In emergencies, providing mental health as part of general health care is more accessible, cost-effective and less stigmatizing. In 2014 International Medical Corps (IMC) began implementing integrated maternal and child health and mental health psychosocial support services to refugees from Blue Nile Region of Sudan in three camps at Gendrassa, Kaya and Doro in Maban, South Sudan. These services are integrated with general health services within the area to account for the stigma associated with mental health disorders and also due to limited referral services for mental health and local mental health professionals (0.03 psychiatrists for 100,000 of the population) in the country4.
MHPSS Refugee Response program components:
Treatment and service delivery
- Since the beginning of the MHPSS refugee response, IMC’s staff has been providing integrated health services at clinics including:
- Pharmacological and non-pharmacological management of priority mental illnesses and health promotion activities at both facility and community level
- Management of acute and chronic diseases by outpatient consultations, provision of essential drugs
- Basic laboratory services, Routine immunization
- Maternal and child healthcare
- The frequency of sessions was informed by the individual treatment plan and related to the severity of the symptoms. Clients with more severe mental health conditions require more frequent follow and sessions
- The program also organizes regular clients forums in which patients are able to identify their own needs in relation to the challenges they experience as a result of their condition
- Clients are encouraged to find personalized solutions, suggest areas of support and select their own leadership to represent their needs to the respective persons and agencies
- In these forums, clients are able to understand their basic human rights and discuss their challenges, coping mechanisms and strategies
- Referral pathways and linkages to available services such as livelihood, protection, gender-based violence (GBV), physiotherapy services, shelter, and other community-based services are also made available to clients in need
Detection and outreach
- The mobilisation and engagement of existing community assets such as community health promotions, lead mothers and birth attendants, teachers, youth and community leaders and the Village health nutrition committee were sought to improve holistic mental health services as well as healthcare seeking behaviour among beneficiaries
- Community Health Promoters (CHPs) are trained to provide support to the clinicians in referring clients to the clinic, support clients at the household level and also contribute valuable data and information in reporting
- CHP’s also played a pivotal role in mobilization, patient tracing and community awareness on mental health issues.
- Non-specialized health care providers were trained in the pharmacological management of mental health disorders using WHO’s mhGAP Intervention guidelines and national guidelines. The training and subsequent on the job support supervision was conducted by an IMC psychiatrist and a national psychiatric nurse. Refresher trainings were also conducted on site focusing on areas of need observed during the supervision visits e.g. pharmacological interventions
- Capacity building on skills like building rapport, confidentiality, empathy and practical support promoted trust and good communication between clients and health care staff
- Topics covered included: General principles of care, moderate- severe depression, psychosis, seizures/epilepsy, acute stress, Post-Traumatic Stress Disorder (PTSD) and significant emotional or medically unexplained somatic complaints
- A wide array of community workers were also trained to identify mental health symptoms with a particular focus on epilepsy, psychosis, acute stress and PTSD, and depression, to know when to refer to IMC’s clinics for further management and the roles of community members regarding care for their clients.
- A number of incentivized community workers, teachers and selected lead mothers were trained in basic of psychological first aid. These trainings were facilitated by the national mental health officers who received training of trainers (TOT) sessions on Psychological First Aid (PFA) and spoke the local language
Promotion and awareness
- Promotional mental health messages were disseminated by trained community health workers at the registration, triage and waiting areas of primary health clinics in Kaya, Gendrassa and Doro. Messages included information on symptom recognition, referral processes, and psychoeducation for families and community members
- CHPs and mental health officers also conducted supportive home visits to assess levels of family support and care for clients, stigma, involvement in family activities, strength of the client in doing self-supportive activities and to promote socialization, human dignity in care and check for gaps which require support and intervention
- Need-based group sessions were held to support families of people with severe mental illness, groups of patients and other interested parties. The groups provided a social support system and an opportunity to discuss common issues in the camps, learn from one another and receive relevant information from staff. These sessions were facilitated by community workers and some beverage, games and play activities were also provided for children receiving services.