Author Archives: Heather Pearson

Heather Pearson

About Heather Pearson

A specialist in mental health and disability, Heather Pearson was Programme Coordinator of CBM’s Enabling Access to Mental Health programme in Sierra Leone for two years until December 2013. She has also worked with CBM’s Emergency Response Unit, ensuring that people with disabilities are included in disaster relief and reconstruction, including in Haiti after the 2010 earthquake. Currently Heather works as a consultant in the fields of emergency mental health, global mental health and disability.

You have the will, you have the power

The International Day for Persons with Disabilities is celebrated on Dec 3 every year. This year the theme is Inclusion matters: access and empowerment for people of all abilities, and one of the sub-themes is – Including persons with invisible disabilities in society and development.

 

Often when we think about ‘inclusion’, persons with physical and sensory disabilities come to mind.  We think about making buildings physically accessible for persons who use wheelchairs and printing books in Braille for children with visual impairments.
‘Inclusion matters: access and empowerment for people of all abilities’ is the theme for the 2015 International Day of Persons with Disabilities.  On this day, December 3, we will be called to remember that true inclusion will never occur unless persons with invisible disabilities are included in society and development. But what do we mean by ‘persons with invisible disabilities’?

Mr Kaikai and other service users in a group discussion on the issue of dignity, at the EAMH office in Freetown

Mr Kaikai and other service users in a group discussion on the issue of dignity, at the EAMH office in Freetown

Persons with invisible disabilities include those whose disabilities are not immediately obvious.  It is estimated that worldwide, 1 in 4 persons will experience a mental health condition at some point in their lives.  Despite being extremely common, mental health conditions are some of the most untreated and most stigmatized around the world.  People with psychosocial disabilities are amongst those forgotten and misunderstood because of the ‘invisible’ nature of mental illness, leading to human rights abuses.
As an example, in Sierra Leone, people with psychosocial disabilities have historically been under prioritized, forgotten and abused.  In the national health budget, less than 1% of the budget goes to the Sierra Leone Psychiatric Hospital, and 0% is allocated to other mental health services.  The mental health legislation of Sierra Leone, ‘the Lunacy Act,’ was written in 1902 and is yet to be rewritten or updated.  In addition, a shocking number of human rights abuses take place around the country on a daily basis, including the routine chaining of people with psychosocial disabilities.
Mr Kaikai is the secretary of the Sierra Leone Association of Service Users and Family Support Group, explains: “Thousands of people with mental health conditions around the world are deprived of their human rights. They are not only discriminated against, stigmatised and marginalised, but are also subject to emotional and physical abuse in both mental health facilities and within their communities.”

 

But things in Sierra Leone are slowly changing.  5 years ago, the Enabling Access to Mental Health programme began with the support of CBM and Global Initiative of Psychiatry (GIP) and funded by the European Union.  The aim of the programme was to do exactly what the name suggests: to improve access to mental health care.  A large focus of the programme revolves around mental health advocacy and it was for this reason that the Mental Health Coalition – Sierra Leone was born.

The coalition brought together a broad range of stakeholders: health care providers, teachers, religious leaders, local and international non-government organizations, and many other members interested in mental health.  The Coalition was successful at pushing for changes in mental health in Sierra Leone including launching the National Mental Health Policy and ensuring that patients received food and water during a strike at the psychiatric hospital.  However, until recently, there were very few people with psychosocial disabilities in the Coalition.  Despite having a safe and welcoming environment for people psychosocial disabilities, the Coalition continued to speak on their behalf rather than giving them opportunities to speak for themselves.

 

In 2014, however, a new committee within the Coalition was formed: the Sierra Leone Association of Service Users and Family Support Group. The group has 27 members: mental health service users and their family members. The group meets on a monthly basis with the aim of empowering service users to advocate with their own voice for better medical facilities, medication, social inclusion and respect for the dignity and human right of people with mental disability.

