, and feelings of irritability and despair.

The survey participants are exposed, like the rest of Mexican society, to the daily scenes of terror splashed across newspapers, blaring from television screens and circulating in cyberspace through the social networks and blogs.

The violence began to escalate after President Felipe Calderón took office Dec. 1, 2006 and immediately deployed the armed forces in the battle against the drug cartels.

After nearly six years, the success of the strategy is doubtful, as more than 50,000 people have been killed, 250,000 displaced from their homes, 10,000 disappeared and 8,000 orphaned, according to human rights organisations.

At first the hardest hit communities with the highest levels of PTSD were found in the outlying states where the cartels are powerful. But the psychosocial damage has spread beyond those areas due to the heavy media coverage.

The disorder can occur when an individual directly experiences assault, kidnapping, rape or natural disaster.

However, “not only the direct victims of criminal acts are at risk of this kind of disorder, but also their communities, neighbours and relatives,” Edith Zúñiga, the academic director and founder in 1998 of Tech Palewi (which roughly translates as “I support you and help you grow” in the Nahuatl language), told IPS.

“Reporters who experience the thick of the battle can get PTSD,” she added.

“People have tried to pass off the violence as normal, and it has not been given the importance it deserves. Attention has not been given to the mental health risks that are incurred. Early intervention is important, but not enough people are diagnosed,” she said.

The Attorney-General’s Office records at least 2,886 police officers killed since 2006, while the armed forces report at least 250 fatalities among soldiers. Military personnel have been attacked nearly 2,000 times.

“The costs are high. For instance, soldiers’ families know when the troops go away on an operation, but they don’t know when they’ll come back,” Jorge Álvarez, head of a crisis intervention programme for victims of natural and social disasters at the National Autonomous University of Mexico (UNAM), told IPS.

“Moreover, they (police and military) are accused of many human rights violations, so people do not trust them,” he said.

Created in 1997, the UNAM programme trains people like firefighters, rescue workers and soldiers in psychological first aid, and helps victims and their families.

The study “Estrés postraumático en la población pediátrica atendida en el Hospital Infantil del estado de Chihuahua, México” (Post traumatic stress disorder in a paediatric population treated at the Children’s Hospital of the state of Chihuahua, Mexico), published in 2011 in the Medical Bulletin of the Mexico City Children’s Hospital, reported that PTSD has increased considerably among children in recent years.

Six researchers from the state Autonomous University of Chihuahua and the Chihuahua Children’s Hospital authored the study, which reviewed 125 PTSD patients treated by the child psychology department over a period of three months. Of these, 52 had been traumatised by violence and 73 by accidents.

The patients were aged 5 to 15, and the highest prevalence was in the 5 to 7 year age group.

Psychological support “should be a priority. First of all those responsible should be brought to justice and there should be an end to impunity. Then we ought to think about psychological treatment,” said Sánchez, who will open a school specialising in auto mechanics, named after his son, on Jun. 18.

“It is essential to work with vulnerable populations. I think the state’s response is too slow and it is failing to detect the problem in a comprehensive way,” said Meschoulam.

He said he intends to continue carrying out national surveys and research on the effects of violence, to assess the needs of at-risk groups (children, women, police, soldiers and journalists), reduce hurdles for access to health care, and train personnel.

Zúñiga said “This kind of care needs to become more widely available, because the losses are so painful. We want to train people in the states, so as to form human resources who can make positive interventions in circumstances of this kind.”

A new approach to mental health care is slowly making headway in Argentina, against heavy resistance. Based on short-term hospitalisation, fewer psychiatric hospitals, and more services to strengthen the social integration of patients, it is aimed at eradicating inhumane treatment of the mentally ill.

In the last four years, Argentina ratified the United Nations Convention on the Rights of Persons with Disabilities and passed a law on mental health that is in line with the international convention and protects the rights of people with psychiatric problems.

The new law states that mental health services must be community-based, and promotes interdisciplinary action involving psychiatrists, psychologists, social workers and other professionals. According to the law, admission to institutional health facilities is a last resort.

But implementation of the law is going slowly. “Some practices are being modified in an isolated manner, but there have been no concrete institutional changes yet,” Macarena Sabin, the psychologist who works with the Centre for Legal and Social Studies (CELS), told IPS.

CELS was one of the human rights groups that pushed for passage of the mental health law in 2010. Three years earlier, it had published the report “Vidas arrasadas: La segregación de las personas en los asilos psiquiátricos argentinos” (Ruined Lives: Segregation from Society in Argentina’s Psychiatric Asylums) denouncing the abuse and negligence to which some 25,000 institutionalised mental patients were exposed in this South American country.

