Attachments
EXECUTIVE SUMMARY
Globally, it is estimated by WHO that 22% of forcibly displaced people suffer from a men-tal disorder (Charlson, et al., 2019). Children make up to almost half of the displaced pop-ulations and are most vulnerable and at increased risk in times of emergencies (Dangmann,
Dybdahl, & Solberg, 2022). According to UNICEF, “prolonged conflict, mass displacement, violence, exploitation, terrorism, poverty, outbreaks, intensifying natural disasters and cli-mate change can have a catastrophic impact on children’s behaviour and emotions as well as learning and development in the short and long term” (UNICEF, 2018) (UNICEF, 2023).
Studies show that children and families have shown great resilience, once they are safe, have their basic needs met, and have access to social and community support (UNICEF, 2023).
Due to limited psychosocial support services targeting children, it was a challenge estab-lishing their key psychosocial support needs. It is for this reason the multiagency MHPSS Technical Working Group (MHPSS TWG) spearheaded by UNHCR decided to conduct a needs assessment in Alemwach with the main objective of determining the mental health and psychosocial needs among children and adolescents. This is therefore a report on the needs assessment conducted in June 2023 from a sample size of 441 KII respondents aged 12-17 years, 70 activity-based interviewees aged 6-11 years and 7 FGDs with com-munity resource persons.
Key findings of the assessment indicated that 48% of the respondents have experienced mental health problems with feelings of hopelessness, sadness, flashbacks being most prominent. It also highlighted Displacement (61%), GBV (51%), insecurity (43%) and long stays at the camp (41%) as the main causes for mental health problems. 56% respondents shared that people with mental health problems are accepted in the community with fam-ily members, humanitarian workers and religious leaders being the most common sources of support. Despite this, children with mental problems experience several challenges namely: neglect (59%), discrimination (50%) and abuse (41%).
The study also indicated excessive anger, learning difficulties and suicidal and self-harm behaviors as common psychological impact, relationship problems, family conflicts and isolation/withdrawal as common social impacts and fighting, alcohol and substance abuse and GBV (both as survivor and perpetrator) as common behavioral impacts across the pop-ulation. Child neglect (68%) was highlighted as a major behavioral impact among caregiv-ers. 5.9% of the respondents shared to having experienced suicidal ideation with 31% re-ported having attempted suicide in their lifetime. Exposure to violence and war, multiple displacements, limited access to basic needs, separation from family or relatives, loss of loved ones during flight and experiencing of witnessing physical and sexual violence were highlighted in the FGDs as common predisposing factors. The assessment also identified stressful life circumstances, family related conflicts and lack of support from the commu-nity as common risk factors for suicidal behavior. The most common method for attempting suicide used included drinking poison and use of rope. Praying, talking to some-one, fear of God’s judgement and thinking about one’s family were identified as protective factors. Alcohol and substance use was found to be both a mental health problem and a means of coping. The respondents shared that 2% use alcohol, 2% smoke cigarettes and 5% chew khat. Of those using alcohol, 7 reported to taking it daily and 4 respondents consume weekly. 60% reported that the children with mental health problems receive medications at the health centres and 50% can talk to a psychologist/ counsellor/psychiatric nurse. Distance, language barrier, lack of medications and lack of services were listed as the main existing barriers to accessing MHPSS services. Talking to family members and friends, community members, counselling and prayers were among the common coping mechanisms. The FGDs highlighted physical or verbal abuse, self-injurious behaviours (burning, scraping, slashing, etc.), withdrawal from family and friends, experimentation, subsequent abuse of drugs or alcohol Refusing support from loved ones, stealing, disobedience as common neg-ative coping mechanisms that are in use among the children and adolescents.
Gaps identified during this study include limited psychosocial support services targeting children and adolescents especially trauma informed interventions, limited information and awareness on mental health, coping skills and services available and limited access to basic services namely energy, education and livelihood opportunities, health care and safe spaces (child and youth safe spaces, women and girls’ safe spaces). Other gaps include inconsistent provision of psychotropic medications and MHPSS services which leads to increased relapse and decreased quality of life, limited funding for MHPSS interventions and suicide and self-harm response and prevention and lack of behaviour change/modifi-cation interventions to address alcohol and sub-stance use in the community.
This report suggests the following recommendations: first, integration of MHPSS to other sectors with a key focus on Child protection, Education, GBV and Health guided by the MHPSS Minimum Service Package. Another recommendation is to mainstream the imple-mentation of community Based MHPSS Interventions targeting strengthening of children and youth spaces, community support systems and creation of awareness of child and family wellbeing and protection needs. Additionally, there is need to develop child and adolescent suicide prevention programmes for promotion of mental, emotional and social wellbeing, prevention of suicide and development of mental health conditions as guided by the Helping Adolescents Thrive Toolkit. Moreover, there is need for implementation of interventions targeting alcohol and substance use. This report further recommends strengthening of care systems through capacity building of professional and lay staff and volunteers in coordinated MHPSS care for children and families. Also, there is need for strengthening the referral systems for children with protection risks or MNS disorders.
Finally, there is need for advocacy for additional resources (financial and human) for ef-fective implementation of MHPSS activities and interventions.