Tag Archives: mental health

The WHO increases its focus on dignity in mental health services

All human beings are born free and equal in dignity and rights…. – Article 1 of the Universal Declaration of Human Rights

I am at the WHO annual mhGAP Forum in Geneva, discussing the priorities for mental health at a global level. It is exciting to see a profound shift towards recognising the importance of the experiences that people have in services in their communities. CBM has done a lot of work in promoting the right to access decent mental health services, but we must also ensure that the way that people are treated in those services and wider society is dignified.

The theme of World Mental Health Day this year is ‘dignity’, and we spend time looking at the huge abuse of people in communities, and in mental health services. There was plenty of opportunity to hear from people with psychosocial disabilities about what dignity meant to them, and how they had challenged the system to recognise them as individuals.

One of the examples of resources being developed to promote dignity is QualityRights, which is partly supported by CBM.

The QR toolkit aims to –

  • Provide a framework for assessing and improving the quality of care offered to service users
  • Increase the capacity of persons with psychosocial disabilities to speak confidently about their priorities
  • Promote a civil society movement of people working together to improve care
  • Reform policies and law to better reflect the human rights of persons using services. This includes practical guidelines and standard operating procedures in health facilities

A major evaluation of the project is currently under way in Gujarat, India. The head of mental health for the State, which has a population of 62 million people, spoke about how the project was having an impact on the services in the State. Overall the very transformational aim of the work is to shift the emphasis of mental health services from a paternalistic and controlling environment focused on illness, to one where the priorities and decisions of service users are valued, where the environment promotes dignity, and where the focus is on recovery.

This is a dramatic and fundamental change from the tone of services in many parts of the world at present. The availability of a simple toolkit will help many countries to feel confident about practical measures that they can take to move towards meeting their commitments towards the Convention on the Rights of Persons with Disabilities.

Graham Thornicroft from FundaMentalSDG.org described the work that is being done to ensure that the importance of dignity is recognised in the new Sustainable Development Goals. Mental health and well-being now has a good recognition in the SDGs, and at this stage it is crucial to get the indicators required to hold governments to account. Here is a great film about it, produced by FundaMentalSDG.

This is one way in which we can all contribute to seeing dignity being respected in peoples’ lives.


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


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.


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


Nepal – We will rise again

Here is my first blog from Nepal, after a very moving day in Bhaktapur.

This ancient city lies nine miles east of Kathmandu. At its heart lie four connected courtyards containing some of Nepal’s most famous UNESCO World Heritage Sites, many of which were damaged or destroyed by the earthquake which shook Nepal on 25 April 2015.

Durbar Square, Bhaktapur

Durbar Square, Bhaktapur

In the main Durbar Square, around the base of one of the damaged temples, is an exhibition of photos of some of those who lost their lives, either because they were unlucky enough to live in old or poorly constructed homes or caught by the falling masonry in the web of narrow streets that characterise the area. Many of the photos show the faces of elderly men and women, or very young children, both groups disproportionately affected by natural disasters, but there are also faces of many other people, caught indiscriminately by either the first quake, or the one that followed two weeks later on May 12.

In one picture, a teenage girl in school uniform smiles shyly at the camera. Just a few yards away, a group of girls and boys of around her age are donning hard hats and picking up shovels before dividing into teams and heading off in different directions. Their matching t-shirts declare them to be members of the local community who are volunteering in street clearing initiatives.

This is one of the worst hit areas of the city and the lanes are still clogged with rubble, sometimes piled under the eaves of damaged houses, sometimes still filling the street so that you need to scramble over to get through. Despite other parts of Kathmandu being almost untouched, here there is not a road or side street which remains untouched.

Everything is covered with a thin film of dust, and the few shopkeepers who have ventured to open up again, busy themselves continuously with dusters and rags.

Psychosocial counselling and trauma care

A woman amongst rubble

Pramita Shrestha

I am with Pramita Shrestha, a social worker from KOSHISH, a CBM local partner that offers psychosocial counselling and trauma care in the Bhaktapur District. Pramita describes the additional support the psychologists and counsellors are providing, not only for those with mental health problems that they were already supporting, but also to an estimated 3,500 earthquake survivors who will need psychosocial support over the next few months.

