Heal Thy Neighbor: Mental Health Services Recruit Locals to Help Residents of Poor and War-Torn Countries

By Bower, Bruce | Science News, December 14, 2013 | Go to article overview

Heal Thy Neighbor: Mental Health Services Recruit Locals to Help Residents of Poor and War-Torn Countries


Bower, Bruce, Science News


Nearly all the women of Mohmandara, a village in eastern Afghanistan near the Pakistan border, met at a local health clinic one day in 2005. Mental health workers at the clinic, run by a Dutch international aid organization, had heard village women talking to each other about "feelings of sadness" and "worrying too much." The women eagerly accepted an invitation to talk it over at the clinic.

The village women described being beaten and harassed by their husbands, who were spurred on by their mothers and sisters. Families were imploding. Everyone in the group agreed that unemployment and poverty, in a land hounded by warfare, lay behind the surge of domestic violence.

With the help of a local woman trained by the aid organization, HealthNet TPO, the wives formulated a plan of action over several meetings. Close relatives were recruited to act as mediators between wives and their husbands' families. The women practiced settling and defusing disputes at home. With help from another aid group, the wives raised money to buy chickens so they could sell eggs for added income.

Family life didn't suddenly become tranquil. But for the first time, the village women felt hopeful that they could do something to reverse a deteriorating situation.

This emergency intervention was no isolated incident. Promising innovations in mental health care are popping up in some of the world's most impoverished and devastated places.

From Afghanistan to India, Uganda and beyond, a "take it to the people" model of psychotherapy is emerging. Stepping outside their traditional role as treatment providers, psychiatrists and psychologists train and supervise laypeople to deliver brief forms of group or individual psycho therapy. Early research suggests that inexpensive, nonprofessional therapists can effectively treat depression, anxiety and trauma-related problems, the most common mental ailments in the world today.

Scientists are beginning to explore the impact of war and lifelong hardships on mental health. One early discovery: Being accepted back into a family and community greatly alleviates suffering among former child soldiers, a fact that supports a growing international focus on social as well as psychological interventions.

"Humanitarian crises offer opportunities to build effective mental health care systems in developing nations," says psychiatrist Vikram Patel of Sangath Centre, a nonprofit health organization in Goa, India. Massive emergencies focus attention and outside assistance on the psychological needs of survivors. Politicians presiding over distraught populations suddenly become receptive to redoing mental health systems.

In Afghanistan, that opportunity came after the fall of the Taliban government in 2001. With the central Asian nation's entire health system in tatters, the new government contracted with aid agencies to set up mental health training and counseling centers in several regions. After 2004, the Ministry of Public Health worked with aid agencies and the World Health Organization to integrate those services and provide mental health training to physicians, nurses, midwives and people with no health care background. In 2010, Afghanistan's government launched a national strategy for expanding mental health care.

In developing nations, where WHO estimates that there is an average of one psychiatrist serving anywhere from 200,000 to 1 million people, those who need mental health care usually don't get it. Researchers say that a key to extending mental health care's reach is to deploy available psychiatrists and psychologists as trainers and supervisors of nonprofessional counselors--including villagers in some of the world's poorest and most violent regions. Lay counselors do the nitty-gritty work of coordinating each patient's care, as well as providing brief group and individual psychotherapy to those who need and want it.

A 2013 WHO report titled "Building Back Better" describes how, in the aftermath of wars and natural disasters, ambitious mental health reforms have been instituted and are starting to make a difference in Afghanistan and 10 other countries and territories since 2000. …

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