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Mental Health and Psychosocial Support (MHPSS) Needs Assessment Report Ajoung, South Sudan

Africa Humanitarian Action (AHA), founded in 1994, is a Pan-African non-profit humanitarian organization with its headquarter in Addis Ababa, Ethiopia. AHA operates in partnership with UNHCR, BPRM, and UNICEF since 2013 in Ajoung Thok, Jam Jang County, Ruweng State South Sudan. It intervenes in the provision of comprehensive primary health services, including reproductive health, HIV, community health services and nutritional wellbeing services. The services are provided through a Primary Health Care Unit (PHCU) and a Primary Health Care Centre (PHCC) for 40,000 refugees from the Sudan/Kordofan and an estimated 10,000 host community population.

UNHCR public health strategy identified mental health as priority gap in Unity/Ruweng State as early as 2014. Though AHA also felt the need and endeavored to respond, it was enabled to establish a mental health care service only in September 2016, thanks to the support of BPRM. This assessment was carried out to appraise the local context in the effort of building up the mental health and psychosocial support unit.

A qualitative method was applied to collect data. The selection criteria of respondents and FGD participants were based on focused and targeted sampling to reach informants with a good acquaintance of the refugee and host community conditions. The criteria included age > 18 years old) and representation by gender and social function. Collected qualitative information was grouped by category of key coded themes for manual analysis.

The assessment findings showed that both refugees and host community described mental health as “being productively occupied, living in security and freedom, interacting positively with the family and community, participating in social events, feeling happy…” Further, exposure to traumatic events, loss of family members and separation, loss of means of livelihood, poverty, and lack of social support were reported as the major causes of mental illness among both communities. The misconception that possession by an evil spirit from a dead or alive person is the cause of mental of illness widely prevailed especially in the host community. The current conflict in South Sudan, poor economic situation, and food insecurity were pointed out to as causes.

Feeling of loneliness and sadness, self-isolation, immersion in one’s thoughts and imaginations were generally mentioned as a manifestation of depression. Staying in the marketplace and engaging in petty theft and school dropout were described as symptoms of a behavioral problem. Fear, constant worry, shaking the body, increased heartbeat, crying and running away were also stated as symptoms. On the other hand, engagement in recreational activities (playing football, reading holy books, attending religious services, and storytelling) were the reported coping mechanisms to forget problems and stress. Both communities also mentioned participating in traditional dancing, talking to or sharing problems with family, friends, relatives, and neighbors; and asking for support as coping strategies. Host community respondents mentioned frequently that consulting traditional healers, spiritual leaders or witch doctors could alleviate mental illness. There is a lack of awareness that mental illness is treatable; and of recognition that mental health could be treated at health facilities.

Conclusion & Recommendation: A none vertical and integrated MHPSS program with coordination mechanism that includes UNHCR’ protection partners and operates in linkage with the national MHPSS coordination would contribute to strengthen the capacity of providers of mental health and psychosocial services, improve the management of mental health cases from PHCC to hospital in Jam Jang County. The assessment recommends improved and integrated mental health services, sequenced awareness raising activities on the causes of mental illness and on the availability of services. Improving access to recreational/counseling services, collaboration with traditional/spiritual leaders, integration of MHPSS activities with protection partners as well as engaging communities and leaders at different levels to create a conducive environment and addressing stigma against mental health are recommended.

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