The report documented punishment in isolation cells, physical and sexual violence against patients, lack of medical attention, rehabilitation and treatment, unhygienic living conditions, overcrowding, and deaths that were never investigated.

According to the study, 80 percent of people hospitalised in psychiatric wards at the time had been there for over a year, and between 60 and 90 percent of them were “social patients” – in other words, people held in the institutions because they had nowhere else to go.

In its annual report published in May, CELS said the ratification of the convention and the approval of the new law indicated that things had started to change. But the group still pointed to an enormous gap between what is on paper and the reality on the ground.

Grave violations of the human rights of people with mental disorders persist, says the new report, which adds that patients in psychiatric hospitals are still the most vulnerable.

Sabin said that in the eastern province of Buenos Aires, where most of the country’s mental health patients are concentrated, “the application of the new law has been overacted, with an increase in the number of discharges of chronically ill patients.”

She said this is being done to prove that the process of deinstitutionalization of the mentally ill is moving forward. But without intermediate care facilities to attend to their needs, many of the recently discharged patients merely end up being hospitalised again, she added.

“It’s the revolving door phenomenon in psychiatric hospitals,” Sabin said. “The number of occupied beds in the chronic care wing goes down, but there is overcrowding in admissions, where patients are overmedicated to return them to a supposedly normal state.”

This problem is at its worst in the capital.

Socialist city lawmaker Virginia González Gass, chairwoman of the mental health commission in the Buenos Aires legislature, told IPS the situation “is disastrous” and many of the discharged mental health patients end up in homeless shelters.

“There are no halfway houses or ambulatory programmes to help them rebuild ties with their families or rejoin the labour market. The patients, without any support, end up in shelters where they aren’t even visited by a doctor,” she said.

There are three psychiatric hospitals in the capital: for men, women and adolescents. But no institutions have yet been put in place to help patients make the transition from hospitalisation to full integration with the family and the community.

Moreover, services created by patients themselves along with civil society organisations to help forge links between the hospitals and the outside world have been shut down. These included a bakery as well as carpentry and art workshops, Sabin said.

“Many doctors are opposed to the law,” the psychologist said. “They don’t allow patients to exercise their right to a lawyer. Hospital staff who allow legal defenders access to the patients are threatened with penalties.”

Under the new law, the National Public Defenders Office created a mental health unit, made up of 22 professionals, including psychiatrists, psychologists, lawyers and social workers, coordinated by Mariano Laufer, an attorney.

Laufer’s task is to keep patients from being hospitalised against their will. And in cases in which hospitalisation is inevitable, the team works to guarantee that it is brief and that the patients have agreed to the treatment they receive.

“The law is a tool in a slow, gradual process of reform that will take years,” Laufer told IPS. But, he added, “The legislation has radically changed the way the justice system treats these cases.”

In the 10 months since the mental health unit that he leads began to operate, it has helped some 1,700 people, he said. “Seventy percent of them were discharged or their hospitalisation was transformed into voluntary or ambulatory treatment.”

The lawyer said that before the convention was ratified and the new law passed, the approach to the mentally ill was “tutelary and paternalistic…Patients were not the subjects of rights, but objects of state protection or tutelage.”

“People with mental problems were legally stripped of their capacity to exercise their rights, in order to be protected. But what that caused was greater passivity, the annulment of the patient as a person, and their death in terms of civil rights,” he said.

Under the new approach, the patient has full rights, and involuntary hospitalisation, which was commonplace in the past, “is seen as equivalent to the deprivation of liberty” if it does not meet the requisites and guarantees required by law.

A judge must be informed when a patient is involuntarily hospitalised, and the hospitalisation must be brief and must only occur in cases in which there is a risk to the patient or to others, he explained. The judge must also periodically monitor the treatment received by the patient, to make sure it is in line with the law, he added.

In the past, the psychiatric patient remained isolated from the family after hospitalisation, unable to receive visits or phone calls. Many ended up staying in the hospital for months or years, and were subjected to treatment against their will.

But Laufer said the new conception has run up against resistance. Under the new system, “Information and knowledge is democratised, and is no longer in the hands of just one psychiatrist. In addition, our team is multidisciplinary and gets involved with a close understanding of the case in question,” he added.

But he concurred with CELS that “without halfway homes or alternative facilities, the process of deinstitutionalisation is very difficult to carry out. The law is one tool, but public policies are also needed.”