Mental Health Day
Wamundila Waliuya,
10th October,
2016.
Promoting Psychological First
aid to Reduce Psycho-social Problems
I realize that in many
instances people have ignored the psycho-social conditions they find themselves
in which they could lead to critical mental health problems. Almost everyone
sometimes find themselves in stressful psycho-social situations. In many
circumstances, they treat such situations lightly when they could be grave. In
my many years of working around mental health rights and mental health law in
Southern Africa I have interacted with persons with psycho-social disabilities,
mental health practitioners, human rights activists around mental health and
the rights of mental health users and of course public health policy makers. It
is in view of this that my interest to contribute towards the development of
quality mental health services that are comprehensive in nature, but at the
same time sustainable and community-based. I write this article as a
contribution to the Mental Health Day which falls on 10th October,
2016. The theme of the Mental Health Day in 2016 is around “psychological first
aid”.
World Mental Health Day is
observed on 10 October every year, with the overall objective of raising
awareness of mental health issues around the world and mobilizing efforts in
support of mental health.
Just as a way of
engendering critical introspection, I present the following simple questions:
have you ever witnessed a fatal road traffic accident which affected your
thought and psychological state for some time? Have you ever felt hopeless and
neglected after a divorce and just break-off of a sexual relationship? Have you
ever been overwhelmed by debt, but at the same time totally moneyless, while
your family is all looking at you to provide? Have you ever felt abused and exploited
by your spouse, but have remained silent with a ‘hot burning heart’? In
general, have you ever found yourself in a stressful, frustrating and almost
depressing situation where you thought suicide was a best solution? Have you
felt lost, anxious and lonely when you have not taken any form of alcoholic or
drug substance? Have you ever found yourself in situations when your sexual
drive is overwhelming and you simply needed to find any other means of sexual
relief and that this has been consistent? While on duty as a health
professional, have you ever found yourself stressed or depressed by the death
of any patient you needed to save and tie that to your failure? I may sound too
simplistic but I am real!
I just gained interest in
suicide cases in the Southern African countries and discovered that there are
an increasing number of attempted and completed cases of suicide. I have been
asking myself – why this increase in reported cases? My humble unverified
opinion is that there is an absence of psycho-social services; inadequate
policies and legislation on mental health; absence of suicide prevention
strategies; absence of psychological breakdown and crisis management
strategies; inadequate awareness raising on psychosocial conditions. I tend to
realize that I understated the issue of strategies, policy, legislation and
programmes. The true picture in Southern Africa is that there is absence of
policy and legislation to promote psycho-social services and the protection of
persons who are mental health users or survivors of psychiatry services of
survivors of suicide. Worse still, countries do not have psycho-social
strategies to capture community and individual level stress, trauma and depression related conditions. This is in
form of early identification and intervention of psycho-social problems. This
is why there are high occurrences of suicide attempts and suicide. In view of
this, I fully endorse the theme “psychological first aid”.
In my interaction with
mental health professionals, activists and of course literature, I came across
a concept called “psychological first aid”. From my own understanding of this
concept, when providing any form of first aid, psychological first aid should
be integrated. My opinion on this is psychological first aid is supposed to be
provided to everyone found in a stressful condition after a traumatic or near
to traumatic condition. For instance, when a motor vehicle has hit a pedestrian
who as a result dies on the spot, there is need for psychological first aid for
the person who was with the victim of the accident; there is need for
psychological first aid for the driver who hit the person; and maybe
psychological first aid for those who directly witnessed the accident. In many
instance those who witness fatal road traffic accident normally describe the
blood they have seen. This is both psychological and social. It is also
cultural in most of the Southern African countries. The sight of a bleeding
person causes stress!
I am deliberately narrowing
the issue of psycho-social problems to a level where society have not yet
explored. This is for the purpose of triggering thought to ensure individuals,
communities, NGOs, State agencies, the private sector and international
community start thinking of prevention of psycho-social problems. Apart from
prevention, there is need for everyone to mitigate the occurrence of
psycho-social problems in the community. I wish to be clear here that when I
refer to the community, I mean a multi-sectoral or multi-disciplinary approach
to community mental health services. While advocating for such community mental
health based services, I would like to strictly emphasise the need for the full
and effective participation of the directly affected. The persons who are
directly affected are those with psycho-social disabilities. It is simply
essential that they effectively participate in decision making towards
development of regional, national and community protocols, legislation,
policies and strategies on prevention, care and rehabilitation of psycho-social
problems and persons affected by psycho-social problems respectively.
In Southern Africa,
research has clearly indicated that many family and communities usually seek
the intervention of traditional healers before they visit mental health
institutions. This is where the awareness and knowledge on mental health
conditions is crucially critical. Elderly persons with dementia are usually
associated with witchcraft. This is because communities do not understand the
causes and effects of psycho-social problems. This has led to a lot of stigma
in diagnosis, care and community based rehabilitation. It has further led to denying
persons with dementia and of course, those with psycho-social problems, and of
course those with intellectual disabilities from enjoying and exercising the
right to legal capacity.
Apart from the issue of the
elderly persons, there is an increase of young women murdering, dumping or
rejecting born infants on grounds not clear even to them; but usually as a
result of rape, inability to support the child, fear of condemnation and many
unexplained thoughts. Many of such young ladies have lived with traumatizing
situations which communities and families have ignored. Communities and
families need to be educated on matters of early identification of
psycho-social problems in order to initiate psychological first aid at the
right time.
In my own view, the need
for psychological first aid needs to begin with the recognition of the person
with a psycho-social disability as a person. Secondly, that such a person is
recognised and should be protected as a person under the law. Furthermore, and key
that all persons with mental problems are full and recognizable member of the
family and community: and that they contribute effectively to community,
national or regional development.
Countries in Southern
Africa should endeavour to ensure the following:
1.
Development of policy and strategies that
will address the issue of psychological first aid in their main mental health
policies, legislation, programmes and strategies. Such measures should be clear
on indicators and targets that will be effectively used to review implementation,
progress and impact.
2.
Ensure all policies, legislation, programmes
and strategies are in line with universal health coverage taking into consideration
all forms of mental health issues affecting the children, youths, women,
persons with disabilities, the elderly and those living in extreme humanitarian
situations like internally displaced persons, refugees and migrants in general.
3.
World Health Organisation should ensure
States or governments adopt the principles of psychological first aid, and that
they incorporate them into their National Development Plans, policies,
legislation, programmes and strategies. The WHO should ensure that it compels
the State Parties to the WHO General Assembly to provide progress reports on
implementation.
4.
Governments should ensure that persons with
psycho-social problems have their human rights recognised, enjoyed and
exercised on an equal basis with the rest of society.
5.
Governments should ensure that they
recognise and support organisations or networks of persons with psycho-social
problems.
6.
Governments should ensure that scientific
research is carried on all aspects of psycho-social conditions including
prevention, care, support and treatment.
7.
Governments, recognising that women may be disproportionately
affected by psycho-social problems, both as directly affected or as carers,
efforts to develop and implement public health responses towards psycho-social
problems must be gender sensitive.
In view of all the above,
deliberate efforts should be put in place to ensure a multi-disciplinary
approach is taken towards achieving sustainable measures for psychological
first aid. Efforts should further be made to ensure that the psychological
first aid, is, whether deemed necessary, culminated into sustainable, medium or
long term measures to provide psycho-social support.
Executive President,
Disability Rights Watch.
October, 2016.
