Mental health initiatives offer space for refugees and people where they live to overcome pain and isolation – and prevent more deaths.
By Rocco Nuri in Bidibidi settlement, Uganda
When a psychologist asked Rose* to choose a face on a pictorial scale that most represented her mood, she hesitated, bit her lip and then pointed to a face with open eyes and a flat, closed mouth.
Rose felt neither happy nor sad, but that in itself was an improvement.
A single mother of five, she had fled the conflict in South Sudan and witnessed her husband’s murder before making it to this refugee settlement of 230,000 in Uganda.
She had spent the last several months attending regular group counselling sessions after her ten-year-old son saved her from a suicide attempt.
Tears rolled down Rose’s face, but she was not embarrassed.
“I am aware I am not happy with my life, but at least now I know there is no shame in feeling this way,” said Rose, 33.
The number of suicides and suicide attempts among South Sudanese refugees living in settlements in Uganda more than doubled in 2019 compared to the previous year, UNHCR, the UN Refugee Agency, found. There were 97 suicide attempts, with 19 deaths.
Although suicide is also a common issue in the general population in northern Uganda, the increase among refugees in places like Bidibidi illustrates a growing problem: the dire need for mental health-care services for people who have fled crisis, lost support networks and struggled to make a living in their country of asylum.
More than 2 million South Sudanese, most of them women and children, have fled their homeland to escape a brutal conflict between the government and opposition parties. Forty percent live in Uganda. Many have witnessed or experienced attacks, sexual abuse and torture either at home or during their escape.
A 2018 joint assessment by UNHCR and partner organizations found that 19 per cent of refugee households in northern Uganda reported at least one family member suffered psychological distress or felt afraid.
Fewer than half of the respondents said the affected family member had access to psychosocial care, such as individual counselling, group therapy and meditation.
There are few suicide prevention programmes like the one in which Rose participated, which was run by a local non-governmental organization, Transcultural Psychosocial Organization (TPO), with support from UNHCR. The organization reached 9,000 refugees and local Ugandans in and around Bidibidi settlement last year, counselling them on how to manage negative thoughts, engage in social activities and reach out for help.
It also ran programmes to help eliminate the stigma associated with mental health, trained health-care providers and deployed community-based counsellors.
UNHCR and its partners secured only 40 per cent of the US$927 million needed to assist refugees and host communities in Uganda in 2019. With such limited funding, TPO and other organizations delivering mental health and psychosocial support reached only 29 per cent of South Sudanese refugees in need of its services and even a smaller percentage of local community members.
The outlook for 2020 funding is not promising, and it will be impossible to support effective mental health programmes – or even identify who needs help – without more money from governments, the private sector and other donors.
According to a recent UNHCR briefing on this issue, key factors contributing to a higher rate of suicide included incidents of sexual and gender-based violence, traumatic events both before fleeing the home country and after arriving at a refugee settlement, extreme poverty, and lack of meaningful access to education and jobs.
Knowing few people in their new countries contributed to refugees’ feelings of isolation and helplessness.
Forty-two-year-old Adam*, father of five, told UNHCR that his wife, Mary*, was diagnosed with bipolar disorder in 2012 in South Sudan’s Yei town.
Mary’s condition worsened after they arrived in Bidibidi settlement in September 2016. On a sunny June day, Mary told Adam she was going to her brother’s home, but she never made it there.
A neighbour found her hanging from a mango tree the following day.
“My wife could not accept the fact that she was no longer able to cook, look after the crops and sweep the courtyard. She could not bear the persistent tiredness,” Adam said.
“She did not have any friends here to share her feelings and worries. Our neighbours did not really want to deal with us because of my wife’s mental problem. I think that’s what broke her deep inside.”
Host communities are also dealing with cases of mental health problems.
According to the 2018 joint study, 27 per cent of households in northern Uganda reported that at least one family member suffered from psychological distress.
“They have much in common with refugees from South Sudan,” said Charles Olaro, Director of Curative Services at Uganda’s Ministry of Health.
“They have also gone through decades of brutal wars, multiple displacement, epidemics, deprivation and generations of untreated trauma.”
In the town of Yumbe, about 30 kilometres west of Bidibidi settlement, several Ugandans took their own lives recently, including 16-year-old Andrew*. The young football fan used to help his mother sell cow hooves after school and run errands to earn pocket money. He died last October.
Andrew’s father had abandoned the family, and his mother barely had enough money to support them. Lucy said her family had a history of suicide. But she insisted witchcraft killed her son.
“There is no other explanation,” Lucy said.
“The neighbours put a spell on him as they envied me for having a boy able to look after the home and earn his own money.”
Rose, Adam, Lucy and their children regularly receive psychosocial support from TPO, both individually and as a group. They share their stories and forge friendships.
“Counselling helped me regain hope and love for myself,” Rose said.
*Names changed at the request of the interviewees
Related Content: Could “guided self-help” tools jumpstart the healing process during humanitarian crises? A new study by the World Health Organization and Johns Hopkins University with support of UNHCR and other partners offers hope, but more research is needed. “This type of intervention could be rapidly scaled up in emergency settings and reach large numbers of people in need, but must be complemented with more intensive interventions for those who need it,” said Peter Ventevogel, Senior Mental Health Officer for UNHCR.