MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT (MHPSS) NEEDS ASSESSMENT REPORT AJOUNG, SOUTH SUDAN : Home AHA News Mental Health and Psychosocial Support (MHPSS) Needs Assessment Report Ajoung, South Sudan

South Sudan has been at war for more than 50 years(1995-2011) resulting in 2 million peoples death, 4 million people internally displaced and 1 million people forced to seek refuge in neighboring countries.
Although the numbers are only increasing due to conflicts, South Sudan has become the home of many refugees from countries such as Sudan’s South Kordofan, Blue Nile States, DRC, Ethiopia, Central African Republic. South Sudan faces difficulties dealing with the rise in mental illness. According to WHO, the South Sudan health system has broken down due to the prolonged conflict leaving many prone to various illnesses and patients with preventable illnesses are left unattended. The integration of a mental health unit in the AHA managed health facilities in Ajoung Thok fills a gap long overdue.
Objective
The objective of the assessment was to identify gaps and draw recommendations regarding mental disorders and psychological suffering, finding coping mechanisms and assessing gaps with the existing facilities.
Methodology
Data was collected through the qualitative method with the help of focus group discussions (FDG) and semi structured interviews. The FDG asked for the verbal consent of all the voluntary participants and the data collectors were trained in research ethics, data collection tools, and recording interviews. Participants were also informed of their right to withdraw from the assessment at any time during the exercise.
Limitations
Some limitations faced during this process was the language barrier, time constraint and the reserved nature of the respondent due to the traumatic experiences faced particularly when dealing with women and girls victims of sexual abuse and ill treatments of children/orphans were understated.
Respondents Perception
Mental well-being
The refugees and the host community were asked to define what they thought of mental wellness and mental illness, followed by causes and symptoms of mental illness. Participants defined mental illness as with symptoms such as talking alone, crying, isolating oneself, alcohol abuse and mental wellness as positive social interaction and positive emotional state to name a few.
Causes of mental illness
The perception of what causes mental illness was different between the refugees and the host community. Refugees pointed out traumatic experiences as the causes of mental illness while the host community thought causes of mental disorders were from being possessed by an evil spirit.
Mental illness symptoms
There was also a difference of options with symptoms of mental illnesses as well, the host community mentioned suicide or suicidal tendencies, on the other hand, the refugees listed symptoms such as fear, self-isolation, and immersion in one’s thoughts and imaginations.
Behavioral problems
Children are most affected by behavioral problems taking out their frustrations on elders, authoritative figures and interact violently against themselves. This is because a majority of the children have lost their parents and are now living with relatives or in foster care. These children then face abuse, ill-treatment and lack of support leaving them in a state of constant sadness and isolation. Such children are more likely to run away, leave school or commit petty thefts.
Anxiety Problem
When describing anxiety, refugees participants stated increased heartbeat, shaking and running away. When discussing what causes anxiety the following was mentioned traumatic experience, insecurity, lack of family support etc.
Depressive Problems
Changes in personal feelings, sleeping patterns and reducing social interactions were the description of the signs and symptoms of depression for the refugee community. For the host community participants, they related depression with suicidal tendency or suicide.
Coping strategies
The coping mechanisms were also different between the host and refugee participants. In addition to sharing thoughts with on friends and family and attending religious services, the host participants said seeking the help of traditional healers or spiritual leaders is the way they coop. The coping strategies used by refugees were social activities sharing problems with trusted family and friends and making a living.
MHPSS service provision in Ajuong Thok (Who does what?)
A majority of the participants were uninformed about how someone with a mental disorder could receive clinical and psychosocial support. The host community specified that mental health problems are to be dealt with traditional healers, spiritual leader and in some cases sorcerers.
Others stated that even if mentally ill people were aware of the treatment, most would not seek help for fear of being stigmatized.
Agencies such as AHA, DRC, IRC, LWF, and UNHCR provide limited psychological support through education and protection services at Ajuong Thok. Support is provided through a multilayered model and referral pathways(figure 3). The linkage and referral pathway for recipient seeking clinical mental health services partners was found weak or non-existent in some cases.
Since September 2016 AHA recruited mental health specialists and established MHPSS Unit in its Hikima Yakoub PHCC, providing primary health care, reproductive health, including minor surgery and dental care, laboratory services, nutrition, and community health promotion services.
During the three week assessment, the 24/7 working PHCC treated 7 patients per hour by Clinical Officer in the AHA managed Hakim Yacob PHCC and 5 patients per hour by the physicians.
Discussion
Mental health and the psychosocial problem of many people was known to both the refugees and the host community significantly increased during the post war period. Both refugee and host community participants associated loss of beloved ones, separation from family, incapacity to respond to family needs and restriction of movements due to war as contributing factors to psychological vulnerability.
Although Situations of conflict, economic problems as well as traumatic incidences were the major factor of the origin of mental illness, there was a wide spread of misconception about mental illness and psychological suffering within the host community. Beliefs such as mental illness are raised from bad supplications by the dead or alive.
In regards to the symptoms of mental illnesses, refugees repeatedly pointed out ill social behavior, anxiety, insomnia, dropping out from school, straying in the market place and involving in theft, etc. Host community participants mentioned isolation, thinking too much, sleeping for long hours etc.
Conclusion
The main goal of the assessment was to evaluate the situation of mental health among the Sudanese refugees and host in Ajoung Thok refugee camp. This assessment showed that the participants were well informed about the symptoms of mental wellness but had various misconception about the cause and lacked information about clinical mental health services.
The participants also used different coping strategies to reduce stress and help patients cheer up also relying on traditional healers and spiritual leaders.
The role traditional healers and religious leaders play with combating mental health issues are grand for they deal with problems before it reaches extreme levels.
Within the six month period, AHA mental unit was functioning only 30 patients were under consultation and follow up for mental illnesses. this low figure was due to the belief that mental illnesses are untreatable.
The need to build the capacity of the PHCC Clinical Officers and nurses in particular, and of the CHPs, in general, is an understatement. It is also crucial to continue raising awareness in order to reduce the effect of fear of being stigmatized.