Category Archives: Mental health
October 10th is World Mental Health Day. This year we address a key issue facing people living with psychosocial disabilities (disabilities caused by mental illness): dignity.
The theme chosen for October 10, 2015 is “Dignity in mental health”. The word ‘dignity’ comes from the Latin word meaning worthiness. It is the idea that everyone has the right to be valued and respected. But taking it one step further, dignity is also about how people feel: treating someone in a way that they feel valued and feel respected. When people are living with dignity, they feel confident and they are able to make decisions for themselves.
Worldwide, high levels of stigma and discrimination strip people with psychosocial disabilities of dignity and prevent them from the experience of living as, and being treated as, equal members of society.
At CBM, we believe that all people with disabilities deserve to live in a world that treats them with dignity. Here are 3 ways that we believe can promote the dignity of people with psychosocial disabilities:
1) Creating accessible, people-centred care following a humanitarian emergency
Knowing that disasters can negatively influence the mental health of a population, CBM sees humanitarian emergencies as an opportunity to ‘build back better.’ In Sierra Leone, for example, the Ebola virus disease outbreak impacted the mental health of the country in many ways. Not one person was excluded from the experience of stress, fear and loss. CBM used this opportunity to mobilize resources and establish, with other partners, 14 mental health units across the country. Previous to the outbreak, mental health care was only available at the Psychiatric Hospital and in a couple of health units outside of the capital city. Similarly, in the Philippines, following Typhoon Haiyan, CBM used the opportunity to establish mental health units with trained staff who could visit and support people with psychosocial disabilities in their communities.
Creating accessible mental health care following an emergency seeks to reduce the long term psychological impacts of a disaster. However, it also brings care closer to people with psychosocial disabilities, allowing them to rebuild their lives with dignity: close to their homes and families with trained staff who treat them with respect.
2) Supporting opportunities for voices to be heard
An important part of dignity is providing people with the opportunity to make choices and to have control in their lives. It is not enough to speak on behalf of people with psychosocial disabilities. Instead, what is needed is environments that offer support and build confidence, so that people with psychosocial disabilities can find and use their voices.
Maya Angelou put it best when she defined dignity: “Dignity. It means a belief in oneself, that one is worthy of the best. It means that what I have to say is important, and I will say it when it’s important for me to say it. Dignity really means that I deserve the best treatment I can receive. And that I have the responsibility to give the best treatment I can to other people.”
Since 2008, CBM has supported the Presbyterian Community Based Rehabilitation (PCBR) programme based in Northern Ghana, to establish self-help groups (SHGs) with the aim of providing mutual support, and enabling people to re-enter the community, both socially and economically. Now, with over 23 SHGs throughout the upper east region, the groups provide an important source of support to people with psychosocial disabilities and their families. Through the groups, members have been able to challenge discrimination, share support and advice, and attain financial security in a resource poor setting.
3) Advocating for change in global priorities
While local developments, such as the establishment of services and self-help groups, are necessary to promote dignity, progress on a global level is equally important.
In September, 2015, the Sustainable Development Goals (SDGs) were launched. The SDGs build on the Millennium Development Goals (MDGs) and clearly state the priorities for governments and development agencies over the next 15 years. During the drafting process, FundaMentalSDG was formed: an alliance of organizations who believe in a common vision of seeing the SDGs consider the needs of people with psychosocial disabilities.
When the UN adopted the SDGs in September this year, we saw the exciting inclusion of mental health and well-being in the document. This success is in part due to the work of FundaMentalSDG, of which CBM is a founding member.
Mental health was not mentioned in the MDGs. Therefore, the inclusion of mental health and well-being in the SDGs indicates an increased respect for people with psychosocial disabilities on a global level. Equally important, we anticipate a greater investment in interventions that will lead to less human rights abuses against people with psychosocial disabilities.
On World Mental Health Day 2015, we are promoting the value and worth of people living with psychosocial disabilities. Whether we invest in improving access to care, the establishment of self-help groups or changing global priorities …it should all be done in the name of dignity.