Mr Kaikai, Secretary of the Service Users and Family Members Association, at the beach in Freetown

Mr Kaikai, Secretary of the Service Users and Family Members Association, at the beach in Freetown

Mr. Kaikai highlights the importance of including family members in the group: “Something we will never forget is how much our families have suffered and how positive it was for them to get support from other families in similar situations. And also, even more important, we couldn’t have recovered if the family hadn’t been there with us, helping, understanding, encouraging. Our families own our lives.”

This group was established with 6 goals

  • To know each other better
  • To share views and experiences
  • To mobilise for action
  • To provide a platform for awareness raising on those issues that are crucial to  mental health
  • To minimise the stress and stigma attached to mental illness
  • To express the needs of service users to government and other service providers.

The group is working towards their goals by focussing their meetings on topics that members have decided are important, including: stress management, sharing experiences to offer each other support and group counselling from a qualified counsellor.
As the group continues to grow in empowerment, they continue to set new goals and ambitions.  They hope that group will expand in numbers so that more service users can benefit from their activities and experience an increase in confidence through the peer support that the group offers.

Mr. Kaikai says:  My advice to other service-users would be, don’t ever think you are just mentally ill people with no strength to achieve something great. You might also want to know that there is dignity in mental health, as there is no health without mental health.

In a country where persons with psychosocial disabilities were invisible, service users and their families are learning to take a stand in a united front, to speak loudly and to be seen.

“You have the will, you have the power.
Dignity in mental health.
You own the future.
Long live the Service Users and Family Support Group.”
-Mr. Kaikai, Secretary of the Sierra Leone Association of Service Users and Family Support Group

Building Back Better from West Africa’s Ebola Outbreak

Earlier this month, the Government of Liberia and the WHO hosted  the “Technical Consultation Meeting on the Mental Health and Psychosocial Support of People Affected by Ebola Virus Disease.” The purpose of this 2 day meeting was to collect lessons learnt and establish how to “build back better” from the Ebola virus disease outbreak in West Africa. The meeting brought together key mental health and psychosocial support stakeholders from Sierra Leone, Guinea and Liberia. Included amongst these participants were representatives from CBM’s mhLAP programme. The mhLAP Country Representatives from both Liberia and Sierra Leone were active participants in the event and will hold an important role in supporting rolling out the plans made during the meeting. Below is a full description of the event:

Mental Health and Psychosocial Support for People Affected by Ebola Virus Disease

In Monrovia, Liberia on June 10th and 11th, 2015, stakeholders in mental heath and psychosocial support (MHPSS) came together to discuss, learn and make plans to ‘Build Back Better’ from the regional effects of the West African Ebola virus disease outbreak.

Ebola virus disease was first detected in Guinea in March 2014, spreading across the porous borders to Sierra Leone and Liberia by May 2014. While Liberia has recently been declared ‘Ebola Free,’ Sierra Leone and Guinea continue to wage battle against the outbreak. To date,  it is estimated that over 27,000 people have been infected by the virus while over 11,000 people have died. Beyond the loss of human lives, we are only beginning to understand how Ebola virus disease has impacted the Liberia, Guinea and Sierra Leone.

From an MHPSS perspective, we know that the outbreak has led to significant impact on the mental and social health of people in the region.  In addition the experience of loss and fear, many people have been exposed to distressing situations and images, potentially leading to stress, anxiety and mood disorders. Social problems continue to emerge within the 3 countries, including challenges faced by survivors of Ebola virus disease, health care workers and other support workers who are experiencing stigma and discrimination from their within their own families and communities. In addition, due to travel and work restrictions put in place during the outbreak as well as loss of community members, there has also been a drastic decline of income generation within communities.

There is an obvious need to learn and document the experiences of addressing MHPSS needs in the region and for countries to make plans on how they will strengthen their mental health systems to best meet the needs of their residents. It is for this reason that Liberia’s Ministry of Health and Social Welfare with the support of WHO Liberia hosted last week’s ‘Technical Consultation on Mental Health and Psychosocial Support for People Affected by Ebola Virus Disease.’ The meeting brought together over 75 representatives from the three countries, including members of the Ministries of Health and Social Welfare, national and international NGO partners and donor agencies, in addition to WHO MHPSS staff from Headquarters, the AFRO Regional office and the three WHO country offices.

