Let’s just go ahead and state the obvious—it is much easier for an NGO to market basic needs programs than it is to market programs directed at resolving more complicated issues. Because the more complicated issues (for example, mental health care) are more difficult to market, related programs are less funded, and thus less prominent. It is also unfortunately true that donors’ attention to humanitarian needs lasts about as long as a facebook or twitter campaign. It seems that in the world of humanitarian programs, food, blankets and shelter come first—and mental health care often comes last.
In post-conflict (and current conflict) countries like Uganda and Rwanda, there are not nearly enough charities or government organizations providing mental health services to meet the vast need. Several months ago I had the fortunate chance to discuss this with Network for Africa (N4A) founder, Rebecca Tinsley, whose organization is working to address this need in a unique and rather logical way. The aim of this interview (conducted via email) was to get an ‘on the ground’ picture of the global slight of mental health provision in post-conflict societies, and to find out how local charities are attempting to resolve that oversight. Network for Africa, a registered UK charity, is run by Mrs. Tinsley and her international team of employees and volunteers to provide holistic services within Ugandan and Rwandan conflict-affected communities. These services include food security, healthcare, education and training, income generation and women’s support. Within their healthcare services, they include a “Forgotten Survivors of Conflict” program, which works to train community members (called ‘lay counselors’ by N4A) in trauma counseling so those community members can reach out to their peers and provide long-term, sustainable mental health care. This unique method of training the community members and likewise supporting community members in the recovery process is very logical. It removes the notion of a “western-headed” program and likewise provides empowerment where it is needed. In the email interview with Mrs. Tinsley, we discuss not only the success of this particular program, but the attitude of international donors, charities and non-governmental organizations (NGOs) to the provision of mental health services in post-conflict societies.
How would you gauge the success of this program in its lifetime?
Finding credible messengers is crucial to the project, and we have found that training former child soldiers to be lay counsellors is the best approach. We have measured our success by doing a baseline survey before we begin, to assess need. Then each individual counselled is taken through a questionnaire to measure their personal level of PTSD [post traumatic stress disorder, a common disorder among those in post-conflict communities], the issues and threats they face, etc. After a period of time (usually a month) another questionnaire assesses the individual’s perception of whether there has been progress (sleeping better, less suicidal, planning for the future, better able to handle domestic conflict and challenges such as living with an alcoholic).
In your opinion, what is the current attitude of international NGOs, IGOs [inter-governmental organizations], etc. towards mental health provision in post-conflict societies? Is mental health provision regarded as a ‘basic need’ along with food and shelter?
Mental health is increasingly being seen as a basic need because it is understood (by NGOs, at least) that few people with PTSD can move on in their lives until they have broken the cycle of trauma. Running a development programme/encouraging income generating activities is pointless if people are locked in reliving the horror of the past. I know several other NGOs are tackling mental health but I’m not aware [of] anyone else using former child soldiers as lay counsellors.
Do you find that donors are less apt to back mental health programs than they are in funding food and/or education programs or the like?
Finding funding has been hard because many donors think more basic needs (like food, schools and clinics) are the priority. There is also a touch of racism involved in thinking people in less developed societies are less in need of mental health services, as if we in the developed world are more complicated as [a] people.
What is your advice for other NGOs with the desire to implement similar programs?
Always ask the advice of local people before starting a programme. Always do a baseline survey to assess the scale of the need. Don’t try to impose a Western idea on people. Listen carefully to what they tell you. Adapt your project to their needs, and make sure you have well-respected local leaders on your side to adapt your project to the local culture.
What are some of the commendations this program has received?
We’ve had interest from other NGOs and the media. For instance the BBC World Service did a 40-minute radio program about our project (it might be on their website archive—called Heart and Soul). The commendations have come from the people in the program, who assure us they are sleeping better, have fewer nightmares, are handling stress better in their daily lives, making plans for the future, and resolving domestic problems that previously escalated into violence. The local Ugandan authorities are enthusiastic about what we are doing and we work closely to plan the expansion of our projects. We work with both the local government structures and the health service, insofar as it exists here. They are supportive although they have few resources with which to help us.
What sort of criticism, if any, do you receive regarding this program?
I’m not aware of any criticism. However, I should say we are in a remote place and few people who aren’t locals go there or observe what we’re doing.
Are you aware of any other NGOs that are providing similar services?
World Vision, who are approaching similar problems. I think MSF (Medecins Sans Frontieres) does too, only they only stay in an area so long as there is an emergency situation, and war is raging.
In this interview, Mrs. Tinsley painted an apt portrait of the current state of mental health services and trauma counseling provision in post-conflict communities. As she concurred, mental health provision is not necessarily seen by many larger Western donors and NGOs as a pertinent basic need in war-ravaged countries. But this particular facet of social services could be the key to long-term growth and sustainability in recuperating areas. In Cambodia, mental health workers are decrying the lack of mental health services and support by governments and NGOs alike for those who suffered the genocide at the hands of the Khmer Rouge during the 1970’s. This horrific incident occurred over thirty years ago and now it is slowly being recognized that the governments and NGOs could and should work more cooperatively to provide trauma counseling to those most under-served (for example in rural areas, as noted by the Phnom Penh Post in a 2012 article). This is not just a third-world specific problem, either. This is a problem that affects post-conflict societies everywhere and yet it is widely ignored by mainstream donors. Even NGOs have difficulty cooperating, as Mrs. Tinsley noted in our interview, because these NGOs operate in remote areas often where there is no other care. Additionally NGOs often are forced to compete for scarce funding almost forming antagonistic relationships in some NGOs worldwide.
So, where to go from here? How can we ensure that mental health needs will be put up on charity appeals along with food, shelter and education? I would advocate for more research and international cooperation. Of course that sounds as vague as a UN General Assembly resolution, yet I think in this case these vague essentials are necessary. Often times, very well meaning NGOs and donors will set up programs in post-conflict societies without consulting local opinion. More research on local needs would certainly resolve this issue. International cooperation between NGOs and governments (perhaps by the establishment of a more concrete board for this particular issue within the World Health Organization) would connect the ongoing thirty year need for trauma counseling in Cambodia to the numerous ongoing conflicts within Africa, and charity appeals and funding would thus be more efficient in their aims. At the end of the day, what you don’t see on those heart-wrenching humanitarian campaigns is that many of those communities had food, blankets and shelter before the conflict. Conflict creates trauma, not a solely a lack of Westernized basic needs.
A big thank you to Rebecca Tinsley and Network for Africa for the superb amount of research supplied for this editorial interview.
Related Links:
Network for Africa
BBC World Service Heart and Soul, Uganda: Return of the Child Soldiers
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