“Things have a price and can be for sale but people have a dignity that is priceless and worth far more than things.” – Pope Francis
On 4th June I travelled to Nepal to join CBM’s team of local staff and emergency response specialists, who have been working since the devastating earthquake on April 25th to ensure that people with disabilities and injuries receive the help they need. Here is my first blog from Nepal, after a very moving day in Bhaktapur.
This ancient city lies nine miles east of Kathmandu. At its heart lie four connected courtyards containing some of Nepal’s most famous UNESCO World Heritage Sites, many of which were damaged or destroyed by the earthquake that shook Nepal on 25 April 2015. In the main Durbar Square, around the base of one of the damaged temples, is an exhibition of photos of some of those who lost their lives, either because they were unlucky enough to live in old or poorly constructed homes or caught by the falling masonry in the web of narrow streets that characterise the area. Many of the photos show the faces of elderly men and women, or very young children, both groups disproportionately affected by natural disasters, but there are also faces of many other people, caught indiscriminately by either the first quake, or the one that followed two weeks later on May 12.
In one picture, a teenage girl in school uniform smiles shyly at the camera. Just a few yards away, a group of girls and boys of around her age are donning hard hats and picking up shovels before dividing into teams and heading off in different directions. Their matching t-shirts declare them to be members of the local community who are volunteering in street clearing initiatives. This is one of the worst hit areas of the city and the lanes are still clogged with rubble, sometimes piled under the eaves of damaged houses, sometimes still filling the street so that you need to scramble over to get through. Despite other parts of Kathmandu being almost untouched, here there is not a road or side street which remains untouched. Everything is covered with a thin film of dust, and the few shopkeepers who have ventured to open up again, busy themselves continuously with dusters and rags.
I am with Pramita Shrestha, a social worker from KOSHISH, a CBM local partner that offers psychosocial counselling and trauma care in the Bhaktapur District. Pramita describes the additional support the psychologists and counsellors are providing, not only for those with mental health problems that they were already supporting, but also to an estimated 3,500 earthquake survivors who will need psychosocial support over the next few months. This is one of the less visible after-effects of a disaster of this scale but one which touches on the lives of so many survivors. Schools have just reopened again and we are passed by rows of neat white shirts and royal blue skirts, matching ribbons bouncing above – but numbers are down as many children are too anxious to leave their parents, too scared to enter the school building or, with the many aftershocks still being experienced, too sleep-deprived to function well. People have also started to return to work where they can, or to the social activities they used to enjoy and we see a few small groups of men on the verandas of undamaged houses playing cards or board games, while women sit in twos and threes knitting. But there are also those who sit in their doorways staring into space, and KOSHISH is reporting new cases every day of people of all ages struggling to come to terms with what has happened. Sadly for all those that come, as many remain unwilling to seek treatment for any kind of mental health condition which remains widely misunderstood and taboo in Nepal, as in many places.
We come across a single house collapsed among a row of otherwise intact buildings. Further along, two stories of a house withno side wall stand open to the air, as if a huge serrated knife has sliced vertically through the building. As we approach, we see two figures rolling brick pieces down a corrugated iron sheet propped against the wall. On every street we come to, similar activity is beginning to take place. People on rooftops, shovelling debris. People pushing wheelbarrows of dust out of alleyways or carrying piles of bricks to the truck that cannot make its way down the blocked streets where life has started to go on once again. Around the next corner, we come across a slogan daubed on a partially collapsed wall, “We will rise again”. Later someone walks past with this printed on a t-shirt.
The photos in Durbar Square are one of the ways that the city is mourning its loss and it will take decades before the country is close to full recovery. But this slogan has started to appear across the city and perfectly reflects the resilience of a nation that is already working hard to pick itself up and move forward. KOSHISH was there in the days immediately following the earthquake, providing psychological first aid as vital as the bandages being so much more visibly applied, and it will continue to support for the long term the efforts of the Bhaktapur community to “rise again”.