Participants at the workshop

Participants at the meeting

Objectives

There were three objectives for the meeting:

  1. To identify achievements, challenges and lessons learned in relation to the Ebola-related mental health and psychosocial emergency response in the three countries
  2. To produce a roadmap of mental health system recovery/development for the three countries
  3. Identification of a minimum response framework for mental health and psychosocial support that can be rolled out in case of similar future outbreaks in other countries based on the experience of Ebola mental health and psychosocial response in the three countries.

Representatives from the Ministries of Health and Ministries of Social Welfare presented lessons learned and challenges faced in addressing MHPSS needs. Presentations were also made to highlight the priority MHPSS activities in each of the countries.  Extensive amounts of time were allocated for group discussions, providing opportunities for participants to share experiences and learn from each other.  A draft of “Mental Health and Psychosocial Support (MHPSS) Considerations in Ebola Virus Disease Outbreaks: What should public health officers know?,” a minimum response framework for addressing MHPSS in future Ebola outbreaks, was also shared and discussed amongst participants.  The feedback received from the participants will be integrated into the final draft of the document.

Testimonies

The feedback from participants attending the meeting was extremely positive. Many participants expressed that the meeting set a positive momentum for mental health and psychosocial support in their countries:

“I think the meeting is a potential game-changer for mental health service delivery and policy implementation in Liberia and most likely the region.  In my experience for mental health in Liberia this is ‘truly huge’!” -Janice Cooper, Country Lead for the Liberia Mental Health Initiative, The Carter Centre, Liberia

Others participants conveyed the priceless opportunity to share experiences from such a broad range of stakeholders from the region, recommending that such meetings take place annually:

“There is no better moment than meeting with other delegates in such a great gathering, sharing experiences with great minds.  The sessions provided a forum where shared ideas were analyzed, processed and reproduced to meet felt needs of the EVD stoked Mano River Union countries; thus laying a solid foundation to building back better. Bunch of thanks to the organizers and facilitators.  I recommend that such meetings be held annually.” – Joshua A. Duncan, Coordinator Mental Health Coalition, Sierra Leone

In addition, there was a sense of morale boosting amongst participants:

“For me, the impact on our team (international and national) was huge; partly so because we could see the difference between the countries in terms of resources, which gave some context for us. For one of my counterparts present, it was so helpful to her that another person in Liberia offered ideas on how they could collaborate (Guinea/Liberia) on women’s issues relevant to effects of Ebola. For her, French speaking only, this was a huge sense of collaboration and camaraderie. That last piece was also part of the morale boost for the team. Guinea is difficult because of the acute situation of Ebola transmission, the lack of budget for mental health, and on the other hand, the intense commitment and motivation of host country nationals working with us and trying so hard to change things. As one told me, “I feel motivated now!” and eager to talk to others so they too become engaged in a national agenda to support the implementation of mental health services.” – Laurie Lopez Charlés, Mental Health and Psychosocial Support, WHO Guinea

Overall, the consensus from participants and organizers was that the meeting was worthwhile. It is anticipated that the discussions that took place will support the governments and mental health and psychosocial support stakeholders to ‘Build Back Better’ in Liberia, Guinea and Sierra Leone.

For further information contact: Heather Pearson

Related site – Mental Health Innovation Network

 

Mental Health and Emergencies: CBM Partners Meeting the Needs of their Communities

As we watch the events unfold in Nepal since April 25, we are reminded of the extra challenges that people with disabilities experience during disasters. Those with physical disabilities may struggle to flee to safety or travel long distances for essentials like food and water. The methods used to communicate an approaching disaster may not consider the needs of people who live with blindness, deafness or learning disabilities. Temporary shelter facilities, as well as other relief and longer-term recovery services, may not be accessible. And suddenly there is an influx of people experiencing new disabilities within the population; physical trauma caused by an earthquake, for example, may lead to the amputation of limbs or spinal cord injuries.

At the same time, people with disabilities show incredible amounts of resilience in emergencies. There are countless stories of people with disabilities helping their own community members. I think back to working in Haiti with CBM after the 2010 earthquake. Key members of our community rehabilitation team had disabilities themselves, yet refused to let disability equal inability. They worked hard within our teams to ensure that the needs of their whole society were being met.

