November 2015 - Volume 13 - Issue 3
REFLECTIONS, COMMENTS, LETTERS
Personal perspectives of protracted displacement: an ethnographic insight into the isolation and coping mechanisms of Syrian women and girls living as urban refugees in northern Jordan
The ongoing conflict in Syria has provoked mass exodus on an unprecedented scale, with over four million Syrian refugees now registered with the United Nations High Commissioner for Refugees. Most of these refugees fled across the borders to Jordan, Lebanon, Egypt, Iraq and Turkey, where the vast majority of Syrian refugees now live outside of the camps, their priorities and coping mechanisms shifting due to their protracted displacement. The ethnographic study presented here focuses on the experiences and emotions of the women and adolescent girls living in continued and uncertain displacement in the Jordanian border towns of Irbid and Ramtha. Presented within a historical and cultural context, and drawing on the refugees’ own personal narratives, this paper offers an insight into the perspectives of Syrian women of different ages and social backgrounds as they share some of their thoughts and feelings around their prolonged separation, and different levels of hardship, vulnerability and isolation.
The effects of war: local views and priorities concerning psychosocial and mental health problems as a result of collective violence in Burundi
This paper explores how people in Burundi view the impact of the past civil war on their lives and wellbeing. The methodology consisted of focus group discussions (n = 104), including participatory ranking techniques, and key informant interviews with traditional healers (n = 8). Respondents saw economic decline (poverty, loss of livelihoods), worsened health and nutritional status as major issues, but also mentioned social aspects (erosion of mechanisms for social support and conflict resolution), and psychological aspects (sadness, grief). When invited to elaborate on the mental health and psychosocial consequences of war, the respondents mentioned a range of issues related to depressive states, fear/anxiety, grief, madness, and substance abuse. These findings lend support to the notion that mental health and psychosocial wellbeing need to be given due attention in the reconstruction of Burundian society. The findings corroborate the conceptualising of programmes for mental health and psychosocial support as multi-layered approaches with varying goals: to promote social cohesion, to strengthen family support, to help people deal with issues related to loss, grief and sadness, and to support individuals with severe mental disorders. The design of such interventions should take into account what people themselves find important in their lives and social settings.
Mental health and psychosocial support in humanitarian settings: reflections on a review of UNHCR's approach and activities
Mental health and psychosocial support activities are increasingly becoming a core component of humanitarian response and support for displaced persons in emergencies. However, recognition of the mental health and psychosocial impacts of conflict, disaster and displacement is relatively new within the sphere of humanitarian assistance. This paper, therefore, describes and expands on findings from a review of the UN Refugee Agency's engagement with mental health and psychosocial support for refugees. While this review specifically focused on one agency within the humanitarian field, it should be useful to many humanitarian agencies working in the field as the number of displacement scenarios grow and mental health and psychosocial aspects of displacement are increasingly evident. This review identified three key themes; 1) engaging with mental health and psychosocial support in humanitarian settings as an approach and as a set of interventions was found to be a useful framework; 2) challenges in measuring and evaluating mental health and psychosocial support activities, and the ways in which these challenges influence mental health and psychosocial support in humanitarian settings is discussed; and 3) limitations in provision of clinical mental health services were evident.
Taskshifting: translating theory into practice to build a community based mental health care system in rural Haiti
In 2012, Zanmi Lasante, a Haitian nonprofit organisation, along with its sister organisation, Partners in Health, developed a mental health plan intended to go beyond the immediate post earthquake context by building capacity for mental health and psychosocial services within primary care services at 11 Zanmi Lasante sites throughout Haiti's Central Plateau and Artibonite regions. This paper describes laying the foundation for a community based, mental health care system through the articulation of a ‘depression care pathway’, in which patients are identified and treated within the community, but referred to clinics and more specialised care when required. We emphasise taskshifting clinical, service delivery, systems building, and quality improvement responsibilities to psychologists, the central players in the Zanmi Lasante mental health model. By describing challenges and providing practical, implementable solutions, we highlight how this fundamental theory in global mental health translates into daily practice in a health care setting with limited biomedical services, clinical training and human resources. We also provide recommendations for optimising taskshifting when initiating community based mental health services in similar resource limited settings.
Implementing psychosocial methods to reinforce women's legal rights awareness training in Jordan
There are often large gaps between providing information on legal rights and the actual use of that information in women's daily lives. Clinical psychologists from the Arab Renaissance for Democracy and Development - Legal Aid devised joint psychosocial legal awareness training sessions to empower women through culturally sensitive assertiveness skills training, so they could make better practical use of legal rights information. Training of trainers sessions were held with Family Guidance Awareness Center lawyers and social workers, who conducted an anecdotal study with women from the community of Zarqa, Jordan to verify two different methods. The first method involved conducting both legal awareness and a psychosocial session on the same day. The second method, utilised modules, both legal and psychosocial, spread over the course of two days. Quotes from participants strongly suggest that women are able to make better use of legal information if provided with a supportive, skills based psychosocial session as an adjunct, it also suggested that it is likely that longer information and longer psychosocial training sessions (method 2) result in the best outcomes, so long as there is a sufficient break between sessions to overcome fatigue. However, before more widespread implementation of these methods, we recommend more longitudinal research, specifically focused on testing for unintended negative consequences, seeing how well changes can be generalised to fit into women's everyday lives, and how well they last over time.
REFLECTIONS, COMMENTS, LETTERS
From victim to survivor: the girls of water and rice
This personal reflection is based on key lessons that have emerged as a result of a year of fieldwork with female (former) child soldiers in reintegration programmes in Colombia. In working with, and observing, a local non-profit organisation in Bogotá, Colombia, it became evident that assisting the girls in transitioning from a victim mentality to that of a survivor was critical to successful reintegration. This reflection seeks to demonstrate the important work being undertaken in Colombia, and highlights the importance of this transition, which ideally can influence reintegration programmes on a global scale.
Kelly & Michèle O’Donnell (Eds.). Global Member Care: Crossing Sectors for Serving Humanity. Pasadena, CA: William Carey Library, 2013 (421 pages) ISBN-13: 9780878081226