As we watch the events unfold in Nepal since April 25, we are reminded of the extra challenges that people with disabilities experience during disasters. Those with physical disabilities may struggle to flee to safety or travel long distances for essentials like food and water. The methods used to communicate an approaching disaster may not consider the needs of people who live with blindness, deafness or learning disabilities. Temporary shelter facilities, as well as other relief and longer-term recovery services, may not be accessible. And suddenly there is an influx of people experiencing new disabilities within the population; physical trauma caused by an earthquake, for example, may lead to the amputation of limbs or spinal cord injuries.
At the same time, people with disabilities show incredible amounts of resilience in emergencies. There are countless stories of people with disabilities helping their own community members. I think back to working in Haiti with CBM after the 2010 earthquake. Key members of our community rehabilitation team had disabilities themselves, yet refused to let disability equal inability. They worked hard within our teams to ensure that the needs of their whole society were being met.
This week, in the UK, we celebrate Mental Health Awareness Week- a perfect time to talk about the importance of mental health in disasters. People with psychosocial disabilities (those living with disabilities caused by mental illness) are often left behind during a disaster. In the Philippines after Typhoon Haiyan, we heard stories of people living with mental illness who had been chained in their homes and were unable to flee to safety when the typhoon was approaching. In addition, access to mental health care – and psychotropic medicines in low and middle income countries is an ongoing issue. During a disaster, the ability to access care and medication often shifts from challenging to virtually impossible.
The World Health Organization (WHO) estimates that after an emergency, the number of people experiencing mental disorders can as much as double within the population. At the same time, normal signs of distress within a population increase greatly. This information highlights something very important. First, there is a great need to continue to care for people with psychosocial disabilities after a disaster. In fact, the need has now doubled. But secondly, suddenly there is a large amount of psychosocial stress being experienced within the general population. This stress is a normal reaction to loss and to exposure to distressing events. Many will recover from these experiences, however a number of those who need psychosocial support can benefit from simple, cost-effective approaches such as Psychological First Aid.
CBM recognizes the importance of mental health and psychosocial support during emergencies. We also place a high value on the knowledge and understanding that our local partners have during emergencies within their countries. This is why CBM works hand in hand with our partners during and after emergencies.
In Sierra Leone, for example, our Enabling Access to Mental Health programme had already established an active mental health advocacy group, the Mental Health Coalition – Sierra Leone. The Coalition had become a focal point for mental health system development, in collaboration with the Government of Sierra Leone. When the Ebola outbreak started in West Africa, the Coalition was in the perfect position to support the coordination of mental health and psychosocial actors in Sierra Leone. They were able to advocate for better psychosocial support for health care workers. They also pushed to have mental health professionals (trained under the Enabling Access to Mental Health Programme) placed strategically throughout the country to offer support for those experiencing signs of distress and ongoing care for people with psychosocial disabilities. The Coalition supported the adaptation of training and activities to the local context, and advised on the development of strategies, policies and basic packages. Because we had a trusted partner already engaged on the ground, CBM was able to mobilize financial support so that they could continue their impressive work.
Now, looking to Nepal, CBM is currently implementing response work, again with strong partners, to offer mental health and psychosocial support. Already, CBM is a partner with a national level mental health group- KOSHISH. Our emergency response unit based in Kathmandu has been liaising with them since the earthquake struck, as part of our overall response, and we are now at the stage of providing them with support to be able to meet immediate psychosocial needs of people affected by the earthquake, and to improve access to basic relief aid as well as to specialise services for persons with psychosocial disabilities. In addition, we will draw on the knowledge and experience of our partners doing Community Based Rehabilitation work throughout Nepal. They are in the perfect position to provide their communities with psychosocial support, and we are already working to ensure that relevant staff members are also trained in Psychological First Aid.
People with Epilepsy often face similar stigma and discrimination in their communities as those with psychosocial disabilities. For this reason, we encourage our partners to also include people with Epilepsy into our mental health and psychosocial support programmes.
Addressing mental health and psychosocial needs is essential for complete and effective disaster response. I hope that by highlighting the work of CBM in emergencies, the experience, rights and needs of people with psychosocial disabilities, are clear. But more importantly, I hope to have shown a way to approach these challenges – not only will this strategy improve the situation for many individuals affected by the current emergency, but will build their resilience for the future, and therefore that of their families, communities and society as a whole.