7 results
Health and care system assessment aimed at cultural adaptation of MhGAP modules
- E. Dozio, L. Caron
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S155
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Introduction
As part of the Global Mental Health (GMH) movement, WHO launched the Mental Health Gap Action Program (mhGAP). One of the key initiatives of the MhGAP is to train lay health professionals to meet the mental health needs of populations, particularly in low- and middle-income countries (LMICs) where the need far exceeds the availability and quality of services. Training modules are standardized and designed for use in many countries and settings. In practice, there is often a stereotyped reproduction of modules without consideration of specific cultural adaptation needs.
ObjectivesAs part of a psychosocial support program in two provinces of the eastern Democratic Republic of Congo (Ituri and North Kivu), the NGO Action contre la Faim proposed a health and care system assessment aimed at adapting MhGAP modules for health center staff. The objective was to know the local practices in terms of psychic care as well as to identify the competences already existing to reinforce them, but also to contextualize the tools and the contents of the trainings.
MethodsThe methodology used was mixed.
A questionnaire based on the WHO situation analysis tools was revised, simplified and adapted to the zone, allowing us to obtain quantitative data on the health centers, the care provided, referrals and supervision. Health care workers were interviewed using the questionnaire from ACF’s “Strengthening the Health Care System” guide, focusing on care methods, knowledge of mental health and the most frequently encountered symptoms. Focus Group Discussions with the Community Relais in the area allowed for the collection of information on the level of knowledge of the population in terms of mental health, their awareness on this subject, their cultural vision and the means of care.
ResultsThe data collected from 9 health centers in the two provinces allowed us to learn about:
- Poor knowledge of mental health and school readiness
- Identification of barriers to access to care
- Beliefs around mental health, mental suffering and care
- Details about the different pathologies and symptoms as well as the issues related to the therapeutic framework.
ConclusionsThe evaluation was fundamental to have a better knowledge of the context, which made it possible to adapt the content of the MhGap training modules les, to design tools more adherent to reality. The data collected may also be the subject of advocacy aimed at mobilizing the country’s policies in terms of mental health, as well as raising awareness in the international community.
Disclosure of InterestNone Declared
Study on cultural representations in mental health and psychosocial support in the Ituri region of the Democratic Republic of Congo
- E. Dozio
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S155
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Introduction
In the Ituri region of eastern DRC, Djugu territory has been the epicenter of violent clashes in 2020 and significant displacement since 2017. An initial assessment conducted by Action Contre la Faim (ACF) in January 2021 showed a significant level of psychological distress among 85% of respondents. Following this finding, an emergency response was proposed with the aim of contributing to the improvement of the psychological state of men, women, boys and girls affected by displacement and conflict while strengthening their psychological resilience. As part of this response, prior to the intervention, the NGO conducted a study on the representations of mental health and psychosocial needs as well as locally existing support mechanisms.
ObjectivesThe study aimed to better understand the cultural dimension of the perception of mental health and psychological suffering as well as the use of traditional care or support systems. This will allow for better adaptation of clinical approaches to psychosocial intervention as well as the identification of risks incurred by communities in the context of mental health programming, in a context of inter-community tensions, and the development of mitigation measures, co-constructed with the targeted communities.
MethodsAn analysis of strengths, weaknesses, opportunities and threats related to the local perception of mental health issues and pre-existing community support mechanisms was conducted using a mixed methodology. A quantitative approach was used to estimate the prevalence of psychological/psychiatric pathologies present in the intervention area and relate it to known data in the country. This was complemented by qualitative data collection including semi-structured interviews with key informants and focus group discussions with community members (adult men and women) as well as health workers, legal and customary authorities, religious leaders, community leaders, traditional practitioners, humanitarian actors, etc.
Results12 interviews, 8 focus group discussions and 316 questionnaires confirmed the high rates of distress in the community surveyed.
The cultural representations of mental suffering were better understood (i.e. the origin of suffering and mental illness is exogenous and a spiritual cause is often evoked: witchcraft, curse, divine punishment). Resilience factors (the most resilient would be children and women) and local support mechanisms have been identified, notably in religious leaders.
A very strong group cohesion and solidarity was highlighted.
ConclusionsThis study helped to understand the issues related to a mental health care and psychosocial support proposal. This type of study is fundamental to culturally adapting care in humanitarian aid contexts. Concrete details of adaptation will be presented as an example.