This is one of the less visible after-effects of a disaster of this scale but one which touches on the lives of so many survivors. Schools have just reopened again and we are passed students with neat white shirts and royal blue skirts, matching ribbons bouncing above – but numbers are down as many children are too anxious to leave their parents, too scared to enter the school building or, with the many aftershocks still being experienced, too sleep-deprived to function well.

People have also started to return to work where they can, or to the social activities they used to enjoy and we see a few small groups of men on the verandas of undamaged houses playing cards or board games, while women sit in twos and threes knitting. But there are also those who sit in their doorways staring into space, and KOSHISH is reporting new cases every day of people of all ages struggling to come to terms with what has happened. Sadly for all those that come, as many remain unwilling to seek treatment for any kind of mental health condition which remains widely misunderstood and taboo in Nepal, as in many places.

Cleaning up, rising again

Man with wheelbarrow clearing rubble from street

Clearing rubble

We come across a single house collapsed among a row of otherwise intact buildings. Further along, two stories of a house with no side wall stand open to the air, as if a huge serrated knife has sliced vertically through the building.

As we approach, we see two figures rolling brick pieces down a corrugated iron sheet propped against the wall. On every street we come to, similar activity is beginning to take place. People on rooftops, shovelling debris. People pushing wheelbarrows of dust out of alleyways or carrying piles of bricks to the truck that cannot make its way down the blocked streets where life has started to go on once again.

Around the next corner, we come across a slogan daubed on a partially collapsed wall, “We will rise again”. Later someone walks past with this printed on a t-shirt.


Graffiti, Bhaktapur

The photos in Durbar Square are one of the ways that the city is mourning its loss and it will take decades before the country is close to full recovery. But this slogan has started to appear across the city and perfectly reflects the resilience of a nation that is already working hard to pick itself up and move forward.

KOSHISH was there in the days immediately following the earthquake, providing psychological first aid as vital as the bandages being so much more visibly applied, and it will continue to support for the long term the efforts of the Bhaktapur community to “rise again”.

Read more about mental health and emergencies


Finally we are looking beyond Ebola in Sierra Leone

CBM has been working with partners throughout the Ebola outbreak in West Africa, which has seen over 10,000 people lose their lives, communities decimated, and the economies collapse. In Sierra Leone, where I have just finished a week-long visit, the schools have just re-opened and the numbers of new cases are now very few. The Ebola Treatment Centres are mostly on stand-by, and life is slowly returning to normal. It felt strange not shaking hands or touching people, and having to wash hands and have your temperature taken every time you enter a building.




I was here to facilitate a national consultation on rebuilding mental health services organised by the WHO, as we emerge from emergency response to recovery and rebuilding. I also used to opportunity to visit our well established mental health programme, Enabling Access to mental Health in Sierra Leone, and the two Ebola response projects that our partners have been running over the last year.

I was extremely proud to hear the essential role that the psychiatric nurses trained by our programme placed in all districts in the country played in supporting the people affected by Ebola, including survivors, orphans, health workers, and other members of communities who experienced loss of loved ones and fear of this terrible disease. Because the Enabling Access programme had been in place for 4 years, they were able to provide this essential service when the disease arrived, and our partner staff showed remarkable dedication in the face of great personal risk to themselves. Sadly one of our dedicated nurses died from Ebola, and one survived the infection.




As the epidemic took hold, CBM decided to start two new programmes focused on the Ebola response. Our partner West Africa Medical Missions worked to ensure that the key messages about safety and protection from infection were made available to community of persons with disabilities. They worked with national groups of persons with visual and hearing impairments, and physical and mental disabilities, to create relevant and accessible messages through posters, music and video, as well as visiting special schools and disabled persons’ organisations with people who could communicate through sign language. The Mental Health Coalition, a new and strong voice for mental health that emerge from the Enabling Access programme, led an initiative to ensure that emotional needs were addressed for those affected by Ebola. Without these CBM partners, these vulnerable groups would have been neglected.




During my visit there, many people thanked CBM for the support provided during the outbreak. I left immensely proud of our partners’ work, and it is exciting now to be embarking on establishing stronger services for the long term.