3 yr old Aarti and her grandmother

Aarti was not injured in the earthquake but the 3yr old, who has spina bifida, hasn’t smiled or played since.

This week we celebrate Mental Health Awareness Week– a perfect time to talk about the importance of mental health in disasters. People with psychosocial disabilities (those living with disabilities caused by mental illness) are often left behind during a disaster. In the Philippines after Typhoon Haiyan, we heard stories of people living with mental illness who had been chained in their homes and were unable to flee to safety when the typhoon was approaching. In addition, access to mental health care – and psychotropic medicines in low and middle income countries is an ongoing issue. During a disaster, the ability to access care and medication often shifts from challenging to virtually impossible.

The World Health Organization (WHO) estimates that after an emergency, the number of people experiencing mental disorders can as much as double within the population. At the same time, normal signs of distress within a population increase greatly. This information highlights something very important. First, there is a great need to continue to care for people with psychosocial disabilities after a disaster. In fact, the need has now doubled. But secondly, suddenly there is a large amount of psychosocial stress being experienced within the general population. This stress is a normal reaction to loss and to exposure to distressing events. Many will recover from these experiences, however a number of those who need psychosocial support can benefit from simple, cost-effective approaches such as Psychological First Aid.

CBM recognizes the importance of mental health and psychosocial support during emergencies. We also place a high value on the knowledge and understanding that our local partners have during emergencies within their countries. This is why CBM works hand in hand with our partners during and after emergencies.

Counselling session, Sierra Leone

Mental health professionals trained by CBM’s programme in Sierra Leone offered vital support during the Ebola crisis (Photo:Tamsin Evans, Enabling Access to Mental Health)

In Sierra Leone, for example, our Enabling Access to Mental Health programme had already established an active mental health advocacy group, the Mental Health Coalition – Sierra Leone. The Coalition had become a focal point for mental health system development, in collaboration with the Government of Sierra Leone. When the Ebola outbreak started in West Africa, the Coalition was in the perfect position to support the coordination of mental health and psychosocial actors in Sierra Leone. They were able to advocate for better psychosocial support for health care workers. They also pushed to have mental health professionals (trained under the Enabling Access to Mental Health Programme) placed strategically throughout the country to offer support for those experiencing signs of distress and ongoing care for people with psychosocial disabilities. The Coalition supported the adaptation of training and activities to the local context, and advised on the development of strategies, policies and basic packages. Because we had a trusted partner already engaged on the ground, CBM was able to mobilize financial support so that they could continue their impressive work.

Now, looking to Nepal, CBM is currently implementing response work, again with strong partners, to offer mental health and psychosocial support. Already, CBM is a partner with a national level mental health group- KOSHISH. Our emergency response unit based in Kathmandu has been liaising with them since the earthquake struck, as part of our overall response, and we are now at the stage of providing them with support to be able to meet immediate psychosocial needs of people affected by the earthquake, and to improve access to basic relief aid as well as to specialise services for persons with psychosocial disabilities. In addition, we will draw on the knowledge and experience of our partners doing Community Based Rehabilitation work throughout Nepal. They are in the perfect position to provide their communities with psychosocial support, and we are already working to ensure that relevant staff members are also trained in Psychological First Aid.

People with Epilepsy often face similar stigma and discrimination in their communities as those with psychosocial disabilities. For this reason, we encourage our partners to also include people with Epilepsy into our mental health and psychosocial support programmes.

Addressing mental health and psychosocial needs is essential for complete and effective disaster response. I hope that by highlighting the work of CBM in emergencies, the experience, rights and needs of people with psychosocial disabilities, are clear. But more importantly, I hope to have shown a way to approach these challenges – not only will this strategy improve the situation for many individuals affected by the current emergency, but will build their resilience for the future, and therefore that of their families, communities and society as a whole.

CBM is working to bring urgent relief to people with disabilities in Nepal after the earthquake on 25th April, and provide vitally needed healthcare for both physical and mental health needs.

Support our emergency appeal today.