Disclosure of InterestNone Declared
How countries’ legislations can sustainably impact children’s mental health
- M. R. Moro, A. Ogrizek, E. Dozio, D. Attias, G. Papazian-Zohrabian, J.-M. Jesus-Martin, M. Teicher, T. Baubet
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S730
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Introduction
In a new era where, more and more children are standing up against governments concerning important subjects like climate change that will impact their physical health in a near future, it is time to question ourselves on all the other decisions that are being taken and that could have a sustainably high impact on some of our children’s development and mental health. Unfortunately, many of those children are forced to remain silent - unable to express themselves - or are just not being heard – unable to gain international medias’ attention - because of their social condition, cultural background, age or religion. But more sadly, most of them remain silent because they are just unaware of the consequences their living conditions or hardships might have on their future mental health, due to lack of information or education.
ObjectivesTherefore, it is our responsibility as childhood experts and professionals to speak for those children who cannot, to stand up for themselves and promote the importance of putting their interest first no matter what.
MethodsWe have chosen six different studies led in different contexts of struggle for children all around the world to illustrate the consequences on their development and mental health.
ResultsWe will communicate on the situations of children living in refugee camps, children living with their mothers in prison cells, children being forcibly separated from their mothers returning from Daesh territories in France or children being forcibly separated from their migrant mothers at the US border, we will describe the hardships but also the effective support provided to unaccompanied minors in Canada, and especially discuss with our cochair expertise how the issue is or could be different for them according to government policies and legislations.
ConclusionsBy describing these different contexts of unstable living conditions or traumatic experiences orchestrated by government legislation regarding children care, we want to highlight the responsibility that every government legislation must consider when it comes to child care and how it should become an absolute priority.
Disclosure of InterestNone Declared
Emotional stabilization interventions for people exposed to chronic traumatic events, in humanitarian settings
- E. Dozio
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S178
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Introduction
In contexts of chronic crisis, such as wars, the population is affected by prolonged traumatic exposure. In this type of context, it is sometimes difficult to provide psychological support to work through the trauma because the environment is neither stable nor reassuring. It is about finding care devices that despite the complexity of the situation, manage to bring relief and improve the ability to manage negative emotions and stress.
ObjectivesThe objective of the intervention was to relieve people in distress, to help them contain their reactions to moments of anxiety so that they are more available and calm in their daily lives. Since the intervention could not provide long-term treatment for the potential traumatic stress, due to the abuses still in progress, it aimed to prevent the appearance and installation of the symptoms.
MethodsA group protocol based on emotional stabilization exercises was offered to children and adults from communities affected by the fighting in the civil war in the Central African Republic in 2021. In addition to giving elements of psychoeducation, participants could practice exercises aimed at stabilizing emotions and managing stress.
People could benefit from this psychosocial support with daily frequency for four consecutive days. At the beginning and at the end of the care device, psychometric scales were administered in order to be able to measure the improvement in well-being (WHO5) the reduction in symptoms of anxiety and depression (HAD) as well as traumatic symptoms in adults (PCL -5) and children (CPTS-RI).
ResultsBetween February and April 2021, 1,200 adults and 400 children were able to participate in the emotional stabilization device. 90% of the participants showed an improvement in well-being and a reduction in stress and axiety reactions. The participants particularly appreciated the exercises for the ease with which they could be reproduced in daily life and transmitted to other members of the family and the community. Despite the fact that exposure to stress remained significant and daily, they expressed the feeling of having regained some control, at least over their own emotions and reactions.
ConclusionsIn situations of chronic stress, where psychic traumatic symptoms cannot be treated sustainably, this emotional stabilization protocol can be an effective option to regulate the emotional states of exposed people and give them tools to cope with anxiety.
Two important points to emphasize are also the fact that this device can reach a large part of the population without a lot of means and that it can be provided by non-professionals in mental health, if properly trained and constantly supervised by experts.
Disclosure of InterestNone Declared
Intervention to promote mental health and psychosocial support to promote social cohesion in the context of ongoing crisis and post conflict
- E. Dozio
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S76
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Introduction
Armed conflicts, collective situations of adversity, and gross social injustices cause widespread mental suffering in affected populations. In these crises, conflicts break down and traditional community support mechanisms are weakened or destroyed. The loss of trust in others and the lack of hope for change undermine social cohesion at the deepest levels of communities. Therefore, it is important not to overlook the psychosocial impacts of social injustice and violence on the individual and society undermines other efforts to build peaceful societies. Nevertheless, the use of mental health and psychosocial support (MHPSS) approaches to support social cohesion is still very uncommon.
