Monday, June 18, 2012

IDPs still suffering poor mental health

Sunday Nation 17 June 2012

Last year, we conducted a study on the mental health of internally displaced persons (IDPs) in parts of Uasin Gishu County. The findings from this study are compelling insofar as they demonstrate serious inadequacies in our disaster response and management of the mental health consequences of disasters.

A relatively well-coordinated response was mounted in 2008 to address the mental health and psychosocial needs of the displaced populations in Uasin Gishu County. Considering that there are regions in this country where the response was not as robust or organised as it was in Uasin Gishu, it is highly likely that, were we to repeat this study in the rest of the country, the results would be significantly worse.

Two findings stood out in our study.

Firstly, the IDPs had significantly higher prevalence rates of depression compared to a control group consisting of people who did not experience internal displacement. Indeed, one group of IDPs, those still living in camps, were found to be four times more likely to be suffering from depression than the control group. Integrated IDPs and those that have already returned to their farms had lower prevalence rates of depression, but their rates were still two to three times higher than the rate in the control group.

Secondly, IDPs were almost twice as likely to be suffering from post-traumatic stress disorder (PTSD) as the control group. PTSD is an anxiety disorder that arises among some of the people exposed to events they consider to be traumatic, and the symptoms may be so severe as to result in serious problems in daily life.
Instructively, over three-quarters of the IDPs who had returned to their homes were suffering from PTSD at the time of the study.

In this study, the commonest traumatic events associated with these disorders were the sudden death of a loved one, and witnessing the killing or serious injury of another person. During post-election violence, these events became so common that, at some point, someone described the televised killing of a protester as the stuff of Rambo movies.

The first lesson we learn from this study is that short-term interventions in disaster situations are often not very useful and may, in fact, be harmful. Early on in the intervention, we clarified that any organisation intending to deal with mental health and psychosocial support in the region had to have a long-term plan for both the immediate and delayed consequences of exposure to traumatic events.

However, due to dependence on limited donor funding, none of the programmes had a proper long-term plan for addressing chronic mental health and psychosocial issues for the IDPs. The government itself has continued to dither and prevaricate on the fate of IDPs and, as demonstrated by our study, this has had a very adverse impact on their mental well-being.

Secondly, we have learnt that it is important to integrate mental health and psychosocial support services into the overall disaster response mechanism, right from the apical coordination level. Absence of competent professionals at the planning levels results in substandard services and programmes being offered, resulting in more harm than good.

Finally, we now know that unless governments develop programmes to address the mental health needs of their populations, violence and instability will remain prominent features on our landscape.

Dr Atwoli is secretary, Kenya Psychiatric Association, and lecturer, Moi University School of Medicine.; twitter @LukoyeAtwoli

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