[#WHD2017 Blog Series] Inspiring Innovations: MHPSS in the Middle East
This blog is part of our series celebrating World Health Day, this year themed “Depression: Let's Talk.” Hear what our community of innovators has to say about the ideas behind their Inspiring Innovations, and how they address depression across the globe.
Here, the International Medical Corps teams in Turkey and Iraq discuss their approach to integrating MHPSS services into primary healthcare in the Middle East.
Tell us about your country’s context and the circumstances that inspired your innovation.
Estimates indicate that there are about 2.8 million refugees living in Turkey as of the end of 2016 (UNHCR)1. As no end to the conflict in Syria is foreseen in the near future, Syrians will remain living in Turkey and are becoming increasingly vulnerable. Many resort to negative coping mechanisms such as child labour, early marriage, obsessive worry, social withdrawal, smoking, and crying which increase the risk of developing mental health and psychosocial problems the longer the conflict and their displacement continue. Furthermore, stigma surrounding mental health and psychosocial support (MHPSS) issues, especially among males, as well as a shortage of Syrian and/or Arabic speaking mental health professionals in Southern Turkey has further put conflict-affected Syrians at risk of developing or worsening mental health conditions.
As the ongoing conflicts in Iraq continue over the years, including ongoing military operations to retake Mosul from ISIS over the past 4 months, the lack of adequate health care services including MHPSS services in camp and non-camp settings remain a major challenge. International Medical Corps (IMC) has been providing humanitarian assistance in Iraq since 2003, providing health, MHPSS, and gender-based violence (GBV) services. In east Mosul (around 150,000 persons), IMC has been the sole provider of MHPSS services since January 2017. IMC also works to meet the needs of internally displaced persons (IDP) and refugees in six governorates. For example, in Dohuk (Population: 1,356,415), IMC is working closely with the Directorate of Health (DoH) to address the MHPSS needs of Syrian refugees (81,673 persons) and IDP (174,615 persons) living in camp and non-camp settings.
What aspect of your project are you most excited about? How is the project innovative or unique?
IMC Turkey’s MHPSS programming has thus far responded to the needs of beneficiaries in emergency settings through case management, psychiatry, group activities, awareness raising, and psycho-education, as well as training for service providers to use tools provided by the WHO such as Psychological First Aid and Detection and Referral of mental health issues. These services can be provided by psychiatrists, psychosocial workers, or mhGAP-trained community workers. Due to the protracted conflict in Syria, causing protracted displacement, IMC needs to respond to the changing and medium-term MHPSS needs of this population. As there is a noticeable lack of Arabic language mental health services in the area, particularly psychological services, IMC is also in the process of providing training on counselling skills, Acceptance and Commitment Therapy and self-help techniques to increase the skills of Syrian mental health workers. Together, these activities are improving the quality of services available, and improving resilience to mental health conditions among the displaced Syrian population.
As part of its contribution to building sustainable national mental health care systems, IMC signed a Memorandum of Understanding (MOU) with DoH Duhok in January 2017, to provide rationalized, integrated quality health and MHPSS services to Iraqi IDPs, Syrian refugees, and vulnerable host populations. Currently, two staff work as part of the DoH in Dohuk and a third will be recruited within the upcoming months. This was established to create a harmonized approach towards various levels of health care provided through DoH primary health care centres integrating mental health into primary health care and providing continuous support in terms of addressing common mental health conditions, of which Depression is the most prevalent.
Have you noticed an impact ‘on the ground’? What is the best feedback you have received (from service users, team members, or otherwise)?
In 2016, IMC Turkey piloted Self Help Plus (SH+), which is a new MHPSS intervention tool developed by WHO for use in low-resource and emergency settings. Based on Acceptance and Commitment Therapy (ACT) principles, it is intended as a stand-alone tool for use by persons experiencing mild to moderate mental health or stress-related conditions and symptoms who cannot regularly access MHPSS services. The aim of the guide is to give users the information and practical skills to help them deal better with day-to-day or more periodic challenges in life (but is not intended to treat mental disorders). Results from the pilot study were overwhelmingly positive with feedback such as “motivational”, “helps to build self-confidence”, and “a good addition to regular psychosocial support sessions”. Beneficiaries also reported a range of benefits of using the SH+ workbook, such as decreasing levels of stress, irritability, and negative thoughts, and improved relationships. Due to the success of the use of SH+ among conflict-affected Syrians with mental health needs, IMC decided to pilot the use of ACT as an effective method of support for this population.IMC have just begun training psychosocial workers on psychological theory and counselling skills, and will continue with specialised training on ACT in May 2017.
This project is motivating to both IMC as an organisation and the DoH as it helps address the needs of the population, of which 4,000 women survivors from areas previously occupied by ISIS – mostly Yazidis – have benefited from support. DoH, IMC, and other actors have collaborated over the past year to address and overcome the gaps in service delivery and make this system sustainable. The intervention through the mental health center and the integration of mental health into primary health care have resulted in a significant decrease in suicide attempts and number of individuals with Depression.
IMC have developed a year-long continuous professional development strategy for mental health workers in Turkey, incorporating psychological and social work theory, counselling skills, ACT, self-help techniques, and clinical supervision through psychologists. As a result, mental health workers will be able to benefit from their training, use it in their work, and improve their skills on a continual basis.
The future plan is to increase the number of staff in order to establish an independent MHPSS department inside DoH-Duhok and expand services on a community-based level. IMC will be working with the DoH to conduct mhGAP trainings to all primary health care and DoH staff, and ensure continuous support and supervision as an integrated part of the DoH.
What is the one message about depression you want people to take away from your innovation?
People have the strength to take control of their depression and continue to lead meaningful lives according to their own personal values. With ongoing training and supervision, paraprofessionals can provide effective and safe interventions that support this process.
We’re all responsible, together we can make it work.