ObjectivesThe objective of the proposed intervention in the Ituri province of the Democratic Republic of Congo was to complement the economic recovery activities of the most vulnerable populations with a psychological support approach. This was to ensure more sustainable results in the appropriation of problem management strategies through the strengthening of individual well-being and group support mechanisms.
MethodsThe psychosocial intervention is organized around a community psycho-education to sensitize the populations to mental health issues and to promote the awareness of their possible suffering in order to access a psychological care system. The protocol included five weekly group sessions designed to strengthen participants’ individual and collective psychological resources. Several indicators were measured to assess the impact on social cohesion (psychological well-being, psychological resilience, prosocial behavior, etc.)
ResultsIn eight months of intervention between July 2021 and February 2022, 1024 people were able to participate in the psychological support program. 90% of them showed improvement in psychological well-being, daily functioning and resilience. In addition to these very optimistic results on individual aspects, 65% of the participants increased the level of prosocial behaviour.
ConclusionsThe psychosocial intervention proposed in an area of permanent conflict and adversity was mainly aimed at improving the well-being of people showing signs of distress to make them better able to complete their economic activity project. The results showed that taking into account the psychosocial dimension, not only reduced distress and allowed people to better project themselves in the future, but also promoted prosocial behavior. All these elements contribute strongly to social cohesion.
Disclosure of InterestNone Declared
Psychological rapid response to population movements in democratic republic of congo (DRC)
- E. Dozio, C. Bizouerne
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S321-S322
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Introduction
In DRC, the North Kivu province has been plagued by recurring humanitarian crises for nearly two decades, with multiple displacements of populations triggered low intensity armed inter-communal conflicts spread throughout nearly all territories. 818,605 people (displaced, returnees and indigenous) affected by these movements are in alarming psychosocial vulnerability.
ObjectivesIn 2019, the NGO Action contre la Faim started a psychological intervention with the objective to contribute to reducing the vulnerability of conflict-affected populations.
MethodsParticipants have been identified through psychoeducation sessions in the community in which people recognizing corresponding symptoms in themselves were evaluated through a short one-on-one interview. Persons identified as particularly in distress, including those who have experienced gender-based violence, have been involved in a short group therapeutic intervention. Two different options have been proposed in order to evaluate the most effective for the specific context: six sessions with a weekly or bi-weekly frequency.
Results767 people participated in the psychosocial intervention, 457 with weekly frequency and 310 bi-weekly. The measures of post traumatic symptoms (PCL-5), anxiety and depression (HAD) and resilience (CD-RISC) show that the two approaches have the same positive effects. This is very important in volatile contexts with difficulties of access to the population due to security problems.
ConclusionsThe fact that even a short intervention focused on a bi-weekly frequency, can reduce the distress and increase the psychological resilience of populations living in contexts of conflict, gives us the possibility of intervening in areas with limited access, while guaranteeing therapeutic efficacy.
Group psychological intervention for people affected by conflict in Central African republic
- E. Dozio, C. Bizouerne
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S105
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Introduction
A large part of the Central African population has been exposed to potentially traumatic events as a result of the recent conflict, which has led to the breakdown of social ties.
ObjectivesFaced with this situation, the NGO Action contre la Faim proposed a psychosocial intervention aimed at helping the displaced people to reduce their psychological suffering and strengthen individual and community resilience.
MethodsAfter psychoeducation sessions organized in communities affected by the conflict, people identified with traumatic symptoms are invited to participate in a psychological support intervention. The protocol used is based on the Problem Management Plus (PM+), developed by the WHO. The approach was adapted in groups to reach more suffering people and also to take advantage of the group dynamic in the possibility of recovering and developing better resilience.
Results946 IDPs in the country’s capital, participated in the group intervention led by a team of paraprofessionals. Data collected from 111 participants show that after five weeks of intervention, there was a significant reduction in post-traumatic symptoms (PCL-5) and functional impairment (WHODAS). These results were confirmed during the post-intervention evaluation four weeks later. In addiction, participants declared that they had observed effects on their ability to live together in the community and to regain social cohesion.
ConclusionsThis experience gives encouraging results with regard to the feasibility and replicability of the group protocol, taking into account specific cultural and contextual adaptations.
DisclosureNo